In this study, a target population of primiparous women delivering at Shijiazhuang Obstetrics and Gynecology Hospital between January 1, 2020, and December 31, 2021, was defined. Eligible women were identified through the hospital’s delivery registry on a rolling basis and screened by trained research nurses during their postpartum hospitalization. All women meeting the inclusion criteria were invited to participate, and those who expressed interest were provided with detailed study information before obtaining written informed consent. A consecutive sampling approach was used to minimize selection bias, enrolling participants in the order they met the criteria until the required sample size was reached.

The study received approval from the Ethics Committee of Shijiazhuang Obstetrics and Gynecology Hospital, and included patients who provided written informed consent. This study was performed in strict accordance with the Declaration of Helsinki, Ethical Principles for Medical Research Involving Human Subjects.

Inclusion criteria:

Exclusion criteria:

A total of 375 puerperal women who were discharged and followed up for three months were initially screened. Among them, 188 received routine care (Control group), and 187 received routine care and a multidisciplinary health (iHealth) education (iHealth group). After applying exclusion criteria, a total of 192 puerperal women were included in the final analysis—95 in the Control group and 97 in the iHealth group ( Figure 1 ).

Using an independent samples t-test to examine differences between the control and iHealth groups, we assumed a medium Cohen’s effect size of 0.5 with 80% power and a 0.05 significance level (2-sided). Based on these parameters, a minimum of 64 participants were required for each group.

The mothers in the control group received basic health guidance on a regular basis. In contrast, the mothers in the iHealth group received health education based on the proof-of-concept model in addition to the same routine treatment as the control group. The main components of the procedure included disease education provided by doctors, lifestyle and dietary guidance from nutritionists, and psychological support from counselors.

These education measures primarily relied on the smartphone application iHealth to deliver postpartum-related disease education, lifestyle and dietary guidance, and psychological counseling services to the mothers in the iHealth group. For example, the app offers articles and videos on topics such as stress reduction, nutrition, infant care, and infant vaccination. Users can access iHealth anytime and anywhere.

Additionally, mothers can inquire about issues related to pregnancy, childbirth, and infant health and care through iHealth, with all questions answered by professionals via private messages within the app. The app records parameters such as login frequency and app usage duration.

Mothers in the iHealth group were advised to use iHealth three times a week for one hour each session, for a minimum of two months. If any mother in the iHealth group fails to log in during the study period, she will receive reminders via email or phone.

Baseline assessments were performed within three days of delivery. Subsequent data collection was conducted by professional psychologists, who were blinded to the study, at the sixth week and third month postpartum. Maternal depression, anxiety, and quality of life were assessed at these time points.

The EPDS was used to assess maternal depression in this study. The EPDS consists of 10 items, with a total score ranging from 0 to 30. The scoring system is as follows: 0–9 points: The vast majority of cases are considered normal. 10–13 points: High-risk group for postpartum depression. 14–30 points: Indicating postpartum depression (22).

The STAI was used to assess patient anxiety. The STAI consists of 40 items, divided into two subscales that assess different types of anxiety (23).

Items 1 to 20 comprise the State Anxiety Subscale (STAI-Form Y-I, S-AI), with half of the items describing negative emotions and the other half describing positive emotions. This subscale is primarily used to assess an individual’s immediate or recent experience of fear, tension, anxiety, and neuroticism in specific situations or at a particular time.

Items 21 to 40 comprise the Trait Anxiety Subscale (STAI-Form Y-I, T-AI), which assesses relatively stable anxiety and tension-related personality traits. This subscale contains 11 items that describe negative emotions and 9 items that describe positive emotions.

The SF-12 was used to assess participants’ quality of life. The SF-12 scale contains a total of 12 questions. This scale consists of twelve questions and is designed to evaluate a patient’s daily activities, self-perception, and social participation. The SF-12 is widely regarded as an important measure of a patient’s overall quality of life (24).

All analyses were performed using GraphPad. Prior to analysis, the distribution of continuous variables was assessed using the Shapiro–Wilk test, and homogeneity of variances was checked with Levene’s test to guide the choice of statistical tests. The data are presented as mean ± standard deviation (SD) for continuous variables or n (percentage) for categorical variables. For between-group comparisons of continuous variables that were normally distributed and met variance homogeneity assumptions, the independent samples Student’s t-test was applied. For non-normally distributed continuous variables, the Mann–Whitney U test was used as a non-parametric alternative. Categorical variables were compared using the Chi-square test; when expected cell counts were <5, Fisher’s exact test was employed to ensure valid inference. All statistical tests were two-tailed, and a p-value <0.05 was considered statistically significant.

Baseline data for 192 patients in the control and iHealth groups were collected prior to the start of the study. As shown in Table 1 , there were no significant differences between the two groups in terms of age, education, occupation, pregnancy expectations, mode of delivery, and breastfeeding status.

To illustrate the effect of our proof-of-concept health education on maternal psychological status in the short and long term after delivery, we measured changes in EPDS and STAI scores in the two groups of participants at the sixth week and third month postpartum, respectively.

As shown in Figure 2A , there was no significant difference in baseline EPDS scores between the control (7.83 ± 3.02) and iHealth groups (7.98 ± 3.08). However, the EPDS scores at the sixth week and third month postpartum were significantly lower in the iHealth group (7.20 ± 2.74, 5.66 ± 1.93) compared to the control group (8.56 ± 2.16, 7.54 ± 2.65). Similarly, STAI scores in the iHealth group (82.00 ± 8.16, 78.13 ± 9.75, 70.41 ± 10.25) were significantly lower than those in the control group (81.18 ± 9.28, 84.29 ± 11.19, 79.08 ± 10.37) at both the sixth week and third month postpartum ( Figure 2B ).

The SF-12 scoring system was used to assess patients’ quality of life. The SF-12 score was divided into two components based on the relevance of the questions: mental health and physical health.

As shown in Figure 3A , the self-assessed physical health scores of the iHealth group (44.48 ± 7.93, 50.37 ± 7.98, 53.54 ± 7.09) were significantly higher than those of the control group (44.39 ± 6.93, 47.76 ± 7.21, 50.18 ± 7.40) at both the sixth week and third month postpartum. Similarly, maternal self-assessed mental health scores in the iHealth group (49.04 ± 8.47, 53.47 ± 9.42, 55.50 ± 10.48) were significantly higher than those in the control group (48.62 ± 9.43, 50.11 ± 8.70, 52.21 ± 9.97) at the same time points ( Figure 3B ).