Using Metro Mapping to Explore Changes in Integrated Care Pathways for a Digital Lifestyle Intervention in Pregnancy with Obesity

Background: In maternity care, obesity in pregnancy is a major concern due to its association with complications and increased long-term health risks for both mother and child. Digital technologies offer new opportunities in preventive care to promote healthy lifestyle behaviours, provide remote support, enable self-management and strengthening collaboration between healthcare professionals and patients.

 

This research focuses on evaluating the cost and cost-effectiveness of a digital lifestyle intervention—specifically, a mobile app combined with professional coaching—to support behaviour change in pregnant women with obesity.

 

As a preparatory step towards economic evaluation, this study applies Metro Mapping, a participatory visualisation method, to explore how such an intervention could alter integrated care pathways. The aim is to identify potential shifts in activities, responsibilities, and resource use across the maternity care continuum.

 

Approach: A mixed-methods design was used to map current and potential care trajectories for pregnant women with obesity, both with and without the digital lifestyle intervention. Metro Mapping served as both a co-design and analytic tool.

 

Data were gathered through focus groups with stakeholders such as pregnant women, midwives, obstetricians, and other healthcare professionals, as well as through clinical observations and analysis of existing protocols. The stakeholders identified key touchpoints in the current care pathway and explored how digital self-monitoring, lifestyle feedback, and coaching could modify care delivery. The visual care maps were iteratively refined and form the foundation for upcoming Time-Driven Activity-Based Costing (TDABC) and cost-effectiveness analyses.

 

Results: (preliminary insights) While no cost or outcome data are yet available, Metro Mapping has yielded important conceptual insights. Stakeholders identified areas where the digital intervention could change care delivery, including the volume and type of services used, the frequency of complications, and utilisation of different levels of care (primary, secondary, tertiary).

Stakeholders highlighted that preventive digital support might redistribute workloads, adjust care sequences, and improve interdisciplinary communication. The process provided a shared understanding of how digital tools might reshape integrated care for pregnant women with obesity. Visualisations and the developed app prototype will be presented.

 

Implications: This study demonstrates Metro Mapping as a useful methodological approach to explore anticipated changes in care pathways resulting from digital innovations. It facilitates early stakeholder engagement and supports realistic modelling of care processes before full implementation or formal economic evaluation.

The findings will guide upcoming TDABC-based costing and cost-effectiveness studies, ensuring that these analyses are grounded in real-world practice and stakeholder perspectives. More broadly, this work contributes to understanding how structured mapping methods can support the integration of digital preventive interventions into routine maternity care, enhancing both collaboration and sustainability.