User requirements and affective drivers of satisfaction in women's health apps

Women's health applications represent a rapidly growing segment of the mobile health (mHealth) ecosystem, yet large-scale empirical evidence on user requirements and satisfaction determinants remains limited. This study analyzes 221,389 user reviews from 202 women's health apps on the Google Play Store (United States) to examine how requirement themes and affective expressions relate to user satisfaction. We employ topic modeling to identify dominant requirement themes from review text, transformer-based models to classify sentiment and discrete emotions, and multivariate regression to estimate their associations with star ratings. The analysis identifies 14 coherent requirement domains spanning core reproductive tracking, usability, technical reliability, subscription management, device integration, and community governance. Regression results show that technical reliability issues, subscription-related issues, and community governance concerns are significantly associated with lower ratings, whereas confirmation of core functionality is positively associated with satisfaction. Affective intensity further amplifies these effects, with stronger negative emotional expression linked to additional reductions in ratings. Overall, the findings highlight technical reliability, monetization transparency, and psychologically safe community spaces as central determinants of user satisfaction in women's health digital ecosystems.