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Daehn D, Meyer C, Loew V, Wabiszczewicz J, Pohl S, Böttche M, Pawils S, Renneberg B. Smartphone-based intervention for postpartum depressive symptoms (Smart-e-Moms): study protocol for a randomized controlled trial. Trials 2024; 25:469. [PMID: 38987846 PMCID: PMC11234544 DOI: 10.1186/s13063-024-08304-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Accepted: 06/28/2024] [Indexed: 07/12/2024] Open
Abstract
BACKGROUND Postpartum depression constitutes a significant public health issue, with prevalence rates ranging between 8 and 19% in high-income nations. Nevertheless, numerous barriers, including time constraints, societal stigmatization, and feelings of shame, contribute to the limited utilization of healthcare services during the postpartum period. Digital interventions offer an opportunity to enhance care for women experiencing postpartum depressive symptoms. METHODS We will conduct a two-arm randomized controlled trial to assess the effectiveness of a smartphone-based intervention in comparison to a treatment-as-usual control group in Germany. Our aim is to randomize 556 participants in a 1:1 ratio. Participants in the intervention group will be provided access to a preventive smartphone-based intervention called "Smart-e-Moms," which incorporates therapeutic support and comprises 10 concise modules rooted in cognitive-behavioral therapy. For the intervention group, evaluations will take place at baseline (t0), prior to sessions 4 and 8 (intermediate assessments), and upon completing the intervention 6 weeks after baseline (t1). The control group's assessments will be at baseline (t0) and 6 weeks after baseline. Follow-up assessments are scheduled at 12 and 24 weeks from baseline to examine the short-term stability of any observed effects. We anticipate that participants in the intervention group will exhibit improvements in their postpartum depressive symptoms (as measured with the Edinburgh Postnatal Depression Scale). Additionally, we will analyze secondary outcomes, including maternal bonding, stress levels, self-efficacy, satisfaction with the intervention, and healthcare utilization. DISCUSSION If Smart-e-Moms proves to be effective, it has the potential to play a significant role in postpartum depression care within German-speaking regions. Ideally, this intervention could not only benefit maternal well-being but also improve the prospects for healthy child development. TRIAL REGISTRATION German clinical trials registry DRKS00032324. Registered on January 26, 2024.
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Affiliation(s)
- Daria Daehn
- Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany.
| | - Caroline Meyer
- Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
| | - Viola Loew
- Department of Medical Psychology, University Medical Center Hamburg‑Eppendorf, Hamburg, Germany
| | | | - Steffi Pohl
- Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
| | - Maria Böttche
- Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
| | - Silke Pawils
- Department of Medical Psychology, University Medical Center Hamburg‑Eppendorf, Hamburg, Germany
| | - Babette Renneberg
- Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
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Valla L, Haga SM, Garthus-Niegel S, Drozd F. Dropout or Drop-In Experiences in an Internet-Delivered Intervention to Prevent Depression and Enhance Subjective Well-Being During the Perinatal Period: Qualitative Study. JMIR Pediatr Parent 2023; 6:e46982. [PMID: 38153796 PMCID: PMC10766164 DOI: 10.2196/46982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 10/24/2023] [Accepted: 11/06/2023] [Indexed: 12/30/2023] Open
Abstract
Background The perinatal period is a vulnerable time when women are at increased risk of depression. "Mamma Mia" is a universal preventive internet-delivered intervention offered to pregnant women, with the primary goals of preventing the onset or worsening of depression and enhancing subjective well-being during the perinatal period. However, treatment dropout from internet-delivered interventions is often reported. Objective The study aim was to acquire an understanding of the different experiences among participants who dropped out of the Mamma Mia intervention during pregnancy, compared to participants who dropped out during the postpartum follow-up phase. Methods A total of 16 women from a larger randomized controlled trial (Mamma Mia) participated in individual semistructured interviews following a strengths, weaknesses, opportunities, and threats format. Of the 16 participants included, 8 (50%) women dropped out early from the intervention during pregnancy (pregnancy group), whereas 8 (50%) women dropped out later, after giving birth (postpartum follow-up group). Data were analyzed using the framework approach. Results The results showed that there were differences between the groups. In general, more participants in the postpartum follow-up group reported that the program was user-friendly. They became more aware of their own thoughts and feelings and perceived that the program had provided them with more new knowledge and practical information than participants in the pregnancy group. Participants in both groups suggested several opportunities for improving the program. Conclusions There were differences between women who dropped out of the intervention during pregnancy and the postpartum follow-up phase. The reported differences between groups should be further examined.
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Affiliation(s)
- Lisbeth Valla
- Regional Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Silje Marie Haga
- Regional Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway
| | - Susan Garthus-Niegel
- Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
- Department of Childhood and Families, Norwegian Institute of Public Health, Oslo, Norway
- Institute for Systems Medicine and Faculty of Medicine, Medical School Hamburg, Hamburg, Germany
| | - Filip Drozd
- Regional Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway
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Weil MT, Spinler K, Lieske B, Dingoyan D, Walther C, Heydecke G, Kofahl C, Aarabi G. An Evidence-Based Digital Prevention Program to Improve Oral Health Literacy of People With a Migration Background: Intervention Mapping Approach. JMIR Form Res 2023; 7:e36815. [PMID: 37166956 DOI: 10.2196/36815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 02/02/2023] [Accepted: 03/08/2023] [Indexed: 05/12/2023] Open
Abstract
BACKGROUND Studies in Germany have shown that susceptible groups, such as people with a migration background, have poorer oral health than the majority of the population. Limited oral health literacy (OHL) appears to be an important factor that affects the oral health of these groups. To increase OHL and to promote prevention-oriented oral health behavior, we developed an evidence-based prevention program in the form of an app for smartphones or tablets, the Förderung der Mundgesundheitskompetenz und Mundgesundheit von Menschen mit Migrationshintergrund (MuMi) app. OBJECTIVE This study aims to describe the development process of the MuMi app. METHODS For the description and analysis of the systematic development process of the MuMi app, we used the intervention mapping approach. The approach was implemented in 6 steps: needs assessment, formulation of intervention goals, selection of evidence-based methods and practical strategies for behavior change, planning and designing the intervention, planning the implementation and delivery of the intervention, and planning the evaluation. RESULTS On the basis of our literature search, expert interviews, and a focus group with the target population, we identified limited knowledge of behavioral risk factors or proper oral hygiene procedures, limited proficiency of the German language, and differing health care socialization as the main barriers to good oral health. Afterward, we selected modifiable determinants of oral health behavior that were in line with behavior change theories. On this basis, performance objectives and change objectives for the relevant population at risk were formalized. Appropriate behavior change techniques to achieve the program objectives, such as the provision of health information, encouragement of self-control and self-monitoring, and sending reminders, were identified. Subsequently, these were translated into practical strategies, such as multiple-choice quizzes or videos. The resulting program, the MuMi app, is available in the Apple app store and Android app store. The effectiveness of the app was evaluated in the MuMi intervention study. The analyses showed that users of the MuMi app had a substantial increase in their OHL and improved oral hygiene (as measured by clinical parameters) after 6 months compared with the control group. CONCLUSIONS The intervention mapping approach provided a transparent, structured, and evidence-based process for the development of our prevention program. It allowed us to identify the most appropriate and effective techniques to initiate behavior change in the target population. The MuMi app takes into account the cultural and specific determinants of people with a migration background in Germany. To our knowledge, it is the first evidence-based app that addresses OHL among people with a migration background.
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Affiliation(s)
- Marie-Theres Weil
- Department of Periodontics, Preventive and Restorative Dentistry, Center for Dental and Oral Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Prosthetic Dentistry, Center for Dental and Oral Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Kristin Spinler
- Department of Periodontics, Preventive and Restorative Dentistry, Center for Dental and Oral Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Medical Sociology, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Berit Lieske
- Department of Periodontics, Preventive and Restorative Dentistry, Center for Dental and Oral Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Medical Sociology, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Demet Dingoyan
- Department of Medical Sociology, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Carolin Walther
- Department of Periodontics, Preventive and Restorative Dentistry, Center for Dental and Oral Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Guido Heydecke
- Department of Prosthetic Dentistry, Center for Dental and Oral Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christopher Kofahl
- Department of Medical Sociology, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ghazal Aarabi
- Department of Periodontics, Preventive and Restorative Dentistry, Center for Dental and Oral Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Tan X, He Y, Hua N, Wiley J, Sun M. Study Protocol of an App-Based Prevention Program for Perinatal Depression. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11634. [PMID: 36141922 PMCID: PMC9517436 DOI: 10.3390/ijerph191811634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 09/13/2022] [Accepted: 09/13/2022] [Indexed: 06/16/2023]
Abstract
The prevalence of perinatal depression (PND) in China is continuously rising, and the suicide rate among pregnant women is remarkably high. Preventing the occurrence of PND based on the management of primary health care is of great significance. Improving adherence to intervention programs is a key concern for PND prevention. Thus, a new intervention strategy based on mobile health could bring a new perspective to prevent the occurrence of PND and reduce the sample dropout rate. A single-blind, cluster randomized controlled trial will be performed to evaluate the effectiveness of a personalized, dynamic, and stratified intervention strategy based on an app. Four health centers will be randomly selected and randomly assigned to an intervention group (two centers) and a control group (two centers). Participants (n = 426) will be enrolled from the four selected health centers, with 213 in each group. The intervention group will receive the interventions personalized by the feature-matching algorithm of the user profile and be reassigned to the low-risk group (Edinburgh Postnatal Depression Scale [EPDS] < 9) or moderate/high-risk group (9 ≤ EPDS < 13 and EPDS ≥ 13, but not meeting the criteria for PND) for intervention based on each EPDS score until 6 months after delivery. The control group will receive the same intervention components of the app but without the dynamic, personalized, and stratified function. Depression status, negative emotion symptoms, parental competence, and sample dropout rate will be measured at different weeks of pregnancy (12-16 [baseline], 24, 37) and at 42 days, 3 months, and 6 months after delivery. Follow-up evaluation (t6: 12 months after delivery) will also be conducted. If the intervention is effective, it will provide a personalized, time-friendly, and dynamic intervention for preventing PND. This phenomenon can effectively reduce the sample dropout rate and provide an empirical basis for promoting maternal mental health.
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Affiliation(s)
- Xiangmin Tan
- Xiangya School of Nursing, Central South University, Changsha 410013, China
| | - Yuqing He
- Xiangya School of Nursing, Central South University, Changsha 410013, China
| | - Nan Hua
- Xiangya School of Nursing, Central South University, Changsha 410013, China
| | - James Wiley
- School of Nursing, University of California, San Francisco, CA 94118, USA
| | - Mei Sun
- Xiangya School of Nursing, Central South University, Changsha 410013, China
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Song JE, Roh EH, Kim YJ, Ahn JA. Effects of Maternal Adjustment Enhancement Program Using Mobile-Based Education for Chinese Immigrant Women in Korea: A Quasi-Experimental Study. J Transcult Nurs 2022; 33:685-694. [PMID: 35941817 DOI: 10.1177/10436596221107601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION This study aimed to develop a maternal adjustment program for Chinese immigrant primiparous women in Korea and to investigate its effectiveness. METHODOLOGY Forty-five Chinese immigrant women with newborns were recruited and conveniently assigned into experimental and control groups. A maternal adjustment enhancement program was initiated to the experimental group using a mobile-based education regarding cultural intimacy for 4 weeks. RESULTS In the follow-ups, the experimental group showed significantly higher knowledge of childcare and parenting efficacy. Both the experimental and control groups showed an improvement in social support and a decrease in childcare stress without between-group differences. DISCUSSION The maternal adjustment enhancement program can be utilized as an effective approach to improve knowledge of childcare and reinforce parenting efficacy of Chinese immigrant women in Korea. Strategies to reduce language barrier and to provide education with culturally friendly manners should be utilized for successful transition to motherhood among immigrant mothers.
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Affiliation(s)
| | - Eun Ha Roh
- Ajou University, Suwon, Republic of Korea.,Global Korean Nursing Foundation, Seoul, Republic of Korea
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Xavier S, Monteiro F, Canavarro MC, Fonseca A. Be a Mom: Patterns of Program Usage and Acceptability Among Women With Low-Risk and High-Risk for Postpartum Depression. Front Glob Womens Health 2022; 3:841427. [PMID: 35368996 PMCID: PMC8969511 DOI: 10.3389/fgwh.2022.841427] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 02/21/2022] [Indexed: 11/25/2022] Open
Abstract
Background Be a Mom is a self-guided web-based intervention developed to prevent postpartum depression (PPD) symptoms and to promote maternal wellbeing, respectively among high and low-risk new mothers. This study aims to examine and compare (1) Be a Mom's patterns of usage and (2) Be a Mom's acceptability among women presenting high and low risk for PPD. Methods The sample was composed by 800 women who were randomized to Be a Mom [542 presenting high-risk (Postpartum Depression Predictors Inventory-Revised ≥ 5.5) and 258 presenting low-risk for PPD]. Data regarding patterns of usage were collected through the Be a Mom website. Acceptability data were collected through a brief questionnaire. Results 27.9% of high-risk and 36.3% of low-risk women completed the program. A higher proportion of participants in the low-risk group completed Be a Mom [X(1)2 = 5.29, p = 0.021] and completed more modules [t(723) = −3.01, p = 0.003]. No significant differences were found between the groups in number of logins, minutes spent on the program, exercises completed and number of times audios were played. a higher proportion of women in the high-risk group considered that participating in Be a Mom was too demanding [X(1)2 = 8.21, p = 0.004]. Conclusions Despite the low rates of completion, Be a Mom appears to be an acceptable option for both women with high-risk and low-risk for PPD. Lack of time seems to be the main reason for non-completion, so it is important to develop briefer versions of the program and introduce engagement strategies that may increase completion rate.
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Wan Mohd Yunus WMA, Matinolli HM, Waris O, Upadhyaya S, Vuori M, Korpilahti-Leino T, Ristkari T, Koffert T, Sourander A. Digitalized Cognitive Behavioral Interventions for Depressive Symptoms During Pregnancy: Systematic Review. J Med Internet Res 2022; 24:e33337. [PMID: 35195532 PMCID: PMC8908191 DOI: 10.2196/33337] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 11/12/2021] [Accepted: 12/13/2021] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Studies have shown a high prevalence of depression during pregnancy, and there is also evidence that cognitive behavioral therapy (CBT) is one of the most effective psychosocial interventions. Emerging evidence from randomized controlled trials (RCTs) has shown that technology has been successfully harnessed to provide CBT interventions for other populations. However, very few studies have focused on their use during pregnancy. This approach has become increasingly important in many clinical areas due to the COVID-19 pandemic, and our study aimed to expand the knowledge in this particular clinical area. OBJECTIVE Our systematic review aimed to bring together the available research-based evidence on digitalized CBT interventions for depression symptoms during pregnancy. METHODS A systematic review of the Web of Science, Cochrane Central Register of Controlled Trials, CINAHL, MEDLINE, Embase, PsycINFO, Scopus, ClinicalTrials.gov, and EBSCO Open Dissertations databases was carried out from the earliest available evidence to October 27, 2021. Only RCT studies published in English were considered. The PRISMA (Preferred Reporting Items of Systematic Reviews and Meta-analyses) guidelines were followed, and the protocol was registered on the Prospective Register of Systematic Reviews. The risk of bias was assessed using the revised Cochrane risk-of-bias tool for randomized trials. RESULTS The review identified 7 studies from 5 countries (the United States, China, Australia, Norway, and Sweden) published from 2015 to 2021. The sample sizes ranged from 25 to 1342 participants. The interventions used various technological elements, including text, images, videos, games, interactive features, and peer group discussions. They comprised 2 guided and 5 unguided approaches. Using digitalized CBT interventions for depression during pregnancy showed promising efficacy, with guided intervention showing higher effect sizes (Hedges g=1.21) than the unguided interventions (Hedges g=0.14-0.99). The acceptability of the digitalized CBT interventions was highly encouraging, based on user feedback. Attrition rates were low for the guided intervention (4.5%) but high for the unguided interventions (22.1%-46.5%). A high overall risk of bias was present for 6 of the 7 studies. CONCLUSIONS Our search only identified a small number of digitalized CBT interventions for pregnant women, despite the potential of this approach. These showed promising evidence when it came to efficacy and positive outcomes for depression symptoms, and user feedback was positive. However, the overall risk of bias suggests that the efficacy of the interventions needs to be interpreted with caution. Future studies need to consider how to mitigate these sources of biases. Digitalized CBT interventions can provide prompt, effective, evidence-based interventions for pregnant women. This review increases our understanding of the importance of digitalized interventions during pregnancy, including during the COVID-19 pandemic. TRIAL REGISTRATION PROSPERO International Prospective Register of Systematic Reviews CRD42020216159; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=216159.
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Affiliation(s)
- Wan Mohd Azam Wan Mohd Yunus
- Research Centre for Child Psychiatry, University of Turku, Turku, Finland.,INVEST Research Flagship, University of Turku, Turku, Finland.,Department of Psychology, School of Human Resource Development & Psychology, Faculty of Social Sciences & Humanities, Universiti Teknologi Malaysia, Johor, Malaysia
| | - Hanna-Maria Matinolli
- Research Centre for Child Psychiatry, University of Turku, Turku, Finland.,INVEST Research Flagship, University of Turku, Turku, Finland
| | - Otto Waris
- Research Centre for Child Psychiatry, University of Turku, Turku, Finland.,INVEST Research Flagship, University of Turku, Turku, Finland.,Turku University of Applied Sciences, Turku, Finland
| | - Subina Upadhyaya
- Research Centre for Child Psychiatry, University of Turku, Turku, Finland.,INVEST Research Flagship, University of Turku, Turku, Finland
| | - Miika Vuori
- Research Centre for Child Psychiatry, University of Turku, Turku, Finland.,INVEST Research Flagship, University of Turku, Turku, Finland.,Department of Teacher Education, Turku Institute for Advanced Studies, University of Turku, Turku, Finland
| | - Tarja Korpilahti-Leino
- Research Centre for Child Psychiatry, University of Turku, Turku, Finland.,INVEST Research Flagship, University of Turku, Turku, Finland
| | - Terja Ristkari
- Research Centre for Child Psychiatry, University of Turku, Turku, Finland.,INVEST Research Flagship, University of Turku, Turku, Finland
| | - Tarja Koffert
- Research Centre for Child Psychiatry, University of Turku, Turku, Finland
| | - Andre Sourander
- Research Centre for Child Psychiatry, University of Turku, Turku, Finland.,INVEST Research Flagship, University of Turku, Turku, Finland.,Turku University Hospital, Turku, Finland
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8
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Davis JA, Ohan JL, Gibson LY, Prescott SL, Finlay-Jones AL. Understanding engagement in digital mental health and wellbeing programs for sub-clinical women in the perinatal period: A Systematic Review without Meta-Analysis (SWiM) (Preprint). J Med Internet Res 2022; 24:e36620. [PMID: 35943773 PMCID: PMC9399849 DOI: 10.2196/36620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 05/22/2022] [Accepted: 05/31/2022] [Indexed: 11/13/2022] Open
Abstract
Background Pregnancy and the postnatal period can be a time of increased psychological distress, which can be detrimental to both the mother and the developing child. Digital interventions are cost-effective and accessible tools to support positive mental health in women during the perinatal period. Although studies report efficacy, a key concern regarding web-based interventions is the lack of engagement leading to drop out, lack of participation, or reduced potential intervention benefits. Objective This systematic review aimed to understand the reporting and levels of engagement in studies of digital psychological mental health or well-being interventions administered during the perinatal period. Specific objectives were to understand how studies report engagement across 4 domains specified in the Connect, Attend, Participate, and Enact (CAPE) model, make recommendations on best practices to report engagement in digital mental health interventions (DMHIs), and understand levels of engagement in intervention studies in this area. To maximize the utility of this systematic review, we intended to develop practical tools for public health use: to develop a logic model to reference the theory of change, evaluate the studies using the CAPE framework, and develop a guide for future data collection to enable consistent reporting in digital interventions. Methods This systematic review used the Cochrane Synthesis Without Meta-analysis reporting guidelines. This study aimed to identify studies reporting DMHIs delivered during the perinatal period in women with subclinical mood symptoms. A systematic database search was used to identify relevant papers using the Ovid Platform for MEDLINE, PsycINFO, EMBASE, Scopus, Web of Science, and Medical Subject Headings on Demand for all English-language articles published in the past 10 years. Results Searches generated a database of 3473 potentially eligible studies, with a final selection of 16 (0.46%) studies grouped by study design. Participant engagement was evaluated using the CAPE framework and comparable variables were described. All studies reported at least one engagement metric. However, the measures used were inconsistent, which may have contributed to the wide-ranging results. There was insufficient reporting for enactment (ie, participants’ real-world use of intervention skills), with only 38% (6/16) of studies clearly recording longer-term practice through postintervention interviews. The logic model proposes ways of conceptualizing and reporting engagement details in DMHIs more consistently in the future. Conclusions The perinatal period is the optimal time to intervene with strength-based digital tools to build positive mental health. Despite the growing number of studies on digital interventions, few robustly explore engagement, and there is limited evidence of long-term skill use beyond the intervention period. Our results indicate variability in the reporting of both short- and long-term participant engagement behaviors, and we recommend the adoption of standardized reporting metrics in future digital interventions. Trial Registration PROSPERO CRD42020162283; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=162283
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Affiliation(s)
- Jacqueline A Davis
- Telethon Kids Institute, Nedlands, Australia
- School of Medicine, University of Western Australia, Perth, Australia
- School of Health Sciences, Curtin University, Bentley, Australia
| | - Jeneva L Ohan
- School of Medicine, University of Western Australia, Perth, Australia
| | - Lisa Y Gibson
- Telethon Kids Institute, Nedlands, Australia
- School of Medicine, University of Western Australia, Perth, Australia
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Australia
| | - Susan L Prescott
- Telethon Kids Institute, Nedlands, Australia
- School of Medicine, University of Western Australia, Perth, Australia
- The Nova Institute for Health, Baltimore, MD, United States
| | - Amy L Finlay-Jones
- Telethon Kids Institute, Nedlands, Australia
- School of Medicine, University of Western Australia, Perth, Australia
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Kavanagh DJ, Connolly J, Fisher J, Halford WK, Hamilton K, Hides L, Milgrom J, Rowe H, Scuffham PA, White KM, Wittkowski A, Appleton S, Sanders D. The Baby Steps Web Program for the Well-Being of New Parents: Randomized Controlled Trial. J Med Internet Res 2021; 23:e23659. [PMID: 34842534 PMCID: PMC8665385 DOI: 10.2196/23659] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 02/25/2021] [Accepted: 08/02/2021] [Indexed: 01/20/2023] Open
Abstract
Background New parents face increased risks of emotional distress and relationship dissatisfaction. Digital interventions increase support access, but few preventive programs are optimized for both parents. Objective This study aims to conduct the first randomized controlled trial on universal self-guided digital programs to support positive perinatal adjustment of both mothers and fathers. Effects of childcare information (Baby Care) and information plus an interactive program (Baby Steps Wellbeing) were compared from the third trimester baseline to 3 and 6 months subsequently. Methods The study recruited 388 co-parenting male-female adult couples expecting their first single child (26-38 weeks’ gestation), using web-based registration. Most (337/388, 86.8%) were obtained from prenatal hospital classes. Couples’ randomization was automated and stratified by Edinburgh Postnatal Depression Scale (EPDS) scores (50% couples scored high if either mother >7, father >5). All assessments were web-based self-reports: the EPDS and psychosocial quality of life were primary outcomes; relationship satisfaction, social support, and self-efficacy for parenting and support provision were secondary. Linear mixed models provided intention-to-treat analyses, with linear and quadratic effects for time and random intercepts for participants and couples. Results Selection criteria were met by 63.9% (248/388) of couples, who were all randomized. Most participants were married (400/496, 80.6%), tertiary educated (324/496, 65.3%), employed full time (407/496, 82%), and born in Australia (337/496, 67.9%). Their mean age was 32.2 years, and average gestation was 30.8 weeks. Using an EPDS cutoff score of 13, 6.9% (18/248) of men, and 16.1% (40/248) of women screened positive for depression at some time during the 6 months. Retention of both partners was 80.6% (201/248) at the 6-month assessments, and satisfaction with both programs was strong (92% ≥50). Only 37.3% (185/496) of participants accessed their program more than once, with higher rates for mothers (133/248, 53.6%) than fathers (52/248, 20.9%; P<.001). The EPDS, quality of life, and social support did not show differential improvements between programs, but Baby Steps Wellbeing gave a greater linear increase in self-efficacy for support provision (P=.01; Cohen d=0.26) and lower reduction in relationship satisfaction (P=.03; Cohen d=0.20) than Baby Care alone. Mothers had greater linear benefits in parenting self-efficacy over time than fathers after receiving Baby Steps Wellbeing rather than Baby Care (P=.01; Cohen d=0.51). However, the inclusion of program type in analyses on parenting self-efficacy and relationship satisfaction did not improve model fit above analyses with only parent gender and time. Conclusions Three secondary outcomes showed differential benefits from Baby Steps Wellbeing, but for one (parenting self-efficacy), the effect only occurred for mothers, perhaps reflecting their greater program use. Increased engagement will be needed for more definitive testing of the potential benefits of Baby StepsWellbeing for perinatal adjustment. Trial Registration Australian New Zealand Clinical Trials Registry ACTRN12614001256662; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=367277
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Affiliation(s)
- David John Kavanagh
- Centre for Children's Health Research, Queensland University of Technology, South Brisbane Qld, Australia.,School of Psychology and Counselling, Queensland University of Technology, South Brisbane Qld, Australia
| | - Jennifer Connolly
- Centre for Children's Health Research, Queensland University of Technology, South Brisbane Qld, Australia.,School of Psychology and Counselling, Queensland University of Technology, South Brisbane Qld, Australia
| | - Jane Fisher
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - W Kim Halford
- School of Psychology, The University of Queensland, Brisbane, Australia
| | - Kyra Hamilton
- School of Applied Psychology, Griffith University, Brisbane, Australia.,Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| | - Leanne Hides
- School of Psychology, The University of Queensland, Brisbane, Australia
| | - Jeannette Milgrom
- Perinatal and Infant Research Institute, Austin Health, Melbourne, Australia.,Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia
| | - Heather Rowe
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Paul A Scuffham
- Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| | - Katherine M White
- School of Psychology and Counselling, Queensland University of Technology, South Brisbane Qld, Australia
| | - Anja Wittkowski
- School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | - Shelley Appleton
- Centre for Children's Health Research, Queensland University of Technology, South Brisbane Qld, Australia.,School of Psychology and Counselling, Queensland University of Technology, South Brisbane Qld, Australia
| | - Davina Sanders
- Centre for Children's Health Research, Queensland University of Technology, South Brisbane Qld, Australia.,School of Psychology and Counselling, Queensland University of Technology, South Brisbane Qld, Australia
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10
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Davis JA, Gibson LY, Bear NL, Finlay-Jones AL, Ohan JL, Silva DT, Prescott SL. Can Positive Mindsets Be Protective Against Stress and Isolation Experienced during the COVID-19 Pandemic? A Mixed Methods Approach to Understanding Emotional Health and Wellbeing Needs of Perinatal Women. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18136958. [PMID: 34209693 PMCID: PMC8297209 DOI: 10.3390/ijerph18136958] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 06/23/2021] [Accepted: 06/25/2021] [Indexed: 11/23/2022]
Abstract
The aim of this study was to explore the relationship between emotional health and wellbeing and support needs of perinatal women during the COVID-19 pandemic, and to understand their experiences and need for support. This is a potentially vulnerable group and a critical developmental phase for women and infants. A mixed methods design was used to collect quantitative and qualitative data that provided a robust insight into their unique needs. A total of 174 women who were either pregnant or post-birth participated. The main findings demonstrated that women in this cohort experienced varying levels of stress and isolation but also positive experiences. Exploring the relationship between mental health (perceived stress and wellbeing) and resilience (mindfulness and self-compassion) revealed an association between positive mental health and higher levels of mindfulness and self-compassion. Positive mindsets may be protective against psychological distress for the mother and her child, suggesting that meditation-based or similar training might help support expectant and post-birth mothers during times of crisis, such as a pandemic. This information could be used to make recommendations for future planning for practitioners and policymakers in preparing for prospective infection waves, pandemics, or natural disasters, and could be used to develop targeted tools, support, and care.
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Affiliation(s)
- Jacqueline A. Davis
- Telethon Kids Institute, 15 Hospital Avenue, Nedlands, WA 6009, Australia; (L.Y.G.); (A.L.F.-J.); (J.L.O.); (D.T.S.); (S.L.P.)
- School of Medicine, The University of Western Australia, Perth, WA 6009, Australia
- School of Public Health, Curtin University, Bentley, WA 6102, Australia
- Correspondence:
| | - Lisa Y. Gibson
- Telethon Kids Institute, 15 Hospital Avenue, Nedlands, WA 6009, Australia; (L.Y.G.); (A.L.F.-J.); (J.L.O.); (D.T.S.); (S.L.P.)
- School of Medicine, The University of Western Australia, Perth, WA 6009, Australia
- School of Medical and Health Sciences, Edith Cowan University, Perth, WA 6027, Australia
| | - Natasha L. Bear
- Institute for Health Research, Notre Dame University, Fremantle, WA 6160, Australia;
| | - Amy L. Finlay-Jones
- Telethon Kids Institute, 15 Hospital Avenue, Nedlands, WA 6009, Australia; (L.Y.G.); (A.L.F.-J.); (J.L.O.); (D.T.S.); (S.L.P.)
- School of Medicine, The University of Western Australia, Perth, WA 6009, Australia
| | - Jeneva L. Ohan
- Telethon Kids Institute, 15 Hospital Avenue, Nedlands, WA 6009, Australia; (L.Y.G.); (A.L.F.-J.); (J.L.O.); (D.T.S.); (S.L.P.)
- School of Medicine, The University of Western Australia, Perth, WA 6009, Australia
| | - Desiree T. Silva
- Telethon Kids Institute, 15 Hospital Avenue, Nedlands, WA 6009, Australia; (L.Y.G.); (A.L.F.-J.); (J.L.O.); (D.T.S.); (S.L.P.)
- School of Medicine, The University of Western Australia, Perth, WA 6009, Australia
- School of Public Health, Curtin University, Bentley, WA 6102, Australia
- School of Medical and Health Sciences, Edith Cowan University, Perth, WA 6027, Australia
- Joondalup Health Campus, Joondalup, WA 6027, Australia
| | - Susan L. Prescott
- Telethon Kids Institute, 15 Hospital Avenue, Nedlands, WA 6009, Australia; (L.Y.G.); (A.L.F.-J.); (J.L.O.); (D.T.S.); (S.L.P.)
- School of Medicine, The University of Western Australia, Perth, WA 6009, Australia
- School of Public Health, Curtin University, Bentley, WA 6102, Australia
- School of Medical and Health Sciences, Edith Cowan University, Perth, WA 6027, Australia
- Institute for Health Research, Notre Dame University, Fremantle, WA 6160, Australia;
- inVIVO Planetary Health, Worldwide Universities Network (WUN), West New York, NJ 10704, USA
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11
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Kinser P, Jallo N, Huberty J, Jones E, Thacker L, Moyer S, Laird B, Rider A, Lanni S, Drozd F, Haga S. Study protocol for a multisite randomized controlled trial of an internet and mobile-based intervention for preventing and reducing perinatal depressive symptoms. Res Nurs Health 2021; 44:13-23. [PMID: 33319443 PMCID: PMC7856295 DOI: 10.1002/nur.22092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 09/02/2020] [Accepted: 11/29/2020] [Indexed: 01/07/2023]
Abstract
Nearly 20% of women in the United States experience clinically significant depressive symptoms during pregnancy or the postpartum period. These women may benefit from easily accessible, nonpharmacologic, and inexpensive self-management approaches, such as via internet and mobile-based interventions, to prevent development of symptoms and/or intervene with current symptoms. This paper summarizes the research protocol of a nationally-funded large-scale randomized controlled study to evaluate "Mamma Mia," a self-guided program with 44 modules that women use throughout pregnancy to 6 months postpartum. The program contains a novel combination of components designed to enable women to enhance self-efficacy, emotional self-regulation, and perceived social support. The overall goal of this three-arm longitudinal randomized controlled trial is to evaluate the effects and mechanisms of this self-management approach in diverse women in the U.S. (n = 1950). Enrolled pregnant women will be randomly assigned to one of three groups: (1) "Mamma Mia" alone, which is self-guided; (2) "Mamma Mia Plus" in which participants engage in the "Mamma Mia" modules plus receive brief guided support from a registered nurse; or (3) usual prenatal/postpartum care. The first specific aim is to evaluate effects by group on the primary outcome of interest, depressive symptoms, over time. The second aim is to evaluate effects by group on subjective well-being, anxiety, and stress. Using a conceptual framework based upon Individual and Family Self-Management Theory, the third aim is to evaluate possible mediators (self-efficacy, emotion self-regulation, perceived support) and possible moderators (e.g., race/ethnicity, type of healthcare clinician) of this self-management approach.
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Affiliation(s)
| | - Nancy Jallo
- Virginia Commonwealth University, Richmond, Virginia, USA
| | - Jennifer Huberty
- College of Health Solutions, Arizona State University, Tempe, Arizona, USA
| | - Evelyn Jones
- Virginia Commonwealth University, Richmond, Virginia, USA
| | - Leroy Thacker
- Virginia Commonwealth University, Richmond, Virginia, USA
| | - Sara Moyer
- Virginia Commonwealth University, Richmond, Virginia, USA
| | - Breanne Laird
- College of Health Solutions, Arizona State University, Tempe, Arizona, USA
| | - Amy Rider
- Virginia Commonwealth University, Richmond, Virginia, USA
| | - Susan Lanni
- Virginia Commonwealth University, Richmond, Virginia, USA
| | - Filip Drozd
- Regional Centre for Child and Adolescent Mental Health, Oslo, Norway
| | - Silje Haga
- Regional Centre for Child and Adolescent Mental Health, Oslo, Norway
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12
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Mu TY, Li YH, Xu RX, Chen J, Wang YY, Shen CZ. Internet-based interventions for postpartum depression: A systematic review and meta-analysis. Nurs Open 2020; 8:1125-1134. [PMID: 33373101 PMCID: PMC8046152 DOI: 10.1002/nop2.724] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Revised: 10/19/2020] [Accepted: 11/04/2020] [Indexed: 11/15/2022] Open
Abstract
Aim To determine the efficacy of Internet‐based interventions in decreasing the prevalence of postpartum depression in perinatal women. Design This review was conducted according to the standards outlined in the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses statement. Methods We performed a systematic meta‐analysis of randomized controlled trials on the efficacy of Internet‐based interventions for postpartum depression. Studies (2008–2018) were identified through a search conducted on PubMed, EMBASE and the Cochrane Library. Risk ratios or weighted mean differences with 95% confidence intervals were calculated using a fixed‐effects model or a random‐effects model. Stata software 11.0 was used to perform the meta‐analysis. Results Most of the seven eligible studies were randomized controlled trials. The random‐effects model indicated that Internet‐based interventions significantly improved postpartum depression (d = 0.642, N = 7). Attrition rates ranged from 4.5%–86.9% and from 0%–87.1% for the intervention and control groups, respectively.
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Affiliation(s)
- Ting-Yu Mu
- School of Nursing, Zhejiang Chinese Medical University, Hangzhou, China.,Nursing College, Anhui University of Chinese Medicine, Hefei, China
| | - Yu-Hong Li
- Nursing College, Anhui Medical University, Hefei, China
| | - Ri-Xiang Xu
- School of Pharmacy, Hangzhou Medical College, Hangzhou, China
| | - Jun Chen
- Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Ya-Ya Wang
- Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Cui-Zhen Shen
- School of Nursing, Zhejiang Chinese Medical University, Hangzhou, China
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13
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Li Y, Mu T, Zhang L, Zhang C, Wu D, Chen J, Wang F. Internet‐based intervention for postpartum depression in China (“Mommy go”): Protocol for a randomized controlled trial. J Adv Nurs 2020; 76:2416-2425. [PMID: 32449228 DOI: 10.1111/jan.14436] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 04/12/2020] [Accepted: 05/06/2020] [Indexed: 01/21/2023]
Affiliation(s)
- Yu‐Hong Li
- Nursing College Anhui Medical University Hefei Anhui P.R. China
| | - Ting‐Yu Mu
- Nursing College Anhui Medical University Hefei Anhui P.R. China
- Nursing CollegesAnhui University of Traditional Chinese Medicine Hefei Anhui P.R. China
| | - Liu Zhang
- Nursing College Anhui Medical University Hefei Anhui P.R. China
| | - Cheng‐Lu Zhang
- Nursing College Anhui Medical University Hefei Anhui P.R. China
| | - Dan Wu
- The Second Affiliated Hospital of Anhui Medical University Hefei AnhuiP.R. China
| | - Jin‐Ju Chen
- The Second Affiliated Hospital of Anhui Medical University Hefei AnhuiP.R. China
| | - Fang Wang
- The Second Affiliated Hospital of Anhui Medical University Hefei AnhuiP.R. China
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14
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Westerhoff B, Trösken A, Renneberg B. Online Interventions for Postpartum Depression. VERHALTENSTHERAPIE 2019. [DOI: 10.1159/000501779] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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15
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Haga SM, Drozd F, Lisøy C, Wentzel-Larsen T, Slinning K. Mamma Mia - A randomized controlled trial of an internet-based intervention for perinatal depression. Psychol Med 2019; 49:1850-1858. [PMID: 30191779 PMCID: PMC6650775 DOI: 10.1017/s0033291718002544] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 08/09/2018] [Accepted: 08/16/2018] [Indexed: 11/02/2022]
Abstract
BACKGROUND Studies suggest that 10-15% of perinatal women experience depressive symptoms. Due to the risks, problems with detection, and barriers to treatment, effective universal preventive interventions are needed. The aim of this study was to assess the effectiveness of an automated internet intervention ('Mamma Mia') on perinatal depressive symptoms. Mamma Mia is tailored specifically to the perinatal phase and targets risk and protective factors for perinatal depressive symptoms. METHODS A total of 1342 pregnant women were randomized to an intervention ('Mamma Mia') and control group. Data were collected at gestational week (gw) 21-25, gw37, 6 weeks after birth, and 3 and 6 months after birth. We investigated whether (1) the intervention group displayed lower levels of depressive symptoms compared with the control group, (2) the effect of Mamma Mia changed over time, (3) the effect on depressive symptoms was moderated by baseline depressive symptoms, previous depression, and parity, and (4) this moderation changed by time. Finally, we examined if the prevalence of mothers with possible depression [i.e. Edinburgh Postnatal Depression Scale (EPDS)-score ⩾10] differed between the intervention and control group. RESULTS Participants in the Mamma Mia group displayed less depressive symptoms than participants in the control group during follow-up [F(1) = 7.03, p = 0.008]. There were indications that the effect of Mamma Mia was moderated by EPDS score at baseline. The prevalence of women with EPDS-score ⩾10 was lower in the Mamma Mia group at all follow-up measurements. CONCLUSIONS The study demonstrated the effects of the automated web-based universal intervention Mamma Mia on perinatal depressive symptoms.
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Affiliation(s)
- Silje Marie Haga
- Department for Infant Mental Health, Regional Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo,Norway
| | - Filip Drozd
- Department for Infant Mental Health, Regional Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo,Norway
| | - Carina Lisøy
- Department for Infant Mental Health, Regional Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo,Norway
| | - Tore Wentzel-Larsen
- Department for Infant Mental Health, Regional Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo,Norway
- Norwegian Center for Violence and Traumatic Stress Studies, Oslo,Norway
| | - Kari Slinning
- Department for Infant Mental Health, Regional Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo,Norway
- Department of Psychology, University of Oslo, Oslo,Norway
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16
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Corno G, Espinoza M, Maria Baños R. A narrative review of positive psychology interventions for women during the perinatal period. J OBSTET GYNAECOL 2019; 39:889-895. [PMID: 31179814 DOI: 10.1080/01443615.2019.1581735] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Recent studies suggest that positive perinatal maternal mood can buffer the effects of negative feelings and promote women and infant well-being. Evidence from Positive Psychology has shown that Positive Psychology Interventions (PPIs) can enhance well-being and/or reduce negative symptoms. The objective of this comprehensive narrative review was to identify and critically review the current evidence about the use of PPIs designed to improve women's mental well-being during the perinatal period. A systematic search of four online databases was conducted. Two intervention programmes have been identified. Both interventions were online-based and gratitude was the common PPI. The common target was women's mental health well-being during the perinatal period. This review has synthesised the first studies in the wake of a new model of PPIs aimed to foster women's well-being during the perinatal period. Nevertheless, much more research is required to establish which, how, and for whom PPIs can be suitable.
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Affiliation(s)
| | | | - Rosa Maria Baños
- Universitat de Valencia , Valencia , Spain.,CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III , Spain
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17
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Holter MT, Johansen AB, Ness O, Brinkmann S, Høybye MT, Brendryen H. Qualitative Interview Studies of Working Mechanisms in Electronic Health: Tools to Enhance Study Quality. J Med Internet Res 2019; 21:e10354. [PMID: 31066683 PMCID: PMC6526686 DOI: 10.2196/10354] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 01/17/2019] [Accepted: 02/07/2019] [Indexed: 01/23/2023] Open
Abstract
Future development of electronic health (eHealth) programs (automated Web-based health interventions) will be furthered if program design can be based on the knowledge of eHealth’s working mechanisms. A promising and pragmatic method for exploring potential working mechanisms is qualitative interview studies, in which eHealth working mechanisms can be explored through the perspective of the program user. Qualitative interview studies are promising as they are suited for exploring what is yet unknown, building new knowledge, and constructing theory. They are also pragmatic, as the development of eHealth programs often entails user interviews for applied purposes (eg, getting feedback for program improvement or identifying barriers for implementation). By capitalizing on these existing (applied) user interviews to also pursue (basic) research questions of how such programs work, the knowledge base of eHealth’s working mechanisms can grow quickly. To be useful, such interview studies need to be of sufficient quality, which entails that the interviews should generate enough data of sufficient quality relevant to the research question (ie, rich data). However, getting rich interview data on eHealth working mechanisms can be surprisingly challenging, as several of the authors have experienced. Moreover, when encountering difficulties as we did, there are few places to turn to, there are currently no guidelines for conducting such interview studies in a way that ensure their quality. In this paper, we build on our experience as well as the qualitative literature to address this need, by describing 5 challenges that may arise in such interviews and presenting methodological tools to counteract each challenge. We hope the ideas we offer will spark methodological reflections and provide some options for researchers interested in using qualitative interview studies to explore eHealth’s working mechanisms.
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Affiliation(s)
- Marianne Ts Holter
- Norwegian Centre for Addiction Research (SERAF), Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Ayna B Johansen
- Norwegian Centre for Addiction Research (SERAF), Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Ottar Ness
- Department of Education and Lifelong Learning, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Svend Brinkmann
- Department of Communication and Psychology, Aalborg University, Aalborg, Denmark
| | - Mette T Høybye
- Elective Surgery Centre, Regional Hospital Silkeborg, Silkeborg, Denmark.,Department of Clinical Medicine, Interacting Minds Centre, Aarhus University, Aarhus, Denmark
| | - Håvar Brendryen
- Norwegian Centre for Addiction Research (SERAF), Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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18
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Li Y, Mu T. Internet-Based Intervention for Postpartum Depression in China: Formative Research and Design of the “Mommy go” Program (Preprint). JMIR Res Protoc 2019. [DOI: 10.2196/14514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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19
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Westerhoff B, Trösken A, Renneberg B. Online-Interventionen bei postpartaler Depression. VERHALTENSTHERAPIE 2019. [DOI: 10.1159/000496095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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20
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Pot M, Ruiter RAC, Paulussen TWGM, Heuvelink A, de Melker HE, van Vliet HJA, van Keulen HM. Systematically Developing a Web-Based Tailored Intervention Promoting HPV-Vaccination Acceptability Among Mothers of Invited Girls Using Intervention Mapping. Front Public Health 2018; 6:226. [PMID: 30356852 PMCID: PMC6190841 DOI: 10.3389/fpubh.2018.00226] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 07/25/2018] [Indexed: 12/03/2022] Open
Abstract
Background: Currently, the eHealth field calls for detailed descriptions of theory-based interventions in order to support improved design of such interventions. This article aims to provide a systematic description of the design rationale behind an interactive web-based tailored intervention promoting HPV-vaccination acceptability. Methods: The 6-step Intervention Mapping (IM) protocol was used to describe the design rationale. After the needs assessment in Step 1, intervention objectives were formulated in Step 2. In Step 3, we translated theoretical methods into practical applications, which were integrated into a coherent intervention in Step 4. In Step 5, we anticipated future implementation and adoption, and finally, an evaluation plan was generated in Step 6. Results: Walking through the various steps of IM resulted in a detailed description of the intervention. The needs assessment indicated HPV-vaccination uptake remaining lower than expected. Mothers play the most important role in decision-making about their daughter's immunization. However, they generally feel ambivalent after they made their decisions, and their decisions are based on rather unstable grounds. Therefore, intervention objectives were to improve HPV-vaccination uptake and informed decision-making, and to decrease decisional conflict among mothers of invited girls. Computer-tailoring was chosen as the main method; virtual assistants were chosen as a practical application to deliver interactive tailored feedback. To maximize compatibility with the needs of the target group, a user-centered design strategy by means of focus groups and online experiments was applied. In these, prototypes were tested and sequentially refined. Finally, efficacy, effectiveness, and acceptability of the intervention were tested in a randomized controlled trial. Results showed a significant positive effect of the intervention on informed decision-making, decisional conflict, and nearly all determinants of HPV-vaccination uptake (P < 0.001). Mothers evaluated the intervention as highly positive. Discussion: Using IM led to an innovative effective intervention for promoting HPV-vaccination acceptability. The intervention maps will aid in interpreting the results of our evaluation studies. Moreover, it will ease the comparison of design rationales across interventions, and may provide leads for the development of other eHealth interventions. This paper adds to the plea for systematic reporting of design rationales constituting the process of developing interventions.
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Affiliation(s)
- Mirjam Pot
- Child Health, Netherlands Organization for Applied Scientific Research (TNO), Leiden, Netherlands.,Department of Work & Social Psychology, Maastricht University, Maastricht, Netherlands
| | - Robert A C Ruiter
- Department of Work & Social Psychology, Maastricht University, Maastricht, Netherlands
| | - Theo W G M Paulussen
- Child Health, Netherlands Organization for Applied Scientific Research (TNO), Leiden, Netherlands
| | - Annerieke Heuvelink
- Perceptual and Cognitive Systems, Netherlands Organization for Applied Scientific Research (TNO), Soesterberg, Netherlands
| | - Hester E de Melker
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, Netherlands
| | - Hans J A van Vliet
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, Netherlands
| | - Hilde M van Keulen
- Child Health, Netherlands Organization for Applied Scientific Research (TNO), Leiden, Netherlands
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21
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Scheerman JFM, van Empelen P, van Loveren C, van Meijel B. A Mobile App (WhiteTeeth) to Promote Good Oral Health Behavior Among Dutch Adolescents with Fixed Orthodontic Appliances: Intervention Mapping Approach. JMIR Mhealth Uhealth 2018; 6:e163. [PMID: 30120085 PMCID: PMC6119215 DOI: 10.2196/mhealth.9626] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 04/26/2018] [Accepted: 05/15/2018] [Indexed: 12/23/2022] Open
Abstract
Background The insertion of fixed orthodontic appliances increases the risk of dental caries, particularly in adolescents. Caries can be prevented through good oral health behavior. To support adolescents with fixed orthodontic appliances and for promoting oral health behavior, we developed a theory- and evidence-based mHealth program, the WhiteTeeth app. Objective The objective of our paper was to describe the systematic development and content of the WhiteTeeth app. Methods For systematic development of the program, we used the intervention mapping (IM) approach. In this paper, we present the results of applying the first 5 steps of IM to the design of an mHealth program: (1) identifying target behaviors and determinants through problem analysis, including a literature search, a survey study, and semistructured interviews, to explore adolescent oral health behavior during orthodontic therapy; (2) defining program outcomes and objectives; (3) selecting theoretical methods and translating them into practical strategies for the program design; (4) producing the program, including a pilot test with 28 adolescents testing the acceptability and usability of the WhiteTeeth app; and (5) planning implementation and adoption. Results On the basis of our literature search, we identified fluoride use and control of dental plaque levels (eg, tooth brushing and proxy brush usage) as target behaviors for preventing caries. Next, we identified important and changeable determinants of oral health behavior that fitted the theoretical concepts of the Health Action Process Approach (HAPA) theory. The HAPA theory, the self-regulation theory, and the results of the semistructured interviews were used to define the program objectives, that is, the performance and change objectives. After defining the objectives, we identified multiple behavior change techniques that could be used to achieve these objectives, such as providing oral health information and feedback, prompting self-monitoring, coaching of set actions and coping plans, and sending reminders. We translated these methods into practical strategies, such as videos and a brushing timer. Next, we combined these strategies into a single program resulting in the WhiteTeeth app (which is available on both iTunes and Google Play stores as “Witgebit”). Adolescents with fixed orthodontic appliances and dental professionals were included in the development process to increase the success of implementation. The pilot test revealed that the app users appreciated and liked the app. The WhiteTeeth app can be integrated into current orthodontic care. Conclusions IM allowed us to identify multiple techniques that have been shown to be the most effective in initiating behavior change, but have not yet been incorporated into existing orthodontic apps. The WhiteTeeth app contains all these techniques, which makes it a unique and promising home-based app for promoting oral health in adolescents with fixed orthodontic appliances.
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Affiliation(s)
- Janneke Francisca Maria Scheerman
- Department of Preventive Dentistry, Academic Center for Dentistry Amsterdam, University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,Cluster Oral Hygiene, Department of Health, Sports & Welfare, Inholland University, Amsterdam, Netherlands.,Department of Child Health, Netherlands Organization for Applied Scientific Research, Leiden, Netherlands
| | - Pepijn van Empelen
- Department of Child Health, Netherlands Organization for Applied Scientific Research, Leiden, Netherlands
| | - Cor van Loveren
- Department of Preventive Dentistry, Academic Center for Dentistry Amsterdam, University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Berno van Meijel
- Cluster Nursing, Department of Health, Sports & Welfare, Inholland University, Amsterdam, Netherlands.,Department of Psychiatry, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam Medical Center, Amsterdam, Netherlands.,Parnassia Psychiatric Institute, The Hague, Netherlands
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22
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Krusche A, Dymond M, Murphy SE, Crane C. Mindfulness for pregnancy: A randomised controlled study of online mindfulness during pregnancy. Midwifery 2018; 65:51-57. [PMID: 30099285 DOI: 10.1016/j.midw.2018.07.005] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 07/19/2018] [Accepted: 07/23/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Prenatal depression, stress and anxiety are significant predictors of postnatal depression and also have a direct negative impact on the family. Helpful psychological interventions during pregnancy are scarce and expensive, and usually only available for a small percentage of those suffering or deemed to be at risk. The aim of this study was to evaluate the potential of an online mindfulness course for expectant mothers. DESIGN A randomised study was conducted to explore differences between control and active participants allocated to take an online mindfulness course, offered free to research participants, or wait. SETTING The course provided was online and already available but given to study participants for free. Measures were also taken online using a secure site to collect the data. PARTICIPANTS 185 mothers were recruited and randomised to the online course (n = 107) or a waitlist control (n = 78), with 72 completers at post-course (n = 22 active, n = 50 control) and 48 completers at postnatal follow-up (n = 16 active and n = 32 control). INTERVENTION The online mindfulness course is available at www.bemindfulonline.com and comprises a four-week, condensed version of an eight-week mindfulness course, with videos and written instructions for guided meditation and other mindfulness-based exercises. MEASUREMENTS AND FINDINGS A number of psychological well-being measurements were taken including stress, anxiety, depression and pregnancy-specific measure such as labour worry. Intention to treat analysis (baseline carried forwards) showed no group difference in stress from pre to post intervention or control. KEY CONCLUSIONS Results indicated that the course was potentially beneficial for those who completed it, but levels of drop out from the course were very high. IMPLICATIONS FOR PRACTICE Although outcomes for mothers completing the intervention were improved relative to a waitlist control, high rates of drop out indicate that the online course has low completion rates for pregnant women in its current format.
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Affiliation(s)
- Adele Krusche
- Department of Psychology, University of Southampton, UK; Department of Psychiatry, University of Oxford, UK.
| | - Maret Dymond
- Department of Psychiatry, University of Oxford, UK
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A Pilot Randomized Controlled Trial of an Internet-Based Alcohol Intervention in a Workplace Setting. Int J Behav Med 2018; 24:768-777. [PMID: 28755326 DOI: 10.1007/s12529-017-9665-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE The aim of this study was to compare the effectiveness of a brief and an intensive self-help alcohol intervention and to assess the feasibility of recruiting to such interventions in a workplace setting. METHOD Employees who screened positive for hazardous drinking (n = 85) received online personalized normative feedback and were randomly assigned to one out of two conditions: either they received an e-booklet about the effects of alcohol or they received a self-help intervention comprising 62 web-based, fully automated, and interactive sessions, plus reminder e-mails, and mobile phone text messages (Short Message Service). RESULTS Two months after baseline, the responders in the intensive condition drank an average of five to six drinks less per week compared to the responders in the brief condition (B = 5.68, 95% CI = 0.48-10.87, P = .03). There was no significant difference between conditions, using baseline observation carried forward imputation (B = 2.96, 95% CI = -0.50-6.42, P = .09). Six months after baseline, no significant difference was found, neither based on complete cases nor intent-to-treat (B = 1.07, 95% CI = -1.29-3.44, P = .37). Challenges with recruitment are thoroughly reported. CONCLUSION The study supports the feasibility and the safety of use for both brief and intensive Internet-based self-help in an occupational setting. The study may inform future trials, but due to recruitment problems and low statistical power, the findings are inconclusive in terms of the intensive program being more effective than brief intervention alone. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01931618.
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Drozd F, Haga SM, Lisøy C, Slinning K. Evaluation of the implementation of an internet intervention in well-baby clinics: A pilot study. Internet Interv 2018; 13:1-7. [PMID: 30206512 PMCID: PMC6112086 DOI: 10.1016/j.invent.2018.04.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 04/19/2018] [Accepted: 04/27/2018] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Despite promising results, internet interventions are not widely accessible or well-integrated in health services. The objective of this study was, therefore, to examine the implementation of an internet intervention ('Mamma Mia') for the prevention of perinatal depression in Norwegian well-baby clinics (i.e., primary care). METHODS Mamma Mia begins in mid-pregnancy and lasts up to 6 months after childbirth. It consists of 44 online sessions, supported by midwives and public health nurses at up to 5 contact points during this period, following principles of empathic communication. Well-baby clinics offer free, universal services to all pregnant women and children aged 0 to 5 years in Norway and were recruited via an intermediary organization for this study. Data were collected at pre- and post-training, but before the delivery of Mamma Mia in clinics, and at 3 and 6 months follow-up. Quantitative and qualitative data were used to evaluate the training in Mamma Mia, examine program implementation (i.e., number of pregnant women registered for the program), and identify barriers and enablers of implementation. RESULTS Twenty-four self-selected healthcare professionals from 14 well-baby clinics were recruited, for this study. Training increased participants' knowledge about Mamma Mia and exceeded their expectations. The program review and implementation plan were necessary training components. Implementation climate was related to the number of colleagues working with Mamma Mia and overall satisfaction with implementation, while characteristics of the intervention predicted the number of registered women at 6 months. Organizational re-structuring, leadership, and competing activities were identified as barriers to implementation that need to be considered further. CONCLUSIONS The dissemination and implementation of a health-service supported internet intervention appears to be promising but requires further research.
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Affiliation(s)
- Filip Drozd
- Department for Infant Mental Health, Regional Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway,Corresponding author at: Department for Infant Mental Health, Regional Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, P.O. Box 4623, Nydalen, N-0405 Oslo, Norway.
| | - Silje Marie Haga
- Department for Infant Mental Health, Regional Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway
| | - Carina Lisøy
- Department for Infant Mental Health, Regional Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway
| | - Kari Slinning
- Department for Infant Mental Health, Regional Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway,Department of Psychology, University of Oslo, Oslo, Norway
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Hamilton K, Kavanagh D, Connolly J, Davis L, Fisher J, Halford K, Hides L, Milgrom J, Rowe H, Sanders D, Scuffham PA, Tjondronegoro D, Walsh A, White KM, Wittkowski A. Baby Steps - An Online Program Promoting the Well-Being of New Mothers and Fathers: A Study Protocol. JMIR Res Protoc 2016; 5:e140. [PMID: 27370711 PMCID: PMC4963015 DOI: 10.2196/resprot.5706] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Revised: 04/15/2016] [Accepted: 04/15/2016] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Parental well-being can be seriously impacted during the challenging perinatal period. Most research and support services focus on perinatal psychopathology, leaving a need for programs that recognize and enhance the strengths and well-being of parents. Furthermore, fathers have received minimal attention and support relative to mothers, despite experiencing perinatal distress. New parents have limited time and energy to invest in program attendance, and web-based programs provide an ideal platform for delivering perinatal well-being programs. Such programs are globally accessible, available at any time, and can be accessed anywhere with an Internet connection. OBJECTIVE This paper describes the protocol of a randomized controlled trial investigating the effects on first-time parents' perinatal well-being, comparing two versions of the online program Baby Steps. METHODS The clinical trial will randomize 240 primiparous mother-father couples to either (1) Babycare, an online information-only program providing tips on selected childcare issues, or (2) Well-being, an online interactive program including all content from the Babycare program, plus parental well-being-focused content with tools for goal-setting and problem solving. Both programs will be supported by short message service (SMS) texts at two, four, seven, and ten weeks to encourage continued use of the program. Primary outcomes will be measures of perinatal distress and quality of life. Secondary outcomes will be couple relationship satisfaction, parent self-efficacy, and social support. Cost-effectiveness will also be measured for each Baby Steps program. RESULTS Participant recruitment commenced March, 2015 and continued until October, 2015. Follow-up data collection has commenced and will be completed May, 2016 with results expected in July, 2016. CONCLUSIONS Perinatal distress has substantial impacts on parents and their infants, with potential to affect later childhood adjustment, relationships, and development. This study aims to test the impact of a highly accessible online program to support parental coping, and maximize the well-being of both parents. By including fathers in the program, Baby Steps has the potential to engage and support this often neglected group who can make a substantial contribution to familial well-being. CLINICALTRIAL Australian & New Zealand Clinical Trials Registry: ANZCTR12614001256662; https://www.anzctr.org.au/ Trial/Registration/TrialReview.aspx?id=367277 (Archived by WebCite at http://www.webcitation.org/6ibUsjFIL).
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Affiliation(s)
- Kyra Hamilton
- Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
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Holter MTS, Johansen A, Brendryen H. How a Fully Automated eHealth Program Simulates Three Therapeutic Processes: A Case Study. J Med Internet Res 2016; 18:e176. [PMID: 27354373 PMCID: PMC4942686 DOI: 10.2196/jmir.5415] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Revised: 05/30/2016] [Accepted: 05/30/2016] [Indexed: 01/03/2023] Open
Abstract
Background eHealth programs may be better understood by breaking down the components of one particular program and discussing its potential for interactivity and tailoring in regard to concepts from face-to-face counseling. In the search for the efficacious elements within eHealth programs, it is important to understand how a program using lapse management may simultaneously support working alliance, internalization of motivation, and behavior maintenance. These processes have been applied to fully automated eHealth programs individually. However, given their significance in face-to-face counseling, it may be important to simulate the processes simultaneously in interactive, tailored programs. Objective We propose a theoretical model for how fully automated behavior change eHealth programs may be more effective by simulating a therapist’s support of a working alliance, internalization of motivation, and managing lapses. Methods We show how the model is derived from theory and its application to Endre, a fully automated smoking cessation program that engages the user in several “counseling sessions” about quitting. A descriptive case study based on tools from the intervention mapping protocol shows how each therapeutic process is simulated. Results The program supports the user’s working alliance through alliance factors, the nonembodied relational agent Endre and computerized motivational interviewing. Computerized motivational interviewing also supports internalized motivation to quit, whereas a lapse management component responds to lapses. The description operationalizes working alliance, internalization of motivation, and managing lapses, in terms of eHealth support of smoking cessation. Conclusions A program may simulate working alliance, internalization of motivation, and lapse management through interactivity and individual tailoring, potentially making fully automated eHealth behavior change programs more effective.
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Affiliation(s)
- Marianne T S Holter
- The Norwegian Centre for Addiction Research, Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.
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