Evaluation of a Technology-Based Peer-Support Intervention Program for Preventing Postnatal Depression (Part 2): Qualitative Study

Abstract

Background Social support is known to reduce risks of postnatal depression (PND) and improve maternal emotional well-being. However, the Asian cultural context is often neglected when appraising maternal needs and mothers’ preferences for social support. While many preventive efforts have experimented with technology, professionals, and paraprofessionals in providing social support to mothers in need, most studies determined the effectiveness of their interventions through quantitative measurements of maternal outcomes. Experiences and feedback from both participants and administrators are rarely discussed, especially in an Asian setting. Objective The goal of the research was to evaluate the postnatal experiences of Asian mothers at risk of PND and the perceptions of peer volunteers regarding a technology-based peer-support intervention program (PIP). Methods A qualitative semistructured interview was conducted with 20 Asian mothers at risk of depression (10 from the control group and 10 from the intervention group) and 19 peer volunteers from a randomized controlled trial. The PIP included weekly correspondence between peer volunteers and mothers through any telecommunication means over 4 weeks. All interviews were approximately 30 to 60 minutes long, audiotaped, transcribed verbatim, and analyzed using thematic analysis. Study findings were reported according to the Consolidated Standards of Reporting Trials checklist. Results Two overarching themes comprising five subthemes were generated: postnatal experience (a bouncy ride, a way forward) and evaluation of the PIP (valuable, flexible, and supportive program; building blocks of a good relationship; and lessons learned and the road ahead). Mothers from both the control and interventions groups were generally satisfied with hospital care and the support received from family. They also shared similar breastfeeding challenges and needs for more informed decisions and follow-up support from the hospital. However, mothers who received the PIP tended to have more positive outlooks of their birth experiences. Overall, peer volunteers and mothers involved in the PIP found the PIP useful and expressed satisfaction with the program’s flexibility. They also shared their personal takeaways, the qualities of their friendships, and the need for extended correspondence time and recommended outreach to non–at-risk mothers. Conclusions The positive endorsement of the PIP by peer volunteers and mothers suggests the success of the PIP in maintaining positive maternal emotional well-being during the postpartum period. With the help of technology, hospitals can easily provide additional peer support to at-risk mothers in addition to existing standard care offered to these mothers. Trial Registration ISRCTN Registry ISRCTN14864807; http://www.isrctn.com/ISRCTN14864807 International Registered Report Identifier (IRRID) RR2-10.2196/resprot.9416

Professional support during the postpartum period: primiparous mothers’ views on professional services and their expectations, and barriers to utilizing professional help

“…Additionally, cultural differences largely influence the preferred types of support. Unlike individualistic Western culture, Asian culture is more collectivistic, and indirect support from other people giving companionship and attentiveness is preferred [60]. Therefore, cultural differences may account for the mothers' help seeking preference and behaviour in this study.…”

Professional support during the postpartum period: Primiparous mothers' views on professional services, their expectations, and barriers to mobilizing professional help

“…Therefore, cultural differences may account for that mothers more preferred to seek helps from family members and peers in this study. It had been reported in other studies that peer support could help with generating sense of belongs, parenting confidence, self-esteem, and with preventing PPD [55,56]. This illustrated that Chinses cultural context should be considered when providing supports to mothers, and types of peer supports may be effective in solving mothers' problem.…”

“…Due to its profound influence, Chinese people may consider family conflicts and related mental health problems to be shameful and assume that they would lead to gossip and the communicate a negative impression of their entire family to others. This cultural context could be obvious in the other studies that Asian's higher value on family and social relationships, the mothers was regarded as a weaker sex and has more tendency to rely on others, especially on their family members and partner [55]. The results indicated that cultural factors, such as face -saving, should also be considered when conducting interventions in China.…”

“…Additionally, cultural differences largely influence preferred types of supports. Unlike individualistic Western cultural, Asian culture is more collectivistic, and indirect support from others by giving companionship and attentiveness is preferred [55]. Therefore, cultural differences may account for that mothers more preferred to seek helps from family members and peers in this study.…”

Professional support during the postpartum period: Primiparous mothers' views on professional services, their expectations, and barriers to utilizing professional help

“…Additionally, cultural differences largely in uence the preferred types of support. Unlike individualistic Western culture, Asian culture is more collectivistic, and indirect support from other people giving companionship and attentiveness is preferred [61]. Therefore, cultural differences may account for the mothers' help seeking preference and behaviour in this study.…”