Feasibility and Acceptability of a Web-Based Treatment with Telephone Support for Postpartum Women With Anxiety: Randomized Controlled Trial

Abstract

BackgroundPostpartum anxiety can have adverse effects on the mother and child if left untreated. Time constraints and stigma are common barriers to postpartum treatment. Web-based treatments offer potential flexibility and anonymity. What Am I Worried About (WaWa) is a self-guided treatment based on cognitive-behavioral and mindfulness principles for women experiencing postpartum anxiety. WaWa was developed in Australia and consists of 9 modules with optional weekly telephone support. WaWa was adapted to a Web-based version for use in England (Internet-based What Am I Worried About, iWaWa).ObjectiveThis study aimed to investigate the feasibility (engagement and usability) and acceptability (usefulness, satisfaction, and helpfulness) of iWaWa among English postpartum women with anxiety.MethodsPostpartum (<12 months) women with mild-to-severe anxiety were recruited anonymously via social media during an 8-week period. Participants were randomized to the iWaWa treatment (8 weeks) or wait-list control group. Treatment and study feasibility and acceptability were assessed after the treatment, and anxiety symptoms were assessed at baseline, 8 weeks postrandomization, and 12 weeks postrandomization (treatment group only) using Web-based questionnaires. Semistructured telephone interviews were carried out after the treatment period for a more in-depth exploration of treatment acceptability and feasibility.ResultsA total of 89 eligible women were recruited through social media and randomized into the treatment (n=46) or wait-list control group (n=43). Women were predominantly Caucasian, well-educated, married, on maternity leave, first-time mothers and reported moderate levels of anxiety. Dropout rates were high, especially in the treatment group (treatment: 82%, 38/46; wait-list control: 51%, 22/43). A total of 26 women started iWaWa with only 2 women completing all 9 modules. Quantitative and qualitative data suggest iWaWa was experienced as generally useful and helpful. Participants enjoyed iWaWa’s accessibility, anonymity, and weekly reminders, as well as the introduction to the principles of cognitive-behavioral therapy (CBT) and mindfulness. However, iWaWa was also experienced as not user-friendly enough, too long, and not smartphone-friendly. Parts of the content were experienced as not always relevant and appropriate. Participants felt that iWaWa could be improved by having it in a smartphone app format and by making the content more concise and inclusive of different parenting styles.ConclusionsDespite interest in iWaWa, the results suggest that both the study and iWaWa were not feasible in the current format. However, this first trial provides useful evidence about treatment format and content preferences that can inform iWaWa’s future development, as well as research and development of Web-based postpartum anxiety treatments, in general, to optimize adherence.Trial RegistrationClinicalTrials.gov NCT02434406; https://clinicaltrials.gov/ct2/show/NCT02434406 (Archived by WebCite at http://www.webcitation.org/6xTq7...

Barriers to and Facilitators of User Engagement With Digital Mental Health Interventions: Systematic Review

“…The length of the program as well as the length of individual sessions played a role in participants’ satisfaction and their motivation to continue with the program [ 88 , 138 , 147 - 151 ]. In 2 studies evaluating a self-guided CBT program for 8 weeks, the length and pace of modules negatively impacted user motivation [ 88 ], and participants reported preference for more concise modules [ 148 ], although the articles did not attempt to identify an ideal module length. In other studies evaluating a CBT program that included in-person sessions with a therapist, some participants reported preference for both longer individual therapy sessions (greater than the standard 50-70 minutes) [ 151 ] and duration of treatment to maximize benefit [ 150 ].…”

“…However, for interventions that were completely self-guided, participants experienced difficulty engaging with them and at times neglected to use the intervention [ 44 , 95 ]. Participants expressed a need to receive more structured use, for example, through app reminders or a human coach checking on them on a regular basis [ 49 , 50 , 113 , 122 , 133 , 137 , 139 , 148 , 150 , 163 , 175 - 182 ]. In 6 studies, users stated that they would prefer if an intervention served as a complement to existing, in-person therapy rather than a replacement for in-person therapy [ 30 , 122 , 134 , 139 , 166 , 183 ].…”

The Acceptability and Usability of Digital Health Interventions for Adults With Depression, Anxiety, and Somatoform Disorders: Qualitative Systematic Review and Meta-Synthesis

“…Flexibility and autonomy were emphasized in the majority of papers, with 19 papers reporting the flexible and autonomous nature of DHIs [ 24 , 35 - 42 , 45 - 49 , 52 - 56 ]. Some participants perceived DHIs to be more accessible and flexible.…”

“…Questions regarding the suitability of DHIs for some problems were raised in 12 papers, alongside some patients’ desire for additional responsive support when DHIs became challenging or unsuitable [ 24 , 34 , 43 , 45 , 46 , 50 - 56 ]. DHI therapy sessions could be physically and mentally exhausting, and for some participants, it exacerbated symptoms of low mood and anxiety.…”

Supporting perinatal anxiety in the digital age; A qualitative exploration of stressors and support strategies.

“…Mindfulness techniques may also be beneficial (64). To date, only one PNA-specific webbased treatment program has been evaluated via RCT (65). Unfortunately, this program was deemed unacceptable in its current format, with high attrition rates.…”