Web-based Intervention for Postpartum Depression: Formative Research and Design of the MomMoodBooster Program

Abstract

BackgroundPostpartum depression is a significant public health problem affecting approximately 13% of women. There is strong evidence supporting Cognitive Behavioral Therapy (CBT) for successful psychosocial treatment. This treatment model combines cognitive and behavioral strategies to address pessimism, attributions for failure, low self-esteem, low engagement in pleasant activities, social withdrawal, anxiety, and low social support. Encouraging results have been reported for using Web-based CBT interventions for mental health domains, including the treatment of panic disorder, post-traumatic stress disorder, and complicated grief and depression. To date, however, Web-based interventions have not been used and evaluated specifically for the treatment of postpartum depression.ObjectiveWe describe the formative work that contributed to the development of our Web-based intervention for helping to ameliorate symptoms of postpartum depression, and the design and key components of the program.MethodsA total of 17 focus group participants and 22 usability testers, who shared key characteristics with the participants of our planned feasibility study, took part.The proposed structure and ingredients of the program and mock-ups of selected webpages were presented to focus group participants. At various points, participants were asked a series of thought questions designed to elicit opinions and set the occasion for group discussion. At the end of the session, participants were asked to describe their overall reaction to the proposed features of the program emphasizing candid opinions about what they did not like and features they thought were missing and should be added.Usability testers were asked to interact with a series of seven different Web-based interactions planned for the program while receiving minimal direction. Each tester was asked to describe her thoughts using a think-aloud technique. They were then asked to consider all that they had learned about the program and complete the System Usability Scale that we adapted slightly to be appropriate for evaluating the proposed website.Transcripts from the focus groups and usability tests were reviewed by research team members for overarching themes with particular emphasis on suggested changes. A list emerged, and iterative and incremental adjustments were made as a result.ResultsThe qualitative and quantitative data gathered in the focus groups and usability sessions reported here suggest that the new mothers involved had largely positive reactions to the major features of the program and that those program features performed well in terms of usability.ConclusionsAn overview of the eventual design, architecture, and key program ingredients of the MomMoodBooster program is provided including innovative features supplementing 6 core CBT sessions, which include a partner’s website, a library, and individual feedback by a personal coach.

Combining e‐mental health intervention development with human computer interaction (HCI) design to enhance technology‐facilitated recovery for people with depression and/or anxiety conditions: An integrative literature review

“…Bae et al (2009) conducted a need assessment in Korea, where they investigated different types of layout components. Danaher et al (2012) conducted focus group interviews to complement usability testing of a webbased intervention for symptoms of postpartum depression in United States and Australia, and their findings correspond with Tiburcio et al (2016) findings with a preference for images and colours to enhance user experience. Tiburcio et al (2016) conducted usability testing of web-based self-help programmes in Mexico among a sample of people with the comorbid conditions of substance misuse and depression, and discovered that those users preferred additional images and colours as elements to promote usability.…”

“…Among the articles reviewed, seven stated the need for improved instructions to users to enhance usability and promote treatment adherence (Currie et al 2010;Danaher et al 2012;Davidson et al 2014;Ho et al 2016;Kelders et al 2013;Tiburcio et al 2016;Wozney et al 2015). Independently navigating pages, completing online exercises and entering personal information into diary tools are all examples frequently used in e-mental health interventions.…”

“…Whitton et al (2015) log data analysis for users of a web-and mobile-based treatment for depression, anxiety, and stress showed that daily or weekly symptom tracking was one of the most frequently used components. Danaher et al (2012) conducted an usability testing study including the utilization of design to enhance the function of the self-monitoring and concluded that the tracking tool requires a simple interface along with clear instructions for users to benefit adequately. Kok et al (2014) showed log data of users of mobile CBT for depression also found popular use of mood monitors.…”

Mamma Mia: A Feasibility Study of a Web-Based Intervention to Reduce the Risk of Postpartum Depression and Enhance Subjective Well-Being

“…Studies document that people with these mental disorders greatly benefit from Web-based interventions [23,24] and that Web-based interventions represent a low threshold service with a high reach [25]. More recently, two studies found support for the feasibility and usability of Web-based interventions targeting PPD [26,27], but there exist no randomized trials testing the efficacy of PPD interventions. Web-based interventions have been found successful in reaching women of lower socio-economic status, a group typically found to be harder to reach [28].…”

The Neurobiological Impact of Postpartum Maternal Depression

“…94,121 Feasibility of web and smartphone based interventions for PPD to address accessibility challenges have been piloted and represent innovative future directions. 122–126 Examples of larger selected interventions targeting depression after the first year of life have found that improvement in maternal depression symptoms mediated the effect of family based treatment on toddler externalizing and internalizing symptoms, however this was not specific to PPD. 127 …”