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‘It’s a bit of a lifeline really.’ User acceptability of RELAX, an online intervention to reduce worry and anxiety in pregnancy.
ABSTRACT
Background:
Anxiety is very common in pregnancy, with more than 1 in 5 pregnant women/birthing people diagnosed with an anxiety disorder. Anxiety in the perinatal period affects the mother/birthing person, their family and can impact the baby’s long-term development.
Objective:
Treatment for anxiety in the perinatal period is typically offered to women with severe symptoms. However, an effective and acceptable anxiety intervention for those at risk of escalating anxiety may reduce future need for specialist mental health support. This nested qualitative study explored the acceptability of RELAX: an online early intervention for pregnant women/birthing people at risk of escalating anxiety due to high levels of worry and rumination (repetitive negative thinking).
Methods:
A subsample of RELAX-arm participants (n=22 of 134) completed semi-structured interviews within two weeks of completing the RELAX intervention. The intervention offered a scenario-based online training of 12 sessions (approximately 17 minutes duration) completed across 4 weeks using a PC, laptop or tablet device. The training encouraged pregnant women and birthing people to form positive interpretations of everyday ambiguous scenarios. Interviews were analyzed using Framework Analysis, guided by the Theoretical Framework of Acceptability (TFA). Two Patient and Public Involvement (PPI) advisers collaborated with researchers in the analytic process.
Results:
Evidence for acceptability of RELAX was found across the seven TFA domains and 21 subthemes were developed. The majority of participants found the intervention simple to complete, effective and therefore acceptable. Participants engaged well with the intervention and were very likely to recommend it to others, valuing the flexibility of it being available online with no healthcare professional involvement. Participants suggested that offering RELAX via smartphones would widen access and that some participants may find it difficult to complete all the sessions within four weeks.
Conclusions:
Participants found RELAX highly acceptable and made suggestions about ways to increase future engagement. These findings complement the positive quantitative results of the trial and provide support for the value of offering RELAX as an intervention to improve perinatal mental health via self-referral or as part of routine antenatal care. Clinical Trial: ISRCTN 12754931 https://www.isrctn.com/ISRCTN12754931
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