JMIR Publications

ABSTRACT

Background:

New mothers and fathers face increased risks of emotional distress and relationship dissatisfaction. Digital interventions may increase access to support, but few preventive programs are optimised to support both parents.

Objective:

To conduct the first randomised controlled trial on a universal self-guided digital program to support positive perinatal adjustment of both fathers and mothers. Effects of childcare information modules only (Babycare) and the full interactive program (Baby Steps Wellbeing) were compared from Baseline in the third trimester to 3 and 6 months later (approximately 1 and 4 months postpartum).

Methods:

Participants were co-parenting, male-female adult couples expecting their first single child (26-38 weeks’ gestation, 87% from hospital antenatal classes). Randomisation to condition was stratified by Edinburgh Postnatal Depression Scale scores (EPDS; either mother > 7 or father > 5, giving 50% of couples scoring ‘higher’). Primary outcomes were self-reported EPDS and quality of life; secondary outcomes were relationship satisfaction, social support, and self-efficacy for parenting and support provision. Program use and satisfaction were also assessed. Intention-to-treat analyses used linear mixed models.

Results:

Of 388 couples who registered, 248 (64%) met criteria and were randomised. Most were married (81%), tertiary educated (65%), in full-time employment (82%) and born in Australia (68%). Participants’ mean age was 32 years and average gestation was 32 weeks. Using an EPDS cut-off of 12/13, only 4% of men and 6% of women screened positive for probable depression at Baseline (7% and 16% at some time during the 6 months). Retention of both partners to 6-month-assessments was 81%, and program satisfaction was excellent (92% > 50, M = 73/100), regardless of condition. Regardless of condition, only 37-38% of participants accessed their program more than once, with higher rates for mothers (54%) than fathers (21%, P < .001). Changes over Time were seen for EPDS (P = .002, d = .093) and quality of life (P < .001, d = 271). These effects were moderated by sex (P <= .001): fathers appeared to improve linearly; mothers had reduced 3-month-scores that improved by 6 months. Neither outcome showed a Condition x Time interaction (P = .430, .640 respectively). Among secondary outcomes, only self-efficacy for support provision showed greater improvements in Baby Steps Wellbeing (d = .337) than Babycare (d = .093; P = .01)—an effect that was greater for mothers (P = .027). Supplementary analyses examining effects of above/below median Baseline EPDS and of at least one program login did not substantially change results.

Conclusions:

Despite high levels of satisfaction and retention to assessment, program engagement was limited, and only one outcome showed evidence of enhanced effects from the interactive Wellbeing program. Increased engagement in program use and action plans is needed, especially for men. Clinical Trial: Australian & New Zealand Clinical Trials Registry NZCTR12614001256662