JMIR Publications

ABSTRACT

Background:

Adolescents and young adults age <25 (youth) are at higher risk of perinatal depression than older women and experience elevated barriers to in-person care. Digital platforms such as social media offer an accessible avenue to deliver group cognitive behavioral therapy (CBT) to perinatal youth.

Objective:

Our goal was to develop the IMAGINE intervention, a facilitated social media group CBT intervention to prevent perinatal depression in US youth, by adapting the Mothers and Babies (MB) course, an evidence-based in-person group CBT intervention. In order to inform this adaptation, we sought perspectives of youth and healthcare provider stakeholders on perinatal youth’s mental health needs and social media group design recommendations. We report findings from stakeholder interviews and document the IMAGINE adaptation process.

Methods:

We conducted 21 semi-structured in-depth individual interviews with 10 pregnant or postpartum youth age 14-24 and 6 healthcare workers. All interviews were recorded, transcribed, and analyzed using deductive and inductive approaches to characterize perceptions of challenges and facilitators to youth perinatal mental health. Using a human-centered design approach, stakeholder perspectives were incorporated into IMAGINE design. We classified MB adaptations to develop IMAGINE according to the Framework for Modification and Adaptation, reporting the nature, timing, reason and goal of the adaptations.

Results:

Youth and healthcare workers described stigma associated with young pregnancy and parenting, social isolation, and lack of material resources as significant challenges to youth mental wellness. They identified non-judgmental support, peer companionship, and access to step-by-step guidance as facilitators of youth mental wellness. They endorsed the utility of a social media group to prevent perinatal depression and recommended that IMAGINE facilitate peer support, deliver content asynchronously to accommodate varied schedules, use a confidential platform, and facilitate discussion of topics beyond the MB curriculum, such as navigating support resources or asking medical questions. IMAGINE was adapted from MB to accommodate stakeholder recommendations and facilitate transition to online delivery. Content was tailored to be multimodal (text, images and video) and language was shortened and simplified. All content was designed for asynchronous engagement and redundancy was added to accommodate intermittent access. Structure was loosened to allow the intervention facilitator to respond in real-time to youth topics of interest. A social media platform was selected that allows multiple conversation “channels” and conceals group member identity. All adaptations sought to preserve fidelity to MB core components.

Conclusions:

Our findings highlight the impact of stigmatization of young pregnancy and social determinants of health on youth perinatal mental health. Stakeholders supported use of a social media group to create a supportive community and improve access to evidence-based depression prevention. Our study demonstrates how a validated intervention can be tailored to this unique group.