JMIR Publications

ABSTRACT

Background:

Pregnancy and the postnatal period can be a time of increased psychological distress which can be detrimental to both the mother and the developing child. Digital interventions are cost-effective and accessible tools to support positive mental health for women in the perinatal period. While studies report efficacy, a key concern regarding online interventions is lack of engagement leading to dropout, lack of participation, or reduced potential intervention benefits.

Objective:

The aim of this systematic review was to understand reporting and levels of engagement in studies of digital psychological mental health or wellbeing interventions administered in the perinatal period. Specifically, we aimed to: (1) understand how studies report engagement across the four domains of engagement specified in the CAPE (Connect, Attend, Participate, Enact) model; (2) make recommendations on best practice ways to report engagement in Digital Mental Health Interventions (DMHIs); and (3) understand levels of engagement in intervention studies in this area. In order to maximise the utility of this systematic review we intended to develop practical tools for public health use: we aimed to develop a logic model to reference theory of change; to evaluate the studies using the CAPE framework; and, to develop a guide for future data collection to enable consistent reporting in digital interventions.

Methods:

The methods used in this systematic review combine standard rigorous and transparent review methods using the Cochrane Synthesis Without Meta-analysis (SWiM) reporting guideline]. We aimed to identify studies reporting digital mental health and wellbeing programs delivered in the perinatal period.

Results:

Searches generated a database of 3,473 potentially eligible studies, with a final selection of 16 studies, grouped by study design. Participant engagement was evaluated using the CAPE framework and we described comparable variables. All studies reported at least one metric of engagement. However, measures used were inconsistent, which may have contributed to the wide-ranging results. There was insufficient reporting for enactment, that is participants’ real-world use of intervention skills, with only six studies clearly recording longer-term practice through post-intervention interviews. Of the total 16 studies, 12 (75%) provided a CONSORT participant flow diagram but the reporting categories and terminology varied. The logic model proposes ways to conceptualise and report engagement details in digital mental health interventions more consistently in future.

Conclusions:

The perinatal period is an optimal time to intervene with strengths-based digital tools to build positive mental health. Despite the growing number of studies on digital interventions, few robustly explore engagement, and there is limited evidence of long-term skills usage beyond the intervention period. Our results indicate the variability in reporting of both short- and long-term participant engagement behaviours, and we recommend the adoption of standardised reporting metrics in future digital interventions. Clinical Trial: PROSPERO Registration: CRD42020162283