JMIR Publications

ABSTRACT

Background:

Internet-delivered psychological interventions (IPIs) for postpartum depression have been shown to be effective for a variety of psychological concerns, including postpartum depression. Human supported programs produce better adherence and larger effect sizes than unsupported programs, however, what it is about support that impacts outcomes is not well understood. Therapeutic alliance is one possibility that has been found to contribute to outcomes, yet the specific mechanism is not well understood. Participant perspectives and qualitative methodology are virtually absent from the IPI alliance research and may help provide new directions.

Objective:

Provide participant perspectives on engagement with an IPI for postpartum depression to help inform alliance research, development of new IPIs, and inform resources allocation.

Methods:

Qualitative methodology was used to explore participant perspectives of Veteran women’s engagement with the MomMoodBooster (MMB) program, a human-supported internet-delivered intervention for postpartum depression. Participants were asked four open ended questions with their 3-month post-intervention survey: 1) “In what ways did you find the MomMoodBooster most helpful?”, 2) “How do you think the MomMoodBooster could have been improved?”, 3) “In what ways did you find the personal coach calls to be helpful?”, and 4) “How do you think the personal coach calls could have been improved?”

Results:

Data were collected from 184 participants who provided a response to at least one of the open-ended questions. These were analyzed using thematic analysis and a process of coming to consensus among coders. Results suggest that the engagement with the support person is not only perceived as a significant contributor to participant experiences while using the MMB content but that relationship factors are particularly meaningful. Results provide insight into the specific qualities of the support person that were perceived as most impactful, such as warmth, empathy and genuineness, and feeling normalized and supported. Results also provide insight into specific change processes that can be targeted through the support interactions, such as encouraging self-reflection and self-care, and challenging negative thinking.

Conclusions:

These data emphasize the importance of relationship factors between support persons and an IPI program for postpartum depression. Findings suggest that focusing on specific aspects of the alliance and the therapeutic relationship could be fruitful directions for training of support personnel and for future alliance-based research of internet-delivered treatments.