JMIR Publications

ABSTRACT

Background:

Psychological distress in the early postpartum period can have long-lasting deleterious effects on maternal wellbeing, and negatively impact her infant’s development. Intervention approaches based in contemplative practices, such as mindfulness and loving-kindness and compassion, are intended to alleviate distress and cultivate wellbeing, and can be delivered effectively as digital mental health interventions (DMHIs).

Objective:

To understand the feasibility of engaging perinatal women in digital interventions, this study aimed to document participants’ experiences in the Mums Minds Matter (MMM) study, a pilot randomised controlled trial comparing mindfulness, loving-kindness and compassion, and progressive muscle relaxation training delivered in a digital format, undertaken during pregnancy. To assess the different stages of engagement during and post-intervention, we adapted the CAPE framework (Connect, Attend, Participate, Enact) that is based on the idea that individuals go through different stages of engagement before they are able to enact change.

Methods:

The MMM study was nested within a longitudinal birth cohort, The ORIGINS Project. We aimed to recruit 25 participants per randomisation arm. Data were collected sequentially: during the intervention through regular web-based surveys over 8 weeks, with opportunities to provide regular feedback. In the post-intervention phase, qualitative data were collected through purposive sampling.

Results:

A total of 111 participants consented to participate in MMM, that is a connect rate of almost 14% from the full birth cohort. Of those who consented, 27 did not commence to randomization due to either failure to complete the baseline surveys or timed out of eligibility. In total, 84 women were randomised to participate in MMM. Across all program groups, n=13 (15%) participants actively opted out (attend rate), although more may have disengaged from the intervention but not withdrawn. The main reasons for withdrawal were busy life and other priorities. In this study, we assessed active engagement and ongoing skills usage (participate and enact) through post-intervention interviews. We undertook a total of 15 participant interviews, ranging from one month to three months post-intervention. Our results provide insights into participant barriers and enablers, and app changes, such as the ability to choose topics, daily reminders, case studies, and diversity in sounds. DMHIs that are brief, include frequent prompts or ‘nudges’, with easy accessibility are key strategies to target perinatal women.

Conclusions:

Our research will enable future app designs that are sufficiently nuanced to maximise uptake, engagement and application of mental health skills and contemplative practices in the perinatal period. Providing convenient access to engaging and effective prevention programs is critical and should be part of antenatal self-care. Our research underscores the appeal and feasibility of digital intervention approaches based in contemplative practice for perinatal women. Clinical Trial: Australian New Zealand Clinical Trials Registry Number 12620000672954p; http://anzctr.org.au/ACTRN12620000672954p.aspx