JMIR Publications

ABSTRACT

Background:

Digital interventions are increasingly becoming of interest, being structured, readily available and self-administrable, and perinatal women have expressed a desire for their availability. In this regard, behavioral activation (BA) interventions may be particularly appropriate for digital administration.

Objective:

The current study aims to exploratorily investigate and compare the feasibility of the Internet-based self-help Guided vs. Unguided version of the Brief Behavioral Treatment for Depression-Revised (BATD-R), an empirically supported in-person BA protocol, targeting pregnant women with sub-clinical depression symptoms. A user-centered design is employed, whereby data are collected with the intent of further evaluating how to adjust the intervention in line with pregnant women’s needs. Usability and user engagement were evaluated.

Methods:

Participating in the study were N = 11 Italian pregnant women with sub-clinical depressive symptoms based on the Patient Health Questionnaire-9 (scoring < 15); of these, N = 6 women were randomly assigned to the Guided group (Mage = 32.17; SD = 4.36) and N = 5 to the Unguided Group (Mage = 31; SD = 4.95). The Moodle platform was used to administer the BA interventions in an e-learning format; the intervention was structured as six core modules plus three optional modules, the latter aimed at revising the core modules content. Only in the Guided Group each woman also talked, once a week and through the Moodle chat, with their assigned human guide to support them in the homework revisions part of the intervention. Text, pictures, and videos were used to present the intervention’s content. Semi-structured interviews were conducted, and descriptive statistics were assessed.

Results:

Taken together, data suggest that the Guided intervention was better accepted than the Unguided one. However, the high rate of drop-out (50% Guided; 75% Unguided) indicates that the intervention overall, as a replica of the BATD-R, is not feasible to be administered digitally in an e-learning format. The reduced usability of the platform used was reported and homework was perceived as too time and effort requiring. Moreover, the six core modules were deemed sufficient for the intervention’s goals, thus suggesting eliminating the three optional ones. Nonetheless, women from both intervention groups expressed satisfaction with the intervention’s content and felt that it was relevant to their personal experience with pregnancy.

Conclusions:

Overall, findings have emphasized both the intervention’s merits and shortcomings. Pregnant women have though expressed a desire to receive psychological support and commented on the possibilities of digital psychosocial supports, particularly those that are App-based. The information here collected is important to guide the development and co-design of a more refined platform for the intervention deployment and to tailor the intervention’s content to pregnant women’s needs.