JMIR Publications

ABSTRACT

Background:

The perinatal period spans from conception until one year after the birth of a child. Anxiety is highly prevalent during this period, and access to treatment can be difficult due to a range of barriers (e.g., time, distance, childcare, service availability). Online treatments have the potential to circumvent these barriers and may, therefore, be beneficial for this population.

Objective:

The present study leveraged qualitative methods to understand participants’ perspectives on their use of a six-module online self-directed Cognitive Behavioral Therapy (CBT) program for perinatal anxiety as part of a randomized controlled trial.

Methods:

A convergent parallel mixed method design was used for this study. A total of 95 perinatal women were randomized to an intervention or waitlist control condition for an online self-directed program (Overcoming Perinatal Anxiety; OPA). Participants provided open-ended feedback on the content of each of the six program modules via online surveys. Following completion of the intervention, a subset of individuals (n = 20) assigned to the intervention condition completed a virtual qualitative interview about their experiences using the program. Data obtained from open-ended survey questions and qualitative interviews were analyzed using Reflexive Thematic Analysis (interviews) and Conventional Content Analysis (open-ended survey).

Results:

: Open-ended survey data were categorized into three themes, with associated sub-themes: User experience (subthemes: Accessibility and Modality), Perceptions of content (sub-themes: Validating, Informative, Hopeful, Anxiety-inducing, Emotionally “heavy”, and Helpful), and Barriers to program engagement (subthemes: Lack of time and energy, Technical difficulties, Challenging and external factors). Qualitative interview data were analyzed separately and categorized into the following main themes, with associated subthemes: Tensions in engaging with the self-directed program (subthemes: connecting and multi-tasking, finding the time, module length and pacing, pen to paper, and thanks for the reminder but don’t rush me), “I’m not alone,” (subthemes: relating to the content, sharing anxiety with “inner circle,” and voicing a desire to connect with other “moms feeling the same way”), and “I’m managing my anxiety” (subthemes: “understanding my anxiety,” “strategies to help with my anxiety,” “taking time for myself,” and moving forward). Across both data sets, participants spoke about the benefits of the program (e.g., validating, informative, and flexible), but also mentioned limitations, such as troubles with the PDFs and external life circumstances that affected engagement with the program.

Conclusions:

Findings from the two open-ended data sets support online self-directed treatment options as an acceptable and feasible format for perinatal anxiety treatment. Findings show promise for the scalability of OPA in order to improve access to psychological treatment for people experiencing anxiety during pregnancy and postpartum. Clinical Trial Identifier: NCT04844138 (clinicaltrials.gov)