JMIR Publications

ABSTRACT

Background:

Postpartum depression (PPD) is a major public health concern. Despite advancements in treatment, many barriers to accessing care remain. There has been growing interest in digital interventions to prevent and treat PPD. However, for mothers with mild and moderate symptoms of depression, there is a lack of self-guided internet-based interventions developed with user input and with considerations on how to integrate the intervention into stepped care models for postpartum depression.

Objective:

The aim of this study was (I) to describe the process of the design and development of iCARE: A self-guided digital psychological intervention for mothers with mild and moderate symptoms of PPD, (II) present the program’s theory illustrated by a Logic Model, and (III) explore its initial usability and prospective acceptability.

Methods:

Applying user-centered design methods, the intervention development was informed by five supplementary strategies: (1) a systematic review of minimally guided, internet-based interventions for postpartum depression; (2) an existing internet-based cognitive behavioral therapy intervention for depression; (3) findings from two cycles of interviews with 9 mothers with lived experience of PPD, (4) twenty focus group interviews with maternal health care providers (MHCP) who screen mothers for PPD, and (5) discussions with a group of experts in mental health, PPD, and public health interventions.

Results:

Initial interviews with mothers and MHCP emphasized the importance of a digital intervention offering timely psychoeducation, coping strategies, and pathways to in-person care, while addressing the diversity of expressions of PPD symptoms. Stakeholders recommended a flexible program, multimodal content, and integration into maternal care systems with community health nurses supporting engagement and participation. The prototype was designed to be user-centered, engaging and with multiple interactive features. It included components on psychoeducation, cognitive exercises grounded in cognitive behavioral, acceptance, and commitment principles, and mood-monitoring. Prototype testing resulted in five themes that lead to a refinement of content: motivation and engagement, de-stigmatization and diversity of symptoms, gender and family representation, understanding of therapeutic model, and clarity of instructions.

Conclusions:

iCARE is a self-guided internet-based psychological intervention for mothers with mild and moderate symptoms of PPD. It was developed with user input using qualitative methods, user-centered design, and psychological theory. Further research is needed to evaluate the feasibility and effectiveness of the program in a randomized controlled trial and its integration into maternal healthcare models such as universal PPD screening and home visiting.