Ashford Miriam T, Olander Ellinor K, Rowe Heather, Fisher Jane Rw, Ayers Susan
Centre for Maternal and Child Health Research, School of Health Sciences, City, University of London, London, United Kingdom.
Jean Hailes Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
JMIR Ment Health. 2018 Apr 20;5(2):e19. doi: 10.2196/mental.9106.
Postpartum anxiety can have adverse effects on the mother and child if left untreated. Time constraints and stigma are common barriers to postpartum treatment. Web-based treatments offer potential flexibility and anonymity. What Am I Worried About (WaWa) is a self-guided treatment based on cognitive-behavioral and mindfulness principles for women experiencing postpartum anxiety. WaWa was developed in Australia and consists of 9 modules with optional weekly telephone support. WaWa was adapted to a Web-based version for use in England (Internet-based What Am I Worried About, iWaWa).
This study aimed to investigate the feasibility (engagement and usability) and acceptability (usefulness, satisfaction, and helpfulness) of iWaWa among English postpartum women with anxiety.
Postpartum (<12 months) women with mild-to-severe anxiety were recruited anonymously via social media during an 8-week period. Participants were randomized to the iWaWa treatment (8 weeks) or wait-list control group. Treatment and study feasibility and acceptability were assessed after the treatment, and anxiety symptoms were assessed at baseline, 8 weeks postrandomization, and 12 weeks postrandomization (treatment group only) using Web-based questionnaires. Semistructured telephone interviews were carried out after the treatment period for a more in-depth exploration of treatment acceptability and feasibility.
A total of 89 eligible women were recruited through social media and randomized into the treatment (n=46) or wait-list control group (n=43). Women were predominantly Caucasian, well-educated, married, on maternity leave, first-time mothers and reported moderate levels of anxiety. Dropout rates were high, especially in the treatment group (treatment: 82%, 38/46; wait-list control: 51%, 22/43). A total of 26 women started iWaWa with only 2 women completing all 9 modules. Quantitative and qualitative data suggest iWaWa was experienced as generally useful and helpful. Participants enjoyed iWaWa's accessibility, anonymity, and weekly reminders, as well as the introduction to the principles of cognitive-behavioral therapy (CBT) and mindfulness. However, iWaWa was also experienced as not user-friendly enough, too long, and not smartphone-friendly. Parts of the content were experienced as not always relevant and appropriate. Participants felt that iWaWa could be improved by having it in a smartphone app format and by making the content more concise and inclusive of different parenting styles.
Despite interest in iWaWa, the results suggest that both the study and iWaWa were not feasible in the current format. However, this first trial provides useful evidence about treatment format and content preferences that can inform iWaWa's future development, as well as research and development of Web-based postpartum anxiety treatments, in general, to optimize adherence.
ClinicalTrials.gov NCT02434406; https://clinicaltrials.gov/ct2/show/NCT02434406 (Archived by WebCite at http://www.webcitation.org/6xTq7Bwmd).
产后焦虑若不治疗，会对母婴产生不良影响。时间限制和污名化是产后治疗常见的障碍。基于网络的治疗提供了潜在的灵活性和匿名性。“我担心什么”（WaWa）是一种基于认知行为和正念原则的自我引导式治疗方法，用于治疗产后焦虑的女性。WaWa在澳大利亚开发，由9个模块组成，并提供每周一次的电话支持（可选择）。WaWa被改编为网络版，用于英国（基于互联网的“我担心什么”，即iWaWa）。
本研究旨在调查iWaWa在患有焦虑症的英国产后女性中的可行性（参与度和可用性）和可接受性（有用性、满意度和帮助程度）。
在8周内通过社交媒体匿名招募产后（<12个月）轻度至重度焦虑的女性。参与者被随机分为iWaWa治疗组（8周）或等待列表对照组。治疗结束后评估治疗及研究的可行性和可接受性，并在基线、随机分组后8周和随机分组后12周（仅治疗组）使用基于网络的问卷评估焦虑症状。治疗期结束后进行半结构化电话访谈，以更深入地探讨治疗的可接受性和可行性。
通过社交媒体共招募了89名符合条件的女性，并随机分为治疗组（n = 46）或等待列表对照组（n = 43）。女性主要为白种人，受过良好教育，已婚，休产假，初为人母，且报告焦虑程度为中度。退出率很高，尤其是在治疗组（治疗组：82%，38/46；等待列表对照组：51%，22/43）。共有26名女性开始使用iWaWa，只有2名女性完成了所有9个模块。定量和定性数据表明，iWaWa总体上被认为是有用和有帮助的。参与者喜欢iWaWa的可及性、匿名性和每周提醒，以及对认知行为疗法（CBT）和正念原则的介绍。然而，iWaWa也被认为不够用户友好、时间过长且对智能手机不友好。部分内容被认为并非总是相关和合适。参与者认为，将iWaWa以智能手机应用程序的形式呈现，并使内容更简洁且涵盖不同的育儿方式，可能会有所改进。
尽管对iWaWa感兴趣，但结果表明，以当前形式开展的研究和iWaWa均不可行。然而，这项首次试验提供了关于治疗形式和内容偏好的有用证据，可为iWaWa的未来发展以及一般基于网络的产后焦虑治疗的研发提供参考，以优化依从性。
ClinicalTrials.gov NCT02434406；https://clinicaltrials.gov/ct2/show/NCT02434406（由WebCite存档于http://www.webcitation.org/6xTq7Bwmd）
