Telethon Kids Institute, Nedlands, Australia.
Medical School (Paediatrics), University of Western Australia, Crawley, Australia.
J Med Internet Res. 2023 Oct 17;25:e46852. doi: 10.2196/46852.
Psychological distress in the early postpartum period can have long-lasting deleterious effects on a mother's well-being and negatively affect 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 well-being and can be delivered effectively as digital mental health interventions (DMHIs).
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 randomized controlled trial comparing mindfulness, loving-kindness and compassion, and progressive muscle relaxation training delivered in a digital format and undertaken during pregnancy. To assess the different stages of engagement during and after the intervention, we adapted the connect, attend, participate, enact (CAPE) framework that is based on the idea that individuals go through different stages of engagement before they are able to enact change.
The MMM study was nested within a longitudinal birth cohort, The ORIGINS Project. We aimed to recruit 25 participants per randomization arm. Data were collected sequentially during the intervention through regular web-based surveys over 8 weeks, with opportunities to provide regular feedback. In the postintervention phase, qualitative data were collected through purposive sampling.
Of 310 eligible women, 84 (27.1% [connect rate]) enrolled to participate in MMM. Of the remaining 226 women who did not proceed to randomization, 223 (98.7%) failed to complete the baseline surveys and timed out of eligibility (after 30 weeks' gestation), and 3 (1.3%) displayed high psychological distress scores. Across all program groups, 17 (20% [attend rate]) of the 84 participants actively opted out, although more may have disengaged from the intervention but did not withdraw. The main reasons for withdrawal were busy life and other priorities. In this study, we assessed active engagement and ongoing skills use (participate and enact) through postintervention interviews. We undertook 15 participant interviews, conducted 1 month to 3 months after the intervention. Our results provide insights into participant barriers and enablers as well as app changes, such as the ability to choose topics, daily reminders, case studies, and diversity in sounds. Implementing a DMHI that is brief, includes frequent prompts or nudges, and is easily accessible is a key strategy to target perinatal women.
Our research will enable future app designs that are sufficiently nuanced to maximize the 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 prenatal self-care. Our research underscores the appeal and feasibility of digital intervention approaches based in contemplative practices for perinatal women.
Australian New Zealand Clinical Trials Registry (ANZCTR) 12620000672954p; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12620000672954p.
INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.2196/19803.
产后早期的心理困扰会对母亲的健康产生持久的不良影响，并对婴儿的发育产生负面影响。基于正念和慈悲与关爱等冥想实践的干预方法旨在减轻痛苦，培养幸福感，并可以有效地作为数字心理健康干预（DMHI）来实施。
为了了解参与围产期女性数字干预的可行性，本研究旨在记录 Mums Minds Matter（MMM）研究中参与者的体验，这是一项试点随机对照试验，比较了正念、慈悲与关爱以及渐进性肌肉松弛训练，以数字格式提供，并在怀孕期间进行。为了评估干预期间和之后不同阶段的参与度，我们改编了连接、关注、参与、实施（CAPE）框架，该框架基于这样的想法，即个人在能够实施改变之前，要经历不同的参与阶段。
MMM 研究嵌套在一个纵向出生队列中，即 ORIGINS 项目。我们的目标是在每个随机分组中招募 25 名参与者。在 8 周的时间里，通过定期的网络调查收集干预期间的数据，并有机会提供定期反馈。在干预后阶段，通过有针对性的抽样收集定性数据。
在 310 名符合条件的女性中，有 84 名（27.1%[连接率]）报名参加了 MMM。在其余 226 名未进行随机分组的女性中，有 223 名（98.7%）未能完成基线调查并因超时（30 周妊娠后）而失去资格，有 3 名（1.3%）显示出高心理困扰评分。在所有项目组中，有 17 名（20%[关注率]）84 名参与者主动退出，尽管可能有更多的人已经退出干预，但没有退出。退出的主要原因是生活繁忙和其他优先事项。在这项研究中，我们通过干预后访谈评估了积极参与和持续技能使用（参与和实施）。我们进行了 15 名参与者的访谈，在干预后 1 个月至 3 个月进行。我们的研究结果提供了参与者障碍和促成因素以及应用程序变化的见解，例如选择主题、每日提醒、案例研究和声音多样性的能力。实施简短、频繁提示或提示、易于访问的 DMHI 是针对围产期女性的关键策略。
我们的研究将使未来的应用程序设计更加精细，从而最大限度地提高心理健康技能和冥想实践在围产期的应用率、参与度和应用率。为有吸引力和有效的预防计划提供方便的获取途径至关重要，应该成为产前自我保健的一部分。我们的研究强调了基于冥想实践的数字干预方法对围产期女性的吸引力和可行性。
澳大利亚新西兰临床试验注册（ANZCTR）12620000672954p; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12620000672954p。
国际注册报告标识符（IRRID）：RR2-10.2196/19803。
