eHealth Intervention for Postpartum Depression in Healthcare Settings

医疗机构中产后抑郁症的电子健康干预

• 批准号: 9046911
• 负责人: Brian G. Danaher
• 金额: $ 22.43万
• 依托单位: OREGON RES BEHAVIORAL INTERVENTION STRAT
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-02-15 至 2017-08-14
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9046911
• 关键词: Accountability; Address; Administrator; Adopted; Adoption; Adult; Architecture; Back; Breast Feeding; Businesses; Caring; Case Manager; Chronic; Clinic; Clinical; Clinical Trials; Cognitive Therapy; Communication; Computerized Medical Record; Databases; Development; Effectiveness; Exercise; Failure; Family; Family Physicians; Feedback; Feeling; Female of child bearing age; Fright; Funding; Gatekeeping; Goals; Health; Healthcare; Healthcare Systems; Healthy People 2020; High Prevalence; Impairment; Infant; Infant Development; Infant Health; Internet; Intervention; Investigation; Judgment; Knowledge; Libraries; Link; Logic; Maintenance; Medical; Mental Depression; Mental Health; Mental disorders; Methods; Monitor; Moods; Mothers; National Institute of Mental Health; Online Systems; Participant; Patients; Performance; Pharmaceutical Preparations; Phase; Postpartum Depression; Process; Program Evaluation; Provider; Public Health; Randomized Controlled Trials; Recurrence; Reporting; Research; Research Infrastructure; Resources; Role; Rural; Safety; Series; Services; Shapes; Structure; System; Testing; Text; Time; Translating; Transportation; Treatment Efficacy; Woman; Work; animation; arm; base; database structure; depressive symptoms; design; eHealth; effective therapy; evidence base; experience; flexibility; health care quality; health care service organization; health disparity; help-seeking behavior; high risk; improved; innovation; meetings; member; mobile computing; pediatrician; programs; prospective; psychologic; public health relevance; service utilization; skills; social stigma; usability; web page; web portal; web site

 DESCRIPTION (provided by applicant): Approximately 15-20% of women experience postpartum depression (PPD), which results in significant suffering for new mothers and their families, and has an adverse impact on infant development. Fortunately, effective treatments for PPD have been developed and validated. However, there are many barriers that make it difficult for women with PPD to access clinic-based mental health treatments and participation is low. Less than 50% of women with PPD seek help because of psychological barriers (stigma, feelings of failure and embarrassment); knowledge barriers (poor understanding about impact of PPD on infant health, unsure about where to get treatment); infrastructure barriers (fear of negative judgment from pediatrician, avoidance of prescription medications while breastfeeding); physical barriers in rural settings (too few providers of care, unacceptable logistical demands on time, transportation, and childcare); and provider-level barriers (inadequate skills for treating PPD, fear of liability, dearth of treatment options, and inadequate reimbursement). Thus, it is of critical importance to develop innovative service delivery systems that overcome barriers to quality healthcare and reduce health disparities. To address this need, we developed and tested the MomMoodBooster program (MMB), an innovative Web-based program for treating PPD adapted from an evidence-based cognitive-behavioral therapy for depression. The MMB program guides participants through six weekly sessions. Webpages in each session use text, interactions, animations, and video to present program content. The MMB program includes daily tracking and charting of mood and pleasant activities as well as online access to a library, covering a range of issues of concern to new mothers. To enhance supportive accountability, mothers also receive a series of up to six personal coach calls lasting approximately 20 minutes each. In Phase I, we will improve the flexibility of MMB's underlying infrastructure and its administrative website as well as its personal coach features in order to translate the research-focused MMB program into a commercial-ready product that fits the workflow and staffing of healthcare organizations. We will use an iterative formative development process informed by stakeholder input and usability testing by care providers in OB/GYN and family-physician practices. In Phase II, we will add mobile technology to enhance the "push" aspects of the program and develop an improved administrative interface to enable users in medical care organizations to customize features of the program to meet the needs of their different real-world scenarios. We will also explore the possibility that MMB can be linked to prominent electronic medical record systems that could encourage its greater routine use. Finally, we will use a 2-arm pragmatic randomized controlled trial to evaluate the extent to which healthcare barriers for women with PPD can be overcome by the reach, effectiveness, adoption, implementation, and maintenance of the integrated Web/Mobile MMB program in medical care settings.

 描述（由申请人提供）：大约 15-20% 的女性患有产后抑郁症 (PPD)，这给新妈妈及其家人带来巨大痛苦，并对婴儿发育产生不利影响。幸运的是，针对产后抑郁症的有效治疗方法已经被开发出来并得到验证。然而，存在许多障碍，使得患有产后抑郁症的女性很难获得基于诊所的心理健康治疗，而且参与率很低。不到 50% 的产后抑郁症女性因心理障碍（耻辱、失败感和尴尬）而寻求帮助；知识障碍（对产后抑郁症对婴儿健康的影响了解甚少，不确定去哪里接受治疗）；基础设施障碍（担心儿科医生的负面判断、母乳喂养时避免服用处方药）；农村地区的物理障碍（护理提供者太少，对时间、交通和儿童保育的后勤要求不可接受）；以及提供者层面的障碍（治疗 PPD 的技能不足、害怕承担责任、缺乏治疗选择以及不充分的治疗选择） 报销）。因此，开发创新的服务提供系统来克服优质医疗保健的障碍并减少健康差距至关重要。为了满足这一需求，我们开发并测试了 MomMoodBooster 程序 (MMB)，这是一个基于网络的创新程序，用于治疗 PPD，改编自基于证据的抑郁症认知行为疗法。 MMB 计划指导参与者完成每周六次的课程。每个会话中的网页使用文本、交互、动画和视频来呈现节目内容。 MMB 计划包括每日跟踪和绘制情绪和愉快活动的图表以及在线访问图书馆，涵盖了新妈妈们关心的一系列问题。为了加强支持责任，母亲们还会接到最多六次私人教练电话，每次电话持续约 20 分钟。在第一阶段，我们将提高 MMB 底层基础设施及其管理网站以及个人教练功能的灵活性，以便将以研究为中心的 MMB 计划转化为适合医疗机构工作流程和人员配置的商业就绪产品。我们将使用迭代形成性开发流程，该流程根据利益相关者的意见以及妇产科和家庭医生实践中的护理提供者进行的可用性测试提供信息。在第二阶段，我们将添加移动技术来增强程序的“推送”方面，并开发改进的管理界面，使医疗机构的用户能够定制程序的功能，以满足不同现实场景的需求。我们还将探讨 MMB 与著名电子医疗记录系统连接的可能性，以鼓励其更广泛的日常使用。最后，我们将使用 2 组实用随机对照试验来评估通过医疗保健环境中集成的网络/移动 MMB 计划的覆盖范围、有效性、采用、实施和维护可以在多大程度上克服产后抑郁症女性的医疗保健障碍。