eHealth Intervention for Postpartum Depression in Healthcare Settings

 描述（由申请人提供）：大约15 - 20%的妇女经历产后抑郁症（PPD），这会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，PPD的有效治疗方法已经开发和验证。然而，有许多障碍使患有PPD的妇女难以获得基于诊所的心理健康治疗，而且参与率很低。不到50%的PPD患者因心理障碍而寻求帮助（耻辱感、失败感和尴尬感）;知识障碍（不了解PPD对婴儿健康的影响，不确定在哪里获得治疗）;基础设施障碍（害怕儿科医生的负面判断，母乳喂养时避免服用处方药）;农村环境中的物理障碍（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，害怕责任，缺乏治疗选择， 报销）。因此，至关重要的是要发展创新的服务提供系统，克服高质量医疗保健的障碍，减少健康差距。为了满足这一需求，我们开发并测试了MomMoodBooster计划（MMB），这是一种基于网络的创新计划，用于治疗PPD，该计划改编自基于证据的抑郁症认知行为疗法。MMB计划通过每周六次的会议指导参与者。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计划包括每天跟踪和绘制情绪和愉快活动的图表，以及在线访问图书馆，涵盖了新妈妈关心的一系列问题。为了加强支持责任，母亲们还收到一系列多达六个的私人教练电话，每次约20分钟。在第一阶段，我们将提高MMB的基础设施和管理网站的灵活性，以及其个人教练功能，以便将以研究为重点的MMB计划转化为适合医疗保健组织工作流程和人员配备的商业产品。我们将使用一个迭代的形成性开发过程，该过程由利益相关者的输入和OB/GYN和家庭医生实践中的护理提供者的可用性测试提供信息。在第二阶段，我们将增加移动的技术，以增强该计划的"推送"方面，并开发一个改进的管理界面，使医疗保健组织的用户能够定制该计划的功能，以满足他们不同的现实世界场景的需求。我们还将探索MMB可以连接到突出的电子医疗记录系统，可以鼓励其更大的日常使用的可能性。最后，我们将使用一个2臂实用的随机对照试验，以评估在何种程度上可以克服的范围，有效性，采用，实施和维护的综合网络/移动的MMB计划在医疗保健设置的PPD妇女的医疗保健障碍。

 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.