Integrating Text Messages into the Mothers and Babies Course to Address Depression in Low-Income Women and their Partners

项目总结 拟议的R21项目将进行两项研究，旨在提高 在家访(HV)计划中，母亲和婴儿1对1课程(MB)。MB是12个会话的手册 以认知行为疗法和依恋理论为指导的干预。每节课持续15-20分钟 并作为定期家访的一部分交付。之前的甲基溴试验表明，干预是 对于在假设干预机制中表现出较小变化和较少干预的女性来说，成功率较低 全力以赴完成个人项目。为了解决这一限制，研究1将确定可行性 以及进行MB-TXT的可接受性，在MB-TXT中，HV客户接受MB，并每周补充一系列 专注于技能强化、个人项目提醒和抑郁自我监测的短信 症状。我们还将计算可用于计算样本量的初步效应大小 这是未来检验MB-TXT疗效的全功率随机对照试验所必需的。我们将在以下时间进行集群RCT 其中，我们随机选择3个HV方案来实现MB，以及3个方案来实现MB-TXT。我们将招募 108名研究参与者(54 MB，54 MB-TXT)有轻度到中度抑郁症状和行为 评估抑郁症状和假设性干预的基线、6个月和9个月评估 机械装置。将从客户和家庭访客那里收集可行性和可接受性数据，以评估 收到短信的百分比，家庭访客坚持以指定的时间间隔发送短信，以及 客户对短信实用性和清晰度的看法。既往产后抑郁症预防性治疗 干预措施--包括甲基溴--忽视了对孕妇伴侣的干预，尽管 认识到父亲的抑郁会对孩子的社会情绪发展产生影响。致信地址 在这一限制下，研究2将开发一种向男性提供短信的MB-DAD干预方案 高压客户的合作伙伴。由研究1 RCT参与者、他们的男性伴侣和HV工作人员组成的焦点小组将 用于开发MB-DAD课程和协议。MB-DAD短信旨在改善精神状态 男性伴侣的健康，并帮助他支持其伴侣的心理健康。我们会研究有关计划的可行性和 实施MB-DAD方案和评估两种HV的父系和二元结局的可接受性 程序。我们将招募24名母亲-父亲二元组用于非受控飞行员，其中母亲接受MB-TXT 父亲们会收到MB-DYPE。第一阶段使用的可行性、可接受性和结果衡量标准将是 辅以对父亲的精神健康和伴侣关系的评估。参与者评估 将在基线和6个月内进行。该项目的公共卫生意义和创新之处在于 相当可观。如果我们能够将MB-TXT和MB-DAD整合到HV计划中并产生改善的智力 对于HV客户及其合作伙伴的健康结果，我们将准备在HV范围内复制这种干预措施 在HV通过《平价医疗法案》资助迅速激增的时候，我们在全国范围内开展了这些计划。

PROJECT SUMMARY The proposed R21 project will conduct two studies aimed at enhancing the effectiveness and scalability of the Mothers and Babies 1-on-1 Course (MB) among home visiting (HV) programs. MB is a manualized 12-session intervention guided by cognitive-behavioral therapy and attachment theory. Each session lasts 15-20 minutes and is delivered as part of a regularly scheduled home visit. Previous MB trials suggest that the intervention is less successful for women who exhibit smaller changes in hypothesized intervention mechanisms and less fully engage in completion of personal projects. To address this limitation, Study 1 will determine the feasibility and acceptability of conducting MB-TXT, in which HV clients receive MB supplemented by a series of weekly text messages focused on skill reinforcement, personal project reminders, and self-monitoring of depressive symptoms. We will also calculate a preliminary effect size that could be used to calculate sample size necessary for a future fully powered RCT that examines MB-TXT efficacy. We will conduct a cluster RCT in which we randomize 3 HV programs to implement MB and 3 programs to implement MB-TXT. We will recruit 108 study participants (54 MB, 54 MB-TXT) with mild to moderately severe depressive symptoms and conduct baseline, 6-month, and 9-month assessments to assess depressive symptoms and hypothesized intervention mechanisms. Feasibility and acceptability data will be collected from clients and home visitors to assess percentages of received text messages, home visitor adherence to sending texts at specified intervals, and clients' perceptions of text message utility and clarity. Previous postpartum depression preventive interventions—including MB—have neglected to intervene with partners of pregnant women despite growing recognition that paternal depression exerts influence on children's social-emotional development. To address this limitation, Study 2 will develop a MB-DAD intervention protocol that provides text messages to male partners of HV clients. Focus groups with Study 1 RCT participants, their male partners, and HV staff will be used to develop the MB-DAD curriculum and protocol. MB-DAD text messages aim to improve the mental health of the male partner and help him support his partner's mental health. We will examine the feasibility and acceptability of implementing the MB-DAD protocol and assess paternal and dyadic outcomes across two HV programs. We will recruit 24 mother-father dyads for an uncontrolled pilot in which mothers receive MB-TXT and fathers receive MB-DAD. Feasibility, acceptability, and outcome measures used in Phase 1 will be supplemented with assessments of fathers' mental health and partners' relationships. Participant assessments will be conducted at baseline and 6 months. The public health significance and innovation of this project is substantial. If we are able to integrate MB-TXT and MB-DAD into HV programs and generate improved mental health outcomes for HV clients and their partners, we will be prepared to replicate this intervention across HV programs nationally at a time when HV is rapidly proliferating through Affordable Care Act funding.