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

项目摘要 拟议的R21项目将进行两项研究，旨在提高 母亲和婴儿1对1课程（MB）中的家访（HV）计划。MB是一个手动12会话 以认知行为疗法和依恋理论为指导的干预。每节持续15-20分钟 并作为定期家访的一部分进行。以前的MB试验表明，干预是 对于在假设的干预机制中表现出较小变化的女性， 全力完成个人项目。为了解决这一限制，研究1将确定可行性 和进行MB-TXT的可接受性，其中HV客户端接收MB，并辅以一系列每周 短信侧重于技能强化、个人项目提醒和抑郁症患者的自我监测。 症状我们还将计算可用于计算样本量的初步效应量 这是未来一项全面的RCT所必需的，该RCT检查了MB-TXT的疗效。我们将进行一项随机对照试验， 我们随机选择了3个HV程序来实现MB，3个程序来实现MB-TXT。我们将招募 108名研究参与者（54 MB，54 MB-TXT）有轻度至中度重度抑郁症状和行为 基线、6个月和9个月评估，以评估抑郁症状和假设干预 机制等可行性和可接受性数据将从客户和家访者那里收集，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。产后抑郁症的预防 包括MB在内的干预措施忽视了对孕妇伴侣的干预， 认识到父亲的抑郁会影响儿童的社会情感发展。解决 研究2将开发一种MB-DAD干预方案，向男性提供短信， HV客户的合作伙伴。研究1 RCT受试者、其男性伴侣和HV工作人员的焦点小组将 用于开发MB-DAD课程和协议。MB-DAD短信旨在改善精神 健康的男性伴侣，并帮助他支持他的伴侣的心理健康。我们会研究可行性， 实施MB-DAD方案的可接受性，并评估两个HV的父方和二元结局 程序.我们将招募24对母亲-父亲配对进行一项不受控制的试验，其中母亲接受MB-TXT 而父亲则接受MB-DAD。第1阶段中使用的可行性、可接受性和结局指标将 并辅以对父亲心理健康和伴侣关系的评估。参与者评估 将在基线和6个月时进行。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程序中， 为HV客户及其伴侣的健康结果，我们将准备在HV中复制这种干预措施 在HV通过《平价医疗法案》资助迅速扩散的时候，全国范围内的计划。

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.