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

项目概要 拟议的 R21 项目将进行两项研究，旨在提高 R21 的有效性和可扩展性 家访 (HV) 计划中的母婴一对一课程 (MB)。 MB 是手动 12 会话 以认知行为疗法和依恋理论为指导的干预。每节课时长 15-20 分钟 并作为定期家访的一部分提供。之前的 MB 试验表明，干预措施是 对于那些在假设的干预机制中表现出较小变化且较少的女性来说，成功率较低 全力投入完成个人项目。为了解决这个限制，研究 1 将确定可行性 以及进行 MB-TXT 的可接受性，其中 HV 客户收到 MB 并辅以一系列每周 短信重点关注技能强化、个人项目提醒和抑郁症自我监控 症状。我们还将计算可用于计算样本量的初步效应量 对于未来检查 MB-TXT 功效的全面随机对照试验是必要的。我们将在 我们随机化 3 个 HV 程序来实现 MB 和 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的干预措施 机制。将从客户和家庭访客那里收集可行性和可接受性数据以进行评估 收到短信的百分比、家庭访客遵守按指定时间间隔发送短信的情况，以及 客户对短信实用性和清晰度的看法。以前产后抑郁症的预防 尽管越来越多的干预措施（包括MB）忽视了对孕妇伴侣的干预 认识到父亲的抑郁症会对儿童的社会情感发展产生影响。致地址 鉴于此限制，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。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 短信旨在改善心理 男性伴侣的健康并帮助他支持伴侣的心理健康。我们将研究可行性并 实施 MB-DAD 协议并评估两个 HV 的父亲和二元结果的可接受性 程序。我们将招募 24 名父亲和母亲进行不受控制的试点，其中母亲接受 MB-TXT 父亲们接受 MB-DAD。第一阶段使用的可行性、可接受性和结果措施将 补充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。本项目的公共卫生意义和创新点是 实质性的。如果我们能够将 MB-TXT 和 MB-DAD 整合到 HV 计划中并改善心理 HV 客户及其合作伙伴的健康结果，我们将准备在整个 HV 中复制此干预措施 在高压医疗通过《平价医疗法案》资助迅速蔓延之际，该计划正在全国范围内开展。

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.