Prevention of perinatal depression among at-risk individuals through integration of a multimedia, web-based intervention within the healthcare system

拟议的研究评估的可行性和可接受性，整合远程访问围产期 抑郁症（PD）预防程序，其在医疗保健系统内并嵌入现有的基于网络的患者中 门户网站（YoMingo®）。这种类型1的混合有效性-实施项目使用实施研究 逻辑模型（IRLM），用于评估将干预决定因素（包括社会文化因素） 决定因素，并在拉丁美洲人，服务不足（农村）和城市人口的实施成果。一 随机偏好试验将评估患者偏好和社会文化因素（地理 居住地、种族/民族、重大生活事件、精神健康史、精神健康耻辱）对参与和 初步成果。 目的1：评估远程访问MBCT预防PD的实施可行性和可接受性 集成在医疗保健系统中，使用现有的基于Web的患者门户网站（YoMingo®）， 所有处于危险中的人都可以进入。我们采用混合方法评估实施成果; 提供者和患者满意度，以及患者的访问和使用模式（例如，访问YoMingo®，访问 PD内容，并参与远程访问MBCT）。我们将使用电子健康记录（EHR）数据， 识别PD转诊和结果，并将其与YoMingo®中的患者活动联系起来。社区咨询 审计委员会（CAB）将在整个项目过程中提供意见，以通知、调整和完善实施过程。 子目标1.a：基于社会文化和行为特征，检查YoMingo®访问和使用的预测因素 围产期心理健康的决定因素，例如，地理居住地（例如，农村）、族裔/种族背景、 重大生活事件、精神健康状况史和精神健康污名。 目标2：评估8周远程访问MBCT计划中的偏好和参与度; 单独的需求（OD），或具有便利的讨论板（DB）的OD，或具有便利的同步 视频会议（VC）。我们提出了一个随机的，3条件配对选择偏好设计， 哪些人被分配到三个研究小组之一，由配对选项组成; 1） OD或OD + DB; 2）OD + DB或OD + VC;和3）OD或OD + VC。YoMingo®指标允许跟踪 参与者网站访问、点击和内容使用，DB和VC参与。我们还探索参与 基于围产期心理健康的社会文化决定因素的远程访问MBCT。 子目标2.a：对所有配对研究组的PD症状轨迹进行探索性分析。 爱丁堡产后抑郁量表（EPDS）将在5个时间点（产前和产后）完成。 干预和干预后2个月、4个月和6个月），以模拟随时间的变化。

The proposed study evaluates the feasibility and acceptability of integrating a remote-access perinatal depression (PD) prevention program within a healthcare system and embedded in an existing web-based patient portal (YoMingo®). This type 1 hybrid effectiveness-implementation project uses the Implementation Research Logic Model (IRLM) to evaluate systems and strategies that link intervention determinants, including sociocultural determinants, with implementation outcomes in Latino, underserved (rural), and urban populations. A randomized preference trial will assess the impact of patient preference and sociocultural factors (geographic residence, race/ethnicity, significant life events, mental health history, mental health stigma) on participation and preliminary outcomes. Aim 1: Evaluate implementation feasibility and acceptability of a remote-access MBCT for PD prevention integrated within a healthcare system, using an existing web-based patient portal (YoMingo®) to increase access for all at-risk individuals. We use a mixed methods approach to evaluate implementation outcomes; provider and patient satisfaction, and access and use patterns of patients (e.g., accessing YoMingo®, visiting PD content, and participating in remote-access MBCT). We will use Electronic Health Record (EHR) data to identify PD referrals and outcomes, and link these with patient activity in YoMingo®. A Community Advisory Board (CAB) will provide input throughout the project to inform, adjust, and refine the implementation process. Sub Aim 1.a: Examine predictors of YoMingo® access and use based on sociocultural and behavioral determinants of perinatal mental health, e.g., geographic residence (e.g., rural), ethnic/racial background, significant life events, history of mental health conditions, and mental health stigma. Aim 2: Evaluate preference & engagement in an 8-week remote-access MBCT program; multimedia on- demand (OD) alone, or OD with a facilitated discussion board (DB) or OD with facilitated, synchronous videoconference sessions (VC). We propose a randomized, 3-condition paired-choice preference design, in which individuals are assigned to one of three study groups consisting of a choice between paired options; 1) OD or OD + DB; 2) OD + DB or OD + VC; and 3) OD or OD + VC. YoMingo® metrics allows tracking of participant website visits, clicks, and content use, DB and VC engagement. We also explore engagement in the remote-access MBCT based on sociocultural determinants of perinatal mental health. Sub Aim 2.a: Conduct an exploratory analysis of PD symptom trajectory for all paired study groups. The Edinburgh Postnatal Depression Scale (EPDS) will be completed at five timepoints (pre- and post- intervention, and 2-, 4-, and 6-months post-intervention) to model change over time.