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

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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.