eHealth Intervention for Postpartum Depression in Healthcare Settings

 描述(申请人提供)：大约15%-20%的妇女患有产后抑郁症(PPD)，这会给新妈妈及其家人带来巨大的痛苦，并对婴儿的发育产生不利影响。幸运的是，治疗产后抑郁的有效方法已经开发出来并得到了验证。然而，有许多障碍使患有产后抑郁的妇女难以获得以临床为基础的心理健康治疗，参与率很低。不到50%的产后抑郁妇女寻求帮助是因为心理障碍(耻辱、失败感和尴尬)；知识障碍(对产后抑郁对婴儿健康的影响缺乏了解，不确定从哪里获得治疗)；基础设施障碍(害怕儿科医生的负面判断，母乳喂养时避免服用处方药)；农村环境中的身体障碍(护理人员太少，对时间、交通和儿童护理的不可接受的后勤要求)；以及提供者层面的障碍(治疗产后障碍的技能不足，害怕责任，缺乏治疗选择，以及不足 报销)。因此，至关重要的是开发创新的服务提供系统，克服高质量医疗保健的障碍，减少健康差距。为了满足这一需求，我们开发并测试了MomMoodBooster计划(MMB)，这是一个基于网络的创新计划，用于治疗PPD，该计划改编自一种针对抑郁症的循证认知行为疗法。MMB计划通过每周六次的课程指导参与者。每个会话中的网页使用文本、交互、动画和视频来呈现节目内容。MMB计划包括每日跟踪和绘制心情和愉快活动的图表，以及在线访问图书馆，涵盖了新妈妈们关心的一系列问题。为了加强支持性责任，母亲们还会收到一系列最多六个私人教练的电话，每个电话大约持续20分钟。在第一阶段，我们将提高MMB底层基础设施、其行政网站以及个人教练功能的灵活性，以便将以研究为重点的MMB计划转化为适合医疗机构工作流程和人员配备的商业就绪产品。我们将使用一种迭代的形成性开发过程，以利益相关者的意见为基础，并由护理提供者在妇产科和家庭医生实践中进行可用性测试。在第二阶段，我们将增加移动技术，以增强方案的“推送”方面，并开发改进的管理界面，使医疗机构的用户能够定制方案的功能，以满足他们不同的现实世界场景的需求。我们还将探索将MMB与著名的电子病历系统相联系的可能性，以鼓励其更多地常规使用。最后，我们将使用一项双臂务实的随机对照试验来评估在多大程度上可以通过医疗保健环境中整合的Web/Mobile MMB计划的覆盖、有效性、采用、实施和维护来克服PPD女性的医疗障碍。

 DESCRIPTION (provided by applicant): Approximately 15-20% of women experience postpartum depression (PPD), which results in significant suffering for new mothers and their families, and has an adverse impact on infant development. Fortunately, effective treatments for PPD have been developed and validated. However, there are many barriers that make it difficult for women with PPD to access clinic-based mental health treatments and participation is low. Less than 50% of women with PPD seek help because of psychological barriers (stigma, feelings of failure and embarrassment); knowledge barriers (poor understanding about impact of PPD on infant health, unsure about where to get treatment); infrastructure barriers (fear of negative judgment from pediatrician, avoidance of prescription medications while breastfeeding); physical barriers in rural settings (too few providers of care, unacceptable logistical demands on time, transportation, and childcare); and provider-level barriers (inadequate skills for treating PPD, fear of liability, dearth of treatment options, and inadequate reimbursement). Thus, it is of critical importance to develop innovative service delivery systems that overcome barriers to quality healthcare and reduce health disparities. To address this need, we developed and tested the MomMoodBooster program (MMB), an innovative Web-based program for treating PPD adapted from an evidence-based cognitive-behavioral therapy for depression. The MMB program guides participants through six weekly sessions. Webpages in each session use text, interactions, animations, and video to present program content. The MMB program includes daily tracking and charting of mood and pleasant activities as well as online access to a library, covering a range of issues of concern to new mothers. To enhance supportive accountability, mothers also receive a series of up to six personal coach calls lasting approximately 20 minutes each. In Phase I, we will improve the flexibility of MMB's underlying infrastructure and its administrative website as well as its personal coach features in order to translate the research-focused MMB program into a commercial-ready product that fits the workflow and staffing of healthcare organizations. We will use an iterative formative development process informed by stakeholder input and usability testing by care providers in OB/GYN and family-physician practices. In Phase II, we will add mobile technology to enhance the "push" aspects of the program and develop an improved administrative interface to enable users in medical care organizations to customize features of the program to meet the needs of their different real-world scenarios. We will also explore the possibility that MMB can be linked to prominent electronic medical record systems that could encourage its greater routine use. Finally, we will use a 2-arm pragmatic randomized controlled trial to evaluate the extent to which healthcare barriers for women with PPD can be overcome by the reach, effectiveness, adoption, implementation, and maintenance of the integrated Web/Mobile MMB program in medical care settings.