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      Evaluating the Effectiveness of an App-Based Nurse-Moderated Program for New Mothers With Depression and Parenting Problems (eMums Plus): Protocol for a Pragmatic Randomized Controlled Trial

      research-article
      , PhD (Clin Psyc) 1 , 2 , 3 , , , BHlthSci (Hons) 2 , 3 , , MSSc 2 , 3 , , BSc (Community Health Nursing) 4 , , PhD 5 , , BA (Hons), DipEd 2 , 3 , , PhD, MPH, FAHMS 1 , 6 , , MBBS, PhD 2 , 3
      (Reviewer), (Reviewer)
      JMIR Research Protocols
      JMIR Publications
      app, infant, mobile phone, mother-child relations, mother-child nursing, postnatal depression, protocol, randomized controlled trial

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          Abstract

          Background

          Postnatal depression adversely affects many mothers and infants with good evidence that caregiving difficulties associated with depressive symptoms play a key role in later adverse childhood outcomes. In many countries, there is only limited support available for women who experience symptoms of depression during the postnatal period, particularly those experiencing subthreshold symptom levels. Furthermore, mental health services and community family health services in many countries tend to focus primarily on providing help for depressive symptoms or maternal caregiving, respectively, despite these problems commonly being comorbid. Group-based nurse-led interventions delivered over the Web through mobile phone “apps” have the potential to be a cost-effective method of providing a large number of mothers with easy access to integrated support for both maternal depressive symptoms and caregiving difficulties.

          Objective

          This paper describes the protocol for a pragmatic randomized controlled trial of a 4-month group-based nurse-led intervention delivered over the Web when infants were 2-6 months. The primary aims of the trial are to determine whether the intervention (1) reduces levels of maternal depressive symptoms and (2) improves the quality of maternal caregiving when infants are 8-12 months of age.

          Methods

          The trial aimed to recruit and randomize 160 mothers of infants aged 2-8 weeks to either the intervention (eMums plus) or standard care. Assessments were completed when infants were aged 1-2 (preintervention), 8, and 12 months. The primary outcomes were the level of maternal depressive symptoms and the quality of maternal caregiving assessed when infants were aged 12 months. The intervention provided specific support for problems with mood and problems with caregiving. The intervention was delivered by community health nurses as a part of routine service delivery to mothers via a mobile phone app.

          Results

          Participant recruitment was carried out from March to July 2017. Follow-up data collection was completed in mid-2018. Data analysis has commenced.

          Conclusions

          In the past, many mothers participated in nurse-led face-to-face groups postnatally. However, mothers’ groups held in clinics can be difficult for busy mothers to attend. The eMums intervention was delivered over the Web by nurses, allowing easy access by mothers early in an infant’s life. The intervention was evaluated while delivered as part of the routine service practice by community child health nurses. The advantage of evaluating the effectiveness of the intervention in the routine service practice is that if it is found to be effective, it can be more easily adopted by the service provider than if it had been assessed in an efficacy trial.

          International Registered Report Identifier (IRRID)

          RR1-10.2196/11549

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          Most cited references21

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          Detection of postnatal depression. Development of the 10-item Edinburgh Postnatal Depression Scale.

          The development of a 10-item self-report scale (EPDS) to screen for Postnatal Depression in the community is described. After extensive pilot interviews a validation study was carried out on 84 mothers using the Research Diagnostic Criteria for depressive illness obtained from Goldberg's Standardised Psychiatric Interview. The EPDS was found to have satisfactory sensitivity and specificity, and was also sensitive to change in the severity of depression over time. The scale can be completed in about 5 minutes and has a simple method of scoring. The use of the EPDS in the secondary prevention of Postnatal Depression is discussed.
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            • Record: found
            • Abstract: not found
            • Article: not found

            A Measure of Parenting Satisfaction and Efficacy

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              • Abstract: found
              • Article: not found

              Barriers to the uptake of computerized cognitive behavioural therapy: a systematic review of the quantitative and qualitative evidence.

              Studies of cognitive behavioural therapy delivered by computer (cCBT) show clinical efficacy for treating anxiety and depression, but have not focused on barriers to uptake. Potential barriers include adverse consequences, accessibility and acceptability. An integrated systematic review was conducted of quantitative and qualitative studies and surveys from multiple electronic databases where computers delivered cCBT for anxiety or depression. Substantial numbers of potential participants are lost prior to trials commencing with little explanation. Among trial participants, drop-outs may be higher in the cCBT groups (odds ratio 2.03, 95% confidence interval 0.81-5.09). Only a median of 56% completed a full course of cCBT and personal circumstance was a more common cause of drop-out than difficulties with the technology or social background. Risk was rarely assessed in the majority of programs. Significant staff time was needed to support clients. Therapists were more negative about cCBT than clients. While cCBT is likely to be an effective and acceptable intervention for some people, there are barriers to its uptake that will substantially limit its impact if not addressed. These included investigating the outcome and attitudes of those who do not make it as far as cCBT trials and why so few finish a full course of cCBT.
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                Author and article information

                Contributors
                Journal
                JMIR Res Protoc
                JMIR Res Protoc
                ResProt
                JMIR Research Protocols
                JMIR Publications (Toronto, Canada )
                1929-0748
                January 2019
                16 January 2019
                : 8
                : 1
                : e11549
                Affiliations
                [1 ] School of Public Health University of Adelaide Adelaide Australia
                [2 ] School of Medicine University of Adelaide Adelaide Australia
                [3 ] Research and Evaluation Unit Women’s and Children’s Health Network North Adelaide Australia
                [4 ] Child and Family Health Service Women’s and Children’s Health Network Adelaide Australia
                [5 ] Department of Psychology George Washington University Washington, DC United States
                [6 ] Population Health Sciences University of Bristol Bristol United Kingdom
                Author notes
                Corresponding Author: Alyssa CP Sawyer alyssa.sawyer@ 123456adelaide.edu.au
                Author information
                http://orcid.org/0000-0002-8609-7231
                http://orcid.org/0000-0002-5488-3334
                http://orcid.org/0000-0002-1128-6652
                http://orcid.org/0000-0002-6151-7404
                http://orcid.org/0000-0002-8751-4519
                http://orcid.org/0000-0002-1956-1874
                http://orcid.org/0000-0003-2781-7902
                http://orcid.org/0000-0002-7834-0561
                Article
                v8i1e11549
                10.2196/11549
                6351991
                30664487
                2fcb2db9-a16a-45d4-8ae8-b8c9cdf62e71
                ©Alyssa CP Sawyer, Amy L Kaim, Christy E Reece, Denise McDonald, Huynh-Nhu Le, Jennifer Clark, John W Lynch, Michael G Sawyer. Originally published in JMIR Research Protocols (http://www.researchprotocols.org), 16.01.2019.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License ( https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Research Protocols, is properly cited. The complete bibliographic information, a link to the original publication on http://www.researchprotocols.org.as well as this copyright and license information must be included.

                History
                : 1 August 2018
                : 7 September 2018
                : 9 October 2018
                : 10 October 2018
                Categories
                Protocol
                Protocol

                app,infant,mobile phone,mother-child relations,mother-child nursing,postnatal depression,protocol,randomized controlled trial

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