Investigating perspectives on e-health interventions to enhance maternal mental well-being: Results of a stakeholder interview

Abstract

Peripartum mental disorders are highly prevalent conditions and associated with adverse outcomes for the mother, the infant and the whole family. Despite the high burden, help-seeking is low. E-mental health interventions could overcome help-seeking barriers and thus improve perinatal mental health. However, usage and adherence are rather low. This study aims to assess attitudes and needs of different stakeholder groups and to identify relevant topics to develop an intervention meeting the needs of pregnant and postpartum women and thus, increasing utilization and adherence. Therefore, semi-structured interviews and focus groups with pregnant women (n = 3), mothers (n = 4), women who have suffered from a postpartum mood disorder in the past (n = 5), gynaecologists (n = 5), and midwives (n = 5) were conducted. All interviews were audio-recorded, transcribed verbatim, and analyzed using a thematic analysis. Almost half of the stakeholders reported previous experiences with e-mental health services. Anonymity, flexibility, promoting help-seeking, or bridging waiting-time for treatment as usual were regarded as the main benefits. Concerns regarding the usefulness of e-mental health interventions, absence of face-to-face contact or lack of integration into routine care were considered as barriers. With regard to the desired program content, six main topics were identified: pregnancy and puerperium, peripartum mood swings and disorders, support options, self-care, partnership, and fatherhood. Regarding preferred characteristics of e-mental health programs, stakeholders mentioned customizability, individual guidance, evaluation of user-feedback and continuous adoption, as well as a responsive and user-friendly design. Overall, online interventions for perinatal mental health were mainly considered as beneficial. Stakeholders underlined the high need for education regarding the use and effectiveness of e-mental health, to overcome concerns and obstacles and improve acceptability. Furthermore, developing customizable and individually-guided interventions were considered as promising to increase utilization of and adherence to e-mental health interventions. Author summary Postpartum depression (PPD) is a common peripartum mood disorder and occurs in 10–15% of new mothers after giving birth. PPD can cause symptoms like depressed mood, fatigue, loss of interest, sleep disturbances, lack of concentration, anxiety, and suicidal thoughts, but can also have far-reaching consequences for the infant (such as internalising and developmental disturbances) and the whole family system. Due to a lack of social education on such peripartum mood disorders, the absence of a routine screening, as well as maternal feelings of shame and guilt, many affected mothers go undiagnosed and therefore untreated. The high prevalence rates and negative consequences of peripartum mood disorders emphasizes the urgent need for prevention. To overcome help-seeking barriers and to provide low-threshold and anonymous support, electronic mental health (EMH) services may be a feasible option. EMH services are internet-based and computerised services offering, for example, prevention, treatment, or aftercare. As peripartum-specific interventions are rare and the usage of existing interventions often remains low, a program fitting to the needs and circumstances of pregnant women and new mothers should be developed. Therefore, as a first step, stakeholder interviews will be conducted to assess perspectives and needs on peripartum-specific e-mental health interventions in Germany.