Project Title:

A randomised controlled trial evaluating the effectiveness of a nurse-moderated group-based internet support program for mothers with comorbid mild to moderate depression and parenting problems.

Discipline:

Maternal and Child Health

Chief Investigator:

Professor Michael Sawyer

Funding Amount:

$75,000

Recipient:

The University of Adelaide

Overview:

This study will utilise a randomised controlled trial to determine whether a 4-month nurse-supported, group-based intervention delivered via the internet when infants are 2-6 months, reduces levels of maternal depressive symptoms and improves the quality of maternal caregiving when infants are aged 2-12 months. The intervention provides easy access for new mothers to both professional and peer support during the immediate postnatal period. These are the two key elements of support that new mothers seek during this period of time.

Research Outcomes:

Researchers:

Michael Sawyer, John Lynch, Alyssa Sawyer, Anne Sved Williams, Nancy Briggs.

Research Completed:

2018

Research Findings:

Postnatal depression adversely affects mothers and infants. There is also evidence that caregiving difficulties associated with depressive symptoms adversely affect later childhood development. In many countries, resources available to support mothers experiencing depressive symptoms during the postnatal period are limited. Cost-effective online group-based nurse-led interventions delivered by mobile phone ‘apps’ have the potential to help address this problem by providing large numbers of mothers with access to professional and peer support during the postnatal period. The aim of this study was to use a randomised control trial to test the effectiveness the mobile phone app “eMums”, when infants were aged 2-6 months. Outcomes from the intervention group using the app were compared to standard care outcomes. Outcomes were level of maternal depressive symptoms and quality of maternal caregiving.

Results of the trial showed there were no significant differences in the intervention and standard care groups. Mothers engaged well with the app, and the majority of mothers also rated it as helpful and user-friendly. It was also well received by the nurses delivering the intervention. It appears that support for mothers during the postnatal period, provided using mobile phone technology, has the potential to be an important addition to existing services.

Key Outcomes:

Background: Postnatal depression adversely affects mothers and infants. There is also evidence that caregiving difficulties associated with depressive symptoms adversely affect later childhood development. In many countries, resources available to support mothers experiencing depressive symptoms during the postnatal period are limited. Cost-effective online group-based nurse-led interventions delivered by mobile phone ‘apps’ have the potential to help address this problem by providing large numbers of mothers with access to professional and peer support during the postnatal period.

Objective: The aim of this study was to test the effectiveness of a 4-month online group-based nurse-led intervention delivered by mobile phone when infants were 2-6 months, as compared to standard care outcomes. The study was a block randomised control trial of the app we developed, called “eMums”. Mothers were recruited at the time they were contacted for the postnatal health check offered to all mothers in South Australia. Primary outcomes were level of maternal depressive symptoms assessed with the Edinburgh Postnatal Depression Scale (EPDS); and quality of maternal caregiving assessed using the Parenting Stress Index (PSI competence and attachment subscales), the Parenting Sense of Competence Scale, and the Nursing Child Assessment Satellite Training Scale (NCAST). Assessments were completed at baseline (average child age=4.9 weeks) and again when infants were aged 8, and 12 months.

Results: There were no significant differences in the intervention and standard care groups in scores on the PSI competence subscale, nor the Parenting Sense of Competence Scale. While there were differences over time between the EPDS and PSI attachment subscales scores in the intervention and standard care groups, these arose largely because the intervention group had stable scores over time, compared to the standard care group. Mothers engaged well with the intervention with 60% of mothers logging-in once per week during the first 11 weeks of the intervention. The majority of mothers also rated the intervention as helpful and user-friendly. It was also well received by the nurses delivering the intervention.

Conclusions: Mothers reported that the intervention was helpful and the app was described as easy to use. As such, it appears that support for mothers during the postnatal period, provided using mobile phone technology, has the potential to be an important addition to existing services. Possible explanations for the lack of differences in outcomes for the two groups in this study are the failure of many mothers to use some of the key components of the app.

Research Papers:

Sawyer ACP, Kaim AL, Reece CE, McDonald D, Le H-N, Clark JJ, Lynch JW, Sawyer MG, (in press), 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. Journal of Medical Internet Research, Toronto.

Sawyer ACP, Kaim AL, Le H-N, McDonald D, Mittinty M, Lynch JW, Sawyer MG, (in preparation), The effectiveness of an online nurse-moderated program for new mothers with depression and parenting problems: A randomised controlled trial. Journal of Medical Internet Research, Toronto.

Related Publications:

Future Outcomes:

Remarks:

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