Psychology: Summary Of An Article

The Article

Chan, K. L., Leung, W. C., Tiwari, A., Or, K. L., & Ip, P. (2019). Using smartphone-based psychoeducation to reduce postnatal depression among first-time mothers: Randomized controlled trial. JMIR MHealth and UHealth, 7(5), e12794. https://doi.org/10.2196/12794

Hypothesis/Purpose

The postpartum period is an essential phase after birth that may extend up to 42 days. Concerns about pregnancy and childbirth have lessened over this time, as has the patient’s overall burden. However, Berk (2020) estimates that over 80% of first-time mothers endure bouts of tearfulness, sadness, and irritability, symptoms known together as the “baby blues.” While the “baby blues” are only temporary and last around 10 days, about 13% of first-time mothers may have postpartum depression, characterized by sadness, apathy, feelings of worthlessness, difficulties focusing, disrupted sleep, and significant changes in appetite (Berk, 2020).

To reduce postpartum mental sequelae, conventional prenatal intervention—face-to-face support for pregnant parents—is effective; however, it is limited due to a lack of resources, staff, and a support structure. Consequently, the emphasis is turning to computerized technology, especially smartphone technology, which is a helpful instrument for disseminating health information. This study aims to examine whether a smartphone-based psychoeducation program may decrease postnatal depression, anxiety, or stress and improve health-related quality of life.

Methodology

A prospective, single-blind randomized controlled study was undertaken to compare an intervention group that utilized a smartphone-based prenatal education application with a control group that received treatment as usual (TAU). The research was carried out at Kwong Wah Hospital (KWH), a large public hospital in Hong Kong, for a year, from 2017 to 2018.

The Hospital Authority Research Ethics Committee’s Institutional Review Board approved the research for ethical reasons. The study’s participants were first-time pregnant women who visited the KWH prenatal clinic and had less than 24 weeks of gestation remaining.

The following criteria were used to determine eligibility: first-time expecting mothers getting regular prenatal care services at KWH, being able to read and comprehend Chinese and English, and being ready to consent to the conditions of the study. The mother’s incapacity to provide consent and communicate with the interviewers was the exclusion criterion. 660 study participants were randomly allocated to the intervention group (n=330) or the control TAU group (n=330) by drawing lots from sealed opaque envelopes labeled “intervention” or “control.”

Between their first visit to the clinic and the childbirth, the intervention group had access to a smartphone app (the iParent app), and they also received TAU services at KWH. The materials presented in the app were identical to those provided in face-to-face nurse-led antenatal TAU classes at KWH.

The mode of delivery was the most significant difference between the interventions delivered to the two groups. While the control group received face-to-face education at KWH, the intervention group received off-site education organized by topic to improve usability and be available at any time and from any location.

Furthermore, the app enabled users to ask questions, which were answered by obstetricians via private or direct messages via the app. In this study, the independent variable was the psychoeducation delivered to the first-time pregnant mothers via smartphone-based technology and face-to-face.

In contrast, the dependent variable was the postpartum depression which was measured via the Edinburg Postnatal Depression Scale (EPDS), anxiety levels, stress levels, and health-related quality of life.

Results/Discussion

All participants were Chinese, with an average age of 31.3 years for the intervention group and 31.2 years for the control group. The intervention group’s mean EPDS score declined from 7.3 (SD 4.6) to 5.3 (SD 4.4) following the smartphone-based intervention, whereas the control group’s dropped from 7.2 (SD 4.6) to 5.9 (SD 4.7) after receiving TAU services.

After adjusting for baseline mean scores and demographic variables, the mean difference between groups was -0.65 (95% CI -1.29 to 0.00; P=.049), which was a significant difference. Furthermore, although both the mean scores of the anxiety and stress scales decreased from baseline to follow-up in both groups, the difference was not significant after adjusting for baseline scores and demographics.

As a result, the results offer empirical evidence for the relative efficacy of a smartphone-based intervention in decreasing postnatal depression among first-time mothers at 4 weeks postpartum. The author believed that the intervention’s effectiveness was due to the app’s portability and mobility, the availability of unrestricted access to critical information, and the improved sense of connection between mothers and healthcare professionals when using the app. While the author accomplished the study’s goal, the fact that the postpartum period of follow-up was brief (only 4 weeks) and that only first-time mothers were included rather than all mothers was a limitation.

Summary/Conclusion

The study’s goal was to examine whether a smartphone-based psychoeducational intervention might decrease postnatal depression, anxiety, and stress among first-time expectant mothers. According to the findings of the study, although both the intervention and control groups had lower EPDS ratings, the intervention group had a statistically significant lower postnatal depression score. However, no significant findings were observed for the secondary outcomes, which included anxiety, stress, and health-related quality of life.

The psychiatric problems of women in the postpartum period are explored in chapter three of the course book, with a focus on postpartum depression. In that chapter, it is explicitly stated that women suffering from postpartum depression benefit greatly from social support, counseling, and psychoeducation, interventions that, as aforementioned, may be consolidated into a smartphone-based technology and offered in a non-physical manner.

References

Berk, R. R. (2020). HDEV (Canadian Edition) (4th ed.). Cengage Learning Canada Inc. https://bookshelf.vitalsource.com/books/9780176887735