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Cited by 45Maternal Mental Health During Pregnancy and PostpartumDigital Mental Health InterventionsAnxiety, Depression, Psychometrics, Treatment, Cognitive Processes

Feasibility and acceptability of a web-based treatment with telephone support for postpartum women with anxiety: randomized controlled trial

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Ashford, Miriam T, Olander, Ellinor K, Rowe, Heather, Fisher, Jane RW, Ayers, Susan·2018·JMIR Mental Health
DOI 10.2196/mental.9106PMC PMC5938691

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Abstract

BACKGROUND: Postpartum anxiety can have adverse effects on the mother and child if left untreated. Time constraints and stigma are common barriers to postpartum treatment. Web-based treatments offer potential flexibility and anonymity. What Am I Worried About (WaWa) is a self-guided treatment based on cognitive-behavioral and mindfulness principles for women experiencing postpartum anxiety. WaWa was developed in Australia and consists of 9 modules with optional weekly telephone support. WaWa was adapted to a Web-based version for use in England (Internet-based What Am I Worried About, iWaWa). OBJECTIVE: This study aimed to investigate the feasibility (engagement and usability) and acceptability (usefulness, satisfaction, and helpfulness) of iWaWa among English postpartum women with anxiety. METHODS: Postpartum (<12 months) women with mild-to-severe anxiety were recruited anonymously via social media during an 8-week period. Participants were randomized to the iWaWa treatment (8 weeks) or wait-list control group. Treatment and study feasibility and acceptability were assessed after the treatment, and anxiety symptoms were assessed at baseline, 8 weeks postrandomization, and 12 weeks postrandomization (treatment group only) using Web-based questionnaires. Semistructured telephone interviews were carried out after the treatment period for a more in-depth exploration of treatment acceptability and feasibility. RESULTS: A total of 89 eligible women were recruited through social media and randomized into the treatment (n=46) or wait-list control group (n=43). Women were predominantly Caucasian, well-educated, married, on maternity leave, first-time mothers and reported moderate levels of anxiety. Dropout rates were high, especially in the treatment group (treatment: 82%, 38/46; wait-list control: 51%, 22/43). A total of 26 women started iWaWa with only 2 women completing all 9 modules. Quantitative and qualitative data suggest iWaWa was experienced as generally useful and helpful. Participants enjoyed iWaWa's accessibility, anonymity, and weekly reminders, as well as the introduction to the principles of cognitive-behavioral therapy (CBT) and mindfulness. However, iWaWa was also experienced as not user-friendly enough, too long, and not smartphone-friendly. Parts of the content were experienced as not always relevant and appropriate. Participants felt that iWaWa could be improved by having it in a smartphone app format and by making the content more concise and inclusive of different parenting styles. CONCLUSIONS: Despite interest in iWaWa, the results suggest that both the study and iWaWa were not feasible in the current format. However, this first trial provides useful evidence about treatment format and content preferences that can inform iWaWa's future development, as well as research and development of Web-based postpartum anxiety treatments, in general, to optimize adherence. TRIAL REGISTRATION: ClinicalTrials.gov NCT02434406; https://clinicaltrials.gov/ct2/show/NCT02434406 (Archived by WebCite at http://www.webcitation.org/6xTq7Bwmd).

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  • The length of the program and the length of individual sessions play a role in participants' satisfaction and motivation to continue with the program.

    “The length of the program as well as the length of individual sessions played a role in participants’ satisfaction and their motivation to continue with the program [88,138,147-151].”

    From Barriers to and facilitators of user engagement with digital mental health interventions: Systematic review (2021) · cites this paper as [148]

    In Results > Qualitative Treatment Feasibility and Acceptability Outcomes (page unavailable), participants said the modules were too wordy and suggested shorter ones, supporting a role for module length in acceptability. The paper does not establish that the overall program length affected satisfaction or motivation to continue, or directly link module length to those outcomes. (LLM, conf=0.82)

    Experimental — accuracy not yet measured

  • Participants expressed a need for more structured use of DMHIs (e.g., app reminders or a human coach checking on them regularly).

    “Participants expressed a need to receive more structured use, for example, through app reminders or a human coach checking on them on a regular basis [49,50,113,122,133,137,139,148,150,163,175-182].”

    From Barriers to and facilitators of user engagement with digital mental health interventions: Systematic review (2021) · cites this paper as [148]

    The Results (Qualitative Treatment Feasibility and Acceptability Outcomes; page unavailable) say participants valued weekly email or text reminders and suggested more frequent reminders. They also valued the option of support calls, but the paper does not report a need for a coach to check on them regularly; its reminders were not app reminders. (LLM, conf=0.87)

    Experimental — accuracy not yet measured

  • In 7 studies, anonymity (users could share and receive information anonymously) was listed as a facilitating factor to engage and encourage disclosure of information.

    “Overall, 7 studies listed anonymity, meaning that users could share and receive information anonymously, as a facilitating factor to engage and encourage disclosure of information [41,88,129,137,141,148,232].”

    From Barriers to and facilitators of user engagement with digital mental health interventions: Systematic review (2021) · cites this paper as [148]

    In Results > Qualitative Treatment Feasibility and Acceptability Outcomes (page not provided), women appreciated iWaWa’s anonymity, and one said she would not have sought help another way. This supports anonymity as a factor facilitating engagement. The paper does not establish that users could share and receive information anonymously or that anonymity encouraged disclosure; Methods > Study Design and Procedure describes participants as quasi-anonymous. (LLM, conf=0.84)

    Experimental — accuracy not yet measured

  • Factors contributing to dissatisfaction include overlong modules, irrelevant content, lack of customization, and non-responsive or mobile-unfriendly visualization.

    “Factors contributing to dissatisfaction include overlong modules, irrelevant content, lack of customization, and non-responsive or mobile-unfriendly visualization (Ashford et al., 2018).”

    From PandaMom – Feasibility and acceptability of an internet- and mobile-based intervention to enhance peripartum mental well-being and to prevent postpartum depression (2024) · cites this paper as Ashford et al., 2018

  • Participants reported a preference for more concise modules.

    “and participants reported preference for more concise modules [148]”

    From Barriers to and facilitators of user engagement with digital mental health interventions: Systematic review (2021) · cites this paper as [148]

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Authors
Ashford, M. T., Olander, E. K., Rowe, H., Fisher, J. R., & Ayers, S.
Affiliations
  • University of London (GB)
  • Jean Hailes (AU)
Corresponding author
Ashford, Miriam T
ORCID
Venue
JMIR Mental Health
Publisher
JMIR Publications Inc.
Published
2018-04-20
Volume
5
Issue
2
Pages
e19
ISSN
2368-7959 (ISSN-L)
DOI
10.2196/mental.9106
PMC
PMC5938691
OpenAlex
W2801214979
Cited by
45
References
64
Citations by year
2026: 2 · 2025: 5 · 2024: 6 · 2023: 10 · 2022: 12 · 2021: 3 · 2020: 4 · 2019: 2 · 2018: 1
FWCI
2.38
Type
journal article
Language
en
Open access
Licence
cc-by
Locations
  • JMIR Mental Health (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • Monash University Research Portal (Monash University) (publishedVersion, other-oa)
  • PubMed (publishedVersion)
  • City Research Online (City University London) (acceptedVersion)
Funders
City, University of London
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Maternal Mental Health During Pregnancy and Postpartum
  • Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
Keywords
postpartum anxiety, web-based treatment, telephone support, cognitive behavioral therapy, mindfulness, self-guided intervention, treatment acceptability, treatment feasibility, dropout, postpartum women, mobile application, social media recruitment, stigma, user experience, parenting styles, usability, waitlist control

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