Lessons Learned from Remote Assessment of Mother-Infant Interactions Among Women with Postpartum Depression.

Purpose: The COVID-19 pandemic posed challenges to measuring mother-infant interactions, a critical outcome for many interventions to support mothers with postpartum depression symptoms and their new infants. The current study describes the process and lessons learned from implementing a remote assessment of mother-infant interactions during the pandemic. Description: At the onset of the COVID-19 pandemic, we pivoted from in-person to using two different strategies to remotely assess mother-infant interactions: (1) participants independently recorded and uploaded videos of free-play with their child; and (2) research team conducted a live-video recording of the free-play. Assessment: We found initial barriers including technical and video quality issues but overall, a remote option could increase enrollment and retention rates in a sample of postpartum women across various racial/ethnic groups and economic levels. Conclusion: Our experiences in conducting remote assessments with postpartum women add to growing evidence for the feasibility and validity of remote visits. This showed how our methods can be implemented in future research and in practice with postpartum mothers and their infants.

Social Media-based Parenting Program for Women With Postpartum Depressive Symptoms: An RCT.

OBJECTIVES: To test effects of a social media-based parenting program for mothers with postpartum depressive symptoms. METHODS: We conducted a randomized controlled trial from December 2019 to August 2021 of a parenting program using Facebook. Women with mild-to-moderate depressive symptoms (Edinburgh Postnatal Depression Scale [EPDS] 10-19) were randomized to the program, plus online depression treatment or depression treatment alone for 3 months. Women completed the EPDS monthly and the Parent-Child Early Relational Assessment, Parenting Stress Index-Short Form, and Parenting Sense of Competence pre- and postintervention. Differences among groups were assessed using intention-to-treat analysis. RESULTS: Seventy-five women enrolled and 66 (88%) completed the study. Participants were predominantly Black (69%), single (57%), with incomes <$55 000 (68%). The parenting group reported a more rapid decline in depressive symptoms than the comparison group (adjusted EPDS difference, -2.9; 95% confidence interval, -4.8 to -1.0 at 1 month). There were no significant group X time interactions for the Parent-Child Early Relational Assessment, Parenting Stress Index-Short Form, or Parenting Sense of Competence scores. Forty-one percent of women sought mental health treatment for worsening symptoms or suicidality. Women in the parenting group who exhibited greater engagement or reported mental health treatment had greater parenting responsiveness. CONCLUSIONS: A social media-based parenting program led to more rapid declines in depressive symptoms but no differences in responsive parenting, parenting stress, or parenting competence relative to a comparison group. Social media can provide parenting support for women with postpartum depressive symptoms, but greater attention to engagement and treatment access are needed to improve parenting outcomes.

Community-Based, Caregiver-Implemented Early Language Intervention in High-Risk Families: Lessons Learned.

BACKGROUND: High-quality, early caregiver-child interaction facilitates language, cognitive, and health outcomes. Children in low socioeconomic status households experience less frequent and lower-quality language interactions on average than their middle to high socioeconomic status peers. Early caregiver-implemented intervention may help to improve outcomes for these children. OBJECTIVES: This article describes how we used community-based participatory research (CBPR) to develop and implement a community-based, caregiver-implemented early language intervention, including the challenges, solutions, and lessons learned in the process of CBPR. METHODS: We adopted an ethnographic approach to document and analyze our CBPR experiences in multiple phases of the project, including intervention design, training, implementation, and evaluation. LESSONS LEARNED: Developing the CBPR partnership, co-designing and implementing the study, and managing systems- level concerns like obtaining funding were central challenges for the researcher-community team. CONCLUSIONS: The CBPR model enhances early language intervention research by facilitating understanding of families in underserved communities and increasing the cultural relevancy of intervention materials.

Pilot RCT of a social media parenting intervention for postpartum mothers with depression symptoms.

Objective: This pilot study describes the adaptation of a parenting group intervention for social media, and examines the feasibility, acceptability and initial outcomes of the adapted intervention for mothers with postpartum depression symptoms. Background: Postpartum depression can negatively affect parenting and the parent-infant relationship. Mothers with postpartum depression symptoms experience barriers to access in-person parenting interventions. Methods: A small, randomised controlled trial was conducted with an adapted parenting intervention delivered via social media (Facebook) or in-person for mothers who screened positive for depression in paediatric clinics. Parenting sense of competence, depression symptoms and intervention attendance and satisfaction were assessed. Twenty-four mothers (mean age 26 years; predominantly African American with limited economic resources) participated in the study. Results: Linear regressions showed that the social media group had significantly improved parenting competence and decreased depression severity when compared to the in-person group. Attendance in the social media group was high (83%), but extremely poor in the in-person group (3%). The mothers rated the intervention positively and the majority of the mothers participated by posting comments on the group page on social media. Conclusion: The findings suggest the feasibility and benefit of delivering a parenting intervention through social media for postpartum mothers with high levels of depression symptoms.

Social Determinants of Health and What Mothers Say They Need and Want After Release From Jail.

Identifying the biopsychosocial needs of mothers who have been released from jail is critical to understanding the best ways to support their health and stability after release. In May through August 2014, we interviewed 15 mothers who had been released from an urban jail about their reentry experiences, and we analyzed transcripts for themes. Eight domains of community reentry emerged through analysis: behavioral health services, education, employment, housing, material resources, medical care, relationships with children, and social support. Participants defined barriers to successful reentry, which paralleled the social determinants of health, and shared suggestions that could be used to mitigate these barriers.

Preparing for a trial to test a postpartum weight retention intervention among low income women: feasibility of a protocol in a community-based organization.

BACKGROUND: Postpartum weight retention (PPWR) causes intergenerational harm, negatively affecting a mother's cardiovascular health and ability to have future healthy pregnancies. Low-income minority women are at highest risk for PPWR with little guidance concerning timeline or strategy to lose weight after delivery. An academic-community partnership conducted observational and focus group work to develop an intervention for PPWR among low-income mothers. This study's objective is to determine the feasibility of implementing a PPWR intervention trial in partnership with a community-based organization (CBO) serving low-income families with social service support. METHODS: We analyzed five implementation outcomes in this feasibility study: acceptability, adoption, appropriateness, penetration, and sustainability. Other secondary outcomes were the change in psychosocial and clinical outcomes from baseline to one year following the intervention delivery. RESULTS: An academic-community partnership developed and piloted a postpartum weight retention intervention among 17 participants that included 1) six weeks of interactive daily health texting, 2) exercise assistance with baby carrier, home exercise program, and pedometer provision, 3) two live healthy eating and baby feeding workshops, and 4) two 45-min home visits over one year to provide social support and acquire followup data. Implementation outcomes demonstrate an intervention supported by the organization and accepted by end-users, with increased capacity of the CBO to test and deliver an effective intervention. Weight loss was achieved by the majority of participants at one year (Md - 5 pounds (IQR = - 14.5 - 0.3). CONCLUSION: We made protocol enhancements to the developed intervention based on the analysis of this study, and now prepare for a funded randomized controlled trial (RCT) in a community-based setting. Our central hypothesis is that low-income women who participate in a multi-component, low cost-intervention delivered by a CBO will have less postpartum weight retention than those women who do not participate in the program. TRIAL REGISTRATION: The trial was retrospectively registered, ID NCT02867631, 8/11/16.

The Development of a Postpartum Weight Management Intervention for Low-Income Women: End-User Perspectives as Groundwork.

BACKGROUND: Postpartum weight retention (PPWR) leads to increased rates of maternal and childhood obesity, especially among low-income families. Literature is sparse regarding interventions to address PPWR. OBJECTIVE: To gain practical insight into low-income women's preferences and opinions regarding PPWR management at a community-based organization (CBO). METHODS: Mixed female focus groups composed of CBO staff and clients (n = 17) were asked open-ended questions about PPWR and potential intervention components. Systematic analysis of the discussions was performed to identify overarching themes. CONCLUSIONS: The tenets of community-engaged research state the necessity of developing community-based interventions with initial input and partnership with the potential end-users. In this study, low-income women were eager to share their thoughts about the postpartum period and potential solutions to correct unhealthy weight, thus completing a critical step in intervention development. The majority of women wanted to manage their weight in the postpartum setting, but needed structure, social support, assurance they would not injure themselves or their babies, and time saving strategies to do so.

A Pilot Investigation to Enhance Behavioral Health Referral for Perinatal, Low-Income Women With Mood Disorders.

BACKGROUND: Perinatal, low-income, ethnic minority women with mood disorders underutilize behavioral health treatment. A community-academic partnership was used to address behavioral health initiation among this population. OBJECTIVES: We sought to examine the feasibility, acceptability, and preliminary outcomes of a behavioral health referral intervention with low-income, ethnic minority perinatal women diagnosed with mood disorders. METHODS: An open trial pilot study was conducted with 38 perinatal women. The behavioral health referral intervention consisted of two sessions of manualized referral strategies to enhance access to care. The main outcome was attendance at a behavioral health appointment. RESULTS: Approximately 55% of the perinatal women attended a behavioral health appointment within 2 months (i.e., initiated treatment). Intervention participation rates and ratings were high. Depression scores decreased from baseline to after the intervention. CONCLUSIONS: The findings demonstrated favorable outcomes compared with other referral interventions. The behavioral health referral intervention shows promise for implementation in community settings.

Understanding low-income African American women's expectations, preferences, and priorities in prenatal care.

We aimed to explore factors affecting prenatal care attendance and preferences for prenatal care experiences among low-income black women by conducting a focus group study using a community-based participatory research framework and nominal group technique. Discussions were audiorecorded, transcribed, and coded by trained reviewers. Friends/family and baby's health were the top attendance motivators. Greatest barriers were insurance, transportation, and ambivalence. Facilitators included transportation services, social support, and resource education. In a "perfect system," women wanted continuity of care, personal connection, and caring/respect from providers. Relationship-centered maternity care models may mitigate disparities. Group prenatal care may provide the continuity and support system desired.

Psychosocial factors associated with gestational weight gain in a low-income cohort.

BACKGROUND: Excessive gestational weight gain (GWG) causes negative maternal and child outcomes. Literature is sparse regarding reasons in high-risk low-income women. PURPOSE: Assess psychosocial factors associated with GWG using an adapted instrument based on the theory of planned behavior (TPB). METHODS: Community health workers surveyed 101 low-income postpartum women. RESULTS: Mean (SD) age was 24.6 (5.7) years, with 7% White, 66% Black, 22% Hispanic. Over half (58%) of the women reported overweight or obese body mass indices (BMI) prior to pregnancy; 49% had excessive GWG. Theory of planned behavior-informed constructs associated with less GWG included internal weight locus of control (B=-11.6 (221.4, 21.9) pounds) and higher self-efficacy (B=-1.3 (22.6, 0) pounds). Perinatal depression was associated with increased GWG (B=0.88 (0.1, 1.7) pounds). CONCLUSION: The theory of planned behavior is useful in understanding the association of psychosocial factors and GWG. More research is warranted to evaluate the generalizability of the findings prior to the development of an effective intervention.

Screening and Referral for Postpartum Depression among Low-Income Women: A Qualitative Perspective from Community Health Workers.

Postpartum depression is a serious and common psychiatric illness. Mothers living in poverty are more likely to be depressed and have greater barriers to accessing treatment than the general population. Mental health utilization is particularly limited for women with postpartum depression and low-income, minority women. As part of an academic-community partnership, focus groups were utilized to examine staff practices, barriers, and facilitators in mental health referrals for women with depression within a community nonprofit agency serving low-income pregnant and postpartum women. The focus groups were analyzed through content analyses and NVIVO-8. Three focus groups with 16 community health workers were conducted. Six themes were identified: (1) screening and referral, (2) facilitators to referral, (3) barriers to referral, (4) culture and language, (5) life events, and (6) support. The study identified several barriers and facilitators for referring postpartum women with depression to mental health services.