From Idea to Implementation: Development of the Smart-e-Moms App to Reduce Postpartum Depressive Symptoms

Abstract

Introduction: Postpartum depression is the most common mental health disorder associated with the birth of a child. However, postpartum depression often remains untreated because there are not enough prevention and treatment options. Barriers such as lack of knowledge and fear of stigmatization also make it more difficult for affected women to start treatment. Digital interventions could be an option which might circumvent many of these barriers. This study describes the development process of the smartphone-based intervention Smart-e-Moms which aims to reduce postpartum depressive symptoms.

Material and methods: The app was developed using a participatory and iterative approach. The three steps used for the formative evaluation were: (1) an analysis of needs and preferences (focus groups with 9 formerly affected women and 11 midwives), (2) an analysis of the barriers and facilitating factors to use the app (online survey of 37 mothers), and (3) testing of the app (online interviews with 10 acutely affected women). Qualitative data was analyzed with MAXQDA for content analysis.

Results: Step 1 identified numerous challenges after giving birth such as stress, negative thoughts and feelings, and lack of support, all of which flowed into the contents of the app. Ensuring that the units were short and the topics "self-care" and "relationship to the child" were also considered important. In step 2, barriers and facilitating factors were identified and incorporated into the design of the app. Step 3 consisted of a positive assessment of the first version of the app in terms of content and formal design as well as usability. The final app consisted of 10 behavioral units with written psychological guidance, constantly accessible exercises on self-care and the relationship to the child and permanently available information on common challenges after giving birth.

Conclusion: We present a new and innovative approach which aims to reach out more easily to women with postpartum depressive symptoms. The most important insights from the development process, the final design, and the elements of the program are described here.

Keywords: app; formative evaluation; postpartum depression; smartphone-based intervention.

Fig. 1

Hierarchical categories: subcategories model of the biggest challenges after giving birth together with how often they were coded for in the groups of affected women and midwives. The image presents the biggest challenges after giving birth as reported by the focus groups from the perspective of formerly affected women and midwives. Among the formerly affected women, “stress,” “stressful thoughts and feelings,” “breastfeeding,” and “lack of support” were identified as the core challenges. The challenges listed by the midwives were classified under the categories “stress,” “anxiety,” “breastfeeding,” and “lack of support.”

Fig. 2

Overview of the design of the Smart-e-Moms app. The image shows the design of the Smart-e-Moms app and provides an overview of the start screen with the icons for “Units,” “Self-care” and “Information.” Typical contents, exercises, and a writing task are shown.

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Hierarchisches Kategorien-Subkategorien-Modell der größten Herausforderungen nach der Geburt mit Häufigkeiten der Kodierungen für betroffene Frauen und Hebammen. Die Abbildung stellt die in Fokusgruppen benannten größten Herausforderungen nach der Geburt aus der Perspektive ehemals betroffener Frauen und Hebammen dar. Bei den ehemals betroffenen Frauen wurden Stress, belastende Gedanken und Gefühle, Stillen sowie fehlende Unterstützung als zentrale Herausforderungen identifiziert. Die von den Hebammen benannten Herausforderungen ließen sich in die Kategorien Stress, Ängste, Stillen und fehlende Unterstützung einteilen.

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Übersicht über das Design der Smart-e-Moms App. Die Abbildung zeigt das Design der Smart-e-Moms App und gibt einen Überblick über den Startbildschirm mit den Bereichen „Einheiten“, „Selbstfürsorge“ und „Informationen“. Zudem werden beispielhafte Inhalte und Übungen sowie die Schreibaufgabe dargestellt.