1
|
Nguyen QC, Aparicio EM, Jasczynski M, Channell Doig A, Yue X, Mane H, Srikanth N, Gutierrez FXM, Delcid N, He X, Boyd-Graber J. Rosie, a Health Education Question-and-Answer Chatbot for New Mothers: Randomized Pilot Study. JMIR Form Res 2024; 8:e51361. [PMID: 38214963 PMCID: PMC10818229 DOI: 10.2196/51361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 10/24/2023] [Accepted: 11/24/2023] [Indexed: 01/13/2024] Open
Abstract
BACKGROUND Stark disparities exist in maternal and child outcomes and there is a need to provide timely and accurate health information. OBJECTIVE In this pilot study, we assessed the feasibility and acceptability of a health chatbot for new mothers of color. METHODS Rosie, a question-and-answer chatbot, was developed as a mobile app and is available to answer questions about pregnancy, parenting, and child development. From January 9, 2023, to February 9, 2023, participants were recruited using social media posts and through engagement with community organizations. Inclusion criteria included being aged ≥14 years, being a woman of color, and either being currently pregnant or having given birth within the past 6 months. Participants were randomly assigned to the Rosie treatment group (15/29, 52% received the Rosie app) or control group (14/29, 48% received a children's book each month) for 3 months. Those assigned to the treatment group could ask Rosie questions and receive an immediate response generated from Rosie's knowledgebase. Upon detection of a possible health emergency, Rosie sends emergency resources and relevant hotline information. In addition, a study staff member, who is a clinical social worker, reaches out to the participant within 24 hours to follow up. Preintervention and postintervention tests were completed to qualitatively and quantitatively evaluate Rosie and describe changes across key health outcomes, including postpartum depression and the frequency of emergency room visits. These measurements were used to inform the clinical trial's sample size calculations. RESULTS Of 41 individuals who were screened and eligible, 31 (76%) enrolled and 29 (71%) were retained in the study. More than 87% (13/15) of Rosie treatment group members reported using Rosie daily (5/15, 33%) or weekly (8/15, 53%) across the 3-month study period. Most users reported that Rosie was easy to use (14/15, 93%) and provided responses quickly (13/15, 87%). The remaining issues identified included crashing of the app (8/15, 53%), and users were not satisfied with some of Rosie's answers (12/15, 80%). Mothers in both the Rosie treatment group and control group experienced a decline in depression scores from pretest to posttest periods, but the decline was statistically significant only among treatment group mothers (P=.008). In addition, a low proportion of treatment group infants had emergency room visits (1/11, 9%) compared with control group members (3/13, 23%). Nonetheless, no between-group differences reached statistical significance at P<.05. CONCLUSIONS Rosie was found to be an acceptable, feasible, and appropriate intervention for ethnic and racial minority pregnant women and mothers of infants owing to the chatbot's ability to provide a personalized, flexible tool to increase the timeliness and accessibility of high-quality health information to individuals during a period of elevated health risks for the mother and child. TRIAL REGISTRATION ClinicalTrials.gov NCT06053515; https://clinicaltrials.gov/study/NCT06053515.
Collapse
Affiliation(s)
- Quynh C Nguyen
- Department of Epidemiology and Biostatistics, University of Maryland School of Public Health, College Park, MD, United States
| | - Elizabeth M Aparicio
- Department of Behavioral and Community Health, University of Maryland School of Public Health, College Park, MD, United States
| | - Michelle Jasczynski
- Department of Behavioral and Community Health, University of Maryland School of Public Health, College Park, MD, United States
| | - Amara Channell Doig
- Department of Behavioral and Community Health, University of Maryland School of Public Health, College Park, MD, United States
| | - Xiaohe Yue
- Department of Epidemiology and Biostatistics, University of Maryland School of Public Health, College Park, MD, United States
| | - Heran Mane
- Department of Epidemiology and Biostatistics, University of Maryland School of Public Health, College Park, MD, United States
| | - Neha Srikanth
- Department of Computer Science, University of Maryland Institute for Advanced Computer Studies, University of Maryland, College Park, MD, United States
| | - Francia Ximena Marin Gutierrez
- Department of Behavioral and Community Health, University of Maryland School of Public Health, College Park, MD, United States
| | - Nataly Delcid
- Department of Epidemiology and Biostatistics, University of Maryland School of Public Health, College Park, MD, United States
| | - Xin He
- Department of Epidemiology and Biostatistics, University of Maryland School of Public Health, College Park, MD, United States
| | - Jordan Boyd-Graber
- Department of Computer Science, University of Maryland Institute for Advanced Computer Studies, University of Maryland, College Park, MD, United States
| |
Collapse
|
2
|
Juarez Padilla J, Singleton CR, Pedersen CA, Lara-Cinisomo S. Associations between Self-Rated Health and Perinatal Depressive and Anxiety Symptoms among Latina Women. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph191911978. [PMID: 36231278 PMCID: PMC9565349 DOI: 10.3390/ijerph191911978] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 09/13/2022] [Accepted: 09/20/2022] [Indexed: 06/01/2023]
Abstract
PURPOSE The objective of this study was to determine whether decreases in or consistently low preconception to pregnancy self-rated health (SRH) were associated with perinatal depressive and anxiety symptoms among Latinas. METHODS This is a secondary data analysis of 153 perinatal Latinas. Three groups were created to capture SRH from preconception to pregnancy: a decline in ratings, consistently low, and good+ (i.e., good, very good, or excellent). SRH was measured using two questions about their perceived physical health before and during pregnancy. Depressive symptoms and anxiety symptoms were assessed in the third trimester and six weeks postpartum using the Edinburgh Postnatal Depression Scale and State-Trait Anxiety Inventory, respectively. Life stressors were assessed in pregnancy using a modified version of the Life Experiences Survey. Linear regressions tested the associations. RESULTS Women with consistently low (i.e., fair or poor) SRH reported significantly more prenatal depressive symptoms than women who reported consistently good+ SRH. Women who reported a decline in SRH to fair or poor reported more prenatal anxiety symptoms but decreased postpartum anxiety symptoms than women who reported consistently good+ ratings. Life stressors were positively associated with prenatal depressive and anxiety symptoms. CONCLUSIONS Healthcare practitioners should assess changes in SRH ratings to identify risks for prenatal depressive and anxiety symptoms among Latinas, who have elevated rates of depressive and anxiety symptoms compared to non-Hispanic White women. Policymakers should provide healthcare providers with mental health resources to support at-risk Latinas during the prenatal period.
Collapse
Affiliation(s)
- Janeth Juarez Padilla
- Division of Scholarship and Research, Columbia University School of Nursing, New York, NY 10032, USA
| | - Chelsea R. Singleton
- Department of Social, Behavioral, and Populations Sciences, Tulane School of Public Health and Tropical Medicine, New Orleans, LA 70112, USA
| | - Cort A. Pedersen
- Department of Psychiatry, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Sandraluz Lara-Cinisomo
- Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois Urbana-Champaign, Champaign, IL 61820, USA
| |
Collapse
|
3
|
Andreu‐Pejó L, Martínez‐Borba V, Osma López J, Suso‐Ribera C, Crespo Delgado E. Perinatal mental e-health: What is the profile of pregnant women interested in online assessment of their emotional state? Nurs Open 2022; 10:901-914. [PMID: 36068679 PMCID: PMC9834155 DOI: 10.1002/nop2.1358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 07/06/2022] [Accepted: 08/23/2022] [Indexed: 01/19/2023] Open
Abstract
AIM This study explores the profile of pregnant women interested in the online assessment of their emotional status according to their sociodemographic and obstetric characteristics, history of psychopathology, and healthcare setting used (private vs. public). DESIGN This is a comparative and descriptive cross-sectional study. METHOD Participants were 281 Spanish pregnant women assessed with the MamáFeliz (HappyMom) website. RESULTS Participants were probably to be unemployed, in a relationship, and generally had a high educational level and an intermediate economic status. Most of them were primiparous, had non-complicated natural pregnancies and presented healthy habits and good physical and emotional health, despite 31.3% of them had a history of psychological treatment. Our results reveal the profile of women interested in the online assessment of their emotional status, which can contribute to improving future initiatives to facilitate rapid screenings of perinatal mental health by nurses in both public and private settings.
Collapse
Affiliation(s)
- Laura Andreu‐Pejó
- Nursing DepartmentUniversity Jaume ICastellón de la PlanaSpain,Health Research Institute of AragonZaragozaSpain
| | - Verónica Martínez‐Borba
- Health Research Institute of AragonZaragozaSpain,Basic Psychology, Clinic and Psychobiology DepartmentUniversity Jaume ICastellón de la PlanaSpain
| | - Jorge Osma López
- Health Research Institute of AragonZaragozaSpain,Department of Psychology and SociologyUniversity of ZaragozaZaragozaSpain
| | - Carlos Suso‐Ribera
- Basic Psychology, Clinic and Psychobiology DepartmentUniversity Jaume ICastellón de la PlanaSpain
| | - Elena Crespo Delgado
- Health Research Institute of AragonZaragozaSpain,Basic Psychology, Clinic and Psychobiology DepartmentUniversity Jaume ICastellón de la PlanaSpain
| |
Collapse
|
4
|
Kazemi A, Dadkhah A. Changes in prenatal depression and anxiety levels in low risk pregnancy among Iranian women: A prospective study. Asia Pac Psychiatry 2022; 14:e12419. [PMID: 32875714 DOI: 10.1111/appy.12419] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 08/17/2020] [Indexed: 01/05/2023]
Abstract
INTRODUCTION Increasing of depression and anxiety in high risk pregnancy is well known but there is limited information on the changes of psychological symptoms in low risk pregnancies and the aim of the study was evaluation depression and anxiety changes in pregnant women with high risk pregnancy. METHODS This prospective study was performed on 256 pregnant women at the beginning of the first trimester of pregnancy. Inclusion criteria included the absence of pre-pregnancy depression and anxiety and poor pregnancy history. Exclusion criteria were the incidence of pregnancy complications. The level of their depression and anxiety at the time of entering the study were completed by self-report using the DASS questionnaire at 9-10, 11-12, 24-25, and 33-35 weeks of pregnancy. RESULTS The results of the study indicated that the effect of time on the level of perinatal depression and anxiety was significant (P < .001). These findings showed that the level of depression increased significantly from 9 to 24 weeks of pregnancy and decreased in the 32-34 weeks, but did not reach the level of depression at 9 weeks of pregnancy. Also, the anxiety level increased significantly from the onset of pregnancy to the 24 weeks gestation but did not change during the second and third trimesters. CONCLUSION The results of the study showed that the level of depression and anxiety of women in low risk pregnancies increase during pregnancy and psychological health screenings in the second trimester of pregnancy should be performed in pregnant women.
Collapse
Affiliation(s)
- Ashraf Kazemi
- Reproductive Health Department, Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Aazam Dadkhah
- Reproductive Health Department, Isfahan University of Medical Sciences, Isfahan, Iran
| |
Collapse
|
5
|
Anderson CA, Ruiz J. Depressive Symptoms Among Hispanic Adolescents and Effect on Neonatal Outcomes. HISPANIC HEALTH CARE INTERNATIONAL 2021; 20:25-32. [PMID: 33813920 DOI: 10.1177/15404153211003223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Hispanics have the highest birth rate among adolescents and may be vulnerable to experience depression. The purpose of this study was to explore the prevalence of perinatal depression and effects upon neonatal outcomes among Hispanic adolescents 13-19 years old. METHODS Available data from a previously conducted study examining the prevalence of adolescent depression and post-traumatic stress were used for the current secondary analysis. Perinatal data reflected a rating of prenatal depression and scores from the Edinburgh Postpartum Depression Scale (EPDS). Adverse infant outcomes included preterm birth, low birth weight, and neonatal complications. RESULTS Over 20% of adolescents reported an adverse infant outcome. About one third of adolescents reported perinatal depression: prenatally (14%) and postnatally (14% minor depression/12.7% major depression). Significant associations were found between EPDS scores, gestational age, and feelings during pregnancy; however, perinatal depression was not found to predict adverse infant outcomes. CONCLUSION Prenatally depressed adolescents are vulnerable to postpartum depression and if experience an adverse infant outcome, postpartum depression may be more likely reported. Therefore, prenatal- and afterbirth-focused assessments and care, including plans for follow-up, are essential.
Collapse
Affiliation(s)
- Cheryl Ann Anderson
- College of Nursing and Health Innovation, 12329The University of Texas at Arlington, TX, USA
| | - Jocelyn Ruiz
- The 12329TUniversity of Texas at Arlington, TX, USA
| |
Collapse
|
6
|
Molgora S, Fenaroli V, Saita E. Psychological distress profiles in expectant mothers: What is the association with pregnancy-related and relational variables? J Affect Disord 2020; 262:83-89. [PMID: 31715390 DOI: 10.1016/j.jad.2019.10.045] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 09/04/2019] [Accepted: 10/28/2019] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Research has progressively focused on antenatal psychological disease of expectant mothers, showing that anxiety and depression as well as fear of childbirth occur frequently during pregnancy. Some studies have investigated the connection between anxiety, depression, and fear of childbirth with contrasting results. Several authors have analyzed the association between psychological disease of pregnant women and numerous medical-obstetric and relational variables, still reporting inconclusive findings. The present study had three aims: 1) to investigate the psychological well-being of pregnant women based on their levels of anxiety, depression, and fear of childbirth, by identifying psychological profiles; (2) to analyze the association between the emergent psychological profiles and some medical-obstetric variables related to pregnancy; and (3) to examine the association between these profiles and couple's adjustment and social support. METHODS 410 Italian primiparous pregnant women in the 7th-8th month of pregnancy completed a questionnaire packet on site that included the following scales: Wijma Delivery Expectancy Questionnaire, Edinburgh Postnatal Depression Scale, State-Trait Anxiety Inventory, Dyadic Adjustment Scale, Multidimensional Scale of Perceived Social Support. RESULTS Findings revealed the presence of three different clusters: "psychologically healthy women" (34.9%), comprised of women characterized by low levels of symptoms on all the scales; "women experiencing pregnancy- and childbirth-related anxiety" (47.3%), which groups women with an average state anxiety over the clinical value; and "psychologically distressed women" (17.8%), comprised of women who reported high levels of symptoms on all the scales, some above the clinical cut-offs. These profiles were not related to the medical-obstetric variables. On the other hand, findings revealed a significant association between marital adjustment as well as social support and cluster membership. DISCUSSION These results support the importance of early and multilevel psychological screening in order to understand the experience of pregnant women and to develop targeted and increasingly personalized interventions.
Collapse
|
7
|
Muñoz RF, Pineda BS, Llamas JA. Indigeneity, diversity, and equity in Internet interventions: Could ISRII contribute to making health care a universal human right? Internet Interv 2019; 18:100269. [PMID: 31890622 PMCID: PMC6926266 DOI: 10.1016/j.invent.2019.100269] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Revised: 08/16/2019] [Accepted: 08/16/2019] [Indexed: 11/18/2022] Open
Abstract
This article is a partially revised version of a keynote address presented at the 10th Scientific Meeting of the International Society for Research on Internet Interventions (ISRII) in Auckland, New Zealand. It addresses six points: 1) the meanings of indigeneity, diversity, and equity, 2) the strong emotional reactions elicited by the inequities experienced by indigenous groups throughout the world, 3) the aspirations of members of ISRII in terms of what we would like our field to accomplish to address these inequities, 4) the United Nations goal of making health care a universal human right, 5) the difficulties encountered by other health sciences in attempting to include diverse populations into major studies, and 6) ways in which the Internet interventions and digital health field could include indigeneity, diversity, and equity in our work, and by doing so, contribute to the United Nations goal of making health care a universal human right. The authors suggest that providing access to health care to all people, no matter where they are on the socioeconomic continuum, is a key strategy to pursue. The field of Internet interventions could contribute by creating digital apothecaries that would develop, evaluate, and disseminate evidence-based Massive Open Online Interventions to anyone in the world who needs them.
Collapse
Affiliation(s)
- Ricardo F. Muñoz
- Institute for International Internet Interventions for Health (i4Health), Palo Alto University, Palo Alto, CA, USA
- University of California, San Francisco, USA
| | - Blanca S. Pineda
- Institute for International Internet Interventions for Health (i4Health), Palo Alto University, Palo Alto, CA, USA
| | - Jazmin A. Llamas
- Institute for International Internet Interventions for Health (i4Health), Palo Alto University, Palo Alto, CA, USA
| |
Collapse
|
8
|
Pellowski JA, Bengtson AM, Barnett W, DiClemente K, Koen N, Zar HJ, Stein DJ. Perinatal depression among mothers in a South African birth cohort study: Trajectories from pregnancy to 18 months postpartum. J Affect Disord 2019; 259:279-287. [PMID: 31454590 PMCID: PMC6851529 DOI: 10.1016/j.jad.2019.08.052] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 06/24/2019] [Accepted: 08/17/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND Perinatal depression affects 21-50% of women in South Africa and poses significant health risks to mothers and children. Trajectories of depressive symptoms change over time and have not been well characterized during the perinatal period in low and middle-income countries. METHODS Data from women enrolled in a population-based birth cohort study in Paarl, South Africa with at least 3 depression measures from pregnancy through 18 months postpartum (N = 831) were analyzed. Depressive symptoms were measured continuously using the Edinburgh Postnatal Depression Scale (EPDS). Group-based trajectory models were used to estimate trajectories of depressive symptoms during the perinatal period and multinomial multivariable models to identify predictors of trajectory group membership. RESULTS Five distinct trajectory patterns of depressive symptoms were identified: moderate levels of depressive symptoms during pregnancy but minimal postpartum (3.5%), minimal levels during pregnancy and increasing postpartum (3.7%), unstable levels peaking at 12 months postpartum (6.6%), mild levels with slight decrease postpartum (82.9%), and severe levels during pregnancy and postpartum (3.1%). Membership in the chronic severe symptom group was associated with stressful life events, sexual intimate partner violence and tobacco use. LIMITATIONS Modeling limitations prevented determining how changes in psychosocial predictors over time may influence depressive symptom trajectories. CONCLUSIONS Mild to severe depressive symptoms during pregnancy/postpartum were common among this South African cohort. Interventions to treat women with severe chronic depressive symptoms with co-occurring psychosocial issues are urgently needed.
Collapse
Affiliation(s)
- Jennifer A. Pellowski
- Department of Behavioral and Social Sciences, International Health Institute, Brown University School of Public Health, Providence, RI, USA,Corresponding author.
| | - Angela M. Bengtson
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Whitney Barnett
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital and South African Medical Research Council (SAMRC) Unit on Child & Adolescent Health, University of Cape Town, South Africa
| | - Kira DiClemente
- Department of Behavioral and Social Sciences, International Health Institute, Brown University School of Public Health, Providence, RI, USA
| | - Nastassja Koen
- Department of Psychiatry and Mental Health and South African Medical Research Council (SAMRC) Unit on Risk & Resilience in Mental Disorders, Neuroscience Institute, University of Cape Town, South Africa
| | - Heather J. Zar
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital and South African Medical Research Council (SAMRC) Unit on Child & Adolescent Health, University of Cape Town, South Africa
| | - Dan J. Stein
- Department of Psychiatry and Mental Health and South African Medical Research Council (SAMRC) Unit on Risk & Resilience in Mental Disorders, Neuroscience Institute, University of Cape Town, South Africa
| |
Collapse
|