Exploring the postnatal care experience & the opportunity of mHealth to improve psychosocial outcomes: The development of Essential Coaching for Every Mother
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Introduction: After birth, some women struggle with low self-efficacy and social support and higher rates of anxiety and depression. Some women also find this a challenging time to access quality information and support. Mobile health (mHealth) interventions, particularly text messaging, holds significant promise in bridging this gap. Yet little is known about the Canadian postpartum experience. The purpose of this research is to explore (1) mothers’ postpartum psychosocial adjustment in the Maritime provinces and (2) the opportunity to improve maternal psychosocial outcomes through mHealth technology. Methods: This dissertation contains four studies. Manuscript 1 and 2 emerge from a mixed methods online survey with 561 postpartum women across the Maritime provinces. Manuscript 3 is a Joanna Briggs Institute systematic review to synthesize available information on mother-targeted mHealth interventions in the perinatal period. Manuscript 4 used an iterative design with 11 women and 18 healthcare providers to guide the development of Essential Coaching for Every Mother. Results: While many women in the Maritimes experienced satisfactory postpartum care, there were areas where women reported dissatisfaction and facing challenges. Primiparous women had lower self-efficacy and higher postpartum anxiety than multiparous women. Women with older infants (4-6 months) had lower perceived social support and higher levels of postpartum anxiety and postpartum depression than women with younger infants (0-3 months). While outcomes of mHealth interventions on anxiety, social support, and self-efficacy was predominantly inconclusive, mHealth interventions that targeted postpartum depression had a significant positive impact for women who received the intervention. After three rounds of iterative interviewing, 58 messages for Essential Coaching for Every Mother were developed that focused on well-baby and well-mother care. Conclusions: This dissertation addressed a critical gap in the literature that links postpartum care experience and postpartum psychosocial adjustment and the opportunity of mHealth to address these challenges. With the development of Essential Coaching for Every Mother, the hope is to assist women in their postpartum transition through the development of an evidence-based postpartum text message program designed to improve women’s self-efficacy, social support, postpartum anxiety, and postpartum depression during the first six-weeks postpartum.