Engagement with Mental Health Screening on Mobile Devices - Results from an Antenatal Feasibility Study

Kevin Doherty
Kevin Doherty
José Marcano Belisario
José Marcano Belisario
Nikolaos Mastellos
Nikolaos Mastellos

CHI, pp. 1862019.

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Keywords:
ema mental health mobile devices pregnancy psychological wellbeingMore(2+)
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Examining the proportion of the study population1 who installed the app2 allows us to better understand the relationship between women’s demographic characteristics and their tendency to install a mobile app for the self-report of psychological wellbeing in pregnancy

Abstract:

Perinatal depression (PND) affects up to 15% of women within the United Kingdom and has a lasting impact on a woman's quality of life, birth outcomes and her child's development. Suicide is the leading cause of maternal mortality. However, it is estimated that at least 50% of PND cases go undiagnosed. This paper presents the results of th...More

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Introduction
  • Perinatal depression (PND) affects up to 15% of women during pregnancy or within one year of giving birth in the United Kingdom (UK) [5].
  • It is estimated that at least 50% of PND cases go undiagnosed [67, 83]
  • Women report that they refrain from initiating discussions with professionals about their mental health, or provide inaccurate responses to screening scales, due to discomfort, stigma and uncertainty around the expected emotional experience of pregnancy [16, 39]
Highlights
  • Perinatal depression (PND) affects up to 15% of women during pregnancy or within one year of giving birth in the United Kingdom (UK) [5]
  • This paper presents the results of the first feasibility study to examine the potential of mobile devices to engage women in antenatal mental health screening
  • In the context of the United Kingdom’s National Health Service (NHS), mental health screening in pregnancy is currently carried out verbally and using paper based questionnaires completed in waiting rooms. 96% of United Kingdom midwives report asking women about their mental wellbeing at their first appointment [12]
  • This study involved the deployment of a technology, comprising mobile applications (Android & iOS) and a server for data storage, management and alert handling, within a public health service. This system, BrightSelf, was developed in collaboration with pregnant women, mothers and a variety of health professionals including midwives [7, 21]. This mobile application provides a platform for the self-report of psychological wellbeing in pregnancy, including retrospective reports in the form of the Edinburgh Postnatal Depression Scale (EPDS), and momentary reports in the form of visual analogue scales for mood, sleep, worry, enjoyment and energy as well as two questions concerning location and activity context (See Appendix A for video of the mobile app in use)
  • This paper examines women’s engagement with a mobile application for the self-report of wellbeing and depression in pregnancy
  • Perinatal depression (PND) affects up to 15% of women within the United Kingdom and has a lasting impact on a woman’s quality of life, birth outcomes and her child’s development
  • Examining the proportion of the study population1 who installed the app2 allows us to better understand the relationship between women’s demographic characteristics and their tendency to install a mobile app for the self-report of psychological wellbeing in pregnancy
Methods
  • The Study Aims

    The primary aim of this study was to assess the feasibility of a mobile application running on women’s own devices for the repeated and longitudinal self-report of antenatal mood and depression.
  • Secondary aims included comparing two distinct time-based sampling protocol designs, collecting momentary and retrospective reports of wellbeing in daily life, and examining the role of mobile devices as a means to address barriers to antenatal mental health screening.
  • This study involved the deployment of a technology, comprising mobile applications (Android & iOS) and a server for data storage, management and alert handling, within a public health service
  • This system, BrightSelf, was developed in collaboration with pregnant women, mothers and a variety of health professionals including midwives [7, 21].
  • Additional features of the application include interactive visualisations of users’ data, information regarding perinatal wellbeing and the study itself, contacts
Results
  • This paper examines women’s engagement with a mobile application for the self-report of wellbeing and depression in pregnancy.

    The Study Population

    Between April and September 2017, midwives at 14 NHS midwifery clinics across England recruited women to a study involving BrightSelf.
  • This paper examines women’s engagement with a mobile application for the self-report of wellbeing and depression in pregnancy.
  • Of the 355 women who consented to participate, 254 subsequently installed the app.
  • App Installation by Population & Wellbeing.
  • Examining the proportion of the study population1 who installed the app2 allows them to better understand the relationship between women’s demographic characteristics and their tendency to install a mobile app for the self-report of psychological wellbeing in pregnancy
Conclusion
  • This paper presents initial evidence for the feasibility of deploying mobile devices in antenatal mental health screening.

    Engaging Patients in Self-Report

    The feasibility of self-report technologies hinges in large part upon the engagement of users [10, 17, 18, 85].
  • Extending Care to Under-Served and At-Risk GroupsThis paper contributes initial evidence for the appropriate design and feasibility of mobile applications to engage women in the self-report of wellbeing and depression during pregnancy, extend care to under-served and at-risk populations, enable longitudinal, momentary and retrospective data collection, overcome stigma, support disclosure, and foster trust between patients and health professionals
Summary
  • Introduction:

    Perinatal depression (PND) affects up to 15% of women during pregnancy or within one year of giving birth in the United Kingdom (UK) [5].
  • It is estimated that at least 50% of PND cases go undiagnosed [67, 83]
  • Women report that they refrain from initiating discussions with professionals about their mental health, or provide inaccurate responses to screening scales, due to discomfort, stigma and uncertainty around the expected emotional experience of pregnancy [16, 39]
  • Methods:

    The Study Aims

    The primary aim of this study was to assess the feasibility of a mobile application running on women’s own devices for the repeated and longitudinal self-report of antenatal mood and depression.
  • Secondary aims included comparing two distinct time-based sampling protocol designs, collecting momentary and retrospective reports of wellbeing in daily life, and examining the role of mobile devices as a means to address barriers to antenatal mental health screening.
  • This study involved the deployment of a technology, comprising mobile applications (Android & iOS) and a server for data storage, management and alert handling, within a public health service
  • This system, BrightSelf, was developed in collaboration with pregnant women, mothers and a variety of health professionals including midwives [7, 21].
  • Additional features of the application include interactive visualisations of users’ data, information regarding perinatal wellbeing and the study itself, contacts
  • Results:

    This paper examines women’s engagement with a mobile application for the self-report of wellbeing and depression in pregnancy.

    The Study Population

    Between April and September 2017, midwives at 14 NHS midwifery clinics across England recruited women to a study involving BrightSelf.
  • This paper examines women’s engagement with a mobile application for the self-report of wellbeing and depression in pregnancy.
  • Of the 355 women who consented to participate, 254 subsequently installed the app.
  • App Installation by Population & Wellbeing.
  • Examining the proportion of the study population1 who installed the app2 allows them to better understand the relationship between women’s demographic characteristics and their tendency to install a mobile app for the self-report of psychological wellbeing in pregnancy
  • Conclusion:

    This paper presents initial evidence for the feasibility of deploying mobile devices in antenatal mental health screening.

    Engaging Patients in Self-Report

    The feasibility of self-report technologies hinges in large part upon the engagement of users [10, 17, 18, 85].
  • Extending Care to Under-Served and At-Risk GroupsThis paper contributes initial evidence for the appropriate design and feasibility of mobile applications to engage women in the self-report of wellbeing and depression during pregnancy, extend care to under-served and at-risk populations, enable longitudinal, momentary and retrospective data collection, overcome stigma, support disclosure, and foster trust between patients and health professionals
Tables
  • Table1: Reporting by Arm of 2,686 sessions with an average length of 1 minute and 24 seconds. Ancillary usage data allows us to examine exactly how women spent their time. Use of each of the main sections of the app was largely consistent over time, including time spent viewing data, accessing information and interacting with the Ideas Machine
Download tables as Excel
Related work
  • Mobile Technologies for Perinatal Wellbeing

    Mobile devices have long been thought to possess the potential to transform research, clinical practice and wellbeing at a population scale [6, 24, 46, 76, 91]. Millions of women have installed thousands of mobile applications in the hope of supporting a healthy start to life. The majority of these technologies have been designed to communicate healthrelated information to parents [86]. HCI researchers have developed prototype applications for Dutch (Babywijzer), Pakistani (Baby+), and Vietnamese Australian (We-HELP)

    populations [70, 78, 92], deployed SMS-based systems for personalised health information communication in Kenya and Pakistan [8, 63] and conducted qualitative analyses of pregnant women’s motivations for information sharing and support seeking online [29, 43, 65]. Peyton et al propose a ‘pregnancy ecology,’ comprising physical, emotional, informational and social supports, to support the design of physical health interventions [64], which Prabhakar et al extend to include support needs, sources, and interventions within an Evolving Ecology of Support [66].

    Researchers have also explored the design of prototype technologies for health data tracking in pregnancy, including nutrition, hydration, activity, weight and mood (Bloom) [90], nausea and vomiting (Dot-it) [47], and physiological data (Nuwa) [27]. Other perinatal research has examined women’s motivations with respect to menstrual tracking applications [26] and the disclosure of pregnancy loss on social networks [3], the prediction of postnatal depression from survey data [59], the use of twitter to track developmental milestones in young children [82], and the design of applications for monitoring the health of preterm babies (Estrellita) [30], sharing infant activity data with friends and family (MammiBelli) [36], and to support breast-milk donation (Milk Matters) [89].
Funding
  • This research is supported by Science Foundation Ireland through Grant 12/CE/I2267 to the Adapt Centre and a National Institute for Health Research (NIHR) Imperial Biomedical Research Centre award through the Population Health Theme
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