Process evaluation of the development and remote recruitment for Essential Coaching for Every Mother during COVID-19

Background: With the sudden decrease in in-person support and increase in perinatal mental health concerns during the coronavirus pandemic, innovative strategies, such as mHealth, are more important than ever. This study has two objectives: (1) to describe the modification of Essential Coaching for Every Mother during the coronavirus pandemic, and (2) to describe the process evaluation of recruitment and retention of pregnant and postpartum women for a pre-post intervention study. Methods: For objective 1, modified messages were piloted with mothers and postpartum healthcare providers simultaneously. Semi-structured interviews were conducted with a subset of 10 participants from the original development study. For objective 2, three methods were used for recruitment: social media, posters in hospital, and media outreach. First time mothers were eligible for enrollment antenatally (37+ weeks) and postnatally (<3 weeks). Eligibility screening occurred remotely via text message with participants initiating contact. Data were collected via TextIt and REDCap. Outcomes were days to recruit 75 participants, eligibility vs. ineligibility rates, dropout and exclusion reasons, survey completion rates, perinatal timing of enrollment, and recruitment sources. Results: For objective 1, three mothers (M age=30.67 years) and seven healthcare providers (M age = 46.0 years) participated in the modification of the messages. Participants felt the messages were appropriate and relevant related to changes in postpartum care during the coronavirus pandemic. Nine messages were modified related to coronavirus and five messages were added to the program. For objective 2, recruitment ran July 15th-September 19th (67 days) with 200 screened and 88 enrolled, 70% antenatally. It took 50 days to enroll 75 participants. Mothers recruited antenatally (n=53) were more likely to receive all intervention message (68% vs. 19%). Mothers recruited postnatally (n=35) missed more messages on average (13.8 vs. 6.4). Participants heard about the study through family/friends (31%), news (20%), Facebook groups (16%), Facebook ads (14%), posters (12%), or other ways (7%). Conclusion: Antenatal recruitment resulted in participants enrolling earlier and receiving more of the study messages. Word of mouth and media outreach were successful, followed by advertisement on Facebook. Remote recruitment was a feasible way to recruit for Essential Coaching for Every Mother.