Anxiety, Postpartum Depression
Conditions
Keywords
online, postpartum depression, Coparenting relationship
Brief summary
The goal of this pilot randomized controlled trial was to examine the feasibility and acceptability of an ehealth antenatal coparenting intervention (eACoP) in primiparous Pakistani women. The secondary purpose of the study was to see the effectives of the intervention in prevention postpartum depression in women. Two hundred and twelve primiparous couples were randomized into an intervention or a control group from the Aga Khan University Hospital. Couples were randomized using consecutively numbered sealed envelopes. Couples in the intervention group received the eACoP intervention during pregnancy, consist of eight online videos in addition to the standard care provided at the center. Both the intervention group and control group received standard care.
Interventions
BEHAVIORALeHealth Antenatal Coparenting Intervention
This intervention focuses on developing conflict management, problem solving, communication, and mutual support to foster positive joint parenting of an infant. A modification in the delivery of this intervention was made in the current study in order to make it deliver online. The eACoP intervention included eight antenatal videos from Feinberg's Family Foundation intervention. A website for the eACoP intervention was developed, and all the videos were uploaded to the website. These videos were 30-40 minutes each. The videos were in English and subtitles in Urdu were added to the videos. These videos were accompanied by an activity-based coparenting workbook. The coparenting workbook includes a worksheet and homework for each video and was also translated into Urdu
Sponsors
University of Toronto
Brock University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
QUADRUPLE (Subject, Caregiver, Investigator, Outcomes Assessor)
Intervention model description
coparenting framework: it has 3 levels. First is the individual level, which consists of the parent's individual characteristics, which comprises of attitudes, parental beliefs, and emotional and mental health. It has a bidirectional relationship with coparenting and the overall inter-parental relationship. Individual child factors, such as temperament may also play a role in shaping the coparenting relationship. The second level is the family level. It comprises the overall interpersonal relationship, referring to the existing ability of couples to demonstrate support and respect for each other. It could influence the coparental relationship or in reverse, the coparental relationship may influence the overall inter-parental relationship. The third level is the extra-familial level. It has two components: support and stress that are based on a stress-coping perspective. The role of environmental support is viewed as enhancing the coparenting relationship
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
* primiparous * Both women and their partners willing to participate and indicated by signed consent * Up to 24 weeks of gestation (first and second trimester of pregnancy) * Singleton pregnancy * Able to speak, read, and understand English or Urdu * Have access to internet
Exclusion criteria
* Did not have access to internet * Had an EPDS score of \>12.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| feasibility-recruitment rate, adherence, and follow-up rate | recruitment-at the time of recruitment during pregnancy pre intervention, adherence rate-during the intervention, follow up rate- 6 weeks and 12 weeks after the delivery of an infant | feasibility refers to how well the eACoP intervention was implemented. It included recruitment rate, adherence, and follow-up rate. The recruitment log was completed to assess the recruitment rate by the Research Assistant (RA) at the time of recruitment and used to determine a) eligibility rate; b) enrollment rate; c) refusal rates; and d) reasons for non-participation. The eligibility rate was defined as the percentage of screened people who met eligibility criteria. The enrollment rate was defined as the percentage of eligible couples who consented to take part in the study. The intervention Activity Log was completed by the RA weekly by telephone to assess the adherence rate and used to determine a) compliance with intervention material and reasons for non-compliance; and b) completion of workbook and reasons for not completion. The non-compliance form was used to assess reasons for non-compliance. The follow-up rate recorded on follow-up log |
| Acceptability- Participants satisfaction | immediately after the intervention | It is a 14-item self-report questionnaire designed to measure an individual's satisfaction with an intervention which also included four open ended questions. Higher scores indicate higher levels of satisfaction. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Coparenting Relationship | baseline, 4-6 weeks and 12-weeks postpartum | The Coparenting Relationship Scale (CRS) was used to measure coparental quality in couples. The CRS is a thirty-five item self-report questionnaire, consisting of seven subscales. It has good reliability and strong stability with Cronbach's alphas ranging from 0.91 to 0.94 across genders. Each item is scored on a seven-point Likert scale from that is not true of us (score 0) to very true of us (score 6). Six of the scales are scored on the same Likert scale except exposure to conflict scale which is scored on six-point Likert scale from never (score 0) to several times a week (score 6). The CRS tool is in English and was translated into Urdu. The Urdu version was back translated into English. the pilot testing of the tool was done with ten pregnant couples from a community Health Center (CHC), an out-patient clinic at the Aga Khan University Hospital (AKUH), were asked to complete the scale. |
| Relationship Satisfaction- couple relationship satisfaction to discriminate between distressed and non-distressed relationship. | baseline, 4-6 weeks and 12-weeks postpartum | The Revised Dyadic Adjustment Scale (RDAS) was used to measure couple relationship satisfaction and discriminate between distressed and non-distressed relationship. The RDAS has 14 items, each of which asks the respondents to rate certain aspects of their relationship on a six-point Likert scale. Only one question Do you and your mate engage in outside interests together? ask the respondents to rate on a five-point Likert scale. Scores on the RDAS range from 0 to 69 with higher scores indicating greater relationship satisfaction and lower scores indicating greater relationship distress. The cut-off score for the RDAS was ≥ 48 such that scores of 48 and above indicate non-distress and scores of 47 and below indicates relationship distress. Cronbach's alpha for the RDAS is 0.90. The RDAS has been used in the postpartum population in previous studies. |
| Depressive Symptoms | baseline, 4-6 weeks and 12-weeks postpartum | Edinburgh Postnatal Depression Scale (EPDS) is a 10-item self-report measure, asking about the depressive symptomatology during the past week. It is a reliable and valid instrument with a sensitivity of 85% and specificity of 77%. The sensitivity of the Urdu version is 98%. Each item is scored on a four-point scale with a total score ranges from 0-30. The minimum is 0 and the maximum total score is 30. Couples who score greater than twelve are likely to be suffering from depressive symptomatology. |
| Infant Development | 12 weel postpartum | The Ages and Stages Questionnaire (ASQ-3) was used to identify infants at risk of delays in development at communication, gross motor, fine motor, problem solving, and personal-social domains at 12-week postpartum. The ASQ-3 is comprised of 30 age-appropriate questions to which parents respond with three categories: yes (10 points), sometimes (5 points), and not yet (0 points). Scores for each area range from 0 to 60 with higher scores indicating lower risk of delays in overall development. It is a reliable and valid instrument with a sensitivity and specificity of 87.4% and 95.7% respectively |
| partner support | baseline and 12 weeks postpartum | The Postpartum Partner Support Scale (PPSS) is a new instrument, which was used to measure postpartum partner support in couples. The PPSS tool is a twenty-item self-report, asking about the partner support during the past four weeks. Each item is scored on a four-point Likert scale; 1 = Strongly Disagree to 4 = Strongly Agree. Higher scores are indicative of a more positive partner support. The Cronbach's alpha for the PPSS is 0.96. The PPSS tool is available in English and was translated into Urdu. |
| Postpartum Childcare Stress | 12-weeks postpartum | The Postpartum Childcare Stress Checklist (PCSC) was used to identify parental perceptions of childcare stress. The PCSC has 19 items, asking the participants to rate their experience of events mentioned in the items over the past 4 weeks. Each item is rated as yes or (1) or No or (2). The PCSC explores the participant's experience related to the relationship with the partner, caring for the infant, social interactions, and establishing a new routine. Scores on the PCSC range from 1 to 19 with higher scores indicating lower childcare stress and lower scores indicating greater childcare stress. The PCSC had internal consistency of 0.81 (Dennis et al., 2018). The PCSC tool is available in English and was translated into Urdu. The Urdu version was back translated into English. The tool has not been used in Pakistan and has not been tested for reliability and validity for this population |
| anxiety | baseline, 4-6 weeks and 12-weeks postpartum | The State-Trait Anxiety Inventory (STAI) is a twenty item self-report questionnaire with each item scored on a four-point Likert scale; 1 = not at all to 4 = very much so, with a total score ranging from 20 to 80. Couples who score \> 40 are likely to be suffering symptoms of anxiety. Internal consistency of the STAI-S ranges from 0.91 to 0.95. The coefficient alpha of the Urdu version was 0.87. |
Countries
Pakistan
Outcome results
None listed