Perinatal WIC Client Perceptions of a Technology-Assisted, Entertaining, Evidence-Based Depression Treatment Program Tailored for Perinatal People

Background: Rural Americans experience higher rates of perinatal depression (PND) compared to non-rural peers, yet are less likely to access treatment. Barriers to care include limited local mental health providers and accessibility challenges (cost, transportation). Rural residents often find available treatment unacceptable due to stigma, lack of anonymity, and preference for informal providers. To address these disparities, we must build capacity for care within non-mental health settings and leverage technology. This study explores treatment experiences of rural Special Supplemental Nutrition Program for Women, Infants, & Children (WIC) clients with PND who were offered and participated in a technology-assisted, entertaining, cognitive behavioral-based PND treatment, Moms & Babies Feeling Better Together (MBFBT). MBFBT includes 8 online sessions completed independently, an accompanying workbook for in-session activities/homework, and brief (5-10 min.) phone-based weekly check-ins with research staff.

Methods: Perinatal clients at one rural Michigan WIC clinic who screened positive for depression, were enrolled in a pilot study between March 2021 and September 2022. Those who completed at least one MBFBT session were invited to participate in a qualitative interview about their treatment experience. Masters-level research associates conducted qualitative interviews via Zoom at the post-treatment assessment. Interviews were recorded with participants’ permission and transcribed verbatim. Two independent coders followed Strauss and Corbin’s (1990) procedures for thematic analysis of interview data.

Results: Nineteen WIC clients enrolled in the pilot study and completed at least one MBFBT session. Twelve participants were retained for post-treatment assessment (63.2%) and invited to complete an interview about their treatment experience. Seven participants (58.3%) completed interviews. Four core themes emerged: 1) program flexibility; 2) relatability of entertaining storyline; 3) built-in accountability; and 4) suggested improvements. Participants consistently shared that program flexibility allowed them to complete sessions asynchronously. This flexibility made the treatment feasible for their busy lives, which often included employment and caregiving responsibilities. Participants also consistently discussed the relatability of the entertaining, animated, character-driven storyline noting that the storyline created a personal connection to program content, explaining that they felt invested in the character and wanted to see how she would handle challenges. Participants discussed their appreciation for accountability elements built into MBFBT, including workbook activities/homework and weekly check-ins and shared that workbook activities/homework helped them meet their goals, whereas weekly check-ins increased their motivation to complete the program. Finally, participants offered areas for program improvement, most consistently suggesting their desire for the character featured in MBFBT to experience pregnancy and/or have a baby. Other suggested improvements included additional sessions, in-person check-ins, and more workbook activities.

Conclusion: MBFBT offers a potentially acceptable treatment option for perinatal WIC clients and may present a promising model for increasing access to care in rural areas. Participants’ experiences indicate that MBFBT fit into their lifestyle, was relevant to personal experiences, and provided motivation to meet their goals. Results suggest the need to further enhance program acceptability through a storyline featuring a pregnant or postpartum character. More research with larger samples and multiple stakeholders is needed.