Exploring Multiple Stakeholder Perspectives of Tailoring Technology-Assisted, Entertaining CBT-Based Depression Treatment for Perinatal People Served By Head Start

Background: Perinatal depression (PND) is common, with 10-15% of pregnant and postpartum Americans experiencing PND. Despite high PND prevalence, perinatal people have limited access to mental health services. Barriers to treatment are exacerbated in under-resourced, rural communities. Technology-assisted depression interventions have great potential for increasing access to care; however, currently available interventions typically cannot be tailored without substantial time and cost. Treatment tailoring is critical to increasing client engagement and improving outcomes. This study explored multiple stakeholder perspectives of a technology-assisted, entertaining, cognitive behavioral therapy-based (CBT) depression treatment program to identify tailoring needed to increase treatment acceptability among clients with PND served by a rural Michigan Head Start program.

Methods: Stakeholders, including Head Start clients, staff, administrators, and parent advocates, were invited to participate in six focus group sessions held between June and October 2022. Stakeholders reviewed the general version of the technology-assisted, entertaining, evidence-based depression treatment and were asked to: 1) share their perspectives of and reactions to the program, 2) identify gaps in content, and 3) provide feedback on visual and text-based program content. Social work researchers facilitated focus group sessions. A masters-level research associate took field notes during focus groups. Field notes were reviewed by facilitators for consensus. Thematic analysis of field notes was conducted by two independent coders to identify patterns and themes related to tailoring needs for this population and setting.

Results: Two core themes were identified: 1) connection between treatment and clients’ lived experience and 2) power of positive affirmations and motivational statements. Stakeholders identified the need for intervention content to reflect their lived experiences. Stakeholders consistently discussed their desire for the treatment to include content depicting multigenerational families, diverse family structures, and families with multiple children. As the program was originally developed for general adult depression, stakeholders commonly discussed the need to incorporate content, including quotes, educational content, vignettes, and examples, specific to the perinatal period, as well as the experience of having children at different developmental stages. Stakeholders also clearly shared their desire for the treatment to include positive affirmations and motivational statements. Stakeholders described the power of reminding participants to give themselves credit for what they are accomplishing, their value as a person with many identities (not just mother/parent), and the importance of their own mental health needs. Stakeholders talked about the perinatal period being difficult, with many people feeling inadequate and a loss of self. Incorporating affirmations and motivational statements was viewed as a way to empower people to continue engaging with treatment and communicate that it is OK to prioritize their own needs.

Conclusions: Our findings reinforce research suggesting tailoring treatment is essential to enhancing engagement. This innovative collaboration with multiple stakeholders resulted in tailoring a depression treatment to maximize relevance and acceptability for underserved perinatal people. Future research testing the tailored treatment among perinatal Head Start clients is needed. Results also suggest the importance of developing flexible, technology-assisted treatments that allow for low-cost, efficient tailoring for client groups, settings, and contexts, while retaining core, evidence-based content.