Reaching perinatal women all around the world: The Mothers and Babies Internet Project

Article from the June 2014 Edition of Global Mental Health Newsletter

As part of her research program, PAU faculty member, Alinne Barrera, Ph.D., is focused on reducing mental health disparities among women with an emphasis on Spanish-speaking populations and perinatal women around the world. While at the University of California, San Francisco (UCSF) / San Francisco General Hospital (SFGH), Dr. Barrera was funded by an NIMH Individual Postdoctoral Fellowship Award (2007-2009) to design and test a web-adapted prevention of postpartum depression (PPD) intervention, the Mothers and Babies Course/Curso Mamás y Bebés (Muñoz et al., 2001). Dr. Barrera was initially focused on

a) learning whether a fully automated, online version of the intervention would interest pregnant women and
b) examining the efficacy of the web-adapted intervention in reducing PPD risk.

The Mothers and Babies/Mamás y Bebés Internet Project was launched in 2009 as an English and Spanish-language randomzed controlled trial (RCT). During the 3.5 years the site was actively recruiting, it attracted 176,295 Internet users from 183 countries and territories. Of these, 6,745 pregnant women consented to participate and 2,575 completed enrollment procedures (Barrera et al., 2014).

Thus, Dr. Barrera's first question was answered: Yes, pregnant women were interested in online resources focused on managing mood changes during the perinatal months. Given the global reach of the study, Dr. Barrera also determined that women, especially Spanish-speaking women, from all around the world were in greater need of online maternal mental health resources. Spanish-speaking participants represented 78% of the sample and resided in Latin America and Spain. It should be noted that the English-speaking sample was equally diverse, with a majority of participants residing in India, South Africa, Pakistan, and the United Kingdom. Preliminary findings comparing the two conditions demonstrated a strong prevention effect for women who reported higher levels of depression during the prenatal months and who viewed the web-adapted intervention. Therefore, Dr. Barrera's second question was also answered: Yes, the web-adapted intervention could reduce the risk of PPD, especially among women already experiencing depression during pregnancy.

Engaging participants in the RCT website proved to be a challenge. Dr. Barrera along with Ph.D. graduate students are currently working on the redesign of the study website with an emphasis on improving participant engagement and retenttion. To this end, Dr. Barrera recently completed a follow-up study where a subsample of the participants in the RCT provided feedback on the structure, design, and content of the web-adapted intervention. Additionally, participants were asked to provide information relevant to women in their communities (e. g., " What do mothers in your region of the world like to do with their babies?") and to express their interest in new content (e. g., " Would you be interested in learning how to be more compassionate?").
In collaboration with colleagues at George Washington University in D.C. and the University of Zaragoza in Spain, Dr. Barrera and her students are gearing up to launch an online study aimed at identifying psychological and sociocultural factors relevant to perinatal women. These data will inform several new projects, including the next version of the Mothers and Babies/Mamás y Bebés Internet Project, as well as student dissertations.

What began as a small pilot RCT has now expanded to a global maternal mental health research program focused on using technology as a vehicle to educate and support perinatal women. Although there are already multiple websites dedicated to perinatal issues, fewer provide reliable and accurate information, or are culturally relevant to international communities of women. Dr. Barrera's goal is to provide all women the opportunity to learn how to recognize and manage changes in their mood during and after pregnancy with the long-term goal of fostering a healthier and happier life for mothers and their newborn babies. Dr. Barrera joined the PAU Faculty in the fall of 2009. She is an Assistant Professor and Associate Director of Clinical Training in the Ph.D. Clinical Psychology Program, and Associate Director of the PAU Institute for International Internet Interventions for Health (i4Health). For more information about Dr. Barrera's research program, contact her directly at abarrera@paloaltou.edu