Development of Postnatal Mobile Support Application
Condition: Postpartum Depression; Postnatal Complication; Nurse's Role
MeSH terms: Depression, Postpartum; Depression; Depressive Disorder
Study type: Interventional

Summary: 
      A mobile support application will be developed that will support mothers in the postpartum
      period and will be tested the effects of application on anxiety and depression symptoms.The
      study will consist of two phases. The first phase of the action research (participant design
      method) method will be done to provide postpartum mobile support application. In the second
      stage, postpartum mobile support application will be evaluated for the anxiety and depression
      symptoms of the mothers after six weeks of use.
    

Detailed description: 
      The postpartum period is a critical period as it is a unique milestone for many of the
      important physical, emotional and social changes for parents and newborns (Nilsson, Danbjorg,
      Larsen, Clemensen, & Kronborg, 2015). In this period, the mother can have problems such as
      bleeding, infection, pain, breast problems and fatigue. In addition, adaptation to the
      parenting role, eventual difficulties in adaptating this role and efforts to care for the
      newborn can reduce the quality of life (WHO, 2012). At the beginning of the postpartum
      period, mothers need education and support in many subjects such as parenting, baby care,
      breastfeeding and relevant information and effective care (Ellberg, Hogberg, & Lindh, 2010).
      The World Health Organization (WHO) also emphasizes the need in the postpartum period
      suggesting that breastfeeding should be supported, nutrition provided, baby development
      monitored and family care needs met (WHO, 2013; WHO, 1998).

      In recent years, research has shown that postpartum women use information and communication
      technologies more and more frequently (Gibson & Hanson, 2013) to seek health information
      (Walker, Im, & Vaughan, 2012). It has been shown that tele-applications for supporting and
      directing parents in the postnatal period are useful in the transition to parenting in
      studies from Sweden and Denmark (Lindberg, Christensson, & Öhrling, 2009; Danbjorg, Wagner, &
      Clemensen, 2014b). Mobile applications providing information on pregnancy health during the
      prenatal period are widely used (Kennelly, Ainscough, Lindsay, Gibney, McCarthy, & McAuliffe,
      2016). It has been shown that it may be possible to meet the support needs of parents by
      applying innovative communication methods such as online communication at an evidence-based
      knowledge base. Parents saw the phone application as an informative and navigational
      lifestyle. Meeting new parents' information needs with chats, knowledge based and automatic
      messages makes them feel safe and increases their self-sufficiency (Danbjorg, Wagner, &
      Clemensen, 2014a; Danbjorg, Wagner, & Clemensen, 2014b; Danbjorg, Wagner, Kristensen, &
      Clemensen , 2015). It is not possible for nurses to be at their mother's side anytime during
      the whole postpartum period. It is not possible to give all the necessary information without
      leaving the hospital and transfer the information to practice on the mother's side.

      In postpartum period, care needs are increasing so that parents can adapt to their new roles
      and give effective care to the newborn. It is very important for the mothers to manage this
      period effectively for their future well-being and relations (Nilsson et. al. 2015). Studies
      show that mothers and fathers do not get enough postnatal care, do not feel confident with
      the information they have and feel insecure about what they will do.It is important for
      parents to feel secure in the postpartum period which in turn will have postive effects on
      the baby´s health and wellbeing (Danbjorg, Wagner, Kristensen, & Clemensen, 2015; Persson,
      Fridlund, Kvist, & Dykes, 2011).

      Security is defined to feel safe, to be ready, to be satisfied, to feel good and to be sure
      (Löf et al. 2006, Forster et al 2008, Lindberg et al 2009). Insecurity is a predominant
      emotion for parents and is characterized by unpredictablity, uncertainity, stress, anxiety,
      fear, suspicion, feelings of loneliness and despair (George 2005, Forster et al 2008,
      Hjalmhult and Lomborg 2012). Insecurity is associated with lack of knowledge and skills
      experienced by parents in newborn care (George 2005, Forster et al 2008, McLachlan et al.
      2009). Parents that feel they can manage the baby wellness have sense of security (Löf et al.
      2006). They feel safe when they know about the needs of their newborn and aware that they,
      the parents, are in control of their newborns health (Persson & Dykes 2002). Parents sense of
      security was associated with the strengthening behaviors they received from health
      professionals; unity within the family - closeness; autonomy; the mother's physical
      well-being and the involvement of the father during the birth and the postpartum period
      (Persson & Dykes, 2002; Persson, Fridlund, & Dykes, 2007; Persson & Dykes, 2009; Persson,
      Fridlund, Kvist, & Dykes, 2011; Persson, Fridlund, Kvist, & Dykes, 2012).

      The postpartum period is a transitional period in which mixed emotions dominate the whole
      family. In this period, physical symptoms, sleep deprivation, changing demands in work and
      home life are usually stressful and wearing. Additionally stress anxiety symptomatology has a
      positive relationship in susceptible people (Moran, Polanin, & Wenzel, 2014). Anxiety usually
      manifests itself as extreme and persistent fear, anxiety, tension and regularly includes
      physical symptoms such as sleeping difficulties and lack of focus (Dennis, Falah-Hassani,
      Brown, & Vigod, 2016). In studies, the anxiety prevalence rates of mothers during the first
      postpartum year vary between 2% and 45% (Enatescu, et al., 2014; Martini, et al., 2013).
      Unfortunately, there is increasing evidence that postpartum anxiety affects maternal and
      infant health negatively. Fatigue, loss of self-esteem and bad body sensations were seen in
      women who had postpartum anxiety. A deterioration in mother-infant interaction and in sleep
      patterns, excessive crying and also a deterioration in social relationships was shown. As
      anxiety acts as a trigger for development of depression, depression is often accompanied by
      anxiety symptoms (Dennis, Falah-Hassani, Brown, & Vigod, 2016). Depression is a common mental
      disorder characterized by depressed mood, loss of interest and enjoyment, reduced energy,
      guilt, low self-esteem, sleep disturbances, decreased appetite and problems in focusing.
      Depression is a very important health problem for all ages and genders around the world.The
      World Health Organization (WHO) states that by 2020, depression will contribute to 5.7% of
      the total illness burden. Depression is the most common type of disease in women (WHO, 2010).
      For many women, postpartum depression (PPD) usually occurs within the first 12 weeks after
      birth (Dennis & Dowswell, 2013). PPD is characterized by symptoms consistent with major
      depressive disorders, bipolar disorders or brief psychotic disorders occurring within 4 weeks
      of birth (American Psychiatric Association 2013). The symptoms associated with PPD are
      hopelessness, worthlessness, feelings of guilt, dissatisfaction with one's activities,
      difficulty in sleeping and concentration and decision-making problems (Gross & Marcussen,
      2017). Depressive symptoms in the early postpartum period vary between 5% to 20% in mothers
      (Patel, Baiely, Jabeen, Ali, Barker, & Osiezagha, 2012; Kerstis, Berglund, Engström, Edlund,
      Sylven, & Aarts, 2014; O'Hara & McCabe). Dissatisfaction with marriage, antenatal life
      events, past depressive symptoms, late antenatal depressive symptoms, lack of social support,
      stressful life events and marital conflicts were identified as potential risk factors for PPD
      (Dennis, Brown & Morrell, 2016). PPDnegatively affects women's quality of life, close
      relationships, maternal-infant interactions and infantile and school-age child development
      outcomes. Early diagnosis and intervention is essential to ensure optimal care for mothers,
      children and families when short and long term sequels of PPD are considered (McDonald, et
      al., 2012).

      Reducing feelings of loneliness and being lonely, preventing incompatible health behaviors or
      reactions, increasing individual motivation, providing access to medical services or
      providing information about benefits, directly affects the development of PPD by supporting
      health and well-being positively. It is also an indirect means of prevention to identify and
      reduce the stress factors, increase the number of coping strategies, teaching problem-solving
      techniques and supporting self-sufficiency (Dennis & Dowswell, 2013). It is clear that there
      must be a very good support system for all of this to be accomplished. Postpartum support for
      the mother is of utmost importance (Danbjorg, Wagner, Kristensen, & Clemensen, 2015).
      "Current social support", including family, friends and health professionals, is one of the
      factors that mediate the maternal roll (Barclay, Everitt, Rogan, & Schmied 1997; Danbjorg,
      Wagner, Kristensen, & Clemensen, 2015). In theese studies, it is seen that the support
      systems of the mothers discharged from hospital after birth are not enough and there is no
      follow up. The mothers also found it difficult to access the information they need
      immediately (instantly). Parents were disturbed by the thought that they would disturb nurses
      when they were looking for help (Danbjorg, Wagner, & Clemensen, 2014a; Danbjorg, Wagner, &
      Clemensen, 2014b; Danbjorg, Wagner, Kristensen, & Clemensen, 2015). Mothers who are
      postpartum, spend a lot of time caring for their newborn, but they do not have enough time to
      get the information they need (Guerra-Reyes, Christie, Prabhakar, Harris, & Siek, 2016). New
      ways of communicating between healthcare personnel and parents are necessary. More individual
      timely information increases the self-confidence of mothers (Danbjorg, Wagner, & Clemensen,
      2014a; Danbjorg, Wagner, & Clemensen, 2014b; Danbjorg, Wagner, Kristensen, & Clemensen,
      2015). In the postpartum period, adequate care and support have been reported to be
      associated with positive health behaviors and health outcomes, maternal stress reduction and
      baby health improvement (Guerra-Reyes, Christie, Prabhakar, Harris, & Siek, 2016). There has
      been no study evaluating the effects of mobile support application on postpartum sense of
      security, anxiety and depression during the postpartum period.

      Conceptual framework of the study Orem's Self-care Deficit Nursing Theory is used as the
      conceptual framework of this study. Acording to Orem people have a natural ability for self
      care and that nursing should focus on affecting that ability there is a constant need for
      strength and energy in order for a person to move on with his life and ability. The person
      has the power to self-care for her/himself and others and to determine their needs. The
      self-care skill required to maintain the life and function of the adult person varies from
      person to person. The person explores and develops different ways in describing the
      requirements for himself and others, and the necessary power in total. People who live
      together and share their responsibilities as a group are held accountable for the care of
      both themselves and others suffering from inadequate self-care (Orem, 2001, Fitzpatrick &
      Whall, 1996). The self-care of mothers who do not receive accurate health information may be
      affected. Likewise, the health of the children of mothers who do not get enough information
      is affected.
    

Intervention name(s): Postpartum Mobile Support Application
Intervention type(s): Device
Intervention description(s): Women in the experimental group will use the Postpartum Mobile Support Application during six weeks after birth.
Women will be evaluated three times in total, one for the first day after birth, second for the seventh day after birth and the last for the sixth week after birth.
Short messages and calls will be remind of women's Postpartum Mobile Support Application use
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: A randomized controlled trial with a two-group pre-test and post-test design.
Masking: Double (Investigator, Outcomes Assessor)
Primary purpose: Supportive Care
Keywords: Postpartum, Nurse, Mothers, Anxiety, Depression, Mobile Support