eHealth Antenatal Coparenting Intervention to Prevent Postpartum Depression among Primiparous Women, Karachi, Pakistan: A Pilot Randomized Controlled Trial

Background: Postpartum depression is highly prevalent among women and a lack of partner support is a strong risk factor for PPD. Partner support has been shown to decline significantly during the transition to parenthood. The primary objective of this pilot randomized controlled trial was to examine the feasibility and acceptability of an eHealth antenatal coparenting intervention called eACoP and obtain preliminary estimates on clinical outcomes for a future larger trial. Methodology: 212 primiparous couples were recruited from the Aga Khan University Hospital and randomly allocated into the intervention group or the control group using sequentially numbered opaque sealed envelopes. Couples in the intervention group received the eACoP intervention during pregnancy which consists of eight 45-minute online videos. Primary outcomes were feasibility and acceptability measured through enrollment rates, intervention adherence rates, follow-up rates, and intervention satisfaction. Secondary outcomes were depressive symptomatology, anxiety, postpartum partner support, coparenting relationship, relationship satisfaction, postpartum childcare stress, child development, extrafamilial support, and healthcare services utilization. Results: Primary outcomes: The enrollment rate of eligible participants in this pilot study was 83.5%. One in five couples completed the minimum intervention dosage of watching at least five videos. Complete follow-up data was collected from 66.5 (n=137) of women and 56.7% of partners (n=117) at 4-6-weeks, decreasing slightly to 60.7% (n=124) of women and 50.4% of (n=104) partners at 12-weeks postpartum. The 24 couples who watched at least five videos and completed the satisfaction forms felt that the content of the videos was helpful and provided appropriate strategies for managing situations or problems. Participants provided important recommendations, including the inclusion of Pakistani cultural and religious aspects in the videos and making the videos shorter. Secondary Outcomes: At 4-6-weeks postpartum, 22.1% of women and 3.5% of partners in the intervention group showed depressive symptomatology while 32.8% of women and 7% of partners had anxiety symptoms. At 12-week postpartum, 14.1% of women and 5.7% of partners had depressive symptoms while 21.9% of women and 11.3% of partners had anxiety symptoms. Similarly, 13.11% of women and 9.6% of partners reported relationship dissatisfaction. There was no difference found between the intervention group and control group with respect to other secondary outcomes. Conclusion: This pilot trial found that a future randomized controlled trial of eACoP intervention is not feasible nor acceptable in the Pakistani context without modifications. .Ph.D