Examining the Effectiveness of Mothers and Babies Online Delivered in Home Visiting: A Pilot Randomized Controlled Trial.

Background: Although effective interventions exist to prevent postpartum depression, less evidence exists when examining online modalities. Mothers and Babies is an effective postpartum depression preventive intervention, with an online version developed to minimize barriers associated with in-person intervention delivery. Home visiting (HV) programs serve pregnant people and new mothers and provide an innovative setting for intervention delivery, given their ongoing service delivery with clients. Methods: Pregnant women and women with an infant under one year recruited from HV programs were randomized to an intervention or control condition. Intervention participants received an online version of the 7-lesson Mothers and Babies Online Course (eMB), with coaching reinforcement provided by participants' home visitors. Control participants received usual HV services. Primary outcomes were depressive and anxiety symptoms, and perceived stress. Outcomes were measured at baseline, one-week post-intervention, and three months post-intervention. Results: Thirty-three individuals were randomized to eMB with coaching and nine to usual HV. Participants were on average 28 years old, racially and ethnically diverse, and had a modal education attainment of less than a Bachelor's degree. Mean and modal number of eMB lessons completed were 3.61 (2.97SD) and 7, with mean and modal completed coaching sessions 4.32 (3.31SD) and 3, respectively. No main effects of time or treatment group were found, nor were any treatment by time interactions statistically significant. Follow-up analyses revealed a main effect of time on the GAD-7 and CES-D, and dosage analyses found a significant time by intervention dose interaction on the GAD-7, with eMB participants receiving a lower dose exhibiting greater anxiety. Baseline depressive symptoms were positively associated with the number of eMB lessons completed. Conclusion: Future research should prioritize strategies to facilitate eMB lesson completion given findings suggesting greater dosage may lead to improved anxiety outcomes. Home visitors' relationships with perinatal clients should be leveraged to promote eMB lesson completion. Trial registration: The study was registered with Clinicaltrials.gov (NCT05714956, registration date: January 25, 2023).