Programme for the Effective Promotion of Maternal Psychosocial Wellbeing (PREPWELL) in Ghana: Development and field-testing of a mHealth Intervention in a rural setting.

Poor maternal psychosocial well-being, often manifested as mental health challenges, is a significant public health concern - particularly in settings with limited access to mental health care. Although Behavioural Activation (BA) has shown strong promise in promoting psychological well-being, there is a notable lack of comparable evidence from low- and middle-income countries (LMICs). While the WHO advocates for the innovative delivery of psychosocial interventions via mobile health (mHealth) platforms, supporting data from LMIC contexts remain limited, underscoring the need for context-specific research and implementation. The PRogramme for Effective Promotion of maternal psychosocial WELLbeing (PREPWELL) sought to address this innovation and knowledge gap. Through our three-stage intervention development process - (a) formative research to identify contextual information regarding the feasibility and acceptability of Obaatanpa; (b) constructing a prototype Obaatanpa by adapting an evidence-based psychological treatment known as the Healthy Activity Programme; and (c) field testing, our research co-created a prototype psychosocial wellbeing promotion mHealth intervention (Obaatanpa) for mothers in Kintampo, Ghana. Findings showed a phasic intervention comprising psychoeducation, BA, and problem-solving delivered over 8 sessions through mobile phones is feasible, acceptable, comprehensible, and salient. However, the drop in participation from session 6 suggest a preference for smaller number of sessions but this needs further unpacking in a pilot study. The data also suggests that a core aspect of BA such as doing pleasurable activities - though possibly embedded - were less well developed, indicating an area for possible emphasis or clearer articulation in future iterations. With these enhancements, and further testing with a larger sample, Obaatanpa could be scalable and underscores the potential utility of mHealth as a platform for implementing WHO's self-care framework. The PREPWELL programme of work has demonstrated the feasibility of adapting a treatment-focussed psychosocial intervention for promoting mental health and wellbeing.