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An examination of the necessity and feasibility of web-based treatments for postpartum anxiety

Ashford, M. (2018). An examination of the necessity and feasibility of web-based treatments for postpartum anxiety. (Unpublished Doctoral thesis, City, University of London)


Background: Postpartum anxiety is common and can adversely affect the woman, child, family and society if untreated. Despite available effective treatments, practical constraints and stigma keep many women from seeking help or accessing treatments. Self-guided web-based treatments offer convenient and anonymous access and have been shown to be effective and acceptable for anxiety in the general population.

Aims: This thesis by prospective publication aimed to examine the need for and interest in web-based postpartum anxiety treatments, as well as to develop a web-based version of the existing What Am I Worried About (WaWa) program for postpartum generalised anxiety disorder and evaluate the feasibility of the web-based version (iWaWa) in England.

Methods & Results: The thesis aims were addressed using a multi-method approach. Chapter 1 reviews the literature of postpartum anxiety and Internet treatments, as well describes WaWa’s origin and the models guiding iWaWa’s development and evaluation. In Chapter 2 a systematic review of computer- or web-based treatments (n = 11 studies) found that such treatments may be effective for postpartum depression and complicated grief, but no treatment was found for postpartum anxiety specifically. In Chapter 3 a web scoping review found a diversity of web based anxiety programs (n = 34) and identified a variety of online treatment formats. Chapter 4 and 5 stem from one interview study with 13 health visitors. Chapter 4 reports on the need for treatments targeted at postpartum anxiety. Chapter 5 highlights the opportunities and challenges to consider before implementing web-based anxiety treatments in the postpartum care. In Chapter 6 an online survey of 114 postpartum women revealed that social media is a feasible way of reaching of postpartum women with anxiety in England and the majority of participants (61%) expressed interest in web-based anxiety treatments in an accessible smartphone/tablet format and short modules. Chapter 7 presents a randomised controlled trial testing iWaWa’s feasibility and acceptability. The findings showed that despite interest in iWaWa, both the study and iWaWa were not feasible in the current format. The trial also identified evidence about web-based treatment format and content preferences of women with postpartum anxiety.

Discussion: Chapter 8 synthesises and discusses the previous results. Overall, the findings from this PhD suggests a current need and interest in web-based treatments for anxiety in the literature, as well as among postpartum women and health care professionals. However, obstacles in the treatment uptake and adherence were discovered in the current format of iWaWa. Identified treatment format and content preferences can inform future development of iWaWa, as well as web-based postpartum anxiety treatments in general to optimise adherence.

Publication Type: Thesis (Doctoral)
Subjects: B Philosophy. Psychology. Religion > BF Psychology
Departments: Doctoral Theses
School of Health & Psychological Sciences
Text - Accepted Version
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