Closing the northern gap: care provider perspectives on the suitability of an eHealth app for maternal mental health in Northwestern Ontario

Abstract

Maternal depression affects up to 25% of women during the perinatal period; however, less than 10% of these women go on to receive adequate mental healthcare (Andersson et al., 2004; Bailey, 2001; Cox, Sowa, Meltzer-Brody, & Gaynes, 2016; De Tychey et al., 2005; Gavin et al., 2005; Hostetter & Newport, 2005). Women living in Northwestern Ontario (NWO) face a number of unique barriers that further restrict their access to maternal mental health supports. Technological advances in eHealth interfaces may represent novel solutions for overcoming these obstacles. The HOPE app is an e-screening, e-referral, and e-therapy tool with a single, virtual point of access that has been designed to screen, diagnose, monitor, and treat mood and anxiety disorders in pregnant and postpartum women. The primary objective of this qualitative study was to understand maternal care and social service providers’ perspectives on potential barriers and facilitators to using the HOPE app in NWO. The providers were asked to share their perspectives on the following three research questions: (1) What barriers or facilitators currently exist in the delivery of, access to, and use of existing maternal care services and supports in NWO? (2) What barriers or facilitators exist in the delivery of, access to, and use of the HOPE app in NWO? (3) What changes could be made to the current HOPE app in order to facilitate an improved fit to the specific needs of care providers and women (as perceived by care providers) living in NWO? Semi-structured, in-depth interviews were conducted with ten service providers representing various maternal care disciplines in Thunder Bay and Kenora. Five major themes and twenty-one sub-themes were identified and analyzed using an Interpretive Description approach. Notably, the participants acknowledged twenty distinct obstacles to maternal care in Northern communities which could be organized under the following four subsets: individual-level factors, social determinants of health, ecological determinants of health, and structural barriers. Prominent obstacles to maternal care included – among others – the lack of specific maternal mental health services, limited transportation options, diminished internet access, and the shortage of primary care providers. Overall, the social service and care providers viewed the HOPE app as a helpful tool for improving maternal care delivery and access, with six strong stipulations: (1) the content and images must be modified to suit women in NWO; (2) the resource lists must be localized; (3) the content must be culturally expanded in consultation with the communities of interest; (4) the high-risk referral protocol must be re-evaluated for safety; (5) coaches must reside in NWO and should be representative of demographics if at all possible; and (6) coaches must be reachable by telephone, email, text message, and wifi-based chat. The principal concerns for using the app in NWO was the reliability of internet connectivity in smaller rural and remote communities. When asked if they would feel comfortable referring women to the HOPE platform, the response from service providers was overwhelmingly positive. These findings suggest that the HOPE app may represent a beneficial addition to the services currently offered in NWO, particularly after region-specific modifications have been made. The providers suggested that addendums to the app should focus on expanding its visuals and content to better represent the diverse populations of women living in the North. Following revision, further research should include direct input from women using this service.