Digital cognitive behavior therapy to reduce perinatal anxiety symptoms: perceptions of implementation barriers and...

Perinatal anxiety is prevalent, particularly among historically marginalized groups who face barriers to accessing interventions like cognitive behavioral therapy (CBT). While digital CBT adaptations for this population show promise, research on implementation remains limited.

This study engaged potential implementers-perinatal clinicians, doulas, and psychiatrists-to explore perceived barriers and facilitators of digital CBT (BigHealth's Daylight app) use among racially marginalized and low-income perinatal people.

As part of the HOPE THRIVE study (transforming health and reducing perinatal anxiety through virtual engagement), we conducted two focus groups (n = 11) with California-based clinicians and service providers working with low-income (Medicaid-eligible) perinatal patients. The reach, effectiveness, adoption, implementation, and maintenance implementation framework guided our focus group questions and deductive analysis.

We identified 12 perceived barriers and facilitators (themes) that participants believed would influence the reach, effectiveness, adoption, implementation, and sustainability of digital CBT in this population. These themes included intervention design elements, differences between potential users and nonusers, and broader provider- and system-level factors.

While clinicians and service providers viewed digital CBT-specifically Daylight-as acceptable and beneficial for increasing access among marginalized perinatal populations, critical implementation considerations emerged during the focus groups. Addressing these factors through tailored strategies and culturally relevant adaptations is essential for successful implementation, particularly when scaled to healthcare settings. Future research should further explore these issues to support equitable, sustainable digital CBT delivery.