Bolstering Reach: Tailoring Perinatal Mental Health Digital Care for Black and Native American Communities

Perinatal depression is a leading cause of maternal mortality in the US. Center M, a Mindfulness-Based Cognitive Behavioral Therapy intervention, seeks to prevent perinatal depression through the development of a digital app to complement its' therapeutic intervention. The Center M app is used in conjunction with four, weekly, one-hour, telehealth group-based psychoeducational sessions facilitated by a mental health professional. The app facilitates home practice delivery, tracks mental health symptomatology, and provides additional mental health resources. Black and Native American communities are often underrepresented in perinatal mental health intervention research despite experiencing greater risk for perinatal depression. This qualitative study included seven 60-min semi-structured group and individual interviews to gather feedback from 21 Black and Native American women on the clickable app prototype. Participants were asked to provide feedback on acceptability and user experience, content relevancy and meaning, and recommendations for improvement to support greater acceptability. The Consolidated Framework for Implementation Research (CFIR) 2.0 was used to organize participants' perceptions of the Innovation domain [characteristics of the intervention being implemented and how these intervention characteristics shape implementation success], with a focus on app design and packaging; and the Individual domain [characteristics of individuals involved in implementation (e.g., individual beliefs, knowledge, identities) and how these individual characteristics shape implementation success], with a focus on groups' potential engagement as product end users. Identified themes include: (1) Innovation domain: inclusive app-specific structural recommendations for app development; (2) Individual Recipient domain: recommendations for culturally responsive approaches to mental health in app development; and cultural considerations to facilitate engagement of Native American and Black end users. Discussion addresses how recommendations from this study informed wider Center M app development and general recommendations for digital health development that is responsive to Black and Native American women's preferences.