Rosie en Español, a Chatbot-Delivered Intervention for Spanish-Speaking, US-Based Latina Mothers: Pilot Randomized Controlled Trial

Latina pregnant women and mothers of infants in the United States experience elevated risk for perinatal anxiety, stress, and depression alongside persistent barriers to culturally and linguistically responsive care. AI-powered digital health tools offer a potentially scalable approach to address these gaps, yet evidence on their acceptability and effectiveness for this population remains limited.

We aimed to evaluate the feasibility, acceptability, and preliminary outcome changes of Rosie, a Spanish-language AI-powered chatbot designed with and for Latina mothers, on maternal mental health and healthcareuse outcomes.

We conducted a mixed methods pilot randomized controlled trial with 30 Spanish-speaking Latina participants who were pregnant or parenting an infant younger than 6 months. Participants were randomized 1:1 to the Rosie intervention or a comparison book club condition that provided monthly children's board books. Surveys administered at baseline and 3-month follow-up assessed depression (Patient Health Questionnaire-9), anxiety (Generalized Anxiety Disorder-7), perceived stress (Perceived Stress Scale), and health care use. Quantitative analyses examined within- and between-group changes, and qualitative feedback assessed acceptability and user experience.

Baseline mental health scores were low in both groups; however, several baseline demographic differences were observed between study arms, including age, pregnancy vs parenting status, marital status, education, and country of origin. Over 3 months, participants in the Rosie group demonstrated statistically significant within-group reductions in anxiety (mean baseline 3.27, SD 2.89; mean change -2.00, SD 2.94; P=.02) and perceived stress (mean baseline 30.00, SD 5.53; mean change -12.20, SD 12.99; P=.003). Depression scores declined modestly in both groups, with no significant between-group differences. No significant differences were observed in maternal emergency department use or adherence to well-baby visits. Engagement with Rosie was high, and qualitative feedback indicated that participants found the chatbot useful and supportive.

This pilot study suggests that a culturally and linguistically tailored AI-powered chatbot is feasible and acceptable among Latina mothers during the perinatal period. Although anxiety and perceived stress decreased within the Rosie group, no significant between-group differences were observed. Within-group reductions in anxiety and perceived stress among Rosie participants are preliminary and should be interpreted cautiously because the trial was not powered to detect between-group effects and no statistically significant between-group differences were observed. Larger, adequately powered trials are needed to evaluate effectiveness.