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A user centred mobile health approach to postnatal depression intervention adherence management using the theory of planned behaviour

Student thesis: Doctoral Thesis

This research contributes to the development of an intervention that could facilitate adherence to prescribed Postnatal Depression (PND) interventions, and that is achieved by behavioural change. Non-adherence to prescribed PND treatment is a major problem faced by healthcare professionals. Primarily the negative impact upon women’s wellbeing is of significant concern. Secondly, there can be an increase in the cost of providing healthcare service, both in financial terms and time investment. A lack of adherence to treatment is prevalent in women with PND and has shown to decrease the long-term effect of the treatment outcome as well as increase the length of time spent in treatment for psychological disorders. Furthermore, we identified that a large number of women poorly adhere to the prescribed treatment or show only moderate improvement in depression. To help improve increased adherence to PND treatments, however, this would require a change in behaviour.
In order to rigoursly approach this research, this thesis capitalises on a behavioural change model ‘The Theory of Planned Behaviour (TPB)’. A User Centred Design (UCD) and mixed method studies were used in the first stage of this research to identify the perception of women and practitioners on factors that could have an impact on PND treatment adherence. The results of these studies provided valuable insights that lead to the significant development of the ABC-W. TPB guided the development of a novel Adherence Behavioural Change Wheel (ABC-W) for PND. Significantly, the ABC-W has the potential to identify and address women’s behavioural, control beliefs and the perception of significant others that could influence treatment adherence behavioural for PND. It could further help to bridge the gap between the intention to adhere to treatment and carrying out the actual behaviour. It is, however, not anticipated that the proposed adherence framework will replace other measures, but aims to complement existing compliance strategies. This is because we are not practitioners and make no claims that the outcome of this research will cure PND. However, using the increasing mobile technology, we seek to contribute to the development of interventions that could facilitate adherence to prescribed treatments, ensure sustained treatment outcome and most importantly positively impact upon the wellbeing and lives of women with PND.
Advances in mobile technology have enabled a wide range of behavioural change interventions. We identified that using mobile technology for PND treatment support could promote prescribed treatment adherence and long-term maintenance of behavioural change. Therefore, a scenario was developed from the ABC-W and subsequently translated into a set of high-level requirements, which will significantly inform the development of a PND adherence mobile application. This set of requirements contributes to the rapid expanding field of mobile health for women with PND. Detailed description and rationale for the set of general requirements were presented using Volere shell, a requirement specification tool. These requirements were used to shape the development of an adjunct mobile application prototype, AbovePostnatalDepression. AbovePostnatalDepression is the first PND adherence mobile application that has the potential to facilitate adherence to prescribed PND treatments. Furthermore, using the elements of TPB, practitioners evaluated the potential of AbovePostnatalDepression against the features of the ABC-W framework. This study is the first evaluation of an adherence mobile application for women with PND. This research identified whether the AbovePostnatalDepression as an adherence tool could help women with PND have control over their adherence behaviour as well as help facilitate sustained treatment outcome. We identified that AbovePostnatalDepression could be used to motivate postnatal depressed women to adhere to treatment and sustain treatment outcome in the longterm. By using the AbovePostnatalDepression there is a possibility of reducing procedural cost, time or efforts required by practitioner and women alike in ensuring increased adherence to prescribed treatments, but of paramount importance is the potential positive impact it could have on women’s wellbeing.
Original languageEnglish
Supervisors/Advisors
Award dateJan 2018

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