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Strengthen the Evidence for Maternal and Child Health Programs

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Evidence Tools
MCHbest. Postpartum Mental Health Screening.

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Strategy. Digital Health Solutions

Approach. Adopt the use text message- and app-based postpartum depression and anxiety screening tools in the community setting.

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Overview. The use of telemedicine and digital health solutions, such as the use of text message- and app-based postpartum depression and anxiety screening tools have been utilized to expand the availability of validated postpartum depression and anxiety screening tools.[1,2,4] In addition to expanding the access to screening tools, the use of digital health solutions has the ability to increase postpartum women’s access to education materials before and after screening positive to postpartum depression and/or anxiety.[2,3] Text message- and app-based interventions have shown to be a cost-effective and easily applicable method for mental health screening and education in the immediate postpartum period.[3]

Evidence. Emerging Evidence. Strategies with this rating typically trend positive and have good potential to work. They often have a growing body of recent, but limited research that documents effects. However, further study is needed to confirm effects, determine which types of health behaviors and conditions these interventions address, and gauge effectiveness across different population groups. (Clarifying Note: The WWFH database calls this "mixed evidence").

Access the peer-reviewed evidence through the MCH Digital Library or related evidence source. (Read more about understanding evidence ratings).

Source. Peer-Reviewed Literature

Outcome Components. This strategy has shown to have impact on the following outcomes (Read more about these categories):

  • Mental Health. This strategy promotes emotional, psychological, and social well-being of individuals and communities.
  • Timeliness of Care. This strategy promotes delivery of healthcare services in a timely manner to optimize benefits and prevent complications.
  • Access to/Receipt of Care. This strategy increases the ability for individuals to obtain healthcare services when needed, including preventive, diagnostic, and treatment services.

Detailed Outcomes. For specific outcomes related to each study supporting this strategy, access the peer-reviewed evidence and read the Intervention Results for each study.

Intervention Type. Screening (Read more about intervention types and levels as defined by the Public Health Intervention Wheel).

Intervention Level. Individual/Family-Focused

Examples from the Field. There are currently no ESMs that use this strategy. As Title V agencies begin to incorporate this strategy into ESMs, examples will be available here. Until then, you can search for ESMs that have similar intervention components in the ESM database.

Sample ESMs. Here are sample ESMs to use as models for your own measures using the Results-Based Accountability framework (for suggestions on how to develop programs to support this strategy, see The Role of Title V in Adapting Strategies).

Quadrant 1:
Measuring Quantity of Effort ("What/how much did we do?")

PROCESS MEASURES:

  • Number of community-based organizations trained on using digital postpartum mental health screening tools. (Measures the extent of outreach to potential implementing partners)
  • Number of text message or app-based screening tools evaluated for elevance and usability. (Assesses efforts to ensure tools are appropriate)

Quadrant 2:
Measuring Quality of Effort ("How well did we do it?")

PROCESS MEASURES:

  • Percent of community-based organizations trained on using digital postpartum mental health screening tools. (Measures the extent of outreach to potential implementing partners)
  • Percent of text message or app-based screening tools evaluated for elevance and usability. (Assesses efforts to ensure tools are appropriate)

Quadrant 3:
Measuring Quantity of Effect ("Is anyone better off?")

PROCESS MEASURES:

  • Number of providers trained on responding to positive screens identified through the digital tools that report an increase in knowledge and/or skill. (Assesses workforce capacity building)
  • Number of existing maternal and child health coalitions led by Title V that incorporate the digital screening tools who report high levels of engagement. (Measures integration with related efforts)

OUTCOME MEASURES:

  • Number of implementing sites that see an increase in utilization of postpartum mental health services after deploying digital screening. (Measures systems-level impact)
  • Number of women from medically under resourced communities screened through the digital tools who ultimately engage in treatment. (Assesses access to the full continuum of care)

Quadrant 4:
Measuring Quality of Effect ("How are they better off?")

PROCESS MEASURES:

  • Percent of providers trained on responding to positive screens identified through the digital tools that report an increase in knowledge and/or skill. (Assesses workforce capacity building)
  • Percent of existing maternal and child health coalitions led by Title V that incorporate the digital screening tools who report high levels of engagement. (Measures integration with related efforts)

OUTCOME MEASURES:

  • Percent of implementing sites that see an increase in utilization of postpartum mental health services after deploying digital screening. (Measures systems-level impact)
  • Percent of women from medically under resourced communities screened through the digital tools who ultimately engage in treatment. (Assesses access to the full continuum of care)

Note. When looking at your ESMs, SPMs, or other strategies:

  1. Move from measuring quantity to quality.
  2. Move from measuring effort to effect.
  3. Quadrant 1 strategies should be used sparingly, when no other data exists.
  4. The most effective measurement combines strategies in all levels, with most in Quadrants 2 and 4.

Learn More. Read how to create stronger ESMs and how to measure ESM impact more meaningfully through Results-Based Accountability.

References

[1] Lawson, A., Dalfen, A., Murphy, K. E., Milligan, N., & Lancee, W. (2019). Use of text messaging for postpartum depression screening and information provision. Psychiatric services, 70(5), 389-395.
[2] Eisner, E., Lewis, S., Stockton-Powdrell, C., Agass, R., Whelan, P., & Tower, C. (2022). Digital screening for postnatal depression: mixed methods proof-of-concept study. BMC Pregnancy and Childbirth, 22(1), 429.
[3] Lawson, A., Dalfen, A., Murphy, K. E., Milligan, N., & Lancee, W. (2019). Use of text messaging for postpartum depression screening and information provision. Psychiatric services, 70(5), 389-395.
[4] Vanderkruik, R., Raffi, E., Freeman, M. P., Wales, R., & Cohen, L. (2021). Perinatal depression screening using smartphone technology: Exploring uptake, engagement and future directions for the MGH Perinatal Depression Scale (MGHPDS). Plos one, 16(9), e0257065.

This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number U02MC31613, MCH Advanced Education Policy, $3.5 M. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.