The WazzUp Mama tool

The interactive web-based tailored WazzUp Mama tool aims to identify the vulnerability of, or the presence and severity of maternal emotional distress during pregnancy. When emotional distress is absent or vulnerability is identified, the tol is designed to prevent it from developing. When maternal distress is present, the program aims to reduce it. 

 

The web-based tailored program consists of (i) a homepage with three self-directed pathways, (ii) a process for collecting personal information, and (iii) personalized feedback based on the data collection in ii. The self-directed pathways addresses different topics of emotional wellbeing: (1) mood changes as a result of pregnancy, (2) identifying factors that unbalance and disturb emotional wellbeing, and (3) identification of (levels of) emotional distress. Self-direction is based on recognition of a situation presented at the starting point.

 

The first pathway focuses on the signs and symptoms of emotional distress and determines if the respondent’s emotions belong to the physiological process of pregnancy or if they are a deviation from that process. The respondent is asked to score the severity of her emotions on a visual analogue scale from 0 to 10, increasing in severity, in order to identify the level of severity of emotional distress. Scores above set cutoff points lead to the second pathway. 

 

The second pathway focuses on identifying (potential) stress factors, problems or difficult situations in the past or present that may contribute to the development of emotional distress. The respondent is asked to score her level of coping on a visual analogue scale from 0 to 10, increasing in level of difficulty of coping with the situation. Scores above set cut-off points lead to the third pathway. Visual analogue scales are used in the first two pathways as an accurate way to rule out women for emotional distress and to find that larger proportion of women who are struggling with emotional complications that would otherwise go undetected. Cut-off points for these scales are based on the ‘Distress thermometer’ and these cut-off points indicate women’s needs for self-management and for additional support. 

 

The third pathway is a measurement of emotional distress operationalized by means of the Edinburgh Depression Scale (EDS), derived from the Edinburgh Postnatal Depression Scale (EPDS). Scores above defined cut-off points identify the severity of maternal distress and were used as indicators for support. The Edinburgh Depression Scale is incorporated because this is validated to measure depression and anxiety simultaneously and is recognized for its user-friendliness and compact size. 

 

The results of the information collection and screening tests lead to personalized feedback from the screening tests including advice and a synopsis of all the advice given. The respondent is encouraged to print it out and discuss it with her healthcare provider or use it as a reminder when necessary. The tone of voice of the personalized feedback is non-judgmental and reflective. Women are addressed by their first names in the tailored feedback, and feedback is made personal by women’s self-reported reasons for change. The starting points of the website and the different mood states include different images of women reflecting that particular mood. Narratives support the different mood states of maternal distress. 

 

Wazzup Mama different components was pre-tested for user friendliness, design, understandability and comprehensiveness among pregnant women, young mothers, practising midwives, midwifery lecturers, psychologists, scholars, and student midwives. When necessary program elements were adapted. Among the pregnant women and young mothers who helped with the pre-test were women who (had) experienced maternal distress during pregnancy.