Evaluation of Baby Steps: An online program promoting the wellbeing of new mothers and fathers

INTERVENTION: Participants will be assigned to one of two Baby Steps interactive web‐based interventions: Arm 1) Babycare – modules that provide access to information and tips on early childcare in the areas of feeding, soothing, sleep and getting prepared. Links to additional relevant information on childcare are provided throughout. Automated text messages at 2, 4, 7 and 10 weeks post registration remind participants to visit and continue use of the site. Arm 2) Wellbeing ‐ includes all content from Babycare plus additional modules specifically targeting parent wellbeing. The additional Wellbeing modules focus on self‐care through promoting pleasurable physical and social activity, parents’ strengths, sleep tips, and stress reduction. Additionally, Wellbeing focuses on couples’ relationships, interacting with baby and changing roles. Planning tools assist parents to develop action plans based on tips from the program. Wellbeing also includes a Scrapbook section where parents are encouraged to upload photos that remind them of positive aspects of parenting and of achievements. The Wellbeing program is also supported by SMSs at 2, 4, 7 and 10 weeks to encourage continued program use. The two online interventions are designed to be used at times and places that are convenient to the participant. Participants are able to use the program in sessions as brief or long as he or she desires and then can return to the modules whenever they want. The modules are not time‐based and progression through the website is not linear. Rather, participants are able to pick and choose relevant topics to read and then develop plans based on these. Program completion time will depend on the number of topics that participants choose to work through. Participants can spend as much or as little time as they like using the website and there is no minimum or maximum program completion time. Program adherence to each intervention is automatically monitored through the Baby Steps program. The website collects program use data encompassing number of logins, pages viewed, Babycare pages viewed, Wellbeing pages viewed, plans made and photos uploaded as well as total time spent on program pages. There is no end date to either online intervention. Participants can continue to access the website for the life of the website (i.e. indefinitely). Their participation in the research and hence the monitoring of their use of the website will end after the six month follow‐up point. CONDITION: Perinatal psychological distress perinatal quality of life relationship satisfaction satisfaction with parenting role and skills self‐efficacy in child rearing PRIMARY OUTCOME: Perinatal psychological distress as measured by the mean score on the Edinburgh Postnatal Depression Scale. The Edinburgh Postnatal Depression Scale is a 10‐item screening instrument that assesses generalised depression and anxiety symptoms over the past week. Quality of life as measured by the mean score on the Assessment of Quality of Life 8D Instrument (AQoL‐8D). The AQoL‐8D is a 35‐item scale assessing 8 dimensions of quality of life over the past week (independent living, relationships, mental health, coping, pain, senses, life satisfaction and self‐worth). INCLUSION CRITERIA: Inclusion criteria are: 1) Co‐parenting male‐female couple 2) First child for both parents 3) Gestation between 26 and 38 weeks 4) Pregnancy is singleton with no complications 5) Literacy in English 6) Internet and mobile phone access 7) Aged 18 years or over The project aims to enhance wellbeing in the transition to parenthood. It therefore focuses on first‐time parents. SECONDARY OUTCOME: Cost‐effectiveness of the intervention. Past 13‐week number of days of unpaid absenteeism due to: 1. reasons related to the baby, 2. the parent's own illness, and/or 3. other reasons will be assessed. Overall performance on the days parents worked in the past 13 weeks is assessed on a scale ranging from 0 (worst performance) to 10 (top performance). Program satisfaction will be examined using a mean score on each of four created items. The four items assess satisfaction with program relevance, usefulness, and ease of navigation on a scale from 0 (not at all) to 100 (extremely). Program usage is quantified by mean number of logins, pages viewed, Babycare pages viewed, Wellbeing pages viewed, plans made and photos uploaded as well as total time spent on program pages, Babycare pages and Wellbeing pages. Relationship satisfaction will be assessed using the mean score on the Couples Satisfaction Index (CSI‐16). The CSI‐16 is a 16‐item instrument examining overall quality of and satisfaction with romantic relationships. Satisfaction (with parenting role and skills, relationship, and social support) will be measured by the mean score on each of seven satisfaction items. Seven items created for this study ask "How satisfied are you with: 1. Your parenting role, 2. Your parenting skills, 3. Your relationship with your partner, 4. The support you receive from your partner, 5. The practical support you receive from others, 6. The emotional support you receive from others, and 7. The support you have been providing to your partner." Response options range from 0 (not at all) to 100 (extremely) satisfied. Self‐efficacy in child rearing as measured by the mean score on three self‐efficacy items. Three items that were created specifically for this study measure self‐efficacy in a number of child rearing domains. Participants will be asked “Thinking about the next 13 weeks, how confident are you with: 1. Feeding your baby, 2. Putting your baby to sleep, and 3. Settling your baby." Response options range from 0 (not at all confident) to 100 (extremely). Social support as indicated by the mean score on the four‐item Social Support Survey. This scale asks respondents the availability of different types of social support. Participants are recruited antenatally at a gestation of 26 to 38 weeks. This represents a range of strong fetal viability if premature labour were to occur and also allows time to engage with the program before the arrival of the baby.