{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T19:25:31Z","timestamp":1789586731067,"version":"build-2803163510"},"reference-count":40,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,11,28]],"date-time":"2025-11-28T00:00:00Z","timestamp":1764288000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Psychiatry"],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>The perinatal period \u2014 encompassing pregnancy and the first months after childbirth \u2014 is a time of increased psychological vulnerability. It is often associated with high levels of anxiety, stress and depression. Access to psychological support is frequently limited by stigma, geographical barriers, and a shortage of services. Digital health interventions offer promising solutions to overcome these obstacles.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This study evaluates the acceptability, feasibility, and user experience of REA, a virtual coach based on Acceptance and Commitment Therapy (ACT), to promote psychological well\u2212being and prevent postpartum depression (PPD). Fifty pregnant women (25\u201330 weeks of gestation) will be recruited. The 8\u2212week intervention delivers psychoeducational content via text, audio, and video, and collects steps, sleep, and heart rate via smartwatches for triangulation with self\u2212reported measures. User Experience (UX) and User Engagement (UE) will be assessed with the System Usability Scale (SUS), the User Engagement Scale\u2013Short Form (UES\u2212SF), the Italian Chatbot Usability Scale, version B (ITA BUS B), and the User Version of the Mobile Application Rating Scale (uMARS), alongside semi\u2212structured interviews. Psychological outcomes will be assessed pre\u2013post with the two Whooley Questions, the Center for Epidemiological Studies Depression Scale (CES\u2212D), the Multidimensional Psychological Flexibility Inventory (MPFI), and the 12\u2212Item Short Form Health Survey (SF\u221212).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Expected results<\/jats:title>\n                    <jats:p>The intervention is expected to demonstrate high levels of user satisfaction and engagement (SUS \u2265 68, UES-SF \u2265 3,5\/5; ITA BUS B \u2265 44\/55 (\u22484,0\/5); uMARS \u2265 4,0\/5), resulting in improvements in psychological flexibility, perceived well-being, and overall quality of life, recognizing that preventive efficacy will be evaluated in subsequent studies with controlled designs and postpartum outcome measures.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>REA represents a scalable and accessible tool to support perinatal mental health, offering an innovative approach to the early prevention of postpartum distress.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration<\/jats:title>\n                    <jats:p>This study was approved by the ethics committee of the APSS (Provincial Health Services Authority) under number 12090 (May 15, 2025).<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpsyt.2025.1633229","type":"journal-article","created":{"date-parts":[[2025,11,28]],"date-time":"2025-11-28T08:18:21Z","timestamp":1764317901000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["Prevention of postpartum depression via a digital acceptance and commitment therapy-based intervention: protocol for a pilot usability study"],"prefix":"10.3389","volume":"16","author":[{"given":"Silvia","family":"Rizzi","sequence":"first","affiliation":[{"name":"Digital Health Research, Centre for Digital Health & Wellbeing, Fondazione Bruno Kessler","place":["Trento, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna Elena","family":"Nicoletti","sequence":"additional","affiliation":[{"name":"Digital Health Research, Centre for Digital Health & Wellbeing, Fondazione Bruno Kessler","place":["Trento, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chiara","family":"De Luca","sequence":"additional","affiliation":[{"name":"Istituto Pavoniano Artigianelli","place":["Trento, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefania","family":"Poggianella","sequence":"additional","affiliation":[{"name":"Digital Health Research, Centre for Digital Health & Wellbeing, Fondazione Bruno Kessler","place":["Trento, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlo","family":"Dalmonego","sequence":"additional","affiliation":[{"name":"Digital Health Research, Centre for Digital Health & Wellbeing, Fondazione Bruno Kessler","place":["Trento, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudia","family":"Paoli","sequence":"additional","affiliation":[{"name":"Transmural Obstetric Gynecological Department, Healthcare Trust of the Autonomous Province of Trento (APSS)","place":["Trento, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Debora","family":"Marroni","sequence":"additional","affiliation":[{"name":"Operating Unit of Psychology, Healthcare Trust of the Autonomous Province of Trento (APSS)","place":["Trento, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Barbara","family":"Burlon","sequence":"additional","affiliation":[{"name":"Transmural Obstetric Gynecological Department, Healthcare Trust of the Autonomous Province of Trento (APSS)","place":["Trento, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vanda","family":"Chiodega","sequence":"additional","affiliation":[{"name":"Transmural Obstetric Gynecological Department, Healthcare Trust of the Autonomous Province of Trento (APSS)","place":["Trento, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martina","family":"Dallafior","sequence":"additional","affiliation":[{"name":"Transmural Obstetric Gynecological Department, Healthcare Trust of the Autonomous Province of Trento (APSS)","place":["Trento, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Riccardo","family":"Pertile","sequence":"additional","affiliation":[{"name":"Department of Clinical and Evaluative Epidemiology, Healthcare Trust of the Autonomous Province of Trento (APSS)","place":["Trento, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Silvia","family":"Rizzi","sequence":"additional","affiliation":[{"name":"Transmural Obstetric Gynecological Department, Healthcare Trust of the Autonomous Province of Trento (APSS)","place":["Trento, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Valentini","sequence":"additional","affiliation":[{"name":"Transmural Obstetric Gynecological Department, Healthcare Trust of the Autonomous Province of Trento (APSS)","place":["Trento, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irene","family":"Alberi","sequence":"additional","affiliation":[{"name":"Transmural Obstetric Gynecological Department, Healthcare Trust of the Autonomous Province of Trento (APSS)","place":["Trento, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefano","family":"Forti","sequence":"additional","affiliation":[{"name":"Digital Health Research, Centre for Digital Health & Wellbeing, Fondazione Bruno Kessler","place":["Trento, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabrizio","family":"Taddei","sequence":"additional","affiliation":[{"name":"Transmural Obstetric Gynecological Department, Healthcare Trust of the Autonomous Province of Trento (APSS)","place":["Trento, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,11,28]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1037\/tra0000703","article-title":"Loneliness, isolation, and social support factors in post-COVID-19 mental health","volume":"12","author":"Saltzman","year":"2020","journal-title":"psychol Trauma: Theory Res Prac Policy"},{"key":"B2","unstructured":"World mental health report: transforming mental health for all\n          \n          2022"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1007\/s00737-013-0402-7","article-title":"CALM Pregnancy: results of a pilot study of mindfulness-based cognitive therapy for perinatal anxiety","volume":"17","author":"Goodman","year":"2014","journal-title":"Arch Women\u2019s Ment Health"},{"key":"B4","doi-asserted-by":"publisher","first-page":"e01561","DOI":"10.1002\/brb3.1561","article-title":"The effect of mindfulness-based stress reduction on maternal anxiety and self-efficacy: A randomized controlled trial","volume":"10","author":"Zarenejad","year":"2020","journal-title":"Brain Behav"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1192\/bjp.169.5.555","article-title":"Aspects of perinatal psychiatric illness","volume":"169","author":"Pritchard","year":"1996","journal-title":"Br J Psychiatry"},{"key":"B6","doi-asserted-by":"publisher","first-page":"16","DOI":"10.1001\/archpsyc.1968.01740010018003","article-title":"Postpartum blues\u201d Syndrome","volume":"18","author":"Yalom","year":"1968","journal-title":"Arch Gen Psychiatry"},{"key":"B7","doi-asserted-by":"publisher","first-page":"37","DOI":"10.3109\/09540269609037816","article-title":"Rates and risk of postpartum depression\u2014a meta-analysis","volume":"8","author":"O\u2019hara","year":"1996","journal-title":"Int Rev Psychiatry"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1192\/bjp.118.547.689","article-title":"Prospective study into puerperal depression","volume":"118","author":"Dalton","year":"1971","journal-title":"Br J Psychiatry"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1177\/002076409704300308","article-title":"Post partum psychosis: a clinical study","volume":"43","author":"Agrawal","year":"1997","journal-title":"Int J Soc Psychiatry"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1037\/0022-006x.53.6.839","article-title":"Relaxation training and expectation in the treatment of postpartum distress","volume":"53","author":"Halonen","year":"1985","journal-title":"J Consult Clin Psychol"},{"key":"B11","doi-asserted-by":"publisher","first-page":"29","DOI":"10.1016\/0165-0327(88)90006-7","article-title":"The clinical picture of the depressed form of puerperal psychosis","volume":"15","author":"Brockington","year":"1988","journal-title":"J Affect Disord"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.1017\/s0033291796004564","article-title":"Editorial: Postpartum depression and child development","volume":"27","author":"Murray","year":"1997","journal-title":"psychol Med"},{"key":"B13","doi-asserted-by":"publisher","first-page":"35","DOI":"10.1192\/bjp.144.1.35","article-title":"A prospective study of emotional disorders in childbearing women","volume":"144","author":"Kumar","year":"1984","journal-title":"Br J Psychiatry"},{"key":"B14","doi-asserted-by":"publisher","first-page":"296327","DOI":"10.1111\/papt.12441","article-title":"The effectiveness of psychological interventions for anxiety in the perinatal period: A systematic review and meta-analysis","volume":"96","author":"Clinkscales","year":"2022","journal-title":"Psychol Psychother: Theory Res Pract"},{"key":"B15","doi-asserted-by":"publisher","first-page":"431","DOI":"10.1186\/s12884-025-07523-1","article-title":"The efficacy of collaborative psychological interventions in reducing anxiety levels in pregnant women: a systematic review and meta-analysis","volume":"25","author":"Firrahmawati","year":"2025","journal-title":"BMC Pregn Childbirth"},{"key":"B16","doi-asserted-by":"publisher","first-page":"294","DOI":"10.1016\/j.jad.2021.05.010","article-title":"Effectiveness of psychological interventions in the treatment of perinatal depression: A systematic review of systematic reviews and meta-analyses","volume":"291","author":"Branquinho","year":"2021","journal-title":"J Affect Disord"},{"key":"B17","doi-asserted-by":"publisher","first-page":"e46","DOI":"10.1192\/j.eurpsy.2024.1749","article-title":"Perinatal mental health care in the Italian mental health departments: a national survey","volume":"67","author":"Lega","year":"2024","journal-title":"Eur Psychiatry"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.1016\/j.invent.2015.06.002","article-title":"Online prevention of postpartum depression for Spanish- and English-speaking pregnant women: A pilot randomized controlled trial","volume":"2","author":"Barrera","year":"2015","journal-title":"Internet Interventions"},{"key":"B19","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.brat.2005.06.006","article-title":"Acceptance and commitment therapy: Model, processes and outcomes","volume":"44","author":"Hayes","year":"2006","journal-title":"Behav Res Ther"},{"key":"B20","doi-asserted-by":"crossref","DOI":"10.1037\/17335-000","volume-title":"Acceptance and commitment therapy: The process and practice of mindful change","author":"Hayes","year":"2012"},{"key":"B21","volume-title":"Acceptance and commitment therapy: An experiential approach to behavior change","author":"Hayes","year":"1999"},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.1037\/hea0000161","article-title":"From ideas to efficacy: The ORBIT model for developing behavioral treatments for chronic diseases","volume":"34","author":"Czajkowski","year":"2015","journal-title":"Health Psychol"},{"key":"B23","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1080\/17437199.2012.654964","article-title":"Theories and techniques of behaviour change: Developing a cumulative science of behaviour change","volume":"6","author":"Michie","year":"2012","journal-title":"Health Psychol Rev"},{"key":"B24","doi-asserted-by":"crossref","DOI":"10.1046\/j.1525-1497.1997.00076.x","article-title":"Case-finding instruments for depression","volume":"12","author":"Whooley","year":"1997","journal-title":"J Gen Internal Med"},{"key":"B25","doi-asserted-by":"publisher","first-page":"385","DOI":"10.1177\/014662167700100306","article-title":"The CES-D scale: A self-report depression scale for research in the general population","volume":"1","author":"Radloff","year":"1977","journal-title":"Appl psychol Measure"},{"key":"B26","doi-asserted-by":"publisher","DOI":"10.1177\/1073191116645905","article-title":"Disentangling components of flexibility via the hexaflex model: development and validation of the multidimensional psychological flexibility inventory (MPFI)","volume":"25","author":"Rolffs","year":"2016","journal-title":"Assessment"},{"key":"B27","doi-asserted-by":"publisher","DOI":"10.1097\/00005650-199603000-00003","article-title":"A 12-Item Short-Form Health Survey: construction of scales and preliminary tests of reliability and validity","volume":"34","author":"Ware","year":"1996","journal-title":"Med Care"},{"key":"B28","doi-asserted-by":"publisher","first-page":"28","DOI":"10.1016\/j.ijhcs.2018.01.004","article-title":"A practical approach to measuring user engagement with the refined user engagement scale (UES) and new UES short form","volume":"112","author":"O\u2019Brien","year":"2018","journal-title":"Int J Human-Comp Stud"},{"key":"B29","article-title":"Sus: a \u201cquick and dirty\u2019usability","volume":"189","author":"Brooke","year":"1996","journal-title":"Usabil Eval industr"},{"key":"B30","doi-asserted-by":"publisher","first-page":"2161","DOI":"10.1007\/s00779-023-01731-2","article-title":"Ciao AI: the Italian adaptation and validation of the Chatbot Usability Scale","volume":"27","author":"Borsci","year":"2023","journal-title":"Pers Ubiquitous Comput"},{"key":"B31","doi-asserted-by":"publisher","first-page":"e72","DOI":"10.2196\/mhealth.5849","article-title":"Development and validation of the user version of the mobile application rating scale (uMARS)","volume":"4","author":"Stoyanov","year":"2016","journal-title":"JMIR mHealth uHealth"},{"key":"B32","unstructured":"Klausen\n              E\n            \n          \n          Manuale (ACT) per la prevenzione del disagio e della depressione post partum"},{"key":"B33","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbi.2019.103359","article-title":"TreC platform. An integrated and evolving care model for patients\u2019 empowerment and data repository","volume":"102","author":"Eccher","year":"2020","journal-title":"J Biomed Inf"},{"key":"B34","doi-asserted-by":"publisher","DOI":"10.1046\/j.1525-1497.2001.016009606.x","article-title":"The PHQ-9: validity of a brief depression severity measure","volume":"16","author":"Kroenke","year":"2001","journal-title":"J Gen Internal Med"},{"key":"B35","doi-asserted-by":"publisher","first-page":"57","DOI":"10.1016\/j.jcbs.2021.05.007","article-title":"Italian validation of the Italian multidimensional psychological flexibility inventory (MPFI)","volume":"21","author":"Landi","year":"2021","journal-title":"J Context Behav Sci"},{"key":"B36","doi-asserted-by":"publisher","DOI":"10.1097\/00007632-200012150-00008","article-title":"SF-36 health survey update","volume":"25","author":"Ware","year":"2000","journal-title":"Spine"},{"key":"B37","unstructured":"Ministro per la Pubblica Amministrazione\n          \n          2016"},{"key":"B38","doi-asserted-by":"publisher","DOI":"10.15167\/2421-4248\/jpmh2021.62.1.1894","article-title":"Translation and validation of the Italian version of the user version of the Mobile Application Rating Scale (uMARS)","volume":"62","author":"Morselli","year":"2021","journal-title":"J Prev Med Hygiene"},{"key":"B39","volume-title":"Designing qualitative research","author":"Marshall","year":"2022"},{"key":"B40","doi-asserted-by":"publisher","DOI":"10.1080\/01621459.1987.10478478","article-title":"Sample size determination for some common nonparametric tests","volume":"82","author":"Noether","year":"1987","journal-title":"J Am Stat Assoc"}],"container-title":["Frontiers in Psychiatry"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpsyt.2025.1633229\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,16]],"date-time":"2026-01-16T10:16:47Z","timestamp":1768558607000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpsyt.2025.1633229\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,28]]},"references-count":40,"alternative-id":["10.3389\/fpsyt.2025.1633229"],"URL":"https:\/\/doi.org\/10.3389\/fpsyt.2025.1633229","relation":{},"ISSN":["1664-0640"],"issn-type":[{"value":"1664-0640","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11,28]]},"article-number":"1633229"}}