Of the 47 women who participated in the VCI, 17 (36%) agreed to participate in a focus group. Seven women were postpartum (1-5 months) and ten were pregnant (average gestational age, 22.7 weeks; SD, 10.6; range, 3-40 weeks). The mean age of participants was 30.9 years, with a range of 23 to 38, and all 17 reported being married or living with a partner. The EPDS scores ranged from 2 to 23 pre-intervention, and 1-17 post-intervention. For the 47 women, post-intervention PD symptoms decreased for those with mild to moderate symptoms of depression while those who were asymptomatic, but with high-risk factors for developing depression, remained largely asymptomatic (25). Characteristics of the participating women are provided in Table 2.
Table 2
Focus Group Participant Characteristics
Characteristics | Number |
Ethnic/Racial Background | |
White, Not Hispanic | 15 |
Hispanic | 1 |
African American | 1 |
Annual Income | |
$10-20,000 | 1 |
$40-50,000 | 2 |
$50-60,000 | 1 |
$60-70,000 | 3 |
$70-80,000 | 1 |
$80-90,000 | 1 |
$100,000 | 8 |
Education | |
Not reported | 2 |
Some College | 1 |
College Graduate | 7 |
Post Graduate Master’s Degree | 5 |
Doctorate Degree | 2 |
After multiple iterations by the coding team, the data were organized into four major content areas after the primary analysis using grounded theory: (1) positive experiences, (2) negative experiences; (3) suggestions and ideas; and (4) screening and communication. As a result, three core themes emerged (Universality; Normalizing; and Reduced Stigma) across the four content areas with one central theme (Community & Connection) encompassing the three core themes (Figure 1). Examples of the participant’s comments are included in tables for each content area. Screening and communication are outside the scope of this report.
Content Areas
Positive Experiences
Important themes reflecting positive experiences emerged from the focus groups: convenience of attending sessions via VC, community building, normalization of feelings, and learning a variety of techniques for reducing PD symptoms. Each participant provided at least one positive comment relating to her participation in the VCI (Table 3).
Table 3
| Participant Quotes |
Community | “I really enjoyed the group setting. It was nice to be able to connect with other people who were going through similar things.” |
Normalizing | “I really like that safe space with people who are going through similar things, to me, and a place where I really could just be open and honest about what I was feeling about.” |
Variety of Techniques | “It was interesting in our group like everybody liked different Things which was great that there were so many to try…I think because you could just experiment with them and see different things that work, I like that.” |
Negative Experiences
Participants offered insight on negative experiences during the eight-week intervention: technological barriers, inability to connect with women outside of the VCI groups, lack of commitment from other group members, feeling overwhelmed by the number of techniques introduced, timing/scheduling of focus group sessions, lack of personal motivation, and perception of lack of time to adequately engage with the facilitator (Table 4).
Table 4
| Participant Quotes |
Technology | “The technology… I try to be 20 minutes early for this and I was 10 minutes late, just finding the email, getting in, getting the passwords to work. It's usually annoying and it was occasionally prohibitive.” |
Lack of Community | “I had hopes that there would be more interaction with the group and not just the singular like the instructor structure and the instruction.” |
Content/Manual: Too Much Information | “…there were so many different methods that I didn't feel like I got to try them all out.” |
Facilitator: Not Enough Connection with Members | “I think we ran out of time a lot and maybe it's just figuring out the material or figuring out how much conversation needs to be had or maybe there’s just the opportunity to talk afterward. I mean, she was open if we needed to talk but I think for us, it was kind of time prohibitive.” |
Areas for Improvement
Participants identified several areas for improvement: recording of sessions for later viewing when unable to join a particular session, follow-up sessions with structured assignments, an option for connection with one another outside of group sessions, and offering different groups to address specific mental health needs, such as depression or anxiety (Table 5).
Table 5
Suggestions for Improvement
| Participant Quotes |
More Contact and Connection through Technology | “I don't know if it's allowed because it's a study but maybe if there was some sort of maybe a private Facebook group or something where you could connect to the people throughout the week in between meetings just so if you want a little bit of extra peer support you could reach out to them or just share a bad day with them if they wanted to respond they could.” |
Group Composition | “I would say, anything to make it more specialized. I know some people in the group struggled more with depression, some were with anxiety, maybe getting all the people that mainly dealt with depression, people that mainly dealt with anxiety just because there are so many different situations and not enough time so just making it more specialized that way.” |
Core And Central Themes
In each of the four major content areas, three core themes emerged including universal need for community among women with PD, normalizing feelings of depression, and reducing the stigma of depression. The VCI provided a way to normalize depression, and made participants feel less isolated, knowing that there were others with similar experiences. The emerging central themes amongst the four areas focused on women feeling a connection to each other and the facilitator. This connection was either enhanced or diminished based on their experience of the technology.
Results From Secondary Data Analysis
A total of six categories were identified during the secondary analysis and these were similar to the results of the primary analysis; technology, community, keeping connection, program content, program organization, and learning style. However, two of the six categories, community and keeping connection, were found to have significant interactions with the category of technology. Thus the results of the secondary analysis focus on describing how “technology” positively and negatively impacted community and connection between participants.
Participants reported convenience of using technology (i.e. use of their own device and attending via videoconference) in group sessions, which included the convenience of being in a private setting rather than a provider’s office (exemplar codes: private setting), not needing to leave the home setting, ability to join the group from any remote location using an internet connection (don’t need to leave home), and easier accessibility and flexibility in the video chat system (accessibility).
Technology is what makes this program great and the fact that we could do it from home like that, flexibility was huge for me.
The only reason I said yes is because I could go to my master bedroom, lock the door and I didn't have to find a babysitter, I didn't have to schedule an appointment and coordinate like… to get somewhere out of the house. It was just really nice; I could nurse my baby and be in group.
Although some participants expressed positive feedback relating to the use of technology, other participants experienced frustration when using the technology. Some participants described difficulties logging into the web-based video chat or experienced an audio or video malfunction., These incidents led to negative technological experiences in the larger groups as a whole. Due to technological issues, for example, multiple group sessions resulted in a later start time than normal (delayed start). Participants also expressed that the facilitator sometimes experienced technological difficulties requiring them to cancel classes, but notifications were not broadcasted to other group members (facilitator miscommunication). Moreover, participants described their frustration with technological challenges as “perfect storms” and said “technology was a drag.” These expressions showcased the stress and barriers participants experience with use of technology.
The technology. I mean, I know it's part of it but ... Even just now, I try to be 20 minutes early for this and I was 10 minutes late, just finding the email, getting in, getting the passwords to work. It's usually annoying and it was occasionally prohibitive. I know that's sort of the point, I mean, it's better than needing to drive somewhere or something like that but at the same time it's just like…..That's super disappointing so the technology was sort of a drag.
Technology also had positive and negative impacts on other categories. Figure 2 shows how positive/negative technology experiences affect other categories: community connection and keeping a connection.
Technology may have a positive effect on community connection through convenience of technology. A web-based video chat room provided privacy, which led to participants feeling that they had a “safe place” to talk with other women who were “going through a similar thing.” Privacy offered participants a platform where they could be open to express their feelings. This led to participants feeling that they “were not alone.” Although technology allowed participants to have face-to-face interaction and fostered communication during the group sessions, one of the drawbacks was that participants found this secluded video chat room environment somewhat prohibiting in building personal one-on-one relationships. At the conclusion of the sessions, women often turned off their video chat immediately, limiting opportunities to connect with each other pre- and post-session, a different experience from an in-person group. Participants expressed their desire to keep connected with each other between sessions or on their own time. Participants suggested that they would like to keep connected to each other and “build a community” of support after sessions had ended.