Barriers and Facilitators to Resuming In-Person Psychotherapy with Perinatal Patients amid the COVID-19 Pandemic: A Multistakeholder Perspective

Abstract

During the COVID-19 pandemic, outpatient psychotherapy transitioned to telemedicine. This study aimed to examine barriers and facilitators to resuming in-person psychotherapy with perinatal patients as the pandemic abates. We conducted focus group and individual interviews with a sample of perinatal participants (n = 23), psychotherapy providers (n = 28), and stakeholders (n = 18) from Canada and the U.S. involved in the SUMMIT trial, which is aimed at improving access to mental healthcare for perinatal patients with depression and anxiety. Content analysis was used to examine perceived barriers and facilitators. Reported barriers included concerns about virus exposure in a hospital setting (77.8% stakeholders, 73.9% perinatal participants, 71.4% providers) or on public transportation (50.0% stakeholders, 26.1% perinatal participants, 25.0% providers), wearing a mask during sessions (50.0% stakeholders, 25.0% providers, 13.0% participants), lack of childcare (66.7% stakeholders, 46.4% providers, 43.5% perinatal participants), general transportation barriers (50.0% stakeholders, 47.8% perinatal participants, 25.0% providers), and the burden of planning and making time for in-person sessions (35.7% providers, 34.8% perinatal participants, 27.8% stakeholders). Reported facilitators included implementing and communicating safety protocols (72.2% stakeholders, 47.8% perinatal participants, 39.3% providers), conducting sessions at alternative or larger locations (44.4% stakeholders, 32.1% providers, 17.4% perinatal participants), providing incentives (34.8% perinatal participants, 21.4% providers, 11.1% stakeholders), and childcare and flexible scheduling options (31.1% perinatal participants, 16.7% stakeholders). This study identified a number of potential barriers and illustrated that COVID-19 has fostered and amplified barriers. Future interventions to facilitate resuming in-person sessions should focus on patient-centered strategies based on empathy regarding ongoing risk-aversion among perinatal patients despite existing safety protocols, and holistic thinking to make access to in-person psychotherapy easier and more accessible for perinatal patients.

In-person 1-day cognitive behavioral therapy-based workshops for postpartum depression: a randomized controlled trial

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Mothers' and birthing parents' experiences with 1‐day cognitive behavioural therapy‐based workshops for postpartum depression: A descriptive qualitative study

“…Participants in the online group identified new barriers to workshop engagement, including technology and unavailability of childcare during pandemic circumstances. There should be clear expectations when enrolling individuals for this modality that an optimal environment is one that is relatively distraction-free (Andrejek et al, 2021), though this can be difficult for new mothers and birthing parents. Previous research examining participant preferences with online treatment delivery shows mixed results (Branquinho et al, 2023;Pugh et al, 2015;Renn et al, 2019) to their own words (Bradshaw et al, 2017;Sandelowski, 2000).…”

Scaling up Mental Healthcare for Perinatal Populations: Is Telemedicine the Answer?

“…Second, it is unknown for whom telemedicine may be more acceptable and feasible. For example, some perinatal women may experience compromised care due to a lack of privacy, reduced physical and psychological safety and competing household demands [ 23 ]. This will inevitably increase the gap in access to treatment among the most vulnerable, socioeconomic groups.…”