A qualitative exploration of active ingredients and mechanisms of action of an online singing programme with mothers experiencing postnatal depression during the COVID-19 pandemic: SHAPER-PNDO study

Background: Social distancing restrictions and the suspension of in-person treatment and support contributed to an increase in postnatal depression during the coronavirus disease 2019 (COVID-19) pandemic. Creative health interventions can help to alleviate anxiety and depression, with studies showing that singing is particularly effective for supporting the mental health of new mothers. We adapted an in-person group singing programme (Breathe Melodies for Mums (M4M)) to online delivery during the COVID-19 pandemic to support the mental health of new mothers, and, in a feasibility study, found improvements in postnatal depression (PND) symptoms at 6-month follow up. The current qualitative study aimed to explore how and why M4M-online impacted the mental health of those taking part.

Methods: We took a theory-based approach using the INgredients iN ArTs in hEealth (INNATE) Framework of 'active ingredients' and the Multi-level Leisure Mechanisms Framework of 'mechanisms of action' to identify and categorise intervention components and change mechanisms. Iterative consensus building between three researchers was complemented by qualitative semi-structured online interviews with 24 women experiencing PND symptoms who took part in M4M-online. Data were analysed inductively using reflexive thematic analysis.

Results: Consistency was found between the online and in-person interventions in active ingredients relating to project design, content, programme management and the composition of the group. Key differences were in the social and contextual ingredients. Psychological, social and behavioural mechanisms for improved mental health and wellbeing included: (1) Increased self-confidence as a mother, (2) Increased positive emotional responses, (3) A supported exploration of self-dentity, (4) Reduced loneliness and isolation, (5) Increased social bonding and connections with family and (6) Enhanced sense of time through new routines.

Conclusions: Participating in online group singing can support new mothers experiencing PND by triggering psychological, social and behavioural responses that lead to improved mental health. Key programme features are identified which can be used to design future online creative health interventions or tailor in-person activities for remote delivery to support populations who may face practical and social barriers to attending in-person.