Barbara Chyzzy: Mobile phone-based peer support for adolescent mothers

In brief

Barbara Chyzzy

Adolescent mothers are four times more likely to develop postpartum depression than adult mothers. A lack of social support has been consistently identified as a major risk factor for postpartum depression among adolescent mothers. But there are no interventions that specifically use social support as a prevention tool.

PhD student Barbara Chyzzy is trying to develop a support resource for pregnant adolescent mothers with the hopes of preventing depression among this vulnerable maternal population. She wants to find out if cellphone-based support provided by a peer volunteer in the prenatal and early postnatal period will help prevent postpartum depression among adolescent mothers. 

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What you need to know

Pregnant adolescents are at significantly greater risk of developing postpartum depression compared to adult mothers. Barbara wants to examine if mobile phone-based support provided to adolescent mothers by a peer volunteer in the prenatal and early postnatal period will help prevent postpartum depression. For this reason, she’s conducting a pilot, randomized, controlled trial to find out if it’s possible to provide peer support using both cell phone voice calling and text messaging delivered by trained young women who were previously teen mothers.

About Barbara

Barbara Chyzzy is a second year PhD student at the Lawrence S. Bloomberg Faculty of Nursing, University of Toronto. She is also a clinical instructor at the University of Toronto and Humber College / University of New Brunswick Collaborative Bachelor of Nursing Program. She received her Bachelor of Nursing from the University of Manitoba and her Masters of Nursing / Collaborative Program in Community Development from the University of Toronto.

What is Barbara’s Research About?

Using peers to provide social support to adolescent mothers

Adolescent mothers are four times more likely to develop postpartum depression than adult mothers.  A lack of social support has been consistently identified as a major risk factor for postpartum depression among adolescent mothers. But there are no interventions that specifically use social support to prevent the onset of postpartum depression for adolescent mothers. Barbara’s research aims to create a support resource for pregnant adolescent mothers with the hopes of preventing depression among this vulnerable maternal population.

Peer support is a particular type of social support which is provided by a lay individual who has experienced a similar stressor or has common characteristics as the target population. It incorporates the provision of informational (knowledge, facts, and suggestions), emotional (attentive listening, caring and reassurance) and appraisal (motivation, encouragement and positive communication) support. 

Many peer support programs for adolescent mothers have been provided in a group format and have low or inconsistent attendance rates for a variety of reasons (such as preference for one-on-one support, transportation barriers, and lack of desire to attend due to depressive symptoms).

Why telephone-based support

Telephone-based peer support interventions offer increased flexibility, privacy and accessibility in addition to being cost-effective. However, no study has previously evaluated the effect of mobile phone-based peer support for the prevention of postpartum depression.

Barbara’s thesis supervisor, Dr. Cindy-Lee Dennis, has been working in the field of perinatal mental health for almost 15 years and developed an intervention to prevent postpartum depression in adult mothers, with peer support provided by telephone. The results of Dr. Dennis’ study showed a 50% reduction in postpartum depression. So Barbara wants to find out if the same type of support, provided by experienced young mothers using cell phones based support during pregnancy and the early postpartum period, will prevent postpartum depression in adolescent women as well.

“In some ways it sounds similar [to the intervention developed by Dr. Dennis], but it’s completely different,” Barbara said. “Mobile health technology has different capabilities from landline telephones since mobile phones can utilize both voice-calling and text-messaging.”

“As well, the challenges of working with adolescent mothers are very different than the difficulties experienced when working with adult mothers,” she said. A major challenge, she explained, is that, emotionally and developmentally, these young women have to deal with the issues of being an adolescent while also having to deal with the responsibilities and stressors of being a mother. Also, these young women often are emotionally vulnerable and have a history of abuse, she added.

About the pilot trial

Barbara is conducting a pilot, randomized, controlled trial (RCT) with adolescent mothers who are 19 years old and younger and live in Toronto, Ontario. The goal is to find out if a peer support program using cell phones would be feasible and acceptable to these young mothers. For example, she will find out if it’s easy or difficult to recruit participants and how participants and peer volunteers feel about the program.

She will also investigate if the program has any effects on postpartum depression symptoms, anxiety, child care stress, and self-esteem. She plans to conduct the trial from January 2015 to December 2015. Since this is a pilot trial, the number of participants is lower than larger multi-site trials.

Barbara intends to enroll 20 adolescent mothers who will be paired with a peer support volunteer for the intervention group and 20 adolescent mothers who will not receive peer support for the control group.

For this project, Barbara is collaborating with Young Parents No Fixed Address (http://www.ypnfa.ca), a network of about 30 Toronto agencies and organizations that work together to address the challenges faced by young homeless/street involved, pregnant, and parenting youth and their children. The network includes such organizations as child welfare agencies, youth mental health services, youth and family shelters, hospitals, Toronto Public Health, and young parent resource centres. Organizations affiliated with the Young Parents No Fixed Address network are supportive of Barbara’s research and will refer pregnant teens and peer volunteers to the study.

Peer volunteer training

The peer volunteers will be trained to provide emotional, appraisal, and informational support, as well as to identify if the young mother is at risk of suicide. The peers will be of similar age or slightly older than the participants – about 15 to 23 years of age – so that they will be able to relate to what the adolescent mothers are going through, Barbara explained.

“Mothers who are significantly older than the target population may not be able to relate as well as younger mothers,” she said. “So these are questions that you definitely take into consideration in the study such as: What is a peer? What are the characteristics of peers that are viable in this type of support? Does the age matter or is it just the experience of having been a teen mother that is most beneficial?”

Training for peer volunteers will consist of highly interactive sessions, using role playing and other strategies. Barbara will provide ongoing assistance and support to the peer volunteers throughout the study. She plans to recruit and train 15 to 20 peer volunteers.

“I am anticipating that each peer volunteer will provide support to one or maybe two participants at a time. There is the potential that some peer volunteers will drop out of the training since circumstances for the mothers might change, or they might not be able to handle the work. So I plan to train more peer volunteers to account for any losses” she said.

Barbara hopes that the findings of her study will reveal which aspects of mobile phone technology (voice calling, text messaging or a combination of both) and which components of peer support (informational, emotional, or appraisal) are most beneficial for adolescent mothers and if this type of support has any effect on preventing depressive symptoms for adolescent mothers in the early postpartum period. 

What’s next for Barbara?

Her ultimate goal is to get an academic position in nursing at a Canadian university and continue her research in adolescent mental health, mobile health (mHealth) technology, and peer support interventions to prevent physical and mental illness among adolescents. She also hopes to expand her research to include the mental health needs of precariously housed and homeless populations.

For more information about Barbara’s study, please contact her at barbara [dot] chyzzy [at] utoronto [dot] ca.

Author: Rossana Coriandoli