Prevention of Postpartum Depression via a Digital ACT-Based Intervention: Evaluation of a Prototype Using Multiple Case Studies

Postpartum depression (PPD) affects up to 15% of mothers, yet access to preventive psychological interventions during pregnancy remains limited. Acceptance and Commitment Therapy (ACT) has demonstrated efficacy in promoting psychological flexibility and preventing mental distress. Nevertheless, no studies have yet evaluated its use for the prevention of PPD through a chatbot-based digital intervention. The present study describes the development and preliminary evaluation of an ACT-based chatbot intervention (REA) to support women during late pregnancy and the early postpartum period. Nineteen participants interacted with the low-fidelity REA prototype, explored its features, completed two questionnaires, and then participated in semi-structured interviews. Quantitative data were analysed using the Wilcoxon signed-rank test; qualitative data were analysed using thematic analysis. Quantitative analysis revealed significantly elevated scores for the majority of variables, including empathy and listening, fluency, lexicon, clarity, engagement, functionality, aesthetics, information, and perceived impact. The interview findings demonstrated a notable level of appreciation for the intervention. The participants described the chatbot as engaging and supportive, highlighting a smooth interaction flow, content-appropriate language, and messages of suitable length. The REA prototype demonstrated high acceptability, usability, and perceived usefulness among a diverse range of stakeholders, thus supporting its potential as a scalable, stigma-reducing tool for the prevention of PPD. Subsequent research endeavours will focus on refining the chatbot's personalisation features and conducting comprehensive clinical trials to evaluate its efficacy.