Content, Behaviour Change Techniques, and Quality of Postpartum Depression Apps to Be Recommended by Midwives: Systematic Search and Evaluation

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

Dear Authors,

I am happy to review this manusript. It is really good you have made such research - apps are very popular and may cause both, benefits or harms if misused or developed in inproper way.

1. I think you should add and stress in one sentence in the introduction section that depression is multi-factorial.

2. Please add a sentence about negative PDD consequences for an infants' development.

3. Please provide the information about languages apps were avalaible.

4. Please, provide a short information about the preffered screening steps for women in antenatal period in Spain.

5. Please provide the information about the App Behaviour Change Scale (ABACUS) - did people reviewing apps were depressed? How the change in behaviour was assessed?

6. Please consider to cite following papers to the introduction:

a) Adlington K, Vasquez C, Pearce E, Wilson CA, Nowland R, Taylor BL, Spring S, Johnson S. 'Just snap out of it' - the experience of loneliness in women with perinatal depression: a Meta-synthesis of qualitative studies. BMC Psychiatry. 2023 Feb 28;23(1):110. doi: 10.1186/s12888-023-04532-2. PMID: 36849948; PMCID: PMC9970854. - Loneliness or feeling lonely seems to be underestimated feeling mothers suffering PMHP. Regarding to assessed manuscript it seems to be important to propose to mothers some companion and encourage them to make social connections. The use of apps can exacerbate the feeling of isolation, and this should be taken under consideration in my opinion.

b) Wszołek K, Żak E, Żurawska J, Olszewska J, Pięta B, Bojar I. Influence of socio-economic factors on emotional changes during the postnatal period. Ann Agric Environ Med. 2018 Mar 14;25(1):41-45. doi: 10.26444/aaem/74486. Epub 2017 Apr 7. PMID: 29575879. - this paper seems to be perfect to Discussion section - conversational (face-to-face) psychosocial assessment tools were found as one of the important factor in building trustful midwife-parent relationship. Although authors found that it is not always a perfect tool, especially in very vurnelable situations - and this is the part authors of reviewed manuscript potentially could discuss. Maybe apps could be useful in those situations?

Author Response

1. I think you should add and stress in one sentence in the introduction section that depression is multi-factorial.

Thanks for the suggestion. We have included the suggested text.

2. Please add a sentence about negative PDD consequences for an infants' development.

Thanks for the recommendation. We have included a brief comment about the consequences for the suggested text.

3. Please provide the information about languages apps were avalaible.

We describe in the meeting criteria that the selected apps were in Spanish.

4. Please, provide a short information about the preffered screening steps for women in antenatal period in Spain.

Thanks for the comment. Before developing the research, we developed a PPI with women in antenatal period. Based on this we identify the words used by women to find the app. But the screening step was so easy as, included a word in the app store and download one app. Most of them say that check the star rating. As is well known star rating is a non-scientific and/ or non-adequate criterion (DOI: 10.2196/22340). This was one of the reasons why we decide to develop the present research. Our results allow midwifes to recommend the best app for women.

5. Please provide the information about the App Behaviour Change Scale (ABACUS) - did people reviewing apps were depressed? How the change in behaviour was assessed?

Thanks. We answered in order: ABACUS information is included in the section 2.2; The review was developed by researchers, who enjoyed perfect mental health; We didn’t evaluate yet the behavior change, next research are going to be a clinical trial to evaluate the effect of using the best app (in terms of content, quality and behavior change techniques) identified in the present research.

6. Please consider to cite following papers to the introduction:

Thanks for the recommendation, we included the second reference in the discussion section.

Although authors found that it is not always a perfect tool, especially in very vulnerable situations - and this is the part authors of reviewed manuscript potentially could discuss. Maybe apps could be useful in those situations?

Thanks, we have included a paragraph mention the utility for vulnerable groups. In addition, as we mentioned, we are going to develop a clinical trial to evaluate the effect of using the best app. According with your comment we are going to consider and assess the effectiveness in vulnerable groups. 

Reviewer 2 Report

Comments and Suggestions for Authors

Dear Authors, 

I would just like to highlight a few considerations:

* Title: According to the design, this study is a systematic review. Why is not included in the title? The type of study should be included in the title.

I think, the title should be improved. " Systematic search and evaluation" is very confusing.

Introduction. Very consistent. However , the word  "Pospartum depression" is very repetitive in this section. Please, reduce the number of words associated with PPD. In this way, it would improve its readability."

Methods.

*Regarding the intervention, why were paid applications not included in the study?" The reasons should be explained. It would have been interesting to compare the paid and free versions.

 * Who is the target audience for these apps? 

* Malfunctioning apps should be further explained 

Discusion. Provide a general interpretation of the results compared with the existing literature.

Strengh and limitation section, it should be posted from line "..... Some limitations of this study should be noted..........

Author Response

Title

According to the design, this study is a systematic review. Why is not included in the title? The type of study should be included in the title.

I think, the title should be improved. " Systematic search and evaluation" is very confusing.

Thanks for the suggestion. We have modified the title.

Introduction

Very consistent. However, the word  "Pospartum depression" is very repetitive in this section. Please, reduce the number of words associated with PPD. In this way, it would improve its readability."

Thanks. We have rewritten the section.

Methods.

Regarding the intervention, why were paid applications not included in the study?" The reasons should be explained. It would have been interesting to compare the paid and free versions.

Thanks for the comment. We have included the following text in the limitation section “Some limitations of this study should be noted. We deliberately included free apps because we want to act in accordance with the characteristics of the Spanish healthcare model: free and universal”

 * Who is the target audience for these apps? 

Thanks for the suggestion. To clarify this point we include the following text before conclusion section “Therefore, the target audience for these apps are healthcare professionals and, indirectly, pregnant women.”

* Malfunctioning apps should be further explained 

Thanks. We have rewritten the introduction section according with the recommendation.

Discusion. 

Provide a general interpretation of the results compared with the existing literature.

Thanks for the comment. We reviewed the discussion, and it seem that all results were compared with previous literature following the same order that we used in the results section. Nonetheless, we include some paragraphs to trying to summarize the results of quality, content and BCT and to compare with previous research.

Strengh and limitation section.

It should be posted from line "..... Some limitations of this study should be noted..........

Thanks, we have rewritten the section according with the recommendation