Prevention of postpartum depression via a digital acceptance and commitment therapy-based intervention: protocol for a pilot usability study

Introduction: The perinatal period — encompassing pregnancy and the first months after childbirth — is a time of increased psychological vulnerability. It is often associated with high levels of anxiety, stress and depression. Access to psychological support is frequently limited by stigma, geographical barriers, and a shortage of services. Digital health interventions offer promising solutions to overcome these obstacles. Methods: This study evaluates the acceptability, feasibility, and user experience of REA, a virtual coach based on Acceptance and Commitment Therapy (ACT), to promote psychological well−being and prevent postpartum depression (PPD). Fifty pregnant women (25–30 weeks of gestation) will be recruited. The 8−week intervention delivers psychoeducational content via text, audio, and video, and collects steps, sleep, and heart rate via smartwatches for triangulation with self−reported measures. User Experience (UX) and User Engagement (UE) will be assessed with the System Usability Scale (SUS), the User Engagement Scale–Short Form (UES−SF), the Italian Chatbot Usability Scale, version B (ITA BUS B), and the User Version of the Mobile Application Rating Scale (uMARS), alongside semi−structured interviews. Psychological outcomes will be assessed pre–post with the two Whooley Questions, the Center for Epidemiological Studies Depression Scale (CES−D), the Multidimensional Psychological Flexibility Inventory (MPFI), and the 12−Item Short Form Health Survey (SF−12). Expected results: The intervention is expected to demonstrate high levels of user satisfaction and engagement (SUS ≥ 68, UES-SF ≥ 3,5/5; ITA BUS B ≥ 44/55 (≈4,0/5); uMARS ≥ 4,0/5), resulting in improvements in psychological flexibility, perceived well-being, and overall quality of life, recognizing that preventive efficacy will be evaluated in subsequent studies with controlled designs and postpartum outcome measures. Discussion: REA represents a scalable and accessible tool to support perinatal mental health, offering an innovative approach to the early prevention of postpartum distress. Trial registration: This study was approved by the ethics committee of the APSS (Provincial Health Services Authority) under number 12090 (May 15, 2025).