Limitations
EVENT, RECRUITMENT
This study occurred during the COVID-19 pandemic and results are affected in numerous ways due to the historic event. The study recruitment was highly successful, and we meet our target enrollment within a few months; attrition was low. This study occurred in the early part of the pandemic and there was lacking perinatal education and mental health services available given most in-person encounters were stopped due to quarantine order therefore the recruitment and enrollment findings may not be suitable for estimating these outcomes in future studies. Further, the reliance on Facebook at the sole recruitment tool may have contributed to selection bias; future studies may consider multiple approaches for online recruitment.Although the study had zero attrition, the parameters allowed for one or both people in the dyad to miss measurements therefore the analysis and interpretation of results are limited. The study design includes qualitative data collection and the findings from that inquiry provide valuable reflection on ways in which the pandemic shaped participants' perspectives. Understanding why some people did not adhere to study protocols is an important area of research for future study. As this study was a feasibility trial, the sample size was small as is appropriate in the examination of feasibility and for examining preliminary efficacy outcomes; the study is designed to inform future and adequately powered studies with generalizable results.A limitation of this study was the lack of pre-intervention tailoring to adapt the content to the dyad; this likely contributed to the limited lesson completion. Future online studies aiming to decrease PMADs and engage the perinatal couple should use a design process that includes results from this study and engage dyads to gain additional insights for adaptation.Additionally, this study did not explore the potential effect of sociocultural factors and constructs such as social desirability; future research exploring these covariates would strengthen our understanding of dyadic interventions.