Discussion
This multi-center RCT aimed to evaluate the effectiveness of an internet-based support program (ISP) on the improvements of MSE, social support; and the alleviation of PPD symptoms for Chinese primiparous women during the COVID-19 pandemic. Our research found that compared with first-time mothers in the control group, primiparous women in the intervention group had a significant higher level of MSE at T1 and T2, a higher level of social support at T1; and experienced less PPD symptoms at T1 and T2, which was consistent with our pilot study results (To be specific, the ISP was found to increase the MSE level for Chinese first-time mothers, which was well aligned with the findings of prior research that were Owing to the high prevalence and detrimental consequences, PPD has been identified as one of the serious global public health issues in the last decade (Owing to decrease the risk of transmission of COVID-19, delivering psychosocial support was seriously limited during the pandemic (This study possessed several limitations. Firstly, owing to the nature of the research, blinding of researchers during the whole research process can be impossible, which may cause the potential biases. Secondly, the requirement of internet access may have resulted in a more tech-savvy population recruited in the study, potentially limiting the generalization of this study. Thirdly, the self-report tools were used to measure the main variables, such as PPD, and may cause social desirability bias owing to the traditional belief of “domestic shame should not be made public”. Fourthly, because of time and financial limitations, the outcomes of ISP only focused on Chinese primiparous women. The knowledge gained from this study are strongly recommended to be used to plan a culturally appropriate ISP for other kinds of postpartum women, such as first-time mothers from different countries, single mothers, and multiparas.