Translating behavioral interventions into virtual reality: the Transcend Framework for immersive health design

Frontiers in Digital Health · 2026-03-31

Virtual Reality (VR) has evolved from entertainment to a versatile platform for clinical and public health innovation. In medicine, VR supports pain management, rehabilitation, and cognitive training, and shows growing promise for addressing chronic diseases linked to modifiable risk factors. To support this expansion, we introduce the Transcend Framework , the Translational Engineering of Behavioral Interventions into Immersive Contexts for Engagement and Design framework, a systematic model for adapting evidence-based behavioral interventions into VR platforms, illustrated by Joviality™ , a positive psychological intervention designed for use during hemodialysis. The aim of this paper is to outline a clear, reproducible process for translating behavioral interventions into immersive digital formats that supports broader research, clinical, and implementation applications. The framework comprises five stages: (1) identifying the target population; (2) assessing feasibility and adapting the curriculum for VR; (3) pre-production planning, including storyboarding and design specification; (4) previsualization and asset creation of immersive environments; and (5) iterative VR development and testing to refine usability, accessibility, and engagement. Each stage emphasizes user-centered design and attention to physical limitations, cognitive load, and accessibility to ensure feasibility and effectiveness. Interactive, visually rich, modular environments foster engagement, while gamified activities enhance experiential learning and skill acquisition, and culturally attuned content ensures inclusivity. Continuous, data-informed refinement guided by end-user feedback ensures usability and sustained engagement. This methodological framework provides a practical roadmap for developing and optimizing VR-based behavioral health interventions and demonstrates how immersive technology can advance health education, promote behavior change, and enable scalable, equitable implementation across clinical contexts.

A Critical Review of Post-Childbirth Pain Experiences and Management in Relation to Postpartum Depression Risk for Racial and Ethnic Minorities

Current Psychiatry Reports · 2025-12-22

PURPOSE: This critical review examines literature published between January 2020 and January 2025, focusing on overlapping pain-related factors during and after childbirth (e.g., pain experiences and management). These factors may increase vulnerability to postpartum depression, especially among racial and ethnic minorities. RECENT FINDINGS: The findings from the 23 studies reviewed indicate that several factors contribute to peripartum pain experienced by individuals giving birth. Factors influencing the birthing person's pain experiences include their mental health during pregnancy (such as depression and anxiety), delivery method (especially cesarean), pain management practices, discrimination toward racial and ethnic minorities, and overall neglect of pain. Additionally, healthcare providers' beliefs about pain management play a role in postpartum pain experiences. Individuals with a history of depression or anxiety often experience more severe postpartum pain. Mode of delivery is an important factor, as cesarean deliveries are associated with more severe pain than vaginal deliveries. However, intrapartum experiences and pain management significantly influence pain ratings. Analgesics during and after labor may buffer postpartum pain, but not always. Additionally, pain relief medications for patients with opioid use disorders can impact postpartum pain management. While healthcare providers rely on clinical assessments and patient-centered approaches to inform postpartum pain management, data from racial and ethnic minorities revealed that healthcare professionals often fail to recognize these patients' pain. This underscores the disparities in perspectives and experiences among patients. Post-childbirth pain experiences and their management strategies may increase the risk of postpartum depression, highlighting the necessity for researchers and practitioners to consider them.

Erratum to: The Feasibility of Recruiting and Retaining Perinatal Latinas in a Biomedical Study Exploring Neuroendocrine Function and Postpartum Depression

UNC Libraries · 2025-09-19

Perinatal Depression, Adverse Life Events, and Hypothalamic–Adrenal–Pituitary Axis Response to Cold Pressor Stress in Latinas: An Exploratory Study

UNC Libraries · 2025-09-11

Associations Between Postpartum Depression, Breastfeeding, and Oxytocin Levels in Latina Mothers

UNC Libraries · 2025-09-11

BACKGROUND: Postpartum depression (PPD), often comorbid with anxiety, is the leading medical complication among new mothers. Latinas have elevated risk of PPD, which has been associated with early breastfeeding cessation. Lower plasma oxytocin (OT) levels have also been associated with PPD in non-Latinas. This pilot study explores associations between PPD, anxiety, breastfeeding, and OT in Latinas. MATERIALS AND METHODS: Thirty-four Latinas were enrolled during their third trimester of pregnancy and followed through 8 weeks postpartum. Demographic data were collected at enrollment. Depression was assessed using the Edinburgh Postnatal Depression Scale (EPDS) at each time point (third trimester of pregnancy, 4 and 8 weeks postpartum). The Spielberger State-Trait Anxiety Inventory (STAI) was administered postpartum and EPDS anxiety subscale was used to assess anxiety at each time point. Breastfeeding status was assessed at 4 and 8 weeks postpartum. At 8 weeks, OT was collected before, during, and after a 10-minute breast/bottle feeding session from 28 women who completed the procedures. Descriptive statistics are provided and comparisons by mood and breastfeeding status were conducted. Analyses of variance were used to explore associations between PPD, anxiety, breastfeeding status, and OT. RESULTS: Just under one-third of women were depressed at enrollment. Prenatal depression, PPD, and anxiety were significantly associated with early breastfeeding cessation (i.e., stopped breastfeeding before 2 months) (p < 0.05). There was a significant interaction between early breastfeeding cessation and depression status on OT at 8 weeks postpartum (p < 0.05). CONCLUSIONS: Lower levels of OT were observed in women who had PPD at 8 weeks and who had stopped breastfeeding their infant by 8 weeks postpartum. Future studies should investigate the short- and long-term effects of lower OT levels and early breastfeeding cessation on maternal and child well-being.

Exploring the feasibility and acceptability of using fMRI to measure pain responses in women with and without postpartum depression

Psychiatry Research Neuroimaging · 2025-08-08

Little is known about differences in pain perception among depressed versus non-depressed postpartum women. This novel study aimed to determine the feasibility and acceptability of enrolling non-depressed and depressed postpartum women in a laboratory-induced pain study using fMRI. Eleven non-depressed and two depressed postpartum women participated in a cold pain-induced experiment using fMRI. Feasibility and acceptability were assessed. Brain activation of the pain-associated regions of interest was measured. Participants provided subjective pain ratings (i.e., intensity and unpleasantness). The results indicated that enrolling postpartum women in a laboratory-induced pain study using fMRI is feasible. Participants found the study acceptable. The findings showed that the study's pain device activated the amygdala and insula in the non-depressed group, with activation in the anterior cingulate cortex being marginally significant. Exploratory analyses of differences in brain activation by depression status were not statistically significant. There was a significant and positive association between depressive symptoms and pain unpleasantness. Subjective pain ratings differed by depression status but were not statistically significant. This study showed that conducting a pain experiment using fMRI with postpartum women is feasible and acceptable. Future research should include a larger sample to confirm findings and investigate the impact of depression on pain responses.

The Feasibility of Recruiting and Retaining Perinatal Latinas in a Biomedical Study Exploring Neuroendocrine Function and Postpartum Depression

UNC Libraries · 2025-09-19

Mothers and Babies Virtual Group (MBVG) for perinatal Latina women: study protocol for a hybrid type-1 effectiveness-implementation randomized controlled trial

Trials · 2024-09-11 · 3 citations

BACKGROUND: Immigrant Latinas (who are foreign-born but now reside in the USA) are at greater risk for developing postpartum depression than the general perinatal population, but many face barriers to treatment. To address these barriers, we adapted the Mothers and Babies Course-an evidence-based intervention for postpartum depression prevention-to a virtual group format. Additional adaptations are inclusion of tailored supplemental child health content and nutrition benefit assistance. We are partnering with Early Learning Centers (ELC) across the state of Maryland to deliver and test the adapted intervention. METHODS: The design is a Hybrid Type I Effectiveness-Implementation Trial. A total of 300 participants will be individually randomized to immediate (N = 150) versus delayed (N = 150) receipt of the intervention, Mothers and Babies Virtual Group (MB-VG). The intervention will be delivered by trained Early Learning Center staff. The primary outcomes are depressive symptoms (measured via the Center for Epidemiologic Studies-Depression Scale), parenting self-efficacy (measured via the Parental Cognition and Conduct Towards the Infant Scale (PACOTIS) Parenting Self-Efficacy subscale), and parenting responsiveness (measured via the Maternal Infant Responsiveness Instrument) at 1-week, 3-month, and 6-month post-intervention. Depressive episodes (Structured Clinical Interview for DSM-V- Disorders Research Version) at 3-month and 6-month post-intervention will also be assessed. Secondary outcomes include social support, mood management, anxiety symptoms, perceived stress, food insecurity, and mental health stigma at 1-week, 3-month, and 6-month post-intervention. Exploratory child outcomes are dysregulation and school readiness at 6-month post-intervention. Intervention fidelity, feasibility, acceptability, and appropriateness will also be assessed guided by the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework. DISCUSSION: This study will be one of the first to test the efficacy of a group-based virtual perinatal depression intervention with Latina immigrants, for whom stark disparities exist in access to health services. The hybrid effectiveness-implementation design will allow rigorous examination of barriers and facilitators to delivery of the intervention package (including supplemental components) which will provide important information on factors influencing intervention effectiveness and the scalability of intervention components in Early Learning Centers and other child-serving settings. REGISTRATION: ClinicalTrials.gov NCT05873569.

Why an Integrated Approach to Perinatal Depression and Anxiety Is Necessary: An Introduction to the Book

2024-01-01

Developing a Culturally Responsive Mental Health Workforce for Spanish-Speaking and Latina/Latinx Birthing People with Perinatal Depression and Anxiety

2024-01-01 · 3 citations