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Purpose: Global access to adequate resources to address postpartum depression (PPD) are limited and, at times, not reflective of the needs of pregnant women and new mothers. Gathering information about the preferences and needs of women when designing and implementing Internet-based programs is warranted, especially given the diversity of experiences related to childbirth. Thus, the aim of this study was to obtain user feedback on the content, structural, and cultural factors associated with a fully automated online PPD prevention intervention that, like similar programs, suffered from poor adherence and engagement. Methods: Following the completion of the Mothers and Babies Internet Course (eMB), an online prevention of PPD trial, a convenience sampling method was used to invite consenting participants to return to the site. Participants provided anonymous feedback on how to improve and adapt the eMB based on screenshots and video content from the Internet intervention. Demographic information and engagement in the online trial were examined as factors influencing participant responses. Results: One hundred nineteen English and Spanish speaking women from 27 countries and territories provided feedback about the eMB. Content-based feedback included requesting additional detail in explanations and simplifying recommended exercises. Structure-based feedback included requests for more visual representations of the materials. In general, participants did not explicitly suggest culturally specific feedback that differed by geographic region, but instead reported similar themes related to motherhood and childrearing. An unexpected finding that only emerged among English-speaking participants was the need for the eMB to address perfectionism and introspection as factors that impact motherhood. Relative to those who did not access the eMB in the parent study, women who did thought the intervention content was acceptable (i.e., no suggested changes) and provided feedback that referenced maternal stress and pregnancy experiences. Age, education, pregnancy status and number of children were not significant factors associated with participants' use of the eMB. Conclusions: Findings from this study offer preliminary information about the needs and preferences of an international sample of childrearing women who access automated Internet interventions to manage mood changes during the perinatal period. Keywords: Internet interventions, Postpartum depression, Spanish-speaking, Perinatal, Prevention

Recent studies have shown that women are more likely than men to use the Internet to seek health information and that the use of technology is common among perinatal women. Access to the Internet is growing through the global use of mobile phones and apps, in both developed and less developed countries. This pattern is particularly relevant for clinicians and researchers who are interested in the use of technologies to disseminate perinatal depression interventions. In a cross-sectional anonymous online survey for English and Spanish-speaking perinatal women, 509 pregnant (77.6 percent) and postpartum (22.4 percent) women provided demographic and Information and Communication Technologies data. Results indicated that the single device with greatest access was the mobile phone (47.5 percent). The majority of the sample had Internet access through mobile phones, computers, or both. Significant differences in socioeconomic status were found for Internet seeking behavior of health-related information and downloading apps between those with and without Internet access. Ninety percent of respondents (n = 267) searched for health-related information and 72.3 percent had downloaded any kind of app. More than half of respondents (57 percent, n = 188) downloaded a health-related app and 26.9 percent reported having paid for the apps. This study shows preliminary evidence to suggest the need to design, develop, and test apps that aim to disseminate prevention programs for perinatal depression.