Be a Mom implementation study protocol: integrating a universal digital intervention for postpartum depression into the Portuguese national health service

Postpartum depression is a recognised public health concern, affecting approximately one in seven women and contributing to adverse maternal-offspring outcomes. Despite its impact, it remains under‑managed, as evidence‑based interventions are not routinely integrated into standard care. Be a Mom is a self‑guided, internet‑delivered cognitive behavioural therapy (iCBT) intervention designed to prevent postpartum depression and support postpartum mental health. It has demonstrated efficacy in reducing depressive and anxiety symptoms among both low‑ and high‑risk postpartum women, with evidence further supporting its cost‑effectiveness. This protocol outlines the implementation and evaluation of Be a Mom in the Portuguese National Health Service (SNS). This study will evaluate the implementation of Be a Mom across four integrated health systems of the SNS, involving 20 participating health units, over 18 months of implementation support through a Learning Collaborative. A mixed-methods evaluation will be conducted, guided by Practical, Robust Implementation and Sustainability Model (PRISM) framework. Implementation outcomes of reach, effectiveness, adoption, and implementation will be analysed for postpartum women receiving care (patient-level) in these health units (setting-level) and for healthcare professionals promoting the digital health intervention (provider-level). Thematic analysis will be used to explore contextual factors influencing implementation outcomes. Implementation strategies will be mapped. This study was reviewed and authorised by the SNS through agreements with the relevant institutional bodies and will be conducted in compliance with national regulations. Findings will inform future scale‑up efforts and best practices for integrating digital health interventions into routine care, supporting the wider adoption of preventive approaches to maternal mental health. Results will be disseminated through peer‑reviewed publications, conference presentations, and reports to participating health units.