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Gram P, Andersen CG, Petersen KS, Frederiksen MS, Thomsen LLH, Overgaard C. Identifying psychosocial vulnerabilities in pregnancy: A mixed-method systematic review of the knowledge base of antenatal conversational psychosocial assessment tools. Midwifery 2024; 136:104066. [PMID: 38905861 DOI: 10.1016/j.midw.2024.104066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 06/03/2024] [Accepted: 06/11/2024] [Indexed: 06/23/2024]
Abstract
BACKGROUND Early identification of psychosocial vulnerability among expectant parents through psychosocial assessment is increasingly recommended within maternity care. For routine antenatal assessment, a strong recognition exists regarding conversational assessment tools. However, the knowledge base of conversational tools is limited, inhibiting their clinical use. OBJECTIVE Synthesising existing knowledge pertaining to antenatal conversational psychosocial assessment tools, including identifying characteristics, acceptability, performance, effectiveness and unintended consequences. DESIGN Mixed-method systematic review based on searches in CINAHL, PubMed, Embase, PsycINFO, Cochrane and Scopus. 20 out of 5394 studies were included and synthesised with a convergent integrated approach using a thematic analysis strategy. FINDINGS We identified seven antenatal psychosocial assessment tools that partially or completely utilised a conversational approach. Women's acceptability was high, and tools were generally found to support person-centred communication and the parent-health care professional relationship. Evidence regarding effectiveness and performance of conversational tools was limited. Unintended consequences were found, including some women having negative experiences related to assessment of intimate partner violence, lack of preparation and lack of relevance. High acceptability was reported by health care professionals who considered the tools as valuable and enhancing of identification of vulnerability. Unintended consequences, including lack of time and competencies as well as discomfort when assessment is very sensitive, were reported. CONCLUSIONS Evidence regarding conversational tools' effectiveness and performance is limited. More is known about the acceptability of conversational tools, which is generally highly acceptable among women and health care professionals. Some unintended consequences of the use of included conversational tools were identified.
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Affiliation(s)
- Pernille Gram
- Department of Health Science and Technology, Aalborg University, Selma Lagerløfs Vej 249, Gistrup 9260, Denmark; Center for General Practice, Aalborg University, Selma Lagerløfs Vej 249, Gistrup 9260, Denmark.
| | - Clara Graugaard Andersen
- Department of Health Science and Technology, Aalborg University, Selma Lagerløfs Vej 249, Gistrup 9260, Denmark; Research Team of Women, Children, Youth and Families Health, Unit of Health Promotion, Department of Public Health, University of Southern Denmark, Esbjerg Ø 6705, Denmark
| | - Kirsten Schultz Petersen
- Department of Health Science and Technology, Aalborg University, Selma Lagerløfs Vej 249, Gistrup 9260, Denmark
| | - Marianne Stistrup Frederiksen
- Research Team of Women, Children, Youth and Families Health, Unit of Health Promotion, Department of Public Health, University of Southern Denmark, Esbjerg Ø 6705, Denmark
| | - Louise Lund Holm Thomsen
- Research Team of Women, Children, Youth and Families Health, Unit of Health Promotion, Department of Public Health, University of Southern Denmark, Esbjerg Ø 6705, Denmark
| | - Charlotte Overgaard
- Research Team of Women, Children, Youth and Families Health, Unit of Health Promotion, Department of Public Health, University of Southern Denmark, Esbjerg Ø 6705, Denmark
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Trang DTH, Ha BTT, Vui LT, Chi NTQ, Thi LM, Duong DTT, Hung DT, Cronin de Chavez A, Manzano A, Lakin K, Kane S, Mirzoev T. Understanding the barriers to integrating maternal and mental health at primary health care in Vietnam. Health Policy Plan 2024; 39:541-551. [PMID: 38597872 PMCID: PMC11145914 DOI: 10.1093/heapol/czae027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 03/27/2024] [Accepted: 04/08/2024] [Indexed: 04/11/2024] Open
Abstract
The prevalence of common perinatal mental disorders in Vietnam ranges from 16.9% to 39.9%, and substantial treatment gaps have been identified at all levels. This paper explores constraints to the integration of maternal and mental health services at the primary healthcare level and the implications for the health system's responsiveness to the needs and expectations of pregnant women with mental health conditions in Vietnam. As part of the RESPONSE project, a three-phase realist evaluation study, we present Phase 1 findings, which employed systematic and scoping literature reviews and qualitative data collection (focus groups and interviews) with key health system actors in Bac Giang province, Vietnam, to understand the barriers to maternal mental healthcare provision, utilization and integration strategies. A four-level framing of the barriers to integrating perinatal mental health services in Vietnam was used in reporting findings, which comprised individual, sociocultural, organizational and structural levels. At the sociocultural and structural levels, these barriers included cultural beliefs about the holistic notion of physical and mental health, stigma towards mental health, biomedical approach to healthcare services, absence of comprehensive mental health policy and a lack of mental health workforce. At the organizational level, there was an absence of clinical guidelines on the integration of mental health in routine antenatal visits, a shortage of staff and poor health facilities. Finally, at the provider level, a lack of knowledge and training on mental health was identified. The integration of mental health into routine antenatal visits at the primary care level has the potential help to reduce stigma towards mental health and improve health system responsiveness by providing services closer to the local level, offering prompt attention, better choice of services and better communication while ensuring privacy and confidentiality of services. This can improve the demand for mental health services and help reduce the delay of care-seeking.
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Affiliation(s)
- Do Thi Hanh Trang
- Hanoi University of Public Health, 1A Duc Thang, Bac Tu Liem, Ha Noi 10000, Vietnam
| | - Bui Thi Thu Ha
- Hanoi University of Public Health, 1A Duc Thang, Bac Tu Liem, Ha Noi 10000, Vietnam
| | - Le Thi Vui
- Hanoi University of Public Health, 1A Duc Thang, Bac Tu Liem, Ha Noi 10000, Vietnam
| | | | - Le Minh Thi
- Hanoi University of Public Health, 1A Duc Thang, Bac Tu Liem, Ha Noi 10000, Vietnam
| | - Doan Thi Thuy Duong
- Hanoi University of Public Health, 1A Duc Thang, Bac Tu Liem, Ha Noi 10000, Vietnam
| | - Dang The Hung
- Hanoi University of Public Health, 1A Duc Thang, Bac Tu Liem, Ha Noi 10000, Vietnam
| | - Anna Cronin de Chavez
- Global Health and Development, London School of Hygiene and Tropical Medicine, Keppel St, London WC1E 7HT, United Kingdom
| | - Ana Manzano
- School of Sociology and Social Policy, University of Leeds, Leeds LS2 9JT, United Kingdom
| | - Kimberly Lakin
- Nossal Institute for Global Health Melbourne School of Population and Global Health, The University of Melbourne, Victoria 3010, Australia
| | - Sumit Kane
- Nossal Institute for Global Health Melbourne School of Population and Global Health, The University of Melbourne, Victoria 3010, Australia
| | - Tolib Mirzoev
- Global Health and Development, London School of Hygiene and Tropical Medicine, Keppel St, London WC1E 7HT, United Kingdom
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Sarwinanti, Widyawati, Warsini S, Hakimi M, Ramdani WF. Identify mental health needs of adolescent pregnant women: a qualitative study. Int J Adolesc Med Health 2024; 36:259-267. [PMID: 38713895 DOI: 10.1515/ijamh-2024-0028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 04/15/2024] [Indexed: 05/09/2024]
Abstract
PURPOSE The purpose of this study is to explore adolescent pregnant women related to their pregnancy experience about mental health needs during pregnancy for the prevention of depression during pregnancy. METHODS This research is a qualitative study design with a phenomenological approach. Data collection using interviews (in-depth interviews). This study involved 18 participants consisting of 12 pregnant women aged 15-19 years and 6 midwives who work at the health center. The criteria for informants of pregnant women are pregnant with Trimester I to III, age 15-19 years and not experiencing complications of pregnancy. RESULTS Based on interviews conducted with informants, five themes were obtained about the experiences and needs of pregnant women in adolescence. These themes are (1). Risk of depression, (2). Social and family support needs, (3). Needs of mental health services, (4). Obstacles for midwives in providing mental health services, and (5). needs of mental health information media. CONCLUSIONS Five needs of teenage pregnant women are factors that can support mental health to prevent depression during pregnancy.
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Affiliation(s)
- Sarwinanti
- Doctoral Program, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Widyawati
- Department of Pediatric and Maternity Nursing, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Sri Warsini
- Department of Mental Health Nursing, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Mohammad Hakimi
- Department of Medical and Health Sciences/Obstetrics and Gynaecology/Paediatrics and Reproductive, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Wawan Febri Ramdani
- Department of Nursing, Faculty of Health Science, Aisyiyah University Yogyakarta, Yogyakarta, Indonesia
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Tzitiridou-Chatzopoulou M, Orovou E, Zournatzidou G. Digital Training for Nurses and Midwives to Improve Treatment for Women with Postpartum Depression and Protect Neonates: A Dynamic Bibliometric Review Analysis. Healthcare (Basel) 2024; 12:1015. [PMID: 38786425 PMCID: PMC11120917 DOI: 10.3390/healthcare12101015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 05/07/2024] [Accepted: 05/11/2024] [Indexed: 05/25/2024] Open
Abstract
The high prevalence of postpartum depression makes it necessary for midwives and nurses to implement prenatal interventions for expectant mothers. The current study aims to investigate and highlight the importance of the digital training of nurses in order to help women mitigate the symptoms of postpartum depression and protect infants. To approach this, we conducted a bibliometric analysis to address the study's main objective. Articles were retrieved from the Scopus database for the timeframe 2000-2023. Data analysis was conducted using the statistical programming language R (version R-4.4.) and the bibliometric software VOSviewer (version 1.6.20) and Biblioshiny (version 4.1.4), focused on year, journal, and country. For this investigation, we selected a total of 31 MeSH keywords and sub-headings that exhibited significant frequencies. We consistently used six significant clusters of MeSH keywords. We obtained a total of 585 articles from the Scopus database that were major contributors to the field of PPD, as evidenced by their extensive publication of research articles and their influential role in the domain. The studies included a thorough analysis of depression research, the use of scales for diagnosing and screening PPD, psychological studies related to PPD, and the exploration of causes, mechanisms, outcomes, and genetic factors. Our study's results demonstrate a steady and significant increase in the availability of information on PPD. Importantly, the novelty of the current study lies in highlighting the need for a transition in the ways in which nurses and midwives are trained to mitigate postpartum disease by integrating emerging technologies into their practices. The knowledge provided here has the potential to serve as a foundation for future advancements in obstetric psychology, both presently and in the future.
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Affiliation(s)
- Maria Tzitiridou-Chatzopoulou
- Midwifery Department, School of Healthcare Sciences, University of Western Macedonia, Koila, 50100 Kozani, Greece; (M.T.-C.); (E.O.)
| | - Eirini Orovou
- Midwifery Department, School of Healthcare Sciences, University of Western Macedonia, Koila, 50100 Kozani, Greece; (M.T.-C.); (E.O.)
| | - Georgia Zournatzidou
- Department of Accounting and Finance, Hellenic Mediterranean University, 71410 Heraklion, Greece
- Department of Business Administration, University of Western Macedonia, 50100 Kozani, Greece
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5
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Harrison JM. Integrating Mental Health In Perinatal Care: Perspectives Of Interprofessional Clinicians. Health Aff (Millwood) 2024; 43:540-547. [PMID: 38560808 DOI: 10.1377/hlthaff.2023.01427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Despite the prevalence of perinatal mental health issues in the United States, gaps in care persist. To address this, perinatal health care settings are asked to focus on patients' mental health by administering standardized screening and, increasingly, by integrating mental health teams in their clinics. Using in-depth interviews and ethnographic observations, I investigated these emerging practices, exploring the experiences of certified nurse-midwives, obstetricians, and mental health clinicians. I found that certified nurse-midwives and obstetricians lack time, resources, and expertise, restricting their ability to address patients' mental health. Integrated mental health clinicians are constrained by the stratified organization of health care and structural deprioritization of mental health. Redesigning perinatal health care and de-siloing mental health training are necessary to increase clinicians' effectiveness and to improve perinatal health outcomes.
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Affiliation(s)
- Jessica M Harrison
- Jessica M. Harrison , University of California San Francisco, San Francisco, California
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Hall SV, Pangori A, Tilea A, Schroeder A, Admon LK, Zivin K. Antidepressant Prescriptions Increased For Privately Insured People With Perinatal Mood And Anxiety Disorder, 2008-20. Health Aff (Millwood) 2024; 43:514-522. [PMID: 38560803 PMCID: PMC11164068 DOI: 10.1377/hlthaff.2023.01448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
We aimed to determine whether antidepressant prescriptions for perinatal mood and anxiety disorder (PMAD) increased after several professional organizations issued clinical recommendations in 2015 and 2016. This serial, cross-sectional, logistic regression analysis evaluated changes in antenatal and postpartum antidepressant prescriptions among commercially insured people who had a live-birth delivery as well as a PMAD diagnosis during the period 2008-20. For people with antenatal PMAD, the odds of an antenatal antidepressant prescription decreased 3 percent annually from 2008 to 2016 and increased by 32 percent in 2017, and the annual rate of change increased 5 percent for 2017-20 compared with 2008-16. For people with postpartum PMAD, the odds of a postpartum antidepressant prescription decreased 2 percent annually from 2008 to 2016 and experienced no significant change in 2017, but the annual rate of change increased 3 percent for 2017-20 compared with 2008-16. The clinical recommendations issued in 2015 and 2016 were associated with increased antidepressant prescriptions for PMAD, particularly for antenatal PMAD. These findings indicate that clinical recommendations represent an effective tool for changing prescribing patterns.
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Affiliation(s)
| | | | | | | | | | - Kara Zivin
- Kara Zivin, University of Michigan, Veterans Affairs Ann Arbor Healthcare System, and Mathematica, Ann Arbor, Michigan
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McKellar L, Martinez L, De Sousa Machado T, Eden A, Stoodley C, Adelson P. Evaluation of a pilot online education program to develop midwives' knowledge, skill and confidence in perinatal mental health in rural South Australia. Women Birth 2024; 37:355-361. [PMID: 38072708 DOI: 10.1016/j.wombi.2023.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 11/23/2023] [Accepted: 11/23/2023] [Indexed: 03/05/2024]
Abstract
One in five women will experience perinatal anxiety and/or depression. In South Australia, a rural health service identified a high proportion of women with risk of perinatal mental health challenges and sought additional education for midwives. In response, a six-week facilitated, online perinatal mental health education program (e-PMHEP) was piloted. AIM The aim of this study was to evaluate the effectiveness of the (e-PMHEP) for rural midwives, nurses and Aboriginal maternal infant care practitioners. METHOD Program evaluation incorporated a validated online pre/post survey to assess self-reported knowledge, skill and confidence regarding perinatal mental healthcare. Additional questions sought feedback on satisfaction and feasibility. FINDINGS Sixteen participants from rural South Australia engaged in the project from June to August 2022. Twelve participants completed the online pre/post survey. The overall pre/post knowledge scores were statistically significant (t = 2.73, 8df, p = 0.025) with improvement from the pre to post-test. Pre/post data also showed a measurable increase in confidence and skills. All respondents agreed that the content addressed their learning needs and would recommend this program to other practitioners. DISCUSSION The e-PMHEP appeared beneficial in developing knowledge, skills and confidence regarding perinatal mental healthcare in rural midwives and practitioners. Only a third of practitioners routinely developed a mental health care plan with women. Key strengths of the program included the accessible content, and the combination of an experienced mental health clinician and a facilitator with lived experience. CONCLUSION Providing an accessible, facilitated online perinatal mental health education program could be beneficial for rural midwives.
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Affiliation(s)
- Lois McKellar
- School of Health and Social Care, Edinburgh Napier University, United Kingdom.
| | - Lee Martinez
- UniSA Department of Rural Health, University of South Australia, Australia
| | | | - Amye Eden
- UniSA Health and Clinical Sciences, University of South Australia, Australia
| | - Cathy Stoodley
- UniSA Health and Clinical Sciences, University of South Australia, Australia
| | - Pam Adelson
- Rosemary Bryant (AO) Research Centre, University of South Australia, Australia
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Byrne A. Longitudinal impact of an online interdisciplinary perinatal mental health module on Healthcare Professionals' knowledge, skills, attitudes and confidence: A qualitative evaluation. Nurse Educ Pract 2024; 75:103879. [PMID: 38237208 DOI: 10.1016/j.nepr.2024.103879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 12/10/2023] [Accepted: 01/01/2024] [Indexed: 02/21/2024]
Abstract
AIM/OBJECTIVE The current study aimed to explore the following research question; 'What is the longitudinal impact, if any, of an online interdisciplinary perinatal mental health module on HCP knowledge, skills, attitudes and confidence'. BACKGROUND Research suggests that one in five women/people will experience a mental health issue during the perinatal period. Healthcare Professionals (HCPs) play a critical role in identifying, supporting and referring those who disclose health or psychosocial concerns in pregnancy or after birth and consistent research findings highlight the need for appropriate targeted perinatal mental health education among this cohort. To address this need, a thirteen-week (Masters Level) interdisciplinary online module in perinatal mental health was collaboratively developed between one Irish Higher Education Institution and national mental healthcare specialists. The module aims to develop HCP knowledge, skills, attitude and confidence in sustainably supporting women/people and families experiencing perinatal mental health issues. However, a recent scoping review concluded that there was insufficient evidence with respect to the longitudinal impact of such courses on HCP practice. DESIGN/METHODS The study design adopted a qualitative descriptive design that used online individual interviews for data collection. The evaluation was informed by the Kirkpatrick and Kirkpatrick Evaluation Model. The study group consisted of six voluntarily self-selected perinatal mental health module participants. Longitudinal impacts of the module were explored 8-10 months following module completion. Thematic Analysis was undertaken using Braun and Clarkes Framework. Ethical approval for the study was obtained from the author's Higher Education Institution (HEI). RESULTS Findings revealed several interrelated and reinforcing themes that had an impact on the longer-term application of enhanced knowledge, skills, attitude and confidence in practice. These were; pedagogical features of the interdisciplinary perinatal mental health education module, sociocultural and professional influences, persistent enthusiasm and commitment to improve care in spite of systemic obstacles and, ongoing need for perinatal mental health education. CONCLUSIONS Provision of targeted, agile and manageable professional education courses on perinatal mental health care will continue to be required. However, despite sustained commitment and enthusiasm to implement enhanced knowledge and skills, systemic obstacles continue to exist and these may have an impact on the efficacy of such courses in the longer term.
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Affiliation(s)
- Anita Byrne
- Dundalk Institute of Technology, Dublin Road, Dundalk, Co, Louth, Ireland.
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Beňová L, Semaan A, Portela A, Bonet M, van den Akker T, Pembe AB, Moran A, Duclos D. Facilitators and barriers of implementation of routine postnatal care guidelines for women: A systematic scoping review using critical interpretive synthesis. J Glob Health 2023; 13:04176. [PMID: 37997894 PMCID: PMC10668206 DOI: 10.7189/jogh.13.04176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2023] Open
Abstract
Background Postnatal care (PNC) has the potential to prevent a substantial burden of maternal and newborn morbidity and mortality. This scoping review aimed to identify and synthesise themes related to facilitators and barriers of implementation of guidelines on routine PNC for women (postpartum care) in all settings. Methods This is a scoping review guided by the standard principles of Arksey & O'Malley's framework. We used the critical interpretive synthesis method to synthesise the whole body of evidence. We searched four databases (Medline, Embase, Global Health, CINAHL Plus) using a combination of search terms comprising four key concepts: postnatal care, routine care, guidelines and implementation. No restrictions on country or language of publication were applied. We excluded studies not presenting findings about PNC for women. We thematically charted the themes of studies included based on title and abstract screening. All studies included after full text screening were described and their results synthesised using the socio-ecological model framework. We did not conduct a risk of bias analysis or quality assessment of included studies. Results We identified a total of 8692 unique records and included 43 studies which identified facilitators and barriers to implementing routine guidelines in provision of PNC to women. Three quarters of studies pertained to PNC provision in high-income countries. Specific facilitators and barriers were identified and thematically presented based on whether they affect the provision of PNC or the intersection between provision of PNC and its use by women and families. We applied a critical global health lens to synthesise three constructs in the literature: finding a balance between standardisation and individualisation of PNC, the fragmented PNC provision landscape complicating the experiences of women with intersecting vulnerabilities, and the heavy reliance on the short postpartum period as an opportunity to educate and retain women and newborns in the health system. Conclusions This interpretive synthesis of evidence shows that the fragmented and narrow nature of PNC provision presents specific challenges to developing, adapting and implementing routine PNC guidelines. This results in a lack of linkages to social support and services, fails to address intersecting vulnerabilities and inequities among women, and negatively influences care seeking. There is a lack of evidence on how processes of individualising PNC provision can be applied in practice to support health workers in providing woman-centered PNC in various global settings. Registration https://www.protocols.io/private/C99DA688881F11EBB4690A58A9FEAC02.
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Affiliation(s)
- Lenka Beňová
- Institute of Tropical Medicine, Antwerp, Belgium
- London School of Hygiene and Tropical Medicine, London, UK
| | - Aline Semaan
- Institute of Tropical Medicine, Antwerp, Belgium
- Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Anayda Portela
- World Health Organization, Department of Maternal, Newborn, Child and Adolescent Health and Ageing, Geneva, Switzerland
| | - Mercedes Bonet
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Thomas van den Akker
- Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Leiden University Medical Centre, Leiden, the Netherlands
| | - Andrea B Pembe
- Muhimbili University of Health and Allied Sciences, Dar es Salaam Tanzania (s)
| | - Allisyn Moran
- World Health Organization, Department of Maternal, Newborn, Child and Adolescent Health and Ageing, Geneva, Switzerland
| | - Diane Duclos
- London School of Hygiene and Tropical Medicine, London, UK
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Dallison S, Jenkinson C, Davey A, O'Mahen H. Overcoming training bottlenecks: mixed-methods evaluation of digital training for non-specialists in postnatal depression self-help treatment. J Reprod Infant Psychol 2023:1-20. [PMID: 37986141 DOI: 10.1080/02646838.2023.2280714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 10/05/2023] [Indexed: 11/22/2023]
Abstract
OBJECTIVES This mixed-methods study evaluated the feasibility, acceptability and preliminary effectiveness of an interactive digital training programme for non-specialist supporters providing a guided self-help intervention for postnatal depression (PND). METHODS A total of 49 non-specialist trainees participated. Six digital training modules were flexibly delivered over a 5-week period. Training included a chatroom, moderated by a supervised assistant psychologist. Quantitatively, feasibility was assessed via participation and retention levels; acceptability was examined using course evaluation questionnaires; and effectiveness was measured pre-test-post-test quantitatively using a self-report questionnaire and pre-post using scenario questions. Participant focus groups explored feasibility, acceptability and effectiveness. RESULTS The training was feasible; 41 completed the course and 42 were assessed at follow-up. Quantitative course evaluation and thematic analysis of focus group feedback demonstrated high training acceptability. RANOVAs indicated training significantly improved knowledge and confidence pre- to post-test. There were demonstrable increases in specific skills at post-test as assessed via clinical scenarios. CONCLUSION This training is a feasible, acceptable and effective way to upskill non-specialists in supporting treatment for PND, however supervised practice is recommended to ensure participants embed knowledge competently into practice. The training offers an effective first step in upskilling non-specialist supporters to support women with PND treatment at scale.
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Affiliation(s)
- Sophie Dallison
- Mood Disorders Centre, Department of Psychology, University of Exeter, Exeter, UK
| | - Caroline Jenkinson
- Mood Disorders Centre, Department of Psychology, University of Exeter, Exeter, UK
| | - Antoinette Davey
- Mood Disorders Centre, Department of Psychology, University of Exeter, Exeter, UK
| | - Heather O'Mahen
- Mood Disorders Centre, Department of Psychology, University of Exeter, Exeter, UK
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11
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Howard S, Houghton CMG, White R, Fallon V, Slade P. The feasibility and acceptability of a single-session Acceptance and Commitment Therapy (ACT) intervention to support women self-reporting fear of childbirth in a first pregnancy. Psychol Health 2023; 38:1460-1481. [PMID: 35060404 DOI: 10.1080/08870446.2021.2024190] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 12/03/2021] [Accepted: 12/20/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To assess the feasibility and acceptability of a single-session Acceptance and Commitment Therapy intervention to help women manage fear of childbirth during a first pregnancy. DESIGN A mixed-methods approach including qualitative feedback and pre/post-intervention self-report measures. Pregnant women (14-37 weeks gestation) were recruited via the UK National Health Service and attended a single-session (<3 hours) Acceptance and Commitment Therapy intervention alongside routine antenatal care. Data were analysed using content and statistical analyses. MAIN OUTCOME MEASURES Fear of childbirth, anxiety and wellbeing were the main outcome measures. Secondary to these, intolerance of uncertainty and valued life domains (e.g. relationships, recreation) as hypothesised mechanisms of change, were also assessed. RESULTS 33 expressions of interest were received, 21 women signed up, 15 participated, and 11 completed follow-up measures (participation rate: 33%). Findings demonstrated clinical and statistical reductions in fear of childbirth and anxiety alongside positive feedback on the intervention. Intolerance of uncertainty and wellbeing were low at baseline and remained unchanged. CONCLUSION A single-session Acceptance and Commitment Therapy intervention to manage fear of childbirth is potentially feasible and acceptable. A pilot randomised controlled trial is warranted. Further research should explore efficacy and how Acceptance and Commitment Therapy may reduce perinatal distress.
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Affiliation(s)
- Sarah Howard
- Clinical Psychology, University of Liverpool, Liverpool, UK
| | | | - Ross White
- Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Vicky Fallon
- School of Psychology, University of Liverpool, Liverpool, UK
| | - Pauline Slade
- Department of Primary Care and Mental Health, Institute of Population Health, University of Liverpool, Liverpool, UK
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Webb R, Uddin N, Constantinou G, Ford E, Easter A, Shakespeare J, Hann A, Roberts N, Alderdice F, Sinesi A, Coates R, Hogg S, Ayers S. Meta-review of the barriers and facilitators to women accessing perinatal mental healthcare. BMJ Open 2023; 13:e066703. [PMID: 37474171 PMCID: PMC10360426 DOI: 10.1136/bmjopen-2022-066703] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/22/2023] Open
Abstract
Perinatal mental health (PMH) problems are common and can have an adverse impact on women and their families. However, research suggests that a substantial proportion of women with PMH problems do not access care. OBJECTIVES To synthesise the results from previous systematic reviews of barriers and facilitators to women to seeking help, accessing help, and engaging in PMH care, and to suggest recommendations for clinical practice and policy. DESIGN A meta-review of systematic reviews. REVIEW METHODS Seven databases were searched and reviewed using a Preferred Reporting Items for Systematic Reviews and Meta Analyses search strategy. Studies that focused on the views of women seeking help and accessing PMH care were included. Data were analysed using thematic synthesis. Assessing the Methodological Quality of Systematic Reviews-2 was used to assess review methodology. To improve validity of results, a qualitative sensitivity analysis was conducted to assess whether themes remained consistent across all reviews, regardless of their quality rating. RESULTS A total of 32 reviews were included. A wide range of barriers and facilitators to women accessing PMH care were identified. These mapped across a multilevel model of influential factors (individual, healthcare professional, interpersonal, organisational, political and societal) and across the care pathway (from decision to consult to receiving care). Evidence-based recommendations to support the design and delivery of PMH care were produced based on identified barriers and facilitators. CONCLUSION The identified barriers and facilitators point to a complex interplay of many factors, highlighting the need for an international effort to increase awareness of PMH problems, reduce mental health stigma, and provide woman-centred, flexible care, delivered by well trained and culturally sensitive primary care, maternity, and psychiatric health professionals. PROSPERO REGISTRATION NUMBER CRD42019142854.
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Affiliation(s)
- Rebecca Webb
- Centre for Maternal and Child Health Research, City University, London, UK
| | - Nazihah Uddin
- Centre for Maternal and Child Health Research, City University, London, UK
| | | | - Elizabeth Ford
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, UK
| | - Abigail Easter
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK
- Section of Women's Mental Health, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | | | | | - Nia Roberts
- Bodleian Health Care Libraries, University of Oxford, Oxford, UK
| | - Fiona Alderdice
- Nuffield Department of Population Health, National Perinatal Epidemiology Unit, Oxford, UK
| | - Andrea Sinesi
- Nursing, Midwifery and Allied Health Professions Research Unit (NMAHP RU), University of Stirling, Stirling, UK
| | - Rose Coates
- Centre for Maternal and Child Health Research, City University, London, UK
| | - Sally Hogg
- Faculty of Education, University of Cambridge, Cambridge, UK
| | - Susan Ayers
- Centre for Maternal and Child Health Research, City University, London, UK
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Delicate A, Ayers S. The impact of birth trauma on the couple relationship and related support requirements; a framework analysis of parents' perspectives. Midwifery 2023; 123:103732. [PMID: 37229840 DOI: 10.1016/j.midw.2023.103732] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 04/19/2023] [Accepted: 05/16/2023] [Indexed: 05/27/2023]
Abstract
BACKGROUND Ongoing distress following a traumatic birth experience, commonly known as birth trauma, can lead to post-traumatic stress symptoms. Experiencing birth trauma can affect personal well-being and impact the couple relationship. OBJECTIVE The present study aimed to explore the lived experience of the impact of birth trauma on the couple relationship and related support requirements. METHODS A purposive sample of men and women in the UK who had experienced birth as traumatic were recruited and interviewed remotely in 2021. Data were analysed using framework analysis in NVivo 12. RESULTS The sample (N=18) contained 9 women who were first time parents and 9 men; 5 of which were first time parents and 4 who had two children. Twelve themes are reported related to the impact of birth trauma on the couple relationship. Findings suggest the impact of birth trauma on the couple relationship can be negative and distressing, or for some lead to a strengthened relationship. Fourteen themes are reported related to associated birth trauma support. Negative aspects of support were reported in themes: unavailability of help from friends and family; unhelpful birth debriefing services; no personal awareness of birth trauma; absence of trauma validation from health care professionals; lack of awareness of the emotional needs of men; and barriers to accessing psychological services. Potential improvements to support included: supporting parents to understand the traumatic events; birth trauma informed antenatal preparation; improving access to specialist psychological services; and compassionate parent centred maternity services. CONCLUSIONS The impact of birth trauma on the couple relationship appears complex with both positive and negative affects reported. Current support for the impact of birth trauma on the couple relationship has perceived inadequacies for which improvements are proposed.
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Affiliation(s)
- Amy Delicate
- Research Assistant, Centre for Maternal and Child Health Research, City University of London.
| | - Susan Ayers
- Professor, Centre for Maternal and Child Health Research, City University of London
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14
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Cheney K, Black K, Pelosi M, Dorney E. Introduction of the London Measure of Unplanned Pregnancy at the booking visit and the midwives' perspective. BMJ SEXUAL & REPRODUCTIVE HEALTH 2023; 49:112-117. [PMID: 36410764 DOI: 10.1136/bmjsrh-2022-201576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 11/03/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Pregnancy planning and preconception care benefit women, their children, and future generations. The London Measure of Unplanned Pregnancy (LMUP) is a tool that can be used in antenatal care to identify women with unintended pregnancies who require improved access to such services. This tool was recently implemented into routine antenatal care in two maternity centres in New South Wales, Australia. This study explores midwives' attitudes to the LMUP 12 months after it was introduced into the booking visit and their understanding of its application to their scope of practice. METHODS This is a qualitative study using in-depth semi-structured interviews with midwives from two maternity care centres in Australia. All midwives performing antenatal booking visits were eligible to take part. Interviews were transcribed, analysed, and coded to define key themes. Recruitment ceased when thematic saturation was reached. RESULTS Ten midwives from two maternity centres were interviewed. Midwives support the inclusion of the LMUP into the booking visit and felt it was in their scope of practice to be using the tool. Time constraints, the impact of COVID-19 and the lack of structured referral pathways were identified as barriers to the implementation of the LMUP in routine care. CONCLUSIONS Midwives support the inclusion of the LMUP into the antenatal booking visit and see that it falls within their scope of practice. Service barriers were identified at the individual, organisational and external context levels. These need to be addressed to enhance the potential of this tool.
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Affiliation(s)
- Kate Cheney
- The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia
- Sydney Local Health District, Camperdown, New South Wales, Australia
| | - Kirsten Black
- The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia
- Sydney Local Health District, Camperdown, New South Wales, Australia
| | - Marilena Pelosi
- Sydney Local Health District, Camperdown, New South Wales, Australia
| | - Edwina Dorney
- The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia
- Sydney Local Health District, Camperdown, New South Wales, Australia
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Andersen CG, Thomsen LLH, Gram P, Overgaard C. ‘It's about developing a trustful relationship’: A Realist Evaluation of midwives’ relational competencies and confidence in a Danish antenatal psychosocial screening programme. Midwifery 2023; 122:103675. [PMID: 37043942 DOI: 10.1016/j.midw.2023.103675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 12/27/2022] [Accepted: 03/27/2023] [Indexed: 04/04/2023]
Abstract
OBJECTIVE to explore how contextual conditions influence midwives' relational competencies, ability and confidence to undertake psychosocial assessment of pregnant women and their partners during the first antenatal consultation that identifies expectant parents in vulnerable positions. DESIGN a realist evaluation carried out through three phases: 1) development 2) testing and 3) refinement of programme theories. Data was generated through realist interviews and observations. SETTING nine community-based and hospital-based midwife clinics in the North Region of Denmark. INTERVENTION a dialogue-based psychosocial assessment programme in the the North Region of Denmark was evaluated. PARTICIPANTS AND DATA 15 midwives were interviewed and 16 observations of midwives undertaking psychosocial assessment during the first antenatal consultation were conducted. FINDINGS contextual conditions at multiple levels which supported midwives' relational competencies, autonomy and the power of peer reflection-and thus facilitation of a woman-centred approach and trust-were identified, i.e., being experienced, having interest, organisational prioritisation of peer reflection and flexibility. Where midwives lacked experience, competency development regarding psychosocial assessment, opportunities for peer reflection and autonomy to individualise care for expectant parents in vulnerable positions, the approach to assessment tended to become institution-centred which caused a distant dialogue and instrumental assessment which potentially harmed the midwife-woman/couple relationship. CONCLUSION midwives' ability and confidence to undertake psychosocial assessment were affected by whether individual and organisational contextual conditions empowered them to assess and care for expectant parents within a philosophy of woman-centred care. Accordingly, development of trustful midwife-woman/couple relationships - which is essential for disclosure - was achievable. These conditions become fundamental for securing quality of antenatal care for expectant parents in vulnerable positions.
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Marshman A, Saunders E, Chaves D, Morton Ninomiya ME. Barriers to perinatal mental health care experiences by midwives and obstetricians and their patients: A rapid review. Midwifery 2023; 117:103544. [PMID: 36580794 DOI: 10.1016/j.midw.2022.103544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 10/19/2022] [Accepted: 10/31/2022] [Indexed: 11/13/2022]
Abstract
INTRODUCTION While perinatal mental health concerns are common, little attention is paid to noticing or addressing these concerns. Midwives and obstetricians are uniquely positioned to universally screen their patients for mental health conditions during the perinatal period, and provide referrals for additional mental health supports if relevant. Previous studies on perinatal mental health care have focused primarily on midwifery care, excluding perinatal healthcare providers such as obstetricians. This rapid review aims to examine the barriers to accessing mental health care during the perinatal period as experienced by obstetricians, midwives, and their patients. METHODS A rapid review of literature was conducted on barriers to perinatal mental health care as experienced by patients, midwives, and obstetricians. The search strategy included published literature from PubMed, CINAHL, PsycINFO, and Web of Science published between 2000 and 2020. All documents were screened by two researchers and disagreements were resolved through consensus with a third reviewer. After data from all included articles were extracted, thematic analysis was conducted, and findings were compared with related reviews that focused on mental health access for individuals who accessed midwifery care. RESULTS Of the 539 references and documents that were screened, 31 articles met the inclusion criteria. In the extraction phase, country, study objective(s), study design, perspective(s), barriers, and the dimension(s) impacted along the pathway to accessing care were retrieved from the 31 included articles. After all barriers were classified using the Supply-Side Dimensions of Access, we developed a classification framework to further examine stigma at the societal, institutional, and individual levels. DISCUSSION While midwives utilize a more holistic approach to care as compared with obstetricians, the barriers identified through this rapid review indicate that obstetricians and their patients face similar struggles to accessing and providing mental health care. Moreover, stigma plays a large role in the barriers experienced by patients, midwives, and obstetricians - at individual and institutional levels. CONCLUSION Obstetricians encounter similar stigma-related barriers as midwives in detecting mental health concerns, as well as connecting clients to available mental health resources and supports. Therefore, to effectively eliminate barriers to accessing perinatal mental health care, a systemic change must be enacted throughout all three layers to address the deep-rooted stigma associated with accessing mental health care during the perinatal period.
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Affiliation(s)
| | | | | | - Melody E Morton Ninomiya
- Wilfrid Laurier University; Centre for Addiction and Mental Health; Canada Research Chair (Tier II) in Community-Driven Knowledge Mobilization and Pathways to Wellness.
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Shahid Ali S, Letourneau N, Rajan A, Jaffer S, Adnan F, Asif N, Ali TS. Midwives' perspectives on perinatal mental health: A qualitative exploratory study in a maternity setting in Karachi, Pakistan. Asian J Psychiatr 2023; 80:103356. [PMID: 36470193 DOI: 10.1016/j.ajp.2022.103356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Revised: 10/29/2022] [Accepted: 11/25/2022] [Indexed: 11/27/2022]
Abstract
Women experience perinatal mental health problems (PMHP), such as anxiety and depression antenatally and/or postnatally. Among Asian countries, Pakistan has the highest prevalence of postnatal depression ranging from 28% to 63%. This study aimed to explore midwives' perceptions, understanding, thoughts, and feelings regarding perinatal mental health (PMH), as well as experiences and roles in identifying and managing perinatal women cases suffering from PMHP. A qualitative, descriptive, exploratory design was used. The study was conducted at Koohi Goth Hospital. Purposive sampling was used to recruit practicing midwives holding diplomas in midwifery and public health, and with at least two years of experience. Ten participants were recruited. Data were collected by conducting in-depth interviews using a semi-structured interview guide, translated into Urdu. Interviews were audio recorded. Ethics approval was attained by the institutional Ethical Review Committee. Data analysis was done manually by using the content analysis steps described by Creswell. From the analysis, three themes emerged: 1) Dearth of PMH competencies; 2) Importance of PMH; and 3) Myths related to PMH. PMHP undermine mothers' and infants outcomes, thus, midwives should be competent in assessing and managing symptoms in perinatal women to reduce suffering.
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Affiliation(s)
- Shahnaz Shahid Ali
- School of Nursing and Midwifery, Aga Khan University, Karachi, Pakistan.
| | | | | | | | - Farzana Adnan
- School of Nursing and Midwifery, Aga Khan University, Karachi, Pakistan
| | - Nimira Asif
- School of Nursing and Midwifery, Aga Khan University, Karachi, Pakistan
| | - Tazeen Saeed Ali
- School of Nursing and Midwifery, Aga Khan University, Karachi, Pakistan
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18
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Banasova R, Noskova E, Vodickova R, Hasto J, Sebela A. Emotional difficulties, coping strategies, and help-seeking patterns among Czech perinatal women. Midwifery 2023; 116:103526. [PMID: 36323074 DOI: 10.1016/j.midw.2022.103526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 02/15/2022] [Accepted: 10/21/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To understand both, women´s perception of emotional difficulties in perinatal period and their related coping strategies. Further, we mapped and analysed help-seeking patterns utilized by these women to overcome their emotional difficulties. This study serve as an important piece of information for women-centred innovations in perinatal mental health care in Czechia, and more broadly in the region of Central and Eastern Europe. DESIGN A qualitative study with an exploratory and descriptive approach using thematic analysis. SETTING Online survey consisting of open-ended questions mapping women´s perception of emotional difficulties in perinatal period and their related coping strategies and help-seeking patterns. PARTICIPANTS Two hundred women self-reporting emotional difficulties in perinatal period, from whom 108 (54 %) stated that they had sought professional help with their emotional difficulties. FINDINGS Two themes were identified in the analysis of women´s perception of emotional difficulties including Experience of symptoms of mental disorders, and Mother-child relationship. Three themes were identified in the analysis of women´s coping with these difficulties (Personal resources, External resources, and No coping strategy used). Four themes were identified in the analysis of help seeking patterns utilized by study participants (Mental health specialists, Physicians of the first line of contact, Midwifes, and Peer consultants). KEY CONCLUSIONS Emotional difficulties of perinatal women stemmed in both, general symptoms of mental disorders and specific concerns connected to mother-child relationship. Therefore, the perinatal mental health services should cover both topics, preferably by a multidisciplinary team. Women search information about perinatal mental health, so thus, easy to reach valid resources are needed. Finally, Czech perinatal women experiencing emotional difficulties utilize various help-seeking patterns. Some of them naturalistically utilize integrated stepped care even when it is not systematically established.
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Affiliation(s)
- Renata Banasova
- National Institute of Mental Health, Klecany, Czech Republic; Olomouc University Social Health Institute, Palacky University, Olomouc, Czech Republic
| | - Eliska Noskova
- National Institute of Mental Health, Klecany, Czech Republic; Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Renata Vodickova
- Department of Psychology, Faculty of Arts, Palacky University, Olomouc, Czech Republic
| | - Jozef Hasto
- Olomouc University Social Health Institute, Palacky University, Olomouc, Czech Republic; Psychiatric Clinic, Pro Mente Sana, Bratislava, Slovakia
| | - Antonin Sebela
- National Institute of Mental Health, Klecany, Czech Republic; Third Faculty of Medicine, Charles University, Prague, Czech Republic.
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Navarrete L, Lara MA, Berenzon S, Mora-Rios J. Challenges of Perinatal Depression Care in Mexico City Health Centers. Int J Womens Health 2022; 14:1667-1679. [PMID: 36510491 PMCID: PMC9739043 DOI: 10.2147/ijwh.s381196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 10/05/2022] [Indexed: 12/12/2022] Open
Abstract
Background Perinatal depression is a common mental disorder regarded as a severe public health problem. Studies have shown that incorporating mental health care into primary health services that provide pregnancy care makes it easier for women to seek help for depressive symptoms. In this context, the following question is of interest: How prepared are primary health services in Mexico City that provide pregnancy and postpartum care to treat perinatal depression? This article seeks to explore the perceptions and knowledge of perinatal depression in health professionals and analyze the barriers to its care at primary care centers in Mexico City. Methods An exploratory study with a qualitative approach was conducted. Doctors, nurses, social workers who provide maternal and childcare, mental health personnel, and the directors of four centers were interviewed. Interviews were audio-recorded and transcribed for thematic analysis. Results Most primary care personnel are unaware of the Official Standard that recommends providing maternal mental health care during the perinatal period. There is no initiative for its incorporation into routine care. A significant barrier to its implementation is health professionals' biased, stereotyped perception of perinatal depression, motherhood, and the role of women. Other barriers include the workload of health professionals, the division of care between professionals, and the lack of communication between the latter. Women with psychological symptoms are not referred to mental health staff in a timely manner. Social workers are in closer contact with women and are more willing to address their emotional distress. Conclusion Maternal mental health care, contingent on pregnancy, childbirth, and puerperium care at primary care centers is currently not possible due to the lack of knowledge, barriers, and directors' dependence on hospital management decisions.
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Affiliation(s)
- Laura Navarrete
- Directorate of Epidemiological and Psychosocial Research, National Institute of Psychiatry “Ramón de la Fuente Muñiz”, Mexico City, Mexico,Doctorate Program in Medical, Odontology and Health Sciences of the National Autonomous, University of Mexico, Mexico City, Mexico
| | - Ma Asunción Lara
- Directorate of Epidemiological and Psychosocial Research, National Institute of Psychiatry “Ramón de la Fuente Muñiz”, Mexico City, Mexico,Correspondence: Ma Asunción Lara, Tel +52 55 4160 5170, Fax +52 55 5513 3446, Email
| | - Shoshana Berenzon
- Directorate of Epidemiological and Psychosocial Research, National Institute of Psychiatry “Ramón de la Fuente Muñiz”, Mexico City, Mexico
| | - Jazmin Mora-Rios
- Directorate of Epidemiological and Psychosocial Research, National Institute of Psychiatry “Ramón de la Fuente Muñiz”, Mexico City, Mexico
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Asare SF, Rodriguez-Muñoz MF. Understanding Healthcare Professionals' Knowledge on Perinatal Depression among Women in a Tertiary Hospital in Ghana: A Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15960. [PMID: 36498033 PMCID: PMC9740295 DOI: 10.3390/ijerph192315960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 11/25/2022] [Accepted: 11/27/2022] [Indexed: 06/17/2023]
Abstract
Health conditions affecting women in the perinatal period still account for a major contribution to disease burden in Sub-Saharan Africa, yet there is a dearth of empirical research to understanding health professionals' perspective on their experiences and how they care for perinatal women in depression. We used a qualitative exploratory descriptive approach through a face- to face-interview to explore the knowledge of 11 health professionals of Komfo Anokye Teaching Hospital, Kumasi- Ghana. Interviews were taped recorded and transcribed verbatim. The study adopted Haase's modification of Colaizzi's method for the analysis. Four main themes emerged: ineffective communication (Referral lapses among care providers, long waiting time, lack of confidentiality), workload (Inefficient staff to meet perinatal women's need, no screening tools and time constraints), Reaction to patients symptoms (Identifying patient's symptoms, assessment through patient's centeredness and Education and counselling). Our results emerged that time constraints, stigmatization and lack of awareness delayed the care and management of perinatal depression among healthcare professionals in the hospital setting. There is the need to improve healthcare professionals' knowledge on perinatal depression and it is imperative for the hospital administrators to invest in continuous training and professional development for healthcare professionals.
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Affiliation(s)
- Sandra Fremah Asare
- Department of Personality, Assessment and Psychological Treatment, Universidad Nacional de Educación a Distancia, 28015 Madrid, Spain
- Discipline of Nursing, School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban 4001, South Africa
- Seventh-Day Adventist Nursing and Midwifery Training College, Kwadaso, Kumasi P.O. Box PC 96, Ghana
| | - Maria F. Rodriguez-Muñoz
- Department of Personality, Assessment and Psychological Treatment, Universidad Nacional de Educación a Distancia, 28015 Madrid, Spain
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Burton HAL, Pickenhan L, Carson C, Salkovskis P, Alderdice F. How women with obsessive compulsive disorder experience maternity care and mental health care during pregnancy and postpartum: A systematic literature review. J Affect Disord 2022; 314:1-18. [PMID: 35780969 DOI: 10.1016/j.jad.2022.06.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 05/27/2022] [Accepted: 06/20/2022] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Obsessive Compulsive Disorder has a higher prevalence in pregnancy and postpartum than in the general population. Experiences of maternity care and mental health care can impact the health and wellbeing of perinatal women. The aim of this review was to synthesize evidence on the experiences of maternity care and mental health care for women with OCD during pregnancy and postpartum. METHODS Studies were systematically reviewed by two independent reviewers after identification in MEDLINE, Embase, PsycINFO, Global Health, CINAHL, the Cochrane Library, Web of Science and grey literature searches (last searched October 2021). Papers meeting pre-specified inclusion criteria were extracted using a pre-determined extraction sheet and were quality assessed. Thematic synthesis was conducted. RESULTS 19 papers reporting 18 studies describing 33 participants were included. Three descriptive themes were found: experiences of barriers to treatment and care, experiences of treatment/care decision making and experiences of treatment and care. Three analytic themes were found demonstrating tensions: keeping baby healthy vs keeping mother healthy, keeping baby safe vs keeping mother safe, and normal perinatal experience vs not normal perinatal experience. LIMITATIONS Despite an inclusive search strategy, available data was limited. 17 of the studies were case studies that were poor in quality. Synthesis and subsequent findings were limited. CONCLUSIONS There were significant literature gaps for all aspects of care but particularly around experiences of maternity and pharmacological care. Tensions that could impact the experience of care need to be carefully balanced to ensure that women with OCD get the care that they need.
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Affiliation(s)
- Hollie A L Burton
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, The University of Oxford, UK.
| | | | - Claire Carson
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, The University of Oxford, UK
| | - Paul Salkovskis
- Department of Experimental Psychology, The University of Oxford, UK
| | - Fiona Alderdice
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, The University of Oxford, UK
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22
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Ryan A, Barber C. Postnatal depression and anxiety during the COVID-19 pandemic: The needs and experiences of New Zealand mothers and health care providers. Midwifery 2022; 115:103491. [PMID: 36191380 PMCID: PMC9489979 DOI: 10.1016/j.midw.2022.103491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 09/04/2022] [Accepted: 09/19/2022] [Indexed: 12/02/2022]
Abstract
Objective The postnatal period is a vulnerable time for women's mental health, particularly within the context of the COVID-19 pandemic. This study interviewed Auckland-based mothers and healthcare providers to find out their perspectives on the needs and experiences of women with postnatal mental health concerns within the pandemic context. Design Semi-structured interviews were conducted via video conferencing. Setting Interviews were conducted between May and July 2021 during the COVID-19 pandemic. Participants Participants included eight mothers who gave birth during the first year of the pandemic (between January and December 2020) and self-identified as experiencing postnatal depression and/or anxiety, and three healthcare providers who support women with postnatal mental illness. All participants were based in Auckland, New Zealand. Measurements and Findings Interviews were analysed using thematic analysis. Five main themes were identified including (1) uncertainty and anxiety, (2) financial and work stress, (3) importance of the “village”, (4) inner resilience, and (5) “no one cared for mum”. The participants’ stories reflected a period of uncertainty, anxiety, and isolation. A lack of focus on mothers’ mental health during postnatal healthcare appointments was evident, as well as a lack of support services to refer the women to should they reach out for help. Key Conclusions and Implications for Practice The results of this study highlight the importance of prioritising safe, in-person access to healthcare providers and sources of social support for postnatal women during pandemic lockdowns to help reduce isolation during this vulnerable time. Improving accessibility to a range of treatment options for those with mild to moderate mental illness also needs to be a priority. A dedicated postnatal mental health support line could be beneficial to broaden the support options available to mothers, both within and outside the pandemic context. More focus on mental health training for midwives and other postnatal healthcare providers such as well child nurses is also recommended, to increase their ability to support women struggling with postnatal mental illness.
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Affiliation(s)
- Amelia Ryan
- Te Kura Whatu Oho Mauri, School of Psychology, University of Waikato, Private Bag 3105, Hamilton 3240, New Zealand.
| | - Carol Barber
- Te Kura Whatu Oho Mauri, School of Psychology, University of Waikato, Private Bag 3105, Hamilton 3240, New Zealand.
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Carlin E, Ferrari K, Spry EP, Williams M, Atkinson D, Marley JV. Implementation of the ‘Kimberley Mum’s Mood Scale’ across primary health care services in the Kimberley region of Western Australia: A mixed methods assessment. PLoS One 2022; 17:e0273689. [PMID: 36054104 PMCID: PMC9439224 DOI: 10.1371/journal.pone.0273689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 08/13/2022] [Indexed: 11/19/2022] Open
Abstract
The Kimberley Mum’s Mood Scale (KMMS) was co-designed with Aboriginal women and healthcare professionals to improve culturally appropriate screening practices for perinatal depression and anxiety. This paper describes the implementation of the KMMS across the remote Kimberley region of Western Australia from January 2018 to December 2021. We used the Dynamic Sustainability Framework to progress the implementation and assess at the intervention, practice setting and ecological system level using a mixed methods approach to analyse implementation. Rates of administration and results of screening were described using a retrospective audit of electronic medical records. Analyses of KMMS training registry, stakeholder engagement and sustainability initiatives were descriptive. KMMS acceptability was assessed using qualitative descriptive approaches to analyse patient feedback forms (n = 39), healthcare professional surveys (n = 15) and qualitative interviews with healthcare professionals (n = 6). We found a significant increase in overall recorded perinatal screening (pre-implementation: 30.4% v Year 3: 46.5%, P < 0.001) and use of the KMMS (pre-implementation: 16.4% v Year 3: 46.4%, P < 0.001). There was improved fidelity in completing the KMMS (from 2.3% to 61.8%, P < 0.001), with 23.6% of women screened recorded as being at increased risk of depression and anxiety. Most healthcare professionals noted the high levels of perinatal mental health concerns, stress, and trauma that their patients experienced, and identified the KMMS as the most appropriate perinatal screening tool. Aboriginal women reported that it was important for clinics to ask about mood and feelings during the perinatal period, and that the KMMS was appropriate. Aboriginal women consistently reported that it was good to have someone to talk to. This study demonstrates that innovation in perinatal depression and anxiety screening for Aboriginal women is possible and can be implemented into routine clinical care with the support of a sustained multi-year investment and strong partnerships.
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Affiliation(s)
- Emma Carlin
- The Rural Clinical School of Western Australia, The University of Western Australia, Broome, Western Australia, Australia
- Kimberley Aboriginal Medical Services, Broome, Western Australia, Australia
- * E-mail:
| | - Katherine Ferrari
- Kimberley Aboriginal Medical Services, Broome, Western Australia, Australia
| | - Erica P. Spry
- The Rural Clinical School of Western Australia, The University of Western Australia, Broome, Western Australia, Australia
- Kimberley Aboriginal Medical Services, Broome, Western Australia, Australia
| | - Melissa Williams
- Kimberley Population Health Unit, Western Australian Country Health Service, Broome, Western Australia, Australia
| | - David Atkinson
- The Rural Clinical School of Western Australia, The University of Western Australia, Broome, Western Australia, Australia
| | - Julia V. Marley
- The Rural Clinical School of Western Australia, The University of Western Australia, Broome, Western Australia, Australia
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Pilav S, De Backer K, Easter A, Silverio SA, Sundaresh S, Roberts S, Howard LM. A qualitative study of minority ethnic women's experiences of access to and engagement with perinatal mental health care. BMC Pregnancy Childbirth 2022; 22:421. [PMID: 35585579 PMCID: PMC9116695 DOI: 10.1186/s12884-022-04698-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 04/14/2022] [Indexed: 11/20/2022] Open
Abstract
Background Approximately one in five women will experience mental health difficulties in the perinatal period. However, for a large group of women, symptoms of adverse perinatal mental health remain undetected and untreated. This is even more so for women of ethnic minority background, who face a variety of barriers which prevents them from accessing appropriate perinatal mental health care. Aims To explore minority ethnic women’s experiences of access to and engagement with perinatal mental health care. Methods Semi-structured interviews were conducted with 18 women who had been diagnosed with perinatal mental health difficulties and who were supported in the community by a specialist perinatal mental health service in South London, United Kingdom. Women who self-identified as being from a minority ethnic group were purposefully selected. Data were transcribed verbatim, uploaded into NVivo for management and analysis, which was conducted using reflective thematic analysis. Results Three distinct overarching themes were identified, each with two or three subthemes: ‘Expectations and Experiences of Womanhood as an Ethnic Minority’ (Shame and Guilt in Motherhood; Women as Caregivers; Perceived to Be Strong and Often Dismissed), ‘Family and Community Influences’ (Blind Faith in the Medical Profession; Family and Community Beliefs about Mental Health and Care; Intergenerational Trauma and Family Dynamics) and ‘Cultural Understanding, Empowerment, and Validation’ (The Importance of Understanding Cultural Differences; The Power of Validation, Reassurance, and Support). Conclusion Women of ethnic minority background identified barriers to accessing and engaging with perinatal mental health support on an individual, familial, community and societal level. Perinatal mental health services should be aware ethnic minority women might present with mental health difficulties in different ways and embrace principles of cultural humility and co-production to fully meet these women’s perinatal mental health needs. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-022-04698-9.
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Affiliation(s)
- Sabrina Pilav
- Oxleas NHS Foundation Trust, Bexley, Bromley and Greenwich Perinatal Mental Health Service, Queen Mary's Hospital, I Block, Frognal Avenue, Sidcup, DA14 6LT, London, UK
| | - Kaat De Backer
- Department of Women & Children's Health, School of Life Course Sciences, Faculty of Life Sciences & Medicine, King's College London, 10th Floor North Wing, St., Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK
| | - Abigail Easter
- Department of Women & Children's Health, School of Life Course Sciences, Faculty of Life Sciences & Medicine, King's College London, 10th Floor North Wing, St., Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK. .,Section of Women's Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AF, UK.
| | - Sergio A Silverio
- Department of Women & Children's Health, School of Life Course Sciences, Faculty of Life Sciences & Medicine, King's College London, 10th Floor North Wing, St., Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK
| | - Sushma Sundaresh
- Oxleas NHS Foundation Trust, Bexley, Bromley and Greenwich Perinatal Mental Health Service, Queen Mary's Hospital, I Block, Frognal Avenue, Sidcup, DA14 6LT, London, UK
| | - Sara Roberts
- Oxleas NHS Foundation Trust, Bexley, Bromley and Greenwich Perinatal Mental Health Service, Queen Mary's Hospital, I Block, Frognal Avenue, Sidcup, DA14 6LT, London, UK
| | - Louise M Howard
- Section of Women's Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AF, UK
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Midwives’ experiences of supporting women's mental health: a mixed-method study. Midwifery 2022; 111:103368. [DOI: 10.1016/j.midw.2022.103368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 03/07/2022] [Accepted: 05/09/2022] [Indexed: 11/23/2022]
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Zhu Y, Ma J, Wang Q, Xu Y, Xu G, Du S. Factors affecting the implementation of task-sharing interventions for perinatal depression in low- and middle-income countries: A systematic review and qualitative metasynthesis. J Affect Disord 2022; 300:400-409. [PMID: 34990629 DOI: 10.1016/j.jad.2022.01.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 10/24/2021] [Accepted: 01/01/2022] [Indexed: 10/19/2022]
Abstract
Background The vast majority of women with perinatal depression (PND) live in low- and middle-income countries (LMICs). Task sharing is an alternative delivery strategy to implement PND services. However, the exploration of influencing factors for task sharing in PND services is poor. Therefore, this study aimed to identify factors affecting LMICs to implement PND task-sharing interventions from the perspective of stakeholders and weigh their levels of evidence. Methods A comprehensive literature search was carried out through six English and Chinese databases on qualitative data. We used Critical Appraisal Skills Programme (CASP)/Meta Quality Appraisal Tool (MetaQAT) to appraise included studies, extracted data according to the Consolidated Framework for Implementation Research (CFIR), and assigned levels of confidence in the factors through Grading of Recommendations Assessment, Development and Evaluation-Confidence in the Evidence from Reviews of Qualitative research (GRADE-CERQual). Results 17 studies met the eligibility criteria, factors identified with high levels of evidence were coded to the CFIR constructs, including "Knowledge and Attitudes of Those Served by the Organization", "Available Resources", "Compatibility", "Access to knowledge and information", "Resources of Those Served by the Organization" and "Alignment". Conclusion This metasynthesis highlights task sharing in PND interventions is influenced by multiple factors. We synthesized and developed implementation recommendations for practice. Strategies must be actively developed to enable women and their families to enjoy the benefits of good perinatal mental health.
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Affiliation(s)
- Yuan Zhu
- School of Nursing, Nanjing University of Chinese Medicine, 138 Xianlin Avenue, Qixia District, Nanjing Jiangsu Province, China
| | - Jiayuan Ma
- School of Nursing, Nanjing University of Chinese Medicine, 138 Xianlin Avenue, Qixia District, Nanjing Jiangsu Province, China
| | - Qing Wang
- School of Nursing, Nanjing University of Chinese Medicine, 138 Xianlin Avenue, Qixia District, Nanjing Jiangsu Province, China
| | - Yue Xu
- School of Nursing, Nanjing University of Chinese Medicine, 138 Xianlin Avenue, Qixia District, Nanjing Jiangsu Province, China
| | - Guihua Xu
- School of Nursing, Nanjing University of Chinese Medicine, 138 Xianlin Avenue, Qixia District, Nanjing Jiangsu Province, China.
| | - Shizheng Du
- School of Nursing, Nanjing University of Chinese Medicine, 138 Xianlin Avenue, Qixia District, Nanjing Jiangsu Province, China.
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Experiences of Perinatal Mental Health Care among Minority Ethnic Women during the COVID-19 Pandemic in London: A Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19041975. [PMID: 35206163 PMCID: PMC8872278 DOI: 10.3390/ijerph19041975] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 01/30/2022] [Accepted: 01/31/2022] [Indexed: 02/06/2023]
Abstract
(1) Background: Approximately one in five women will experience mental health difficulties in the perinatal period. Women from ethnic minority backgrounds face a variety of barriers that can prevent or delay access to appropriate perinatal mental health care. COVID-19 pandemic restrictions created additional obstacles for this group of women. This study aims to explore minority ethnic women's experiences of perinatal mental health services during COVID-19 in London. (2) Methods: Eighteen women from ethnic minority backgrounds were interviewed, and data were subject to a thematic analysis. (3) Results: Three main themes were identified, each with two subthemes: 'Difficulties and Disruptions to Access' (Access to Appointments; Pandemic Restrictions and Disruption), 'Experiences of Remote Delivery' (Preference for Face-to-Face Contact; Advantages of Remote Support); and 'Psychosocial Experiences' linked to COVID-19 (Heightened Anxiety; Social Isolation). (4) Conclusions: Women from ethnic minority backgrounds experienced disrupted perinatal mental health care and COVID-19 restrictions compounding their mental health difficulties. Services should take women's circumstances into account and provide flexibility regarding remote delivery of care.
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Markey K, Noonan M, Doody O, Tuohy T, Daly T, Regan C, O’Donnell C. Fostering Collective Approaches in Supporting Perinatal Mental Healthcare Access for Migrant Women: A Participatory Health Research Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031124. [PMID: 35162147 PMCID: PMC8834132 DOI: 10.3390/ijerph19031124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 01/07/2022] [Accepted: 01/13/2022] [Indexed: 11/16/2022]
Abstract
Perinatal mental health is a growing public health concern. The mounting evidence examining the prevalence of perinatal mental illness identifies specific vulnerabilities and risk factors among migrant women. We know that migrant women experience persistent and systematic barriers in accessing healthcare and that healthcare services do not always respond appropriately to migrant women's needs, highlighting the need for targeted interventions in supporting positive perinatal mental health among migrant women. The purpose of this participatory health research study was to explore perinatal mental healthcare for migrant women in Ireland, from the perspectives of a diverse range of stakeholders (healthcare service providers, community organisations/networks/associations and migrant women). A key focus of this study was to collaboratively explore solution-focused approaches to improving access to supports and healthcare services for migrant women experiencing perinatal mental illness. Following ethical approval, data were collected during three key convenings, utilising the design principles of world café philosophies. Thematic analysis led to the generation of the following two themes: Building Capability and Capacity and Empowering Migrant Women. The main conclusions lie in the provision of whole-system approaches in collectively, collaboratively and proactively planning strategies that address the many factors that affect access to healthcare services for migrant women experiencing perinatal mental illness. Drawing on the collective perspectives of a wide range of stakeholders, our innovative solution focused on providing recommendations aimed at strengthening supports and healthcare services for migrant women.
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Affiliation(s)
- Kathleen Markey
- Department of Nursing and Midwifery, Faculty of Education and Health Sciences, Health Research Institute, University of Limerick, V94 T9PX Limerick, Ireland; (M.N.); (O.D.); (T.T.); (C.O.)
- Correspondence:
| | - Maria Noonan
- Department of Nursing and Midwifery, Faculty of Education and Health Sciences, Health Research Institute, University of Limerick, V94 T9PX Limerick, Ireland; (M.N.); (O.D.); (T.T.); (C.O.)
| | - Owen Doody
- Department of Nursing and Midwifery, Faculty of Education and Health Sciences, Health Research Institute, University of Limerick, V94 T9PX Limerick, Ireland; (M.N.); (O.D.); (T.T.); (C.O.)
| | - Teresa Tuohy
- Department of Nursing and Midwifery, Faculty of Education and Health Sciences, Health Research Institute, University of Limerick, V94 T9PX Limerick, Ireland; (M.N.); (O.D.); (T.T.); (C.O.)
| | - Tony Daly
- 80:20 Educating and Acting for a Better World, St. Cronan’s National School, A98 NW42 Wicklow, Ireland; (T.D.); (C.R.)
| | - Ciara Regan
- 80:20 Educating and Acting for a Better World, St. Cronan’s National School, A98 NW42 Wicklow, Ireland; (T.D.); (C.R.)
| | - Claire O’Donnell
- Department of Nursing and Midwifery, Faculty of Education and Health Sciences, Health Research Institute, University of Limerick, V94 T9PX Limerick, Ireland; (M.N.); (O.D.); (T.T.); (C.O.)
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Service User and Service Provider Perceptions of Enablers and Barriers for Refugee and Asylum-Seeking Women Accessing and Engaging with Perinatal Mental Health Care Services in the WHO European Region: A Scoping Review Protocol. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19020937. [PMID: 35055761 PMCID: PMC8775706 DOI: 10.3390/ijerph19020937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 01/06/2022] [Accepted: 01/10/2022] [Indexed: 11/17/2022]
Abstract
There is a need to understand the specific perinatal mental health care needs of migrant subgroups who often have differing health care needs and specific barriers to accessing and engaging with health care services. It is important to have evidence about the WHO European context given the rising numbers of refugees and asylum seekers in the region. The aim of this scoping review is to map the factors that enable and prevent access and engagement of refugee and asylum-seeking women with perinatal mental health care services in the WHO European Region, from the perspectives of service providers and service users. The database search will include PsycINFO, Cochrane, Web of Science, MEDLINE, EMBASE, CINAHL complete, Scopus, Academic Search Complete, and Maternity and Infant Care (OVID). Search results will be exported to an online tool that provides a platform to help manage the review process, including title, abstract, and full-text screening and voting by reviewers independently. Data concerning access and engagement with health care services will be mapped on to the candidacy framework. Systematically searching evidence within the WHO European region and examining this evidence through the candidacy lens will help develop a more comprehensive and a deeper conceptual understanding of the barriers and levers of access and engagement with perinatal mental health care services, whilst identifying gaps in existing evidence. Exploring factors that influence access and engagement for refugee and asylum-seeking women from the perspective of key stakeholders in the service provision and/or service utilisation of perinatal mental health care services will add a more comprehensive understanding of the recursive relationship between service provision and use.
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Hicks LM, Ou C, Charlebois J, Tarasoff L, Pawluski J, Roos LE, Hooykaas A, Fairbrother N, Carter M, Tomfohr-Madsen L. Assessment of Canadian perinatal mental health services from the provider perspective: Where can we improve? Front Psychiatry 2022; 13:929496. [PMID: 36213903 PMCID: PMC9537741 DOI: 10.3389/fpsyt.2022.929496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 09/05/2022] [Indexed: 11/13/2022] Open
Abstract
PURPOSE Perinatal mental health disorders are common, and rates have increased during the COVID-19 pandemic. It is unclear where providers may improve perinatal mental health care, particularly in countries lacking national guidelines, such as Canada. METHODS A cross-sectional survey of perinatal health providers was conducted to describe the landscape of perinatal mental health knowledge, screening, and treatment practices across Canada. Providers were recruited through listservs, social media, and snowball sampling. Participants completed an online survey that assessed their perinatal mental health training, service provision types, their patient wait times, and treatment barriers, and COVID-19 pandemic-related impacts. RESULTS A total of 435 providers completed the survey, including physicians, midwives, psychologists, social workers, nurses, and allied non-mental health professionals. Most (87.0%) did not have workplace mandated screening for perinatal mental illness but a third (66%) use a validated screening tool. Many (42%) providers stated their patients needed to wait more than 2 months for services. More than half (57.3%) reported they did not receive or were unsure if they received specialized training in perinatal mental health. Most (87.0%) indicated there were cultural, linguistic, and financial barriers to accessing services. Over two-thirds (69.0%) reported the COVID-19 pandemic reduced access to services. CONCLUSION Survey findings reveal significant gaps in training, screening tool use, and timely and culturally safe treatment of perinatal mental health concerns. There is critical need for coordinated and nationally mandated perinatal mental health services in Canada to improve care for pregnant and postpartum people.
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Affiliation(s)
- Laurel M Hicks
- Renée Crown Wellness Institute, University of Colorado Boulder, Boulder, CO, United States
| | - Christine Ou
- School of Nursing, University of Victoria, Victoria, BC, Canada
| | | | - Lesley Tarasoff
- Department of Health and Society, University of Toronto Scarborough, Toronto, ON, Canada
| | - Jodi Pawluski
- IRSET - Institut de Recherche en Santé, Environnement et Travail, University of Rennes 1, Rennes, France
| | - Leslie E Roos
- Department of Psychology, University of Manitoba, Winnipeg, MB, Canada
| | - Amanda Hooykaas
- College of Social and Applied Social Sciences, University of Guelph, Guelph, ON, Canada
| | | | - Michelle Carter
- School of Nursing, University of British Columbia, Vancouver, BC, Canada
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Peifer JS, Bradley E, Taasoobshirazi G. Pilot Testing a Brief Partner-Inclusive Hybrid Intervention for Perinatal Mood and Anxiety Disorders. Front Psychiatry 2022; 13:735582. [PMID: 35633795 PMCID: PMC9130596 DOI: 10.3389/fpsyt.2022.735582] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 04/22/2022] [Indexed: 11/28/2022] Open
Abstract
The necessity of hybrid and more accessible options for perinatal mood and anxiety disorders (PMADs) has taken on increased urgency in the wake of the COVID-19 pandemic and its lasting impacts. In the New Family Wellness Project (NFWP), participants engage in a hybrid in-person and teletherapy six-session intervention for new parents early in their postpartum period. This small, phase 1 clinical research examined early outcomes of the NFWP's cognitive behavioral intervention on adverse mental health outcomes (i.e., perinatal depression and anxiety, overall mental illness symptoms) and adaptive outcomes and protective factors (i.e., relational health, social support, flourishing, self-efficacy). Despite a small sample size (N = 12), paired t-tests yielded significant effects for improvements in mental health symptoms at posttest, as well as marginally significant improvements in postpartum anxiety and self-efficacy. Findings suggest the brief, partner-inclusive, hybrid intervention shows promise for further study. Lessons learned from this small phase 1 clinical study and recommendations for revising the intervention prior to future trials are discussed.
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Affiliation(s)
- Janelle S Peifer
- Department of Psychology, University of Richmond, Richmond, VA, United States
| | - Erin Bradley
- Department of Public Health, Agnes Scott College, Decatur, GA, United States
| | - Gita Taasoobshirazi
- School of Data Science and Analytics, Kennesaw State University, Kennesaw, GA, United States
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MacDougall C, Johnston K. Client experiences of expertise in midwifery care in New Brunswick, Canada. Midwifery 2021; 105:103227. [PMID: 34954470 DOI: 10.1016/j.midw.2021.103227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 12/13/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE This study contextualizes client experiences of midwifery in New Brunswick within the broader literature on midwifery in Canada and contributes to understandings of how midwifery care fits into the landscape of reproductive healthcare in the province. DESIGN Semi structured interviews with 32 clients and supportive others of the New Brunswick midwifery program were carried out in 2019 and 2020, and transcripts were analysed using general thematic analysis. SETTING N New Brunswick, Canada PARTICIPANTS: Clients of midwifery care provided by the Fredericton Midwifery Centre, as well as their supportive others (partners and spouses, family members, friends) FINDINGS: Participants in this study reported a high degree of satisfaction with midwifery services and identified several approaches to practice that they felt contributed to high quality midwifery care. These include competence and expertise, time and access as abundance rather than scarcity, attention to the familial context, trauma informed care and attention to mental and emotional health, postpartum care, and supporting agency and autonomy. In short, participants' responses indicate that midwifery care in New Brunswick meets the criteria for respectful maternity care, as outlined by Shakibazadeh et al. (Shakibazadeh et al., 2018) and Butler et al. (Butler et al., 2020). Our findings are in line with research on midwifery care in other settings, although there is a significant emphasis on the medical expertise and training of midwives amongst our participants which is less evident in the scholarly literature. KEY CONCLUSIONS In a province where reproductive health care has been systematically underfunded, clients celebrate the expertise and competence of midwives, challenging the narrative which constructs midwifery as 'traditional' care, and hospital-based obstetrics as expert care. Instead, midwives are recognized as highly specialized evidence-based practitioners, and this is particularly prized by clients in relation to processes of information sharing.
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Slade P, Dembinsky M, Bristow K, Garthwaite K, Mahdi A, James A, Rahman A, Downe S. Facilitating Perinatal Access to Resources and Support (PeARS): a feasibility study with external pilot of a novel intervention. BMC Pregnancy Childbirth 2021; 21:769. [PMID: 34772367 PMCID: PMC8588611 DOI: 10.1186/s12884-021-04112-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 09/09/2021] [Indexed: 11/25/2022] Open
Abstract
Background Up to 50% of women in areas of high socio-economic deprivation are at risk of developing depressive symptoms in pregnancy. Feeling well supported, can facilitate good mental health perinatally. A brief, innovative intervention to facilitate access to support and resources was developed and tested. This included one antenatal and one postnatal session, each with three evidence-based components: i) support from a non-professional peer to enable a woman to identify her needs; ii) information about local community services and signposting; and iii) development of a personalised If–Then plan to access that support. The aims were to evaluate the intervention and research methods for feasibility and acceptability for perinatal women, maternity care providers and peers, and provide preliminary effectiveness indications. Methods Pregnant women living in an area of high deprivation were recruited from community-based antenatal clinics and randomised to intervention or control condition (a booklet about local resources). Outcome measures included women’s use of community services by 34 + weeks gestation and 6 months postnatally; mental health and wellbeing measures, and plan implementation. Interviews and focus groups were conducted with women participants, providers, and peers. Data were analysed using framework analysis. Recruitment and retention of peers and participants, intervention fidelity, and acceptability of outcome measures were recorded. Results Peer facilitators could be recruited, trained, retained and provide the intervention with fidelity. One hundred twenty six women were recruited and randomised, 85% lived in the 1% most deprived UK areas. Recruitment constituted 39% of those eligible, improving to 54% after midwifery liaison. Sixty five percent were retained at 6 months postnatally. Women welcomed the intervention, and found it helpful to plan access to community services. Providers strongly supported the intervention philosophy and integrated this easily into services. The study was not powered to detect significant group differences but there were positive trends in community service use, particularly postnatally. No differences were evident in mental health and wellbeing. Conclusions This intervention was well received and easily integrated into existing services. Women living in highly deprived areas could be recruited, randomised and retained. Measures were acceptable. Peer facilitators were successfully trained and retained. Full effectiveness studies are warranted. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-021-04112-w.
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Affiliation(s)
- Pauline Slade
- Institute of Population Health, University of Liverpool, Ground Floor Whelan Building, Brownlow Hill, Liverpool, L69 3GB, UK.
| | - Melanie Dembinsky
- Health Sciences Stirling, University of Stirling, Stirling, FK9 4LA, UK
| | - Katie Bristow
- NIHR CLAHRC North West Coast, Department of Health Services Research, Institute of Psychology, Health and Society, University of Liverpool, Waterhouse Building, Brownlow street, Liverpool, L69 3GL, UK
| | - Kim Garthwaite
- Liverpool City Council, 1 Municipal Buildings, Dale St, Liverpool, l2 2DH, UK
| | - Amy Mahdi
- Liverpool Women's Hospital NHS Foundation Trust, Crown St, Liverpool, L8 7SS, UK
| | - Annette James
- Head of Children's Health Improvement, Liverpool Public Health, Liverpool City Council Cunard Building, Water Street, Liverpool, L3 1DS, UK
| | - Atif Rahman
- Institute of Population Health, University of Liverpool, Waterhouse Building, Brownlow street, Liverpool, L69 3GL, UK
| | - Soo Downe
- School of Community Health and Midwifery, University of Central Lancashire, Preston, PR1 2HE, UK
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"Nobody Listened". Mothers' Experiences and Needs Regarding Professional Support Prior to Their Admission to an Infant Mental Health Day Clinic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182010917. [PMID: 34682666 PMCID: PMC8535578 DOI: 10.3390/ijerph182010917] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 10/08/2021] [Accepted: 10/13/2021] [Indexed: 01/09/2023]
Abstract
Challenges during the perinatal period can lead to maternal distress, negatively affecting mother-infant interaction. This study aims to retrospectively explore the experiences and needs regarding professional support of mothers with difficulties in mother-infant interaction prior to their admission to an infant mental health day clinic. In-depth semi-structured interviews were conducted with 13 mothers who had accessed an infant mental health day clinic because of persistent severe infant regulatory problems impairing the wellbeing of the infant and the family. Data were transcribed and analyzed using the Qualitative Analysis Guide of Leuven (QUAGOL). Three themes were identified: 'experience of pregnancy, birth, and parenthood'; 'difficult care paths'; and 'needs and their fulfillment'. The first theme consisted of three subthemes: (1) 'reality does not meet expectations', (2) 'resilience under pressure', and (3) 'despair'. Mothers experienced negative feelings that were in contradiction to the expected positive emotions associated with childbirth and motherhood. Resilience-related problems affected the mother-child relationship, and infants' regulatory capacities. Determined to find solutions, different healthcare providers were consulted. Mothers' search for help was complex and communication between healthcare providers was limited because of a fragmented care provision. This hindered the continuity of care and appropriate referrals. Another pitfall was the lack of a broader approach, with the emphasis on the medical aspects without attention to the mother-child dyad. An integrated care pathway focusing on the early detection of resilience-related problems and sufficient social support can be crucial in the prevention and early detection of perinatal and infant mental health problems.
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Wang TH, Tzeng YL, Teng YK, Pai LW, Yeh TP. Evaluation of psychological training for nurses and midwives to optimise care for women with perinatal depression: a systematic review and meta-analysis. Midwifery 2021; 104:103160. [PMID: 34753017 DOI: 10.1016/j.midw.2021.103160] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 09/11/2021] [Accepted: 09/26/2021] [Indexed: 01/02/2023]
Abstract
Objective Perinatal depression is linked to poor maternal health and infant development outcomes. The World Health Organization recommends expanding the mental health education and training of primary care providers to improve the quality of perinatal depression care. The present study evaluated the effect of various psychological training methods on nurses' and midwives' competence in administering care to and alleviating symptoms in patients with perinatal depression. Methods A comprehensive search of the PubMed, MEDLINE, Cochrane Library, EMBASE, Web of Science, and CINAHL databases was performed. The data were independently extracted by two reviewers, and the critical appraisal tools of the Joanna Briggs Institute were used for quality assessment. Random-effects meta-analysis was conducted using Review Manager 5.4 software. Findings A total of 13 articles including 246 nurses and midwives and 4,381 perinatal women were reviewed. Care administered through both face-to-face (relative risk [RR] 0.70, 95% confidence interval [CI] 0.61-0.74) and digital training (RR 0.44, 95% CI 0.26-0.74) significantly mitigated symptoms of perinatal depression. Significant benefits were observed after 3- to 5-day and 8-day training, for which the RR were 0.75 (95% CI 0.59-0.97) and 0.72 (95% CI 0.66-0.85), respectively. Studies with high intervention fidelity more effectively reduced the risk of depressive symptoms in perinatal women than those with low intervention fidelity. Key conclusions and implications for practice Compared with face-to-face, digital training methods were more effective in reducing the risk of depressive symptoms. High intervention fidelity and 3- to 5-day and 8-day training resulted in better outcomes. The present findings can serve as a reference for the design of psychological training programs for nurses and midwives to equip them with effective strategies for administering care to patients with perinatal depression.
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Affiliation(s)
| | - Ya-Ling Tzeng
- School of Nursing, China Medical University, No. 100, Sec. 1, Jingmao Rd., Beitun Dist., Taichung 406040, Taiwan; Department of Nursing, China Medical University Hospital, No. 100, Sec. 1, Jingmao Rd., Beitun Dist., Taichung 406040, Taiwan.
| | - Yu-Kuei Teng
- School of Nursing, China Medical University, No. 100, Sec. 1, Jingmao Rd., Beitun Dist., Taichung 406040, Taiwan; Department of Nursing, China Medical University Hospital, No. 100, Sec. 1, Jingmao Rd., Beitun Dist., Taichung 406040, Taiwan.
| | - Lee-Wen Pai
- College of Nursing, Central Taiwan University of Science and Technology, Taichung, Taiwan
| | - Tzu-Pei Yeh
- School of Nursing, China Medical University, No. 100, Sec. 1, Jingmao Rd., Beitun Dist., Taichung 406040, Taiwan; Department of Nursing, China Medical University Hospital, No. 100, Sec. 1, Jingmao Rd., Beitun Dist., Taichung 406040, Taiwan
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Arefadib N, Cooklin A, Nicholson J, Shafiei T. Postnatal depression and anxiety screening and management by maternal and child health nurses in community settings: A scoping review. Midwifery 2021; 100:103039. [PMID: 34058681 DOI: 10.1016/j.midw.2021.103039] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 05/06/2021] [Accepted: 05/08/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To examine the range and nature of primary research evidence on postnatal depression and anxiety screening and management by maternal and child health nurses within community settings. BACKGROUND Maternal and child health nurses are well-placed to identify and support women at risk of, or experiencing, postnatal depression and anxiety- a prevalent public health issue which remains largely undetected. METHODS Scoping methodology, guided by the Arksey and O'Malley (2005) framework, was used. The following electronic databases were searched in June 2019 and again in July 2020: Cumulative Index of Nursing and Allied Health Literature, MEDLINE, PsycINFO, and COCHRANE Library. Primary studies that were published in English, between 2008 and 2020, were included. PRISMA checklist and PRISMA flow diagram were used to adhere to best practice guidelines. RESULTS Twenty-three articles, relating to 22 studies, met the inclusion criteria. Two principal themes were identified: 'screening for postnatal depression and anxiety' and 'factors that influence postnatal depression and anxiety management'. Subthemes in the former related to attitudes toward screening, routine screening practice, screening efficacy, and attitudes toward the Edinburgh Postnatal Depression Scale. Subthemes in the latter included availability of formal care pathways, referral options, knowledge and confidence, and multiagency collaboration. CONCLUSIONS AND RELEVANCE TO CLINICAL PRACTICE While maternal and child health nurses value their role in identifying and supporting mothers at risk of postnatal depression and anxiety, certain individual and organisational factors contribute to a gap between best practice and clinical practice. Narrowing the gap between evidence and practice is unlikely without directly addressing these barriers. Gaps in maternal and child health nurses' knowledge, skills and confidence regarding effective screening and management of mothers experiencing, or at risk of, postnatal depression and anxiety, impacts the quality of care provided. Ongoing training and professional development which adequately addresses these gaps is required.
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Affiliation(s)
- Noushin Arefadib
- Judith Lumley Centre, School of Nursing and Midwifery, George Singer Building, La Trobe University, Bundoora, VIC 3086, Australia.
| | - Amanda Cooklin
- Judith Lumley Centre, School of Nursing and Midwifery, George Singer Building, La Trobe University, Bundoora, VIC 3086, Australia
| | - Jan Nicholson
- Judith Lumley Centre, School of Nursing and Midwifery, George Singer Building, La Trobe University, Bundoora, VIC 3086, Australia
| | - Touran Shafiei
- Judith Lumley Centre, School of Nursing and Midwifery, George Singer Building, La Trobe University, Bundoora, VIC 3086, Australia
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Dadi AF, Miller ER, Azale T, Mwanri L. "We do not know how to screen and provide treatment": a qualitative study of barriers and enablers of implementing perinatal depression health services in Ethiopia. Int J Ment Health Syst 2021; 15:41. [PMID: 33952338 PMCID: PMC8098000 DOI: 10.1186/s13033-021-00466-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 04/27/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Qualitative studies evaluating maternal mental health services are lacking in Ethiopia, and the available evidence targets severe mental illnesses in the general population. We conducted a qualitative study to explore barriers to, enablers of, or opportunities for perinatal depression health services implementations in Ethiopia. METHODS We conducted a total of 13 face to face interviews with mental and maternal health service administrators from different levels of the Ethiopian healthcare system. We interviewed in Amharic (a local language), transcribed and translated into English, and imported into NVivo. We analysed the translated interviews inductively using thematic framework analysis. RESULTS The study identified: (i) health administrators' low literacy about perinatal depression as individual level barriers; (ii) community low awareness, health-seeking behaviours and cultural norms about perinatal depression as socio-cultural level barriers; (iii) lack of government capacity, readiness, and priority of screening and managing perinatal depression as organisational level barriers; and (iv) lack of mental health policy, strategies, and healthcare systems as structural level barriers of perinatal mental health implementation in Ethiopia. The introduction of the new Mental Health Gap Action Programme (mhGap), health professionals' commitment, and simplicity of screening programs were identified enablers of, or opportunities for, perinatal mental health service implementation. CONCLUSIONS This qualitative inquiry identified important barriers and potential opportunities that could be used to address perinatal depression in Ethiopia. Building the capacity of policy makers and planners, strengthening the mental healthcare system and governance should be a priority issue for an effective integration of maternal mental health care with the routine maternal health services in Ethiopia.
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Affiliation(s)
- Abel Fekadu Dadi
- College of Medicine and Public Health, Flinders University, Health Sciences Building, Sturt Road, Bedford Park, Adelaide, SA 5042 Australia
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Emma R. Miller
- College of Medicine and Public Health, Flinders University, Health Sciences Building, Sturt Road, Bedford Park, Adelaide, SA 5042 Australia
| | - Telake Azale
- Department of Health Education and Behavioural Sciences, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Lillian Mwanri
- College of Medicine and Public Health, Flinders University, Health Sciences Building, Sturt Road, Bedford Park, Adelaide, SA 5042 Australia
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Fontein Kuipers YJ, Mestdagh E. The experiential knowledge of migrant women about vulnerability during pregnancy: A woman-centred mixed-methods study. Women Birth 2021; 35:70-79. [PMID: 33745823 DOI: 10.1016/j.wombi.2021.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 02/24/2021] [Accepted: 03/08/2021] [Indexed: 11/30/2022]
Abstract
PROBLEM Within maternity care policies and practice, pregnant migrant women are regarded as a vulnerable population. BACKGROUND Women's experiential knowledge is a key element of woman-centred care but is insufficiently addressed in midwifery practice and research that involves migrant women. AIM To examine if pregnant migrant women's experiential knowledge of vulnerability corresponds with sets of criteria of vulnerability, and to explore how migrant women make sense of vulnerability during pregnancy. METHODS A sequential two-phased mixed-methods study, conducted in the Netherlands, integrating survey data of 89 pregnant migrant women and focus group data obtained from 25 migrant mothers - living in deprived areas according to the Dutch socio-economic index. RESULTS Criteria associated with vulnerability were reported by 65.2% of the participants and 62.9% of the participants reported adverse childhood experiences. On a Visual Analogue Scale, ranging from 0 (not vulnerable) to 10 (very vulnerable), participants self-reported sense of vulnerability showed a mean score of 4.2 (±2.56). Women's experiential knowledge of vulnerability significantly correlated with the mean sum score of clinical criteria of vulnerability (r .46, p .002) and with the mean sum score of adverse childhood experiences (r .48, p<.001). Five themes emerged from the focus group discussions: "Look beyond who you think I am and see and treat me for who I really am", "Ownership of truth and knowledge", "Don't punish me for being honest", "Projection of fear" and "Coping with labelling". CONCLUSION Pregnant migrant women's experiential knowledge of vulnerability is congruent with the criteria. Calling upon experiential knowledge is an attribute of the humane woman-midwife relationship.
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Affiliation(s)
- Yvonne J Fontein Kuipers
- Rotterdam University of Applied Sciences, School of Midwifery, Rochussenstraat 198, 3015 EK Rotterdam, Netherlands; Artesis Plantijn University of Applied Sciences, Department of Health & Social Care, Noorderplaats 2, 2000 Antwerp, Belgium; Antwerp University, Universiteitsplein 1, 2610 Wilrijk, Belgium.
| | - Eveline Mestdagh
- Artesis Plantijn University of Applied Sciences, Department of Health & Social Care, Noorderplaats 2, 2000 Antwerp, Belgium; Antwerp University, Universiteitsplein 1, 2610 Wilrijk, Belgium
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Albendín‐García L, Suleiman‐Martos N, Cañadas‐De la Fuente GA, Ramírez‐Baena L, Gómez‐Urquiza JL, De la Fuente‐Solana EI. Prevalence, Related Factors, and Levels of Burnout Among Midwives: A Systematic Review. J Midwifery Womens Health 2021; 66:24-44. [DOI: 10.1111/jmwh.13186] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 09/12/2020] [Accepted: 09/26/2020] [Indexed: 12/11/2022]
Affiliation(s)
| | - Nora Suleiman‐Martos
- Nursing Department, Faculty of Health Sciences University of Granada Campus Universitario de Ceuta Ceuta Spain
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Brandstetter S, Rothfuß D, Seelbach-Göbel B, Melter M, Kabesch M, Apfelbacher C. Information on, knowledge and utilisation of support services during pregnancy and after childbirth: cross-sectional analyses of predictors using data from the KUNO-Kids health study. BMJ Open 2020; 10:e037745. [PMID: 33109648 PMCID: PMC7592309 DOI: 10.1136/bmjopen-2020-037745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES To investigate mothers' knowledge and utilisation of antenatal and perinatal support services as well as predictors of knowledge and service utilisation. DESIGN Cross-sectional study. SETTING Prospective birth cohort in Regensburg, Eastern Bavaria, Germany. PARTICIPANTS 2455 mothers after delivery. OUTCOME MEASURES Participants' knowledge of distinct antenatal and perinatal support services (poor vs good, defined by median split). Participants' use of antenatal services provided by midwife (yes, no) and of any other antenatal support services (yes, no). RESULTS The vast majority of mothers knew at least some support services. Two-thirds of women (68.4%) reported to have used the services provided by midwives. 23.6% of women reported to have used at least one of the other antenatal services. Good knowledge of services was associated with higher education (OR 1.37, 95% CI 1.13 to 1.67), no migration background (OR 2.26, 95% CI 1.76 to 2.90), better health literacy (OR 1.04, 95% CI 1.03 to 1.06), while being primiparous (OR 0.72, 95% CI 0.60 to 0.86) and being unmarried/living with a partner (OR 0.71, 95% CI 0.57 to 0.89) reduced the chance. Predictors of service utilisation differed with regard to the services considered. CONCLUSIONS Overall, mothers had a good level of knowledge of antenatal and perinatal support services. However, we found that some groups of women were less well informed. This inequality in social predictors of knowledge of services was also partly reflected in differences in service utilisation during pregnancy.
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Affiliation(s)
- Susanne Brandstetter
- University Children's Hospital Regensburg (KUNO-Clinics), University of Regensburg, Regensburg, Germany
| | - David Rothfuß
- Coordinating Center for Early Interventions, City of Regensburg, Regensburg, Germany
| | - Birgit Seelbach-Göbel
- Clinic of Obstetrics and Gynecology St Hedwig, University of Regensburg, Regensburg, Germany
| | - Michael Melter
- University Children's Hospital Regensburg (KUNO-Clinics), University of Regensburg, Regensburg, Germany
| | - Michael Kabesch
- University Children's Hospital Regensburg (KUNO-Clinics), University of Regensburg, Regensburg, Germany
| | - Christian Apfelbacher
- University Children's Hospital Regensburg (KUNO-Clinics), University of Regensburg, Regensburg, Germany
- Institute of Social Medicine and Health Systems Research, Otto von Guericke University Magdeburg, Magdeburg, Germany
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Health care practitioners' views of the support women, partners, and the couple relationship require for birth trauma: current practice and potential improvements. Prim Health Care Res Dev 2020; 21:e40. [PMID: 33004100 PMCID: PMC7576522 DOI: 10.1017/s1463423620000407] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
AIM To examine health care practitioners' views of the support women, partners, and the couple relationship require when affected by birth trauma, barriers to gaining such support, and potential improvements. BACKGROUND Ongoing distress following psychologically traumatic childbirth, also known as birth trauma, can affect women, partners, and the couple relationship. Birth trauma can lead to post traumatic stress symptoms (PTSS) or disorder (PTSD). Whilst there is a clear system of care for a PTSD diagnosis, support for the more prevalent experience of birth trauma is not well-defined. METHOD An online survey of health care practitioners' views of the support parents require for birth trauma, barriers to accessing support, and potential improvements. Practitioners were recruited in 2018 and the sample for the results presented in the article ranged from 95 to 110. RESULTS Practitioners reported differing needs of support for women, partners, and the couple as a unit. There was correlation between practitioners reporting having the skills and knowledge to support couples and feeling confident in giving support. The support most commonly offered by practitioners to reduce the impact on the couple relationship was listening to the couple. However practitioners perceived the most effective support was referral to a debriefing service. Practitioners observed several barriers to both providing support and parents accessing support, and improvements to birth trauma support were suggested. CONCLUSIONS Practitioners indicate that some women, partners, and the couple as a unit require support with birth trauma and that barriers exist to accessing effective support. The support that is currently provided often conflicts with practitioners' perception of what is most effective. Practitioners indicate a need to improve the identification of parents who need support with birth trauma, and more suitable services to support them.
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Schmied V, Reilly N, Black E, Kingston D, Talcevska K, Mule V, Austin MP. Opening the door: midwives' perceptions of two models of psychosocial assessment in pregnancy- a mixed methods study. BMC Pregnancy Childbirth 2020; 20:451. [PMID: 32767969 PMCID: PMC7412833 DOI: 10.1186/s12884-020-03133-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 07/23/2020] [Indexed: 12/22/2022] Open
Abstract
Background One in five women experience psychological distress in the perinatal period. To support women appropriately, Australian guidelines recommend routine depression screening and psychosocial risk assessment by midwives in pregnancy. However, there is some evidence that current screening processes results in higher rates of false positives. The Perinatal Integrated Psychosocial Assessment (PIPA) Project compared two models of psychosocial assessment and referral – Usual Care and the PIPA model – with a view to improving referral decisions. This paper describes midwives’ perspectives on psychosocial assessment, depression screening and referral at the antenatal booking appointment and compares midwives’ experiences with, and perspectives on, the two models of care under investigation. Methods A two-phase, convergent mixed methods design was used. Midwives providing antenatal care completed a self-report survey in phase one prior to implementation of the new model of psychosocial assessment (n = 26) and again in phase two, following implementation (n = 27). Sixteen midwives also participated in two focus groups in phase two. Quantitative and qualitative data were compared and integrated in the presentation of results and interpretation of findings. Results Midwives supported psychosocial assessment believing it was a catalyst for ‘Opening the door” to conversations with women. Midwives were comfortable asking the questions and tailored their approach to build rapport and trust. Overall. midwives expressed favourable views towards the PIPA model. A greater proportion of midwives relied mostly or entirely on the suggested wording for the psychosocial questions in the PIPA model compared to Usual Care (44.4% vs 12.0%, χ2=5.17, p=.023, φ =-.36). All midwives reported finding the referral or action message displayed at the end of the PIPA psychosocial assessment to be ‘somewhat’ or ‘very’ helpful, compared to 42.3% in Usual Care (χ2 = 18.36, p < .001, φ = −.64). Midwives were also more likely to act on or implement the message often or all of the time) in the PIPA model (PIPA = 69.2% vs Usual Care = 32.0%, (χ2 = 5.66, p < .017, φ = −.37). Conclusion The study identified benefits of the new model and can inform improvements in psychosocial screening, referral and related care processes within maternity settings. The study demonstrates that psychosocial assessment can, over time, become normalised and embedded in practice.
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Affiliation(s)
- V Schmied
- School of Nursing & Midwifery, Western Sydney University, Locked Bag 1797 Penrith, Sydney, NSW, 2751, Australia.
| | - N Reilly
- Research Centre for Generational Health and Ageing & School of Nursing and Midwifery, University of Newcastle, Newcastle, NSW, Australia.,Perinatal and Women's Mental Health Unit, St John of God Health Care and University of New South Wales, Sydney, Australia
| | - E Black
- Drug and Alcohol Services, South Eastern Sydney Local Health District, 591 South Dowling Street, Surry Hills NSW 2010 and Discipline of Addiction Medicine, University of Sydney, Camperdown, NSW, 2006, Australia.,School of Public Health and Community Medicine, Faculty of Medicine, University of NSW, Sydney, 2052, Australia
| | - D Kingston
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada
| | - K Talcevska
- Perinatal and Women's Mental Health Unit, St John of God Health Care and University of New South Wales, Sydney, Australia
| | - V Mule
- Perinatal and Women's Mental Health Unit, St John of God Health Care and University of New South Wales, Sydney, Australia
| | - M-P Austin
- Perinatal and Women's Mental Health Unit, St John of God Health Care and University of New South Wales, Sydney, Australia
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Delicate A, Ayers S, McMullen S. Health-care practitioners' assessment and observations of birth trauma in mothers and partners. J Reprod Infant Psychol 2020; 40:34-46. [PMID: 32614606 DOI: 10.1080/02646838.2020.1788210] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Evidence shows that traumatic childbirth can cause ongoing distress, often referred to as birth trauma. This can have an impact on parents and the couple relationship, and consequently identifying and supporting parents with birth trauma is important to practice. AIM To investigate the experiences of health-care practitioners from the United Kingdom (UK) in assessment for birth trauma, perceived occurrence of birth trauma and observed impact on parents and the couple relationship. METHODS An online survey of UK health-care practitioners working with parents in the first postnatal year. RESULTS A sample of 202 practitioners reported identifying birth trauma in 34.4% of mothers and 25.0% of partners. Assessment for birth trauma was only conducted for 50.3% of mothers and 25.9% of partners. The most observed symptoms were re-experiencing among mothers (87.1%) and avoidance among partners (50.9%). Birth trauma was perceived as impacting on the couple relationship for 29.8% of mothers and 26.9% of partners. Written responses provided more detailed observations of the impact of birth trauma. CONCLUSION Understanding how birth trauma may present differently in mothers and partners could support effective assessment. Once birth trauma is identified, parents require personalised support to help them cope with the impact.
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Affiliation(s)
- Amy Delicate
- Centre for Maternal and Child Health Research, School of Health Sciences, City, University of London, London, UK
| | - Susan Ayers
- Centre for Maternal and Child Health Research, School of Health Sciences, City, University of London, London, UK
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Dennis CL, Vigod S. Expanding midwifery's role to improve perinatal mental healthcare access. Evid Based Nurs 2019; 22:72. [PMID: 31138558 DOI: 10.1136/ebnurs-2018-103058] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/19/2019] [Indexed: 06/09/2023]
Affiliation(s)
- Cindy-Lee Dennis
- Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Simone Vigod
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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