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Koç E, Baltaci N, Bal S. The effect of telecounseling on depression in primiparous mothers during the postpartum period: A randomized controlled trial. Nurs Health Sci 2024; 26:e13136. [PMID: 38960587 DOI: 10.1111/nhs.13136] [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: 02/28/2024] [Revised: 05/24/2024] [Accepted: 06/19/2024] [Indexed: 07/05/2024]
Abstract
Postpartum depression is one of the most common mental health disorders in women after giving birth. This study was conducted to examine the effect of telecounseling support on depression in primiparous mothers. This study was conducted as a randomized controlled trial with a parallel group pretest-posttest design. The study comprised 50 participants each in the intervention and control groups. Face-to-face interviews were conducted with all participants, and the Maternal Information Form and the Edinburgh Postpartum Depression Scale (EPDS) were administered. The intervention group received telecounseling for 6 weeks, while the control group received routine postnatal care. After the 6-week period, EPDS was re-administered to both groups. In the intervention group, the EPDS mean score decreased from 7.12 ± 3.96 to 6.34 ± 3.73 after telecounseling (p < 0.001). Conversely, in the control group, the EPDS mean score increased from 6.62 ± 3.55 to 7.90 ± 4.65 without any intervention (p = 0.002). The results indicate that telecounseling is an effective method for reducing the risk of depression among mothers during the postpartum period. It is recommended that healthcare professionals extend their support by providing telecounseling for mothers.
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Affiliation(s)
- Emine Koç
- Department of Midwifery, Faculty of Health Sciences, Ondokuz Mayis University, Samsun, Turkey
| | - Nazlı Baltaci
- Faculty of Health Sciences, Department of Nursing, Ondokuz Mayıs University, Kurupelit Campus, Samsun, Turkey
| | - Sümeyye Bal
- Department of Midwifery, Faculty of Health Sciences, Ondokuz Mayis University, Samsun, Turkey
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Perazzo SI, Hoge MK, Shaw RJ, Gillispie-Bell V, Soghier L. Improving parental mental health in the perinatal period: A review and analysis of quality improvement initiatives. Semin Perinatol 2024; 48:151906. [PMID: 38664078 DOI: 10.1016/j.semperi.2024.151906] [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] [Indexed: 05/12/2024]
Abstract
Parental mental health is an essential sixth vital sign that, when taken into consideration, allows clinicians to improve clinical outcomes for both parents and infants. Although standards exist for screening, referral, and treatment for perinatal mood and anxiety disorders (PMADs), they are not reliably done in practice, and even when addressed, interventions are often minimal in scope. Quality improvement methodology can accelerate the implementation of interventions to address PMADs, but hurdles exist, and systems are not well designed, particularly in pediatric inpatient facilities. In this article, we review the effect of PMADs on parents and their infants and identify quality improvement interventions that can increase screening and referral to treatment of parents experiencing PMADs.
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Affiliation(s)
- Sofia I Perazzo
- Division of Neonatology, Children's National Hospital, Washington DC, USA; The George Washington University School of Medicine and Health Sciences, USA
| | - Margaret K Hoge
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, University of Texas Southwestern, Dallas, TX, USA
| | - Richard J Shaw
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA, USA
| | | | - Lamia Soghier
- Division of Neonatology, Children's National Hospital, Washington DC, USA; The George Washington University School of Medicine and Health Sciences, USA.
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Vamos CA, Foti TR, Reyes Martinez E, Pointer Z, Detman LA, Sappenfield WM. Identification of Clinician Training Techniques as an Implementation Strategy to Improve Maternal Health: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6003. [PMID: 37297607 PMCID: PMC10252379 DOI: 10.3390/ijerph20116003] [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: 03/15/2023] [Revised: 05/23/2023] [Accepted: 05/25/2023] [Indexed: 06/12/2023]
Abstract
Training is a key implementation strategy used in healthcare settings. This study aimed to identify a range of clinician training techniques that facilitate guideline implementation, promote clinician behavior change, optimize clinical outcomes, and address implicit biases to promote high-quality maternal and child health (MCH) care. A scoping review was conducted within PubMed, CINAHL, PsycInfo, and Cochrane databases using iterative searches related to (provider OR clinician) AND (education OR training). A total of 152 articles met the inclusion/exclusion criteria. The training involved multiple clinician types (e.g., physicians, nurses) and was predominantly implemented in hospitals (63%). Topics focused on maternal/fetal morbidity/mortality (26%), teamwork and communication (14%), and screening, assessment, and testing (12%). Common techniques included didactic (65%), simulation (39%), hands-on (e.g., scenario, role play) (28%), and discussion (27%). Under half (42%) of the reported training was based on guidelines or evidence-based practices. A minority of articles reported evaluating change in clinician knowledge (39%), confidence (37%), or clinical outcomes (31%). A secondary review identified 22 articles related to implicit bias training, which used other reflective approaches (e.g., implicit bias tests, role play, and patient observations). Although many training techniques were identified, future research is needed to ascertain the most effective training techniques, ultimately improving patient-centered care and outcomes.
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Affiliation(s)
- Cheryl A. Vamos
- USF’s Center of Excellence in Maternal and Child Health Education, Science & Practice, The Chiles Center, College of Public Health, University of South Florida, Tampa, FL 33612, USA
| | - Tara R. Foti
- College of Public Health, University of South Florida, Tampa, FL 33612, USA; (T.R.F.); (Z.P.)
| | - Estefanny Reyes Martinez
- College of Public Health, Florida Perinatal Quality Collaborative, University of South Florida, Tampa, FL 33612, USA;
| | - Zoe Pointer
- College of Public Health, University of South Florida, Tampa, FL 33612, USA; (T.R.F.); (Z.P.)
| | - Linda A. Detman
- The Chiles Center, College of Public Health, Florida Perinatal Quality Collaborative, University of South Florida, Tampa, FL 33612, USA; (L.A.D.); (W.M.S.)
| | - William M. Sappenfield
- The Chiles Center, College of Public Health, Florida Perinatal Quality Collaborative, University of South Florida, Tampa, FL 33612, USA; (L.A.D.); (W.M.S.)
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Rosan C, Dijk KAV, Darwin Z, Babalis D, Cornelius V, Phillips R, Richards L, Wright H, Pilling S, Fearon P, Pizzo E, Fonagy P. The COSI trial: a study protocol for a multi-centre, randomised controlled trial to explore the clinical and cost-effectiveness of the Circle of Security-Parenting Intervention in community perinatal mental health services in England. Trials 2023; 24:188. [PMID: 36915170 PMCID: PMC10012495 DOI: 10.1186/s13063-023-07194-3] [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: 12/15/2022] [Accepted: 02/20/2023] [Indexed: 03/15/2023] Open
Abstract
BACKGROUND Perinatal mental health difficulties affect up to 27% of birthing parents during pregnancy and the first postnatal year, and if untreated are associated with difficulties in bonding and long-term adverse outcomes to children. There are large evidence gaps related to psychological treatment, particularly in group therapy approaches and parent-infant interventions. One intervention showing preliminary efficacious findings and user acceptability is Circle of Security-Parenting (COS-P), which is a brief, weekly, group programme. However, these studies were underpowered and predominantly non-randomised, and there has never been a research trial in England or with birthing parents experiencing severe and complex perinatal mental health difficulties. The aim of the research is to conduct a randomised control trial to test whether COS-P will reduce perinatal mental health symptoms in birthing parents accessing NHS perinatal mental health services, compared to treatment as usual (TAU). Secondary objectives include exploring whether the intervention improves parenting sensitivity, emotion regulation skills, attachment security and infant development. Additionally, the project aims to examine whether the intervention is acceptable to parents and NHS staff, and whether it is cost-effective. METHODS COSI is an individually randomised, single-blind parallel arm controlled trial with an embedded internal pilot aiming to recruit 369 participants in a 2:1 ratio (intervention: TAU). Participants will be recruited from ten NHS community perinatal mental health services in England and screened based on clinical levels of both mental health symptoms (average CORE-OM score ≥ 1.1) and postnatal bonding difficulties (total PBQ score ≥ 12). This trial has 90% power to detect a MCID of 5 points on the CORE-OM. Primary and secondary outcomes will be measured at baseline, 3, 7 and 12 months after baseline. Service use and quality of life measures will also be collected alongside a process evaluation of parents' and interveners' views and experiences. DISCUSSION This will be the first large pragmatic trial to test whether COS-P is effective for birthing parents with severe and complex perinatal mental health difficulties in improving their mental health symptoms. If shown to be effective, the intervention could be delivered widely across the NHS and other similar services globally. TRIAL REGISTRATION ISRCTN, ISRCTN18308962. Registered 18 February 2022.
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Affiliation(s)
- Camilla Rosan
- Department of Clinical, Educational and Health Psychology, University College London, London, UK. .,Anna Freud National Centre for Children and Families, 4-8 Rodney St, London, N1 9JH, UK.
| | | | - Zoe Darwin
- University of Huddersfield, Huddersfield, UK
| | - Daphne Babalis
- Imperial Clinical Trials Unit, School of Public Health, Imperial College London, London, UK
| | - Victoria Cornelius
- Imperial Clinical Trials Unit, School of Public Health, Imperial College London, London, UK
| | - Rachel Phillips
- Imperial Clinical Trials Unit, School of Public Health, Imperial College London, London, UK
| | - Lani Richards
- Anna Freud National Centre for Children and Families, 4-8 Rodney St, London, N1 9JH, UK
| | - Hannah Wright
- Department of Clinical, Educational and Health Psychology, University College London, London, UK.,Anna Freud National Centre for Children and Families, 4-8 Rodney St, London, N1 9JH, UK
| | - Steve Pilling
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Pasco Fearon
- Department of Clinical, Educational and Health Psychology, University College London, London, UK.,Department of Psychology, University of Cambridge, Cambridge, UK
| | - Elena Pizzo
- Department of Applied Health Research, University College London, London, UK
| | - Peter Fonagy
- Department of Clinical, Educational and Health Psychology, University College London, London, UK.,Anna Freud National Centre for Children and Families, 4-8 Rodney St, London, N1 9JH, UK
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OASI2: a cluster randomised hybrid evaluation of strategies for sustainable implementation of the Obstetric Anal Sphincter Injury Care Bundle in maternity units in Great Britain. Implement Sci 2021; 16:55. [PMID: 34022926 PMCID: PMC8140475 DOI: 10.1186/s13012-021-01125-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 05/03/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Obstetric Anal Sphincter Injury (OASI) Care Bundle comprises four primary and secondary prevention practices that target the rising rates of severe perineal tearing during childbirth, which can have severe debilitating consequences for women. The OASI Care Bundle was implemented in 16 maternity units in Britain in the OASI1 project (2017-2018), which demonstrated the care bundle's effectiveness in reducing OASI rates. In OASI2, the care bundle will be scaled up to 20 additional National Health Service (NHS) maternity units in a hybrid effectiveness-implementation study that will examine the effectiveness of strategies used to introduce, implement and sustain the care bundle. METHODS OASI2 is a two-arm cluster-randomised control trial (C-RCT) of maternity units in England, Scotland and Wales, with an additional non-randomised study arm. C-RCT arm 1 (peer support, n = 10 units) will be supported by 'buddy' units to implement the OASI Care Bundle. C-RCT arm 2 (lean implementation, n = 10 units) will implement without external support. The additional study arm (sustainability, n = 10 units) will include some original OASI1 units to evaluate the care bundle's sustainability and OASI rates over time, from before OASI1 and through the end of OASI2. Units in all three study arms will receive an Implementation Toolkit with training resources and implementation support. The C-RCT arms will be compared in terms of OASI rate reduction (primary effectiveness outcome) and clinicians' adoption of the care bundle (primary implementation outcome). Clinical data will be collated from maternity information systems; implementation data will be collected through validated surveys with women and clinicians, supplemented by qualitative methods. Descriptive statistics and regression modelling will be used for analysis. Emergent themes from the qualitative data will be assessed using framework analysis. DISCUSSION OASI2 will study the impact of various implementation strategies used to introduce and sustain the OASI Care Bundle, and how these strategies affect the bundle's clinical effectiveness. The study will generate insights into how to effectively scale-up and sustain uptake and coverage of similar interventions in maternity units. A locally adaptable 'implementation blueprint' will be produced to inform development of future guidelines to prevent perineal trauma. TRIAL REGISTRATION ISRCTN26523605.
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Beasley DR. An Online Educational Intervention to Influence Medical and Nurse Practitioner Students' Knowledge, Self-Efficacy, and Motivation for Antepartum Depression Screening and Education. Nurs Womens Health 2021; 25:43-53. [PMID: 33460578 DOI: 10.1016/j.nwh.2020.11.004] [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: 04/18/2020] [Revised: 08/16/2020] [Accepted: 11/01/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To evaluate nurse practitioner and medical students' knowledge, self-efficacy, and motivation for antepartum depression screening and education before and after an online educational intervention. DESIGN Quasi-experimental study design. SETTING/LOCAL PROBLEM The University of South Florida, College of Nursing and College of Medicine. Historically, nursing and medical school curricula have a focus on postpartum depression. Testing nurse practitioner and medical students regarding maternal depression throughout pregnancy may give insight into curriculum preparedness. PARTICIPANTS Medical and nurse practitioner students were recruited by convenience sampling. In total, 71 participants completed the study. There were 52 (73%) nurse practitioner students and 19 (27%) medical students. INTERVENTION/MEASUREMENTS Participants used a self-directed learning activity in the form of a slide presentation on the virtual platform REDCap. Knowledge was tested before and after the intervention using the "Speak Up When You're Down"-Postpartum Depression Awareness Campaign examination. Self-efficacy and motivation were measured before and after the intervention by using the Physician/Nurse Practitioner Student Teaching Self-Efficacy Questionnaire and the Physician/Nurse Practitioner Student Teaching Motivation Questionnaire. RESULTS Nurse practitioner and medical students exhibited a mean increase in scores for knowledge, self-efficacy, and motivation. Both groups performed similarly from before to after the intervention, and student profession did not moderate the increase from before to after the intervention. CONCLUSION An intervention to influence health care students' knowledge, self-efficacy, and motivation for antepartum depression screening can be included in medical and nursing curricula and can also be used with currently practicing health care providers. Doing so could possibly benefit pregnant women by enhancing the antepartum care that they receive.
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Abstract
Pregnancy, a sensitive time when two bodies are changing and developing simultaneously, demands careful consideration in assessing and treating mental health conditions. Add to that the restrictions on researching such a vulnerable population, psychiatric nurses face a challenge in providing evidence-based care. The current article focuses on the epidemiology of postpartum depression and long-term consequences, neurobiology of postpartum depression that guides medication selection, and treatment options for supporting postpartum women and their families. [Journal of Psychosocial Nursing and Mental Health Services, 57(11), 9-14.].
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