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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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Clarke JR, Gibson M, Savaglio M, Navani R, Mousa M, Boyle JA. Digital screening for mental health in pregnancy and postpartum: A systematic review. Arch Womens Ment Health 2024; 27:489-526. [PMID: 38557913 PMCID: PMC11230976 DOI: 10.1007/s00737-024-01427-3] [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: 03/31/2022] [Accepted: 01/19/2024] [Indexed: 04/04/2024]
Abstract
PURPOSE This systematic review aimed to determine if digital screening for mental health in pregnancy and postpartum is acceptable, feasible and more effective than standard care (paper-and pen-based screening or no screening). The second aim was to identify barriers and enablers to implementing digital screening in pregnancy and postpartum. METHOD OVID MEDLINE, PsycINFO, SCOPUS, CINAHL, Embase, Web of Science, Joanna Briggs Database and All EMB reviews incorporating Cochrane Database of Systematic Reviews (OVID) were systematically searched for articles that evaluated digital screening for mental health in pregnancy and postpartum between 2000 and 2021. Qualitative articles were deductively mapped to the Theoretical Domains Framework (TDF). RESULTS A total of 34 articles were included in the analysis, including qualitative, quantitative and mixed-methods studies. Digital screening was deemed acceptable, feasible and effective. TDF domains for common barriers included environmental context and resources, skills, social/professional role and identity and beliefs about consequences. TDF domains for common enablers included knowledge, social influences, emotion and behavioural regulation. CONCLUSION When planning to implement digital screening, consideration should be made to have adequate training, education and manageable workload for healthcare professionals (HCP's). Organisational resources and support are important, as well as the choice of the appropriate digital screening assessment and application setting for women. Theory-informed recommendations are provided for both healthcare professionals and women to inform future clinical practice.
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Affiliation(s)
- Jocelyn R Clarke
- Monash Centre for Health Research and Implementation (MCHRI), Faculty of Medicine, Nursing & Health Sciences, Monash University, Melbourne, Australia
| | - Melanie Gibson
- Monash Centre for Health Research and Implementation (MCHRI), Faculty of Medicine, Nursing & Health Sciences, Monash University, Melbourne, Australia
- Te Tātai Hauora o Hine - National Centre for Women's Health Research Aotearoa, Wellington Faculty of Health,, Victoria University of Wellington,, Wellington, New Zealand
| | - Melissa Savaglio
- Health and Social Care Unit (HSCU), School of Public Health and Preventive Medicine (SPHPM), Monash University, Melbourne, Australia
| | | | - Mariam Mousa
- Monash Centre for Health Research and Implementation (MCHRI), Faculty of Medicine, Nursing & Health Sciences, Monash University, Melbourne, Australia
| | - Jacqueline A Boyle
- Health Systems and Equity, Eastern Health Clinical School,, Monash University, Melbourne, Australia.
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Ertmann RK, Nicolaisdottir DR, Siersma V, Overbeck G, Strøyer de Voss S, Modin FA, Lutterodt MC. Factors in early pregnancy predicting pregnancy-related pain in the second and third trimester. Acta Obstet Gynecol Scand 2023; 102:1269-1280. [PMID: 37771202 PMCID: PMC10541159 DOI: 10.1111/aogs.14670] [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: 03/23/2023] [Revised: 06/27/2023] [Accepted: 07/24/2023] [Indexed: 09/30/2023]
Abstract
INTRODUCTION Pain during pregnancy affects women's well-being, causes worry and is a risk factor for the child and the mother during labor. The aim was to investigate the relative importance of an extensive set of pregnancy-related physiological symptoms and psychosocial factors assessed in the first trimester compared with the occurrence of pregnancy-related pain symptoms later in the pregnancy. MATERIAL AND METHODS Included were all women who booked an appointment for a first prenatal visit in one of 125 randomly selected general practitioner practices in Eastern Denmark from April 2015 to August 2016. These women answered an electronic questionnaire containing questions on the occurrence of five pregnancy-related pain symptoms: back pain, leg cramps, pelvic cavity pain, pelvic girdle pain and uterine contractions. The questionnaire also included sociodemographic questions and questions on chronic diseases, physical symptoms, mental health symptoms, lifestyle and reproductive background. The questionnaire was repeated in each trimester. The relative importance of this set of factors from the first trimester on the five pregnancy-related pain symptoms compared with the second and third trimesters was assessed in a dominance analysis. RESULTS A total of 1491 women were included. The most important factor for pregnancy-related pain in the second trimester and third trimester is the presence of the corresponding pain in the first trimester. Parity was associated with pelvic cavity pain and uterine contractions in the following pregnancies. For back pain and pelvic cavity pain, the odds increased as the women's estimated low self-assessed fitness decreased and had low WHO-5 wellbeing scores. CONCLUSIONS When including physical risk factors, sociodemographic factors, psychological factors and clinical risk factors, women's experiences of pregnancy-related pain in the first trimester are the most important predictors for pain later in pregnancy. Beyond the expected positive effects of pregnancy-related pain, notably self-assessed fitness, age and parity were predictive for pain later in pregnancy.
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Väyrynen K, Chen A, Leskelä RL, Raussi-Lehto E, Klemetti R, Heinonen S, Torkki P, Tekay A. Introducing standard patient-reported measures (PRMs) into routine maternity care: A pre-implementation qualitative study on women's perspectives in Finland. BMC Health Serv Res 2023; 23:845. [PMID: 37563587 PMCID: PMC10413725 DOI: 10.1186/s12913-023-09818-5] [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: 12/30/2022] [Accepted: 07/16/2023] [Indexed: 08/12/2023] Open
Abstract
BACKGROUND Systematically using standard patient-reported measures (PRMs) in clinical routines is trending. The International Consortium for Health Outcomes Measurement (ICHOM) has developed condition-specific standard sets of patient-centred measures, one of which is the Pregnancy and Childbirth Standard (PCB) set, where standard PRMs are included. There is limited knowledge on the use of ICHOM PCB set-included PRMs (ICHOM-PCB-PRMs) in routine care. This study investigates women's perspectives on the future implementation of standard ICHOM-PCB-PRMs in routine maternity care in Finland. METHODS Semi-structured interviews were conducted. Pregnant and postpartum women were asked to evaluate each ICHOM-PCB-PRM in several dimensions, e.g., importance and quality of questions, and to provide their views on future implementation in terms of benefits, difficulties, and practices. With the predefined topics and themes, deductive analysis was applied. Ethical committee approval (HUS 220/880/2015) and research permissions were obtained. RESULTS 22 women participated. Participants felt that most of the ICHOM-PCB-PRMs were important, relevant, understandable, and appropriately designed, and agreed that some changes in ICHOM-PCB-PRMs were needed, e.g., adding other important measures, changing the wording, and adding open-ended questions. Women would be hesitant to answer questions honestly if follow-up actions were unclear. Most "outcome" measures could be asked repeatedly as maternal health status changes over time, and "experience" measures could be asked separately for different service providers. Disagreements regarding data collection at birth were observed. PRMs were regarded as a way for women to express their thoughts and feelings. Our participants were concerned about the possible consequences of negatively answering the PREMs questions and the availability of follow-up care. Participants expected that they could answer short and easy questions digitally before appointments, and that instructions and follow-up actions based on their answers should be available. CONCLUSION ICHOM-PCB-PRMs could be applicable in Finnish maternity care, but some modifications may be required. Careful consideration is needed regarding how and when PRMs questions are asked for eliciting more accurate and honest answers and minimizing women feeling judged, embarrassed, or offended. Follow-ups should be available according to women's responses and needs. This study provides insights on the adoption and implementation of standard PRMs in routine maternity care.
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Affiliation(s)
- Kirsi Väyrynen
- Department of Public Health, Faculty of Medicine, University of Helsinki, Biomedicum 1, Helsinki, 00290, Finland
- Department of Obstetrics and Gynaecology, Central Finland Central Hospital, Hoitajantie 3, Jyväskylä, 40620, Finland
| | - An Chen
- Department of Obstetrics and Gynaecology, Helsinki University Hospital and University of Helsinki, Haartmaninkatu 2, Helsinki, 00290, Finland.
- Institute of Healthcare Engineering, Management and Architecture (HEMA), Department of Industrial Engineering and Management, Aalto University, Maarintie 8, P.O. Box 15500, Aalto, FI-00076, Finland.
- Nordic Healthcare Group Oy, Vattuniemenranta 2, Helsinki, 00210, Finland.
- School of Public Health, Zhejiang Chinese Medical University, No. 548 Binwen Road, Binjiang District, Hangzhou, Zhejiang Province, 310053, China.
| | - Riikka-Leena Leskelä
- Department of Public Health, Faculty of Medicine, University of Helsinki, Biomedicum 1, Helsinki, 00290, Finland
- Nordic Healthcare Group Oy, Vattuniemenranta 2, Helsinki, 00210, Finland
| | - Eija Raussi-Lehto
- Customer-oriented Wellbeing and Health Hub, Metropolia University of Applied Sciences, Myllypurontie 1, Helsinki, 00920, Finland
- Department of Neuroscience and Biomedical Engineering, Aalto University, Otakaari 3, Espoo, 02150, Finland
| | - Reija Klemetti
- Finnish National Institute for Health and Welfare, Mannerheimintie 166, Helsinki, 00300, Finland
| | - Seppo Heinonen
- Department of Obstetrics and Gynaecology, Helsinki University Hospital and University of Helsinki, Haartmaninkatu 2, Helsinki, 00290, Finland
| | - Paulus Torkki
- Department of Public Health, Faculty of Medicine, University of Helsinki, Biomedicum 1, Helsinki, 00290, Finland
| | - Aydin Tekay
- Department of Obstetrics and Gynaecology, Helsinki University Hospital and University of Helsinki, Haartmaninkatu 2, Helsinki, 00290, Finland
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Chen A, Väyrynen K, Leskelä R, Torkki P, Heinonen S, Tekay A, Acharya G. The acceptability of implementing patient-reported measures in routine maternity care: A systematic review. Acta Obstet Gynecol Scand 2023; 102:406-419. [PMID: 36647292 PMCID: PMC10008272 DOI: 10.1111/aogs.14506] [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: 09/30/2022] [Revised: 12/10/2022] [Accepted: 12/18/2022] [Indexed: 01/18/2023]
Abstract
INTRODUCTION Patient-reported measures (PRMs) are becoming popular as they might influence clinical decisions, help to deliver patient-centered care, and improve health care quality. However, the limited knowledge and consensus about the acceptability of implementing PRMs in maternity care hinder their widespread use in clinical practice, and evidence-based recommendations are lacking. This systematic review aims to synthesize available evidence on the acceptability of implementing PRMs in routine maternity care. MATERIAL AND METHODS Literature on the implementation of PRMs in maternity care was electronically searched in six databases (PsycARTICLES, PubMed, Scopus, Web of Science, Cochrane Database of Systematic Reviews, and CINAHL), screened and selected for the topic of "acceptability". Theoretical Framework of Acceptability was used as the basic framework guiding data analysis and synthesis. Evidence was thematically analyzed and synthesized. Mixed Method Appraisal Tool and GRADE-CERQual approach were used to assess the quality of studies and evaluate the confidence in the review findings. RESULTS Overall, 4971 articles were screened. From 24 studies, we identified five themes regarding the acceptability of implementing PRMs in routine maternity care: (1) user's action and behavior, (2) stakeholders' attitudes, (3) perceived benefits, (4) perceived challenges and risks, and (5) stakeholders' preferences and suggestions on implementation. While pregnant and postpartum women, health professionals and other stakeholders involved in maternity care were generally positive about the implementation of PRMs in routine care and recognized the potential benefits (eg health improvement, women empowerment, care and services improvement and healthcare system advancement), they pointed out possible challenges and risks in answering PRMs questions, responding to answers, and setting up integrated information systems as well as suggested solutions in the aspects of PRMs data collection, follow-up care, and system-level management. The confidence in the review findings was moderate due to methodological limitations of included studies. CONCLUSIONS Available empirical evidence suggested that the use of PRMs in routine maternity care is acceptable among stakeholders involved in maternity care and the potential benefits of its integration in routine clinical practice to healthcare improvement has been recognized. However, possible challenges in data collection, follow-up care arrangement and system-level integration should be appropriately addressed.
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Affiliation(s)
- An Chen
- Institute of Healthcare Engineering, Management and Architecture (HEMA), Department of Industrial Engineering and ManagementAalto UniversityEspooFinland
- Department of Obstetrics and GynecologyHelsinki University Hospital and University of HelsinkiHelsinkiFinland
- Nordic Healthcare Group OyHelsinkiFinland
| | - Kirsi Väyrynen
- Department of Obstetrics and GynecologyCentral Finland Central HospitaJyväskyläFinland
| | | | - Paulus Torkki
- Institute of Healthcare Engineering, Management and Architecture (HEMA), Department of Industrial Engineering and ManagementAalto UniversityEspooFinland
- Nordic Healthcare Group OyHelsinkiFinland
- Department of Public Health, Faculty of MedicineHelsinki UniversityHelsinkiFinland
| | - Seppo Heinonen
- Department of Obstetrics and GynecologyHelsinki University Hospital and University of HelsinkiHelsinkiFinland
| | - Aydin Tekay
- Department of Obstetrics and GynecologyHelsinki University Hospital and University of HelsinkiHelsinkiFinland
| | - Ganesh Acharya
- Division of Obstetrics & Gynecology, Department of Clinical Science, Intervention and Technology (CLINTEC)Karolinska InstitutetStockholmSweden
- Women`s Health and Perinatology Research grroup, Department of Clinical MedicineUiT The Arctic University of NorwayTromsøNorway
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Chen A, Väyrynen K, Schmidt A, Leskelä R, Torkki P, Heinonen S, Tekay A, Acharya G. The impact of implementing patient-reported measures in routine maternity care: a systematic review. Acta Obstet Gynecol Scand 2022; 101:1184-1196. [PMID: 36065150 PMCID: PMC9812106 DOI: 10.1111/aogs.14446] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 08/04/2022] [Accepted: 08/09/2022] [Indexed: 01/07/2023]
Abstract
INTRODUCTION While there is growing interest in applying patient-reported measures (PRMs) in clinical routine, limited collective evidence of the impact of PRMs hinder their widespread use in specific contexts, such as maternity care. Our objective was to synthesize existing emperical evidence on the impact of implementing PRMs in routine maternity care. MATERIAL AND METHODS We followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines (version 2020). We electronically searched six databases for the literature on the implementation of PRMs in maternity care. A multi-level (woman, clinical, organizational, national and societal) analytic framework for analyzing and synthesizing emperically proven impacts of PRMs was developed. Quality was assessed using the Mixed Method Appraisal Tool. The GRADE-CERQual approach was used to assess the confidence in the review findings and arguments. The protocol was registered in PROSPERO (CRD42021234501). RESULTS Overall, 4971 articles were screened. The emperical evidence, collected from 11 relevant studies, showed that the use of PRMs in routine maternity care could produce positive effects on clinical process (assessment and detection of health problems, clinical visit preparation, resource use, woman-professional communication, decision-making, woman-professional relationship, and care quality), and health behavior and outcomes (women's health and wellbeing, quality of life, health behavior, experiences and satisfaction with healthcare services), awareness, engagement and self-management of own health, and disclosure of health issues. The confidence in the review findings was low to moderate due to a limited number of studies, inadequate data and methodological limitations of included studies. CONCLUSIONS The limited emperical evidence available suggested that the use of PRMs may have positive effects at the individual health level and clinical process level. However, the evidence was not strong enough to provide policy recommendations on the use of PRMs in routine maternity care. This review revealed limitations of currently available research, such as lack of generalizability and narrow scopes in investigating impact. Efforts are needed to improve the quality of research on the use of PRMs in routine maternity care by widening the study population, including different types of PRMs, and considering the effects of PRMs at different levels and domains of healthcare.
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Affiliation(s)
- An Chen
- Department of Industrial Engineering and ManagementInstitute of Healthcare Engineering, Management and Architecture (HEMA), Aalto UniversityEspooFinland,Department of Obstetrics and GynecologyHelsinki University Hospital and University of HelsinkiHelsinkiFinland,Nordic Healthcare Group OyHelsinkiFinland
| | - Kirsi Väyrynen
- Department of Obstetrics and GynecologyCentral Finland Central HospitaJyväskyläFinland
| | | | - Riikka‐Leena Leskelä
- Nordic Healthcare Group OyHelsinkiFinland,Department of Public Health, Faculty of MedicineHelsinki UniversityHelsinkiFinland
| | - Paulus Torkki
- Department of Industrial Engineering and ManagementInstitute of Healthcare Engineering, Management and Architecture (HEMA), Aalto UniversityEspooFinland,Nordic Healthcare Group OyHelsinkiFinland,Department of Public Health, Faculty of MedicineHelsinki UniversityHelsinkiFinland
| | - Seppo Heinonen
- Department of Obstetrics and GynecologyHelsinki University Hospital and University of HelsinkiHelsinkiFinland
| | - Aydin Tekay
- Department of Obstetrics and GynecologyHelsinki University Hospital and University of HelsinkiHelsinkiFinland
| | - Ganesh Acharya
- Division of Obstetrics & Gynecology, Department of Clinical ScienceIntervention and Technology (CLINTEC), Karolinska InstitutetStockholmSweden,Women's Health and Perinatology Research Group, Department of Clinical MedicineUiT ‐ The Arctic University of NorwayTromsøNorway
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Álvarez-Pérez Y, Perestelo-Pérez L, Rivero-Santanta A, Torres-Castaño A, Toledo-Chávarri A, Duarte-Díaz A, Mahtani-Chugani V, Marrero-Díaz MD, Montanari A, Tangerini S, González-González C, Perello M, Serrano-Aguilar P. Co-Creation of Massive Open Online Courses to Improve Digital Health Literacy in Pregnant and Lactating Women. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19020913. [PMID: 35055733 PMCID: PMC8775560 DOI: 10.3390/ijerph19020913] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 12/17/2021] [Accepted: 01/11/2022] [Indexed: 11/17/2022]
Abstract
Background: Digital health literacy (DHL) increases the self-efficacy and empowerment of pregnant and lactating women (PLW) in using the Internet for health issues. The European project IC-Health aimed to improve DHL among PLW, through the co-creation of Massive Open Online Courses (MOOCs). Methods: The co-creation of the MOOCs included focus groups and the creation of communities of practice (CoPs) with PLW and healthcare professionals aimed to co-design the MOOCs. The quantitative measures of MOOCs’ acceptability, experience in the co-creation process and increase in DHL (dimensions of finding, understanding and appraisal) were assessed. Results: 17 PLW participated in focus groups, 113 participants were included in CoPs and 68 participants evaluated the acceptability of MOOCs. A total of 6 MOOCs aimed at improving PLW’s DHL were co-designed. There was a significant improvement in self-perceived DHL after using MOOCs (p-value < 0.001). The acceptability of MOOCs and co-creation experience were positively valued. Conclusions: The preliminary results of the quantitative assessment showed a higher self-perceived DHL after the IC-Health MOOCs. These results suggest that IC-Health MOOCs and the co-creation methodology appear to be a viable process to carry out an intervention aimed to improve DHL levels in European PLW.
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Affiliation(s)
- Yolanda Álvarez-Pérez
- Canary Islands Health Research Institute Foundation (FIISC), 38109 Tenerife, Spain; (A.R.-S.); (A.T.-C.); (A.T.-C.); (A.D.-D.)
- Correspondence:
| | - Lilisbeth Perestelo-Pérez
- Evaluation Unit (SESCS), Canary Islands Health Service (SCS), 38109 Tenerife, Spain; (L.P.-P.); (P.S.-A.)
- Research Network on Health Services in Chronic Diseases (REDISSEC), 38109 Tenerife, Spain
- Center for Biomedical Research of the Canary Islands (CIBICAN), 38320 Tenerife, Spain
| | - Amado Rivero-Santanta
- Canary Islands Health Research Institute Foundation (FIISC), 38109 Tenerife, Spain; (A.R.-S.); (A.T.-C.); (A.T.-C.); (A.D.-D.)
- Research Network on Health Services in Chronic Diseases (REDISSEC), 38109 Tenerife, Spain
| | - Alezandra Torres-Castaño
- Canary Islands Health Research Institute Foundation (FIISC), 38109 Tenerife, Spain; (A.R.-S.); (A.T.-C.); (A.T.-C.); (A.D.-D.)
| | - Ana Toledo-Chávarri
- Canary Islands Health Research Institute Foundation (FIISC), 38109 Tenerife, Spain; (A.R.-S.); (A.T.-C.); (A.T.-C.); (A.D.-D.)
- Research Network on Health Services in Chronic Diseases (REDISSEC), 38109 Tenerife, Spain
| | - Andrea Duarte-Díaz
- Canary Islands Health Research Institute Foundation (FIISC), 38109 Tenerife, Spain; (A.R.-S.); (A.T.-C.); (A.T.-C.); (A.D.-D.)
| | - Vinita Mahtani-Chugani
- Gerencia de Atención Primaria de Tenerife, 38004 Tenerife, Spain; (V.M.-C.); (M.D.M.-D.)
| | | | - Alessia Montanari
- Associazione Comitato Collaborazione Medica (CCM), 10152 Torino, Italy; (A.M.); (S.T.)
| | - Sabina Tangerini
- Associazione Comitato Collaborazione Medica (CCM), 10152 Torino, Italy; (A.M.); (S.T.)
| | - Carina González-González
- ITED Research Group, Department of Computer Science and Engineering, University of La Laguna (ULL), 38200 Tenerife, Spain;
| | | | - Pedro Serrano-Aguilar
- Evaluation Unit (SESCS), Canary Islands Health Service (SCS), 38109 Tenerife, Spain; (L.P.-P.); (P.S.-A.)
- Research Network on Health Services in Chronic Diseases (REDISSEC), 38109 Tenerife, Spain
- Center for Biomedical Research of the Canary Islands (CIBICAN), 38320 Tenerife, Spain
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Bäckström C, Carlén K, Larsson V, Mårtensson LB, Thorstensson S, Berglund M, Larsson T, Bouwmeester B, Wilhsson M, Larsson M. Expecting parents’ use of digital sources in preparation for parenthood in a digitalised society – a systematic review. Digit Health 2022; 8:20552076221090335. [PMID: 35449713 PMCID: PMC9016606 DOI: 10.1177/20552076221090335] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 03/10/2022] [Indexed: 11/16/2022] Open
Abstract
Background In today's society, people are experiencing the rapid development of
digitalisation. Expecting parents may have difficulties evaluating the
information online; they are not always sure which sources of information
are trustworthy, and this exacerbates their feelings of anxiety. More
research is needed to broaden the knowledge about how their use of digital
sources may influence their health. Question The focus of this study was to explore expecting parents’ use of digital
sources and how this influences their health during pregnancy. Methods A systematic review covered the thematic analysis of 39 articles. Findings The analysis resulted in the following theme: The digitalised society
involves both opportunities and challenges, and expecting parents
express a need for a variety of digital sources to improve their
health, and sub-themes: Digital sources could promote
parents’ health and well-being in a digitalised society;
Consuming digital health information facilitates understanding,
different feelings and social connections; and A
variety of digital sources may facilitate parental identification and
adaption to parenthood. Conclusion Different digital sources in our digitalised society mean access to
information and opportunities to extend social connections for expecting
parents. This can promote their ability to understand and adapt to
parenthood, as well as to improve their health and well-being and make the
parental transition. However, professional support during face-to-face
consultations cannot always be exchanged to digital sources. It is important
to base digital sources devoted to expecting parents and digitalisation
overall on multi-sectorial collaborations and coordination between different
organisations and the digital sources they provide.
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Affiliation(s)
| | | | | | - Lena Birgitta Mårtensson
- School of Health Sciences, University of Skövde, Sweden
- School of Nursing, Midwifery and Social Work, Faculty of Health and Rehabilitation Sciences, The University of Queensland, Australia
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Caroline B, Sandi C, Shazima T, Viveca L. Parents' Perceptions About Future Digital Parental Support-A Phenomenographic Interview Study. Front Digit Health 2021; 3:729697. [PMID: 34778868 PMCID: PMC8578718 DOI: 10.3389/fdgth.2021.729697] [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: 06/23/2021] [Accepted: 10/01/2021] [Indexed: 02/05/2023] Open
Abstract
Background: Parents use digital sources (such as the internet or online forums and applications) during pregnancy and after childbirth to receive informative support. Research shows that there is further need for innovation development in digital parental support despite informative support available in digital form. Purpose: To explore parents' perceptions of future digital parental support concerning pregnancy and the first 18 months of parenthood. Method: A phenomenographic interview study with an inductive approach including 15 semi-structured interviews was conducted. Results: The analysis process resulted in three descriptive categories: Opportunities for virtual and in-person meetings, Individualized digital parental support, and Professional knowledge and trustworthiness concerning future digital parental support. Conclusion: The results broaden the knowledge about how future digital parental support can be designed to facilitate the functional, interactive, and critical digital health literacy of new and would-be parents. To succeed, healthcare organizations should allow healthcare professionals to assume an active role in developing digital parental support, both as health educators (i.e., providing parents with knowledge) and facilitators (i.e., facilitating parents' use of digital parental support). However, parents perceived that future digital parental support should complement standard care instead of replacing in-person meetings with healthcare professionals.
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Affiliation(s)
- Bäckström Caroline
- School of Health Sciences, University of Skövde, Skövde, Sweden.,Research Group Family Centered Health (FamCeH), University of Skövde, Skövde, Sweden
| | - Chamoun Sandi
- Region Jönköping County, Högland Hospital of Eksjö, Maternity Ward, Eksjö, Sweden
| | | | - Larsson Viveca
- School of Health Sciences, University of Skövde, Skövde, Sweden.,Research Group Family Centered Health (FamCeH), University of Skövde, Skövde, Sweden
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10
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Busch AS, Ljubicic ML, Upners EN, Fischer MB, Kolby N, Eckert-Lind C, Jespersen K, Andersson AM, Frederiksen H, Johannsen TH, Hegaard HK, Sharif H, Hagen CP, Juul A. Cohort profile: The COPENHAGEN Minipuberty Study-A longitudinal prospective cohort of healthy full-term infants and their parents. Paediatr Perinat Epidemiol 2021; 35:601-611. [PMID: 34156716 DOI: 10.1111/ppe.12777] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 04/25/2021] [Accepted: 04/27/2021] [Indexed: 01/06/2023]
Abstract
BACKGROUND The hypothalamic-pituitary-gonadal (HPG) axis governs sexual maturation and reproductive function in humans. In early postnatal life, it is transiently active during which circulating sex steroids reach adult levels. While this so-called minipuberty represents a universal phenomenon in infants of both sexes, its role for early maturation and growth remains incompletely understood. OBJECTIVES To provide normative data on auxology as well as serum and urinary hormone levels in healthy, full-term infants throughout the first year of life and to investigate associations of postnatal HPG axis dynamics as well as hormonal, genetic and environmental exposures with early genital development and growth. POPULATION Healthy, Danish, full-term, singleton newborns including their parents. DESIGN Single-centre, prospective, observational longitudinal pregnancy and birth cohort. METHODS Newborns were followed with six repeated clinical examinations during a one-year follow-up period. An umbilical cord blood sample was drawn at birth. At each visit, infants underwent a clinical examination focusing on auxology and genital development. Further, blood (serum, plasma, DNA) and urine samples were collected at each visit. Mothers and fathers underwent a clinical examination and provided blood samples prior to and after birth. A subset of parents provided urine samples and breast milk samples. Pregnancy and obstetrical outcomes, and detailed parental questionnaires were compiled. PRELIMINARY RESULTS Between August 2016 and August 2018, 2481 women with singleton pregnancies were invited to participate of which 298, including their partners, were enrolled (12.0%). A total of 268 healthy, full-term newborns born appropriate for gestational age (AGA) were included at birth, 233 newborns participated in the postnatal follow-up period and 186 completed the one-year follow-up period (9.4% and 7.5%, respectively). CONCLUSION The COPENHAGEN Minipuberty Study provides detailed, longitudinal data on early genital development and growth including hormonal and genetic profiles and environmental exposure in healthy infants including additional data in their parents.
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Affiliation(s)
- Alexander Siegfried Busch
- Department of Growth and Reproduction, Copenhagen University Hospital - Rigshospitalet, Copenhagen O, Denmark.,International Center for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC, Copenhagen University Hospital - Rigshospitalet, Copenhagen O, Denmark
| | - Marie Lindhardt Ljubicic
- Department of Growth and Reproduction, Copenhagen University Hospital - Rigshospitalet, Copenhagen O, Denmark.,International Center for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC, Copenhagen University Hospital - Rigshospitalet, Copenhagen O, Denmark
| | - Emmie N Upners
- Department of Growth and Reproduction, Copenhagen University Hospital - Rigshospitalet, Copenhagen O, Denmark.,International Center for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC, Copenhagen University Hospital - Rigshospitalet, Copenhagen O, Denmark
| | - Margit Bistrup Fischer
- Department of Growth and Reproduction, Copenhagen University Hospital - Rigshospitalet, Copenhagen O, Denmark.,International Center for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC, Copenhagen University Hospital - Rigshospitalet, Copenhagen O, Denmark
| | - Nanna Kolby
- Department of Growth and Reproduction, Copenhagen University Hospital - Rigshospitalet, Copenhagen O, Denmark.,International Center for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC, Copenhagen University Hospital - Rigshospitalet, Copenhagen O, Denmark
| | - Camilla Eckert-Lind
- Department of Growth and Reproduction, Copenhagen University Hospital - Rigshospitalet, Copenhagen O, Denmark.,International Center for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC, Copenhagen University Hospital - Rigshospitalet, Copenhagen O, Denmark
| | - Kirstine Jespersen
- Department of Growth and Reproduction, Copenhagen University Hospital - Rigshospitalet, Copenhagen O, Denmark.,International Center for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC, Copenhagen University Hospital - Rigshospitalet, Copenhagen O, Denmark
| | - Anna-Maria Andersson
- Department of Growth and Reproduction, Copenhagen University Hospital - Rigshospitalet, Copenhagen O, Denmark
| | - Hanne Frederiksen
- Department of Growth and Reproduction, Copenhagen University Hospital - Rigshospitalet, Copenhagen O, Denmark.,International Center for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC, Copenhagen University Hospital - Rigshospitalet, Copenhagen O, Denmark
| | - Trine Holm Johannsen
- Department of Growth and Reproduction, Copenhagen University Hospital - Rigshospitalet, Copenhagen O, Denmark.,International Center for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC, Copenhagen University Hospital - Rigshospitalet, Copenhagen O, Denmark
| | - Hanne Kristine Hegaard
- Department of Obstetrics, Copenhagen University Hospital - Rigshospitalet, Copenhagen O, Denmark.,The Research Unit Women's and Children's Health, Juliane Marie Center for Women, Children and Reproduction, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Heidi Sharif
- Department of Obstetrics, Copenhagen University Hospital - Rigshospitalet, Copenhagen O, Denmark
| | - Casper P Hagen
- Department of Growth and Reproduction, Copenhagen University Hospital - Rigshospitalet, Copenhagen O, Denmark.,International Center for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC, Copenhagen University Hospital - Rigshospitalet, Copenhagen O, Denmark
| | - Anders Juul
- Department of Growth and Reproduction, Copenhagen University Hospital - Rigshospitalet, Copenhagen O, Denmark.,International Center for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC, Copenhagen University Hospital - Rigshospitalet, Copenhagen O, Denmark
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Dayyani I, Lou S, Jepsen I. Midwives' provision of health promotion in antenatal care: A qualitative explorative study. Women Birth 2021; 35:e75-e83. [PMID: 33509736 DOI: 10.1016/j.wombi.2021.01.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 01/11/2021] [Accepted: 01/11/2021] [Indexed: 11/15/2022]
Abstract
PROBLEM Studies indicate that health promotion in antenatal care can be improved. Moreover, a schism seems to exist between health promotion and prevention in antenatal care. BACKGROUND Antenatal care to support and improve maternal health is a core midwifery activity in which prevention as well as HP and woman-centeredness are important. AIM To explore how Danish midwives experienced antenatal care and practiced health promotion. METHODS Midwives undertaking antenatal care were interviewed individually (n=8) and two focus groups (n=10) were created. Thematic analysis was performed inductively, and the theoretical models from Piper's health promotion practice Framework for midwives were used to analyse the midwives' health promotion approach. FINDINGS Two major themes were highlighted. Theme 1: 'The antenatal care context for health promotion' described factors contributing to quality in health promotion in antenatal care, such as communication and building relationships with the pregnant women. Theme 2: 'The health promotion approach in antenatal care' described both midwife-focused and woman-focused approaches to pregnant women's health. Barriers to high-quality antenatal care and a holistic health promotion approach were identified, such as shared-care issues, documentation demands and lack of time. DISCUSSION The midwives' experiences were discussed in the context of a health promotion approach. Why midwives practice using a midwife-centred approach has many explanations, but midwives need to learn and help each other understand how they can practice woman-focused care while simultaneously providing prophylactic, evidence-based care. CONCLUSION Midwives mainly had a midwife-focused approach. To further promote women's health, midwives need to focus on a woman-focused approach.
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Affiliation(s)
- Ida Dayyani
- University College of Northern Denmark, Department of Midwifery, Selma Lagerløfs Vej 2, 9220 Aalborg Øst, Denmark.
| | - Stina Lou
- Defactum - Public Health and Health Services Research, Central Denmark Region, Aarhus, Denmark; Center for Fetal Diagnostics, Aarhus University Hospital, Aarhus, Denmark.
| | - Ingrid Jepsen
- University College of Northern Denmark, Department of Midwifery, Selma Lagerløfs Vej 2, 9220 Aalborg Øst, Denmark.
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12
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Masella MA, Godard B. [Ethical issues of Internet use by pregnant women during their medical care]. SANTE PUBLIQUE 2020; 32:171-182. [PMID: 32989946 DOI: 10.3917/spub.202.0171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Pregnant women are heavy users of Internet and this has an impact on their medical follow-up. The purpose of this study is to highlight the ethical issues related to the use of the Internet by women in their medical care.Methode: Through a systematic literature review conducted on PubMed/Medline, Web of Science, CINAHL and Embase between June and July 2019, 10 670 results were obtained, and 79 articles were included in the post-selection study. A thematic analysis was conducted on these articles. RESULTS More than 90% of pregnant women use Internet, particularly to find medical information and social support, mainly on pregnancy and childbirth. This research allows them more equitable access to knowledge and develops their empowerment, which modifies the relationship between caregiver and patient, through the acquisition of greater autonomy for women and the development of experiential knowledge. This access offers a central and active role to pregnant women in their medical care. However, many authors also agree on the possible abuses of this use: misinformation, disproportionate information and the presence of judgment that undermine empowerment, but also digital divide and inequity in understanding information, stigmatization of women, and risks of privacy breaches on data acquired online. CONCLUSION In order to provide pregnant women with the central and active place they seek, the authors recommend involving caregivers in the referral to reliable sites, encouraging them to develop online content, and educating pregnant women in the search for health information on Internet.
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Villadsen SF, Hadi H, Ismail I, Osborne RH, Ekstrøm CT, Kayser L. ehealth literacy and health literacy among immigrants and their descendants compared with women of Danish origin: a cross-sectional study using a multidimensional approach among pregnant women. BMJ Open 2020; 10:e037076. [PMID: 32385065 PMCID: PMC7228522 DOI: 10.1136/bmjopen-2020-037076] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To explore ehealth literacy, ability to actively engage with healthcare providers and health system navigation among pregnant immigrant women and their descendants compared with women of Danish origin. DESIGN AND SETTING A cross-sectional survey at antenatal clinics in 2016, Denmark. PARTICIPANTS Pregnant women attending antenatal care (n=405). OUTCOME MEASURES The eHealth Literacy Questionnaire (eHLQ) and two domains from the Health Literacy Questionnaire (HLQ): ability to actively engage with healthcare providers and health system navigation. Range of response options for eHLQ (1-4) and HLQ (1-5). With mixed-effect linear regressions, eHLQ and HLQ among immigrants and their descendants compared with women of Danish origin were assessed. RESULTS The response rate was 75%. The overall trend was lower ehealth literacy and HLQ domains among immigrants and their descendants compared with women of Danish origin. For ehealth literacy, the results suggest that challenges related more to digital abilities than motivation, trust and access to technology. The mean ability to engage with digital services was 3.20 (SD 0.44) for women of Danish origin. Non-Western descendants (-0.14, 95% CI -0.31 to 0.02), non-Western (-0.20, 95% CI -0.34 to -0.06) and Western (-0.22, 95% CI -0.39 to -0.06) immigrants had lower adjusted means of this outcome. No differences in motivation to engage with digital services were found for descendants (-0.00, 95% CI -0.17 to 0.17), non-Western (0.03, 95% CI -0.11 to 0.18) or Western (-0.06, 95% CI -0.23 to 0.10) immigrants compared with the mean of the reference (2.85, SD 0.45). Lower ability to engage with healthcare providers was found for non-Western born immigrants (-0.15, CI 95% -0.30 to -0.01) compared with the mean of women with Danish origin (4.15, SD 0.47). CONCLUSION Generally, descendant and immigrant women had lower levels of ehealth literacy and health literacy than women of Danish origin. These differences are potentially antecedents of adverse birth outcomes and could inform structural efforts to mitigate health inequalities.
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Affiliation(s)
- Sarah Fredsted Villadsen
- Section of Social Medicine, Department of Public Health, Kobenhavns Universitet, Copenhagen K, Denmark
| | - Hajer Hadi
- Section of Social Medicine, Department of Public Health, Kobenhavns Universitet, Copenhagen K, Denmark
| | - Israa Ismail
- Section of Social Medicine, Department of Public Health, Kobenhavns Universitet, Copenhagen K, Denmark
| | - Richard H Osborne
- Centre for Global Health and Equity, School of Health, Swinburne University of Technology, Hawthorn, Victoria, Australia
| | - Claus Thorn Ekstrøm
- Section of Biostatistics, Department of Public Health, Kobenhavns Universitet, Copenhagen, Denmark
| | - Lars Kayser
- Section of Health Services Research, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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Baker N, Gillman L, Coxon K. Assessing mental health during pregnancy: An exploratory qualitative study of midwives' perceptions. Midwifery 2020; 86:102690. [PMID: 32276157 DOI: 10.1016/j.midw.2020.102690] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 12/10/2019] [Accepted: 03/05/2020] [Indexed: 01/16/2023]
Abstract
BACKGROUND Mental health disorders are estimated to affect between 10% and 20% of women who access maternity services and can be defined as a public health issue due to the potential consequences for women, children and families. Detecting problems early in pregnancy can significantly improve outcomes for women and their families. However, mental health problems are not being consistently identified in routine midwifery practice and little is known from current literature about midwives' practice in relation to current national guidelines or the impact models of care have on assessing maternal mental health. OBJECTIVE To identify midwives' views about barriers and facilitators to screening for mental health in pregnancy using current UK guidelines. DESIGN Nine community midwives from a single district general hospital in the south of England were recruited to take part in focus groups. Thematic analysis was used to extract key themes from the data. FINDINGS Three key themes were identified from the focus groups and included system factors, social factors and trust. Barriers and facilitators to screening maternal mental health were associated with the initial 'booking' appointment' and differences in models of care. Barriers to screening were defined as high workload, poor continuity, and a lack of trust between women and midwives. CONCLUSIONS This study highlights key barriers and facilitators associated with mental health screening during pregnancy, including issues of trust and uncertainty about women's willingness to disclose mental health conditions. Further research is required to evaluate the relationship between women and midwives in contemporary practice and the influence this may have on maternal mental health.
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Affiliation(s)
- Natasha Baker
- The Royal Berkshire NHS Foundation Trust, London Road, Reading, Berkshire RG1 5AN, United Kingdom.
| | - Lindsay Gillman
- Kingston University and St George's University of London, United Kingdom
| | - Kirstie Coxon
- Kingston University and St George's University of London, United Kingdom
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