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Dasgupta T, Horgan G, Peterson L, Mistry HD, Balls E, Wilson M, Smith V, Boulding H, Sheen KS, Van Citters A, Nelson EC, Duncan EL, Dadelszen PV, Rayment-Jones H, Silverio SA, Magee LA. Women's experiences of maternity care in the United Kingdom during the COVID-19 pandemic: A follow-up systematic review and qualitative evidence synthesis. Women Birth 2024; 37:101588. [PMID: 38431430 DOI: 10.1016/j.wombi.2024.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 02/06/2024] [Accepted: 02/06/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND Maternity care services in the United Kingdom have undergone drastic changes due to pandemic-related restrictions. Prior research has shown maternity care during the pandemic was negatively experienced by women and led to poor physical and mental health outcomes in pregnancy. A synthesis is required of published research on women's experiences of maternity care during the latter half of the COVID-19 pandemic. AIM To update a previous systematic review of maternity care experiences during the pandemic to June 2021, exploring experiences of maternity care specifically within the United Kingdom and how they may have changed, in order to inform future maternity services. METHODS A systematic review of qualitative literature was conducted using comprehensive searches of five electronic databases and the Cochrane COVID Study Register, published between 1 June 2021 and 13 October 2022, and further updated to 30 September 2023. Thematic Synthesis was utilised for data synthesis. FINDINGS Of 21,860 records identified, 27 studies were identified for inclusion. Findings included 14 descriptive themes across the five core concepts: (1)Care-seeking and experience; (2)Virtual care; (3)Self-monitoring; (4)COVID-19 vaccination; (5)Ethical future of maternity care. DISCUSSION Our findings in the UK are consistent with those globally, and extend those of the previous systematic review, particularly about women's perceptions of the COVID-19 vaccine during pregnancy. CONCLUSION Our findings suggest the following are important to women for future maternity care: personalisation and inclusiveness; clear and evidence-based communication to facilitate informed decision-making; and achieving balance between social commitments and time spent settling into motherhood.
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Affiliation(s)
- Tisha Dasgupta
- Department of Women & Children's Health, School of Life Course & Population Sciences, King's College London, London, United Kingdom
| | - Gillian Horgan
- Department of Women & Children's Health, School of Life Course & Population Sciences, King's College London, London, United Kingdom
| | - Lili Peterson
- Department of Women & Children's Health, School of Life Course & Population Sciences, King's College London, London, United Kingdom; Department of Population Health Sciences, School of Life Course & Population Sciences, King's College London, London, United Kingdom
| | - Hiten D Mistry
- Department of Women & Children's Health, School of Life Course & Population Sciences, King's College London, London, United Kingdom
| | - Emily Balls
- The RESILIENT Study Patient & Public Involvement & Engagement Advisory Group, United Kingdom
| | - Milly Wilson
- Department of Women & Children's Health, School of Life Course & Population Sciences, King's College London, London, United Kingdom
| | - Valerie Smith
- School of Nursing & Midwifery, Faculty of Health Sciences, Trinity College Dublin, Dublin, Republic of Ireland; School of Nursing, Midwifery and Health Systems, College of Health and Agricultural Sciences, University College Dublin, Dublin, Ireland
| | - Harriet Boulding
- The Policy Institute, Faculty of Social Science & Public Policy, King's College London, London, United Kingdom
| | - Kayleigh S Sheen
- Department of Social Sciences, College of Health, Science and Society, University of the West of England Bristol, Bristol, United Kingdom; The RESILIENT Study Technical Advisory Group, United Kingdom
| | - Aricca Van Citters
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine, Dartmouth College, NH, United States
| | - Eugene C Nelson
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine, Dartmouth College, NH, United States
| | - Emma L Duncan
- Department of Twin Research & Genetic Epidemiology, School of Life Course & Population Sciences, King's College London, London, United Kingdom
| | - Peter von Dadelszen
- Department of Women & Children's Health, School of Life Course & Population Sciences, King's College London, London, United Kingdom
| | - Hannah Rayment-Jones
- Department of Women & Children's Health, School of Life Course & Population Sciences, King's College London, London, United Kingdom
| | - Sergio A Silverio
- Department of Women & Children's Health, School of Life Course & Population Sciences, King's College London, London, United Kingdom; School of Psychology, Faculty of Health, Liverpool John Moores University, Liverpool, United Kingdom
| | - Laura A Magee
- Department of Women & Children's Health, School of Life Course & Population Sciences, King's College London, London, United Kingdom.
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Jackson L, Davies SM, Gaspar M, Podkujko A, Harrold JA, Pascalis LDE, Fallon V, Soulsby LK, Silverio SA. The social and healthcare professional support drawn upon by women antenatally during the COVID-19 pandemic: A recurrent, cross-sectional, thematic analysis. Midwifery 2024; 133:103995. [PMID: 38608542 DOI: 10.1016/j.midw.2024.103995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 04/06/2024] [Accepted: 04/08/2024] [Indexed: 04/14/2024]
Abstract
OBJECTIVE To explore antenatal experiences of social and healthcare professional support during different phases of social distancing restriction implementation in the UK. DESIGN Semi-structured interviews were conducted via telephone or video-conferencing software between 13 July 2020 - 2 September 2020. Interviews were transcribed and a recurrent, cross-sectional, thematic analysis was conducted. PARTICIPANTS Twelve antenatal women were interviewed during UK social distancing restrictions (Timepoint 1; T1) and a separate sample of twelve women were interviewed in the initial easing of these restrictions (Timepoint 2; T2). FINDINGS T1 themes were: 'Maternity care as non-essential' and 'Pregnancy is cancelled'. T2 themes were: 'Technology is a polarised tool' and 'Clinically vulnerable, or not clinically vulnerable? That is the question'. KEY CONCLUSIONS At T1, anxieties were ascribed to the exclusion of partners from routine care, and to perceived insensitivity and aggression from the public. For T2, insufficient Governmental transparency led to disillusionment, confusion, and anger. Covert workplace discrimination also caused distress at T2. Across timepoints: deteriorated mental wellbeing was attributed to depleted opportunities to interact socially and scaled back maternity care. IMPLICATIONS FOR PRACTICE Recommendations are made to: protect maternal autonomy; improve quality of mental health and routine care signposting; prioritise parental community support in the re-opening of 'non-essential' services; prioritise the option for face-to-face appointments when safe and legal; and protecting the rights of working mothers.
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Affiliation(s)
- Leanne Jackson
- Department of Psychology, Institute of Population Health, University of Liverpool, England
| | - Siân M Davies
- School of Psychology, Faculty of Health, Liverpool John Moores University, England; Department of Women & Children's Health, School of Life Course & Population Sciences, King's College London, England
| | - Monic Gaspar
- Department of Psychology, Institute of Population Health, University of Liverpool, England
| | - Anastasija Podkujko
- Department of Psychology, Institute of Population Health, University of Liverpool, England
| | - Joanne A Harrold
- Department of Psychology, Institute of Population Health, University of Liverpool, England
| | - Leonardo DE Pascalis
- Department of Psychology, Institute of Population Health, University of Liverpool, England
| | - Victoria Fallon
- Department of Psychology, Institute of Population Health, University of Liverpool, England
| | - Laura K Soulsby
- Department of Psychology, Institute of Population Health, University of Liverpool, England
| | - Sergio A Silverio
- Department of Women & Children's Health, School of Life Course & Population Sciences, King's College London, England.
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De Backer K, Pali A, Challacombe FL, Hildersley R, Newburn M, Silverio SA, Sandall J, Howard LM, Easter A. Women's experiences of attempted suicide in the perinatal period (ASPEN-study) - a qualitative study. BMC Psychiatry 2024; 24:255. [PMID: 38570802 PMCID: PMC10988966 DOI: 10.1186/s12888-024-05686-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 03/14/2024] [Indexed: 04/05/2024] Open
Abstract
BACKGROUND Suicide is a leading cause of maternal death during pregnancy and the year after birth (the perinatal period). While maternal suicide is a relatively rare event with a prevalence of 3.84 per 100,000 live births in the UK [1], the impact of maternal suicide is profound and long-lasting. Many more women will attempt suicide during the perinatal period, with a worldwide estimated prevalence of 680 per 100,000 in pregnancy and 210 per 100,000 in the year after birth [2]. Qualitative research into perinatal suicide attempts is crucial to understand the experiences, motives and the circumstances surrounding these events, but this has largely been unexplored. AIM Our study aimed to explore the experiences of women and birthing people who had a perinatal suicide attempt and to understand the context and contributing factors surrounding their perinatal suicide attempt. METHODS Through iterative feedback from a group of women with lived experience of perinatal mental illness and relevant stakeholders, a qualitative study design was developed. We recruited women and birthing people (N = 11) in the UK who self-reported as having undertaken a suicide attempt. Interviews were conducted virtually, recorded and transcribed. Using NVivo software, a critical realist approach to Thematic Analysis was followed, and themes were developed. RESULTS Three key themes were identified that contributed to the perinatal suicide attempt. The first theme 'Trauma and Adversities' captures the traumatic events and life adversities with which participants started their pregnancy journeys. The second theme, 'Disillusionment with Motherhood' brings together a range of sub-themes highlighting various challenges related to pregnancy, birth and motherhood resulting in a decline in women's mental health. The third theme, 'Entrapment and Despair', presents a range of factors that leads to a significant deterioration of women's mental health, marked by feelings of failure, hopelessness and losing control. CONCLUSIONS Feelings of entrapment and despair in women who are struggling with motherhood, alongside a background of traumatic events and life adversities may indicate warning signs of a perinatal suicide. Meaningful enquiry around these factors could lead to timely detection, thus improving care and potentially prevent future maternal suicides.
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Affiliation(s)
- Kaat De Backer
- Department of Women & Children's Health, School of Life Course and Population Sciences, Faculty of Life Sciences & Medicine, King's College London, 10th Floor North Wing, St. Thomas' Hospital, Westminster Bridge Road, Lambeth, London, SE1 7EH, UK
| | - Alexandra Pali
- Department of Women & Children's Health, School of Life Course and Population Sciences, Faculty of Life Sciences & Medicine, King's College London, 10th Floor North Wing, St. Thomas' Hospital, Westminster Bridge Road, Lambeth, London, SE1 7EH, UK
- Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Fiona L Challacombe
- Section of Women's Mental Health, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, Denmark Hill, 16 De Crespigny Park, London, SE5 8AF, England
| | - Rosanna Hildersley
- Section of Women's Mental Health, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, Denmark Hill, 16 De Crespigny Park, London, SE5 8AF, England
| | - Mary Newburn
- Patient and Public Involvement and Engagement Lead for ARC South London, Maternity and Perinatal Mental health theme, Department of Women & Children's Health, School of Life Sciences and Medicine, King's College London, 10th Floor North Wing, St. Thomas' Hospital, Westminster Bridge Road, Lambeth, London, SE1 7EH, UK
| | - Sergio A Silverio
- Department of Women & Children's Health, School of Life Course & Population Sciences, Faculty of Life Sciences & Medicine, King's College London, 6th Floor Addison House, Great Maze Pond, Southwark, London, SE1 1UK, UK
- School of Psychology, Faculty of Health, Liverpool John Moores University, Liverpool, Merseyside, L3 3AF, UK
| | - Jane Sandall
- Department of Women & Children's Health, School of Life Course and Population Sciences, Faculty of Life Sciences & Medicine, King's College London, 10th Floor North Wing, St. Thomas' Hospital, Westminster Bridge Road, Lambeth, London, SE1 7EH, UK
| | - Louise M Howard
- Section of Women's Mental Health, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, Denmark Hill, 16 De Crespigny Park, London, SE5 8AF, England
| | - Abigail Easter
- Department of Women & Children's Health, School of Life Course and Population Sciences, Faculty of Life Sciences & Medicine, King's College London, 10th Floor North Wing, St. Thomas' Hospital, Westminster Bridge Road, Lambeth, London, SE1 7EH, UK.
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Worrall S, Christiansen P, Khalil A, Silverio SA, Fallon V. Measurement invariance analysis of the Postpartum Specific Anxiety Scale - Research Short Form in mothers of premature and term infants. BMC Res Notes 2024; 17:75. [PMID: 38486271 PMCID: PMC10941354 DOI: 10.1186/s13104-024-06746-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 03/08/2024] [Indexed: 03/17/2024] Open
Abstract
OBJECTIVE Mothers of premature infants are more likely to develop anxiety during the first postpartum year than mothers of term infants. However, commonly used measures of anxiety were developed for general adult populations and may produce spurious, over-inflated scores when used in a postpartum context. Although perinatal-specific tools such as the Postpartum Specific Anxiety Scale [PSAS] offer a promising alternative form of measurement, it is not clear whether the measure performs similarly in mothers of premature infants as it does in mothers of term infants. The objective of the current study was to identify whether items on the Postpartum Specific Anxiety Scale - Research Short Form (PSAS-RSF) are being interpreted in the same manner in mothers of term infants and mothers of premature infants. Mothers (N = 320) participated in an international on-line survey between February 2022 and March 2023 (n = 160 mothers of premature infants, n = 160 mothers of term infants) where they completed the PSAS-RSF. Data were analysed using a measurement invariance analysis to assess whether constructs of the PSAS-RSF are performing in a similar manner across the two groups. RESULTS Whilst the PSAS-RSF achieved configural invariance and so retains its four-factor structure, metric invariance was not reached and so items are being interpreted differently in mothers of premature infants. Items concerning infant-separation, finance, and anxieties surrounding infant health are potentially problematic. Future research must now modify the PSAS-RSF for specific use in mothers of premature infants, to ensure measurement of anxiety in this population is valid.
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Affiliation(s)
- Semra Worrall
- Department of Psychology, Institute of Population Health, University of Liverpool, Liverpool, UK.
| | - Paul Christiansen
- Department of Psychology, Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Asma Khalil
- Fetal Medicine Unit, Liverpool Women's NHS Foundation Trust, Liverpool, UK
- Fetal Medicine Unit, St. George's University Hospitals NHS Foundation Trust, University of London, London, UK
| | - Sergio A Silverio
- Department of Women & Children's Health, School of Life Course & Population Sciences, King's College London, London, UK
- School of Psychology, Faculty of Health, Liverpool John Moores University, Liverpool, UK
| | - Victoria Fallon
- Department of Psychology, Institute of Population Health, University of Liverpool, Liverpool, UK
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Astaire E, Jennings L, Khundakar M, Silverio SA, Flynn AC. General practitioners' experiences of providing lifestyle advice to patients with depression: A qualitative focus group study. PLoS One 2024; 19:e0299934. [PMID: 38466705 PMCID: PMC10927082 DOI: 10.1371/journal.pone.0299934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 02/17/2024] [Indexed: 03/13/2024] Open
Abstract
OBJECTIVE Depression is an increasingly common mental health disorder in the UK, managed predominantly in the community by GPs. Emerging evidence suggests lifestyle medicine is a key component in the management of depression. We aimed to explore GPs' experiences, attitudes, and challenges to providing lifestyle advice to patients with depression. METHOD Focus groups were conducted virtually with UK GPs (May-July 2022). A topic guide facilitated the discussion and included questions on experiences, current practices, competence, challenges, and service provision. Data were analysed using template analysis. RESULTS 'Supporting Effective Conversations'; 'Willing, but Blocked from Establishing Relational Care'; 'Working Towards Patient Empowerment'; and 'Control Over the Prognosis' were all elements of how individualised lifestyle advice was key to the management of depression. Establishing a doctor-patient relationship by building trust and rapport was fundamental to having effective conversations about lifestyle behaviours. Empowering patients to make positive lifestyle changes required tailoring advice using a patient-centred approach. Confidence varied across participants, depending on education, experience, type of patient, and severity of depression. CONCLUSIONS GPs play an important role in managing depression using lifestyle medicine and a patient-centred approach. Organisational and educational changes are necessary to facilitate GPs in providing optimal care to patients with depression.
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Affiliation(s)
- Emma Astaire
- School of Life Course & Population Sciences, Faculty of Life Sciences & Medicine, King’s College London, London, United Kingdom
| | - Laura Jennings
- School of Life Course & Population Sciences, Faculty of Life Sciences & Medicine, King’s College London, London, United Kingdom
| | - Martina Khundakar
- Pharmacy Department, Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle-upon-Tyne, United Kingdom
- School of Pharmacy, Newcastle University, Newcastle-upon-Tyne, United Kingdom
| | - Sergio A. Silverio
- School of Life Course & Population Sciences, Faculty of Life Sciences & Medicine, King’s College London, London, United Kingdom
- School of Psychology, Faculty of Health, Liverpool John Moores University, Liverpool, United Kingdom
| | - Angela C. Flynn
- School of Life Course & Population Sciences, Faculty of Life Sciences & Medicine, King’s College London, London, United Kingdom
- School of Population Health, Royal College of Surgeons in Ireland, Dublin, Ireland
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Mamrath S, Greenfield M, Fernandez Turienzo C, Fallon V, Silverio SA. Experiences of postpartum anxiety during the COVID-19 pandemic: A mixed methods study and demographic analysis. PLoS One 2024; 19:e0297454. [PMID: 38451908 PMCID: PMC10919661 DOI: 10.1371/journal.pone.0297454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 01/04/2024] [Indexed: 03/09/2024] Open
Abstract
INTRODUCTION The first wave of the COVID-19 pandemic saw the reconfiguration of perinatal and maternity services, national lockdowns, and social distancing measures which affected the perinatal experiences of new and expectant parents. This study aimed to explore the occurrence of postpartum anxieties in people who gave birth during the pandemic. METHODS An exploratory concurrent mixed-methods design was chosen to collect and analyse the quantitative and qualitative data of an online survey during the first UK lockdown. The survey included the Postpartum Specific Anxiety Scale-Research Short Form-for use in global Crises [PSAS-RSF-C] psychometric tool, and open-ended questions in relation to changes in birth plans and feelings about those changes and giving birth in a pandemic. Differences in measured scores were analysed for the participant's ethnicity, sexual orientation and disability using independent Student's t-tests, and for age, the analysis was completed using Pearson's correlation. Qualitative data from open-ended questions were analysed using a template analysis. RESULTS A total of 1,754 new and expectant parents completed the survey between 10th and 24th April 2020, and 381 eligible postnatal women completed the psychometric test. We found 52.5% of participants reported symptoms consistent with a diagnosis of postnatal anxiety-significantly higher than the rates usually reported. Younger women and sexual minority women were more likely to score highly on the PSAS-RSF-C than their older or heterosexual counterparts (p<0.001). Younger participants reported anxieties in the 'infant safety and welfare' category, whilst lesbian, gay, bisexual, and pansexual participants scored highly in the 'psychosocial adjustment to motherhood' category. DISCUSSION Postpartum anxiety is under-reported, and demographic differences in the rates of postpartum anxiety are under-researched. This research demonstrates for the first time a difference in postpartum anxiety rates amongst sexual minority women.
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Affiliation(s)
- Simran Mamrath
- Department of Women & Children’s Health, School of Life Course & Population Sciences, Faculty of Life Sciences & Medicine, King’s College London, London, United Kingdom
| | - Mari Greenfield
- Department of Women & Children’s Health, School of Life Course & Population Sciences, Faculty of Life Sciences & Medicine, King’s College London, London, United Kingdom
- School of Health, Wellbeing and Social Care, Department of Wellbeing, Education, Languages and Social Care, The Open University, Milton Keynes, United Kingdom
| | - Cristina Fernandez Turienzo
- Department of Women & Children’s Health, School of Life Course & Population Sciences, Faculty of Life Sciences & Medicine, King’s College London, London, United Kingdom
| | - Victoria Fallon
- Department of Psychology, Institute of Population Health, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Sergio A. Silverio
- Department of Women & Children’s Health, School of Life Course & Population Sciences, Faculty of Life Sciences & Medicine, King’s College London, London, United Kingdom
- School of Psychology, Faculty of Health, Liverpool John Moores University, Liverpool, United Kingdom
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George-Carey R, Memtsa M, Kent-Nye FE, Magee LA, Oza M, Burgess K, Goodhart V, Jurković D, Silverio SA. Women's experiences of early pregnancy loss services during the pandemic: A qualitative investigation. Women Birth 2024; 37:394-402. [PMID: 38184398 DOI: 10.1016/j.wombi.2023.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 12/19/2023] [Accepted: 12/19/2023] [Indexed: 01/08/2024]
Abstract
PROBLEM Early pregnancy losses [EPL] are common, varied, and require different courses of management and care. BACKGROUND In the UK, women who suspect or suffer a pregnancy loss are usually provided specialist care in early pregnancy assessment units [EPAUs]. Their configuration has recently been evaluated, but recommendations for change in-line with best practice for optimum outcomes were unable to be implemented due to the COVID-19 pandemic health system shock. AIM To compare women's experiences of EPAUs during the pandemic to themes previously found in qualitative work undertaken with women who utilised EPAUs before the pandemic. METHODS We conducted semi-structured virtual interviews, with women (N = 32) who suffered an early pregnancy loss during the pandemic; analysing transcripts using Template Analysis, based on findings about women's (pre-pandemic) experiences of EPAU from The VESPA Study. FINDINGS We report on seven key themes: Barriers to Accessing Services; Communication & Information; Retention of Relational Care; Involvement in Care Decisions; Staffs' Attitude or Approach; Efficiency of Service Delivery; Sensitive Patient Management. DISCUSSION Sensitive patient management and woman-staff interactions in EPAU settings remain a fundamental issue. Women also reported their experiences of EPAUs were comparatively worse during the pandemic. CONCLUSIONS Women valued the care provided by EPAUs and found services to be efficient, despite pandemic-related restrictions. However, psychological recognition surrounding EPL and appropriate, sensitive, relational care and support continue to be areas in need of improvement. Our recommendation is to implement the improvements suggested by VESPA as a priority to ameliorate present sub-optimal experiences and prevent further deterioration.
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Affiliation(s)
- Rhiannon George-Carey
- Gynaecology Services, Royal London Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Maria Memtsa
- Gynaecology Service, Royal Free Hospital, Royal Free London NHS Foundation Trust, London, United Kingdom; Elizabeth Garrett Anderson Institute for Women's Health, Faculty of Population Health Sciences, School of Life and Medical Sciences, University College London, London, United Kingdom
| | - Flora E Kent-Nye
- Department of Women & Children's Health, School of Life Course & Population Sciences, Faculty of Life Sciences & Medicine, King's College London, London, United Kingdom
| | - Laura A Magee
- Department of Women & Children's Health, School of Life Course & Population Sciences, Faculty of Life Sciences & Medicine, King's College London, London, United Kingdom
| | - Munira Oza
- The Ectopic Pregnancy Trust, London, United Kingdom
| | - Karen Burgess
- Petals: The Baby Loss Counselling Charity, Cambridge, United Kingdom
| | - Venetia Goodhart
- Gynaecology Diagnostic and Treatment Unit, Elizabeth Garrett Anderson Wing, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Davor Jurković
- Gynaecology Diagnostic and Treatment Unit, Elizabeth Garrett Anderson Wing, University College London Hospitals NHS Foundation Trust, London, United Kingdom; Elizabeth Garrett Anderson Institute for Women's Health, Faculty of Population Health Sciences, School of Life and Medical Sciences, University College London, London, United Kingdom
| | - Sergio A Silverio
- Department of Women & Children's Health, School of Life Course & Population Sciences, Faculty of Life Sciences & Medicine, King's College London, London, United Kingdom.
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Hacking M, Jackson L, Fallon V, Harrold JA, Davie P, Silverio SA, Slade P. An interpretive phenomenological analysis of the experiences of mothers who continue to breastfeed despite facing difficulties. Women Birth 2024; 37:387-393. [PMID: 38123437 DOI: 10.1016/j.wombi.2023.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 12/12/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Breastfeeding offers many health benefits to mother and infant. PROBLEM Breastfeeding difficulties are common and are linked with postnatal distress. AIM To explore the lived experiences of breastfeeding continuation despite facing difficulties. METHODS Qualitative semi-structured interviews were conducted with eight women who had experienced breastfeeding difficulties yet continued breastfeeding. Interviews were analysed using Interpretative Phenomenological Analysis (IPA). FINDINGS The first superordinate theme, 'Radical acceptance of the imperfect' included sub-themes of: 'Taking it day-by-day', 'Breastfeeding takes a community', and, 'Finding what works for you'. The second superordinate theme, 'Determination and persistence' included sub-themes of: 'Adopting a headstrong attitude' and 'Transient challenges versus lifelong achievement'. DISCUSSION Participants found radical acceptance of breastfeeding as an imperfect, variable process which enabled them to sustain breastfeeding despite challenges. Participants proactively drew on social and personal resources to navigate guidance and to find solutions which worked for their individual circumstances. Finally, open-mindedness, optimism, self-compassion, and being headstrong and determined were all personal qualities which facilitated breastfeeding during exceptionally difficult moments on their breastfeeding journey. CONCLUSION Recommendations are made for healthcare professionals: to provide emotional counselling during routine care (with an aim to instil breastfeeding self-efficacy) and to encourage breastfeeding advocacy among fathers and the maternal social support network (with an aim to further scaffold successful breastfeeding). Recommendations are also made for mothers: to develop and refine maternal confidence, patience, flexibility, self-compassion, and trust.
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Affiliation(s)
- Michelle Hacking
- Department of Psychology, Institute of Population Health, University of Liverpool, United Kingdom
| | - Leanne Jackson
- Department of Psychology, Institute of Population Health, University of Liverpool, United Kingdom
| | - Victoria Fallon
- Department of Psychology, Institute of Population Health, University of Liverpool, United Kingdom
| | - Joanne A Harrold
- Department of Psychology, Institute of Population Health, University of Liverpool, United Kingdom
| | - Philippa Davie
- Department of Women & Children's Health, School of Life Course & Population Sciences, King's College London, United Kingdom
| | - Sergio A Silverio
- Department of Women & Children's Health, School of Life Course & Population Sciences, King's College London, United Kingdom; School of Psychology, Faculty of Health, Liverpool John Moores University, United Kingdom.
| | - Pauline Slade
- Department of Primary Care and Mental Health, Institute of Population Health, University of Liverpool, United Kingdom
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Worrall S, Christiansen P, Khalil A, Silverio SA, Fallon V. Associations between prematurity, postpartum anxiety, neonatal intensive care unit admission, and stress. Front Psychiatry 2024; 15:1323773. [PMID: 38463430 PMCID: PMC10921229 DOI: 10.3389/fpsyt.2024.1323773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 02/02/2024] [Indexed: 03/12/2024] Open
Abstract
Introduction It is well established that a premature birth increases the likelihood of developing anxiety during the postpartum period, and that the environment of the neonatal intensive care unit (NICU) might be a contributing factor. Mothers of earlier premature infants may experience these anxieties to a higher degree compared to mothers of later premature infants. The aim of this study was to explore the association between prematurity and postpartum-specific anxiety, and the relationship between postpartum-specific anxiety and stress in the NICU. Materials and methods Mothers (N = 237) of infants aged between birth and 12 months completed an online survey containing the Postpartum Specific Anxiety Scale - Research Short Form (PSAS-RSF) and the Parental Stressor Scale: Neonatal Intensive Care Unit (PSS:NICU). Structural equation modeling was used to analyze the relationship between gestational age and postpartum-specific anxiety, with one-way ANOVAs used to analyze this relationship with respect to categories of gestational age. Hierarchical regression models analyzed the relationship between postpartum-specific anxiety and stress in the NICU. Results For the PSAS-RSF, Practical Infant Care Anxieties (p = 0.001), Maternal Competence and Attachment Anxieties (p = 0.033), and Infant Safety and Welfare Anxieties (p = 0.020) were significantly associated with week of gestation. Practical Infant Care and Infant Safety and Welfare Anxieties were significantly higher for mothers of late premature infants, compared to mothers of term infants (p < 0.001; p = 0.019). There were no significant between-group differences with respect to Maternal Competence and Attachment Anxieties. After controlling for potential confounders, Infant Safety and Welfare Anxieties were significantly associated with increased stress in the NICU (p < 0.001) as measured by the PSS:NICU. Conclusions Our findings highlight the need for interventions for mothers with premature infants, which specifically target anxieties reflected in the PSAS-RSF, such as routine care and increasing maternal self-efficacy.
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Affiliation(s)
- Semra Worrall
- Department of Psychology, Institute of Population Health, University of Liverpool, Liverpool, United Kingdom
| | - Paul Christiansen
- Department of Psychology, Institute of Population Health, University of Liverpool, Liverpool, United Kingdom
| | - Asma Khalil
- Fetal Medicine Unit, Liverpool Women’s NHS Foundation Trust, Liverpool, United Kingdom
- Fetal Medicine Unit, St George’s University Hospitals NHS Foundation Trust, London, United Kingdom
| | - Sergio A. Silverio
- Department of Women & Children’s Health, School of Life Course & Population Sciences, King’s College London, London, United Kingdom
- School of Psychology, Faculty of Health, Liverpool John Moores University, Liverpool, United Kingdom
| | - Victoria Fallon
- Department of Psychology, Institute of Population Health, University of Liverpool, Liverpool, United Kingdom
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Jackson L, Greenfield M, Payne E, Burgess K, Oza M, Storey C, Davies SM, De Backer K, Kent-Nye FE, Pilav S, Worrall S, Bridle L, Khazaezadeh N, Rajasingam D, Carson LE, De Pascalis L, Fallon V, Hartley JM, Montgomery E, Newburn M, Wilson CA, Harrold JA, Howard LM, Sandall J, Magee LA, Sheen KS, Silverio SA. A consensus statement on perinatal mental health during the COVID-19 pandemic and recommendations for post-pandemic recovery and re-build. Front Glob Womens Health 2024; 5:1347388. [PMID: 38449695 PMCID: PMC10915094 DOI: 10.3389/fgwh.2024.1347388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 02/08/2024] [Indexed: 03/08/2024] Open
Abstract
Introduction The COVID-19 pandemic posed a significant lifecourse rupture, not least to those who had specific physical vulnerabilities to the virus, but also to those who were suffering with mental ill health. Women and birthing people who were pregnant, experienced a perinatal bereavement, or were in the first post-partum year (i.e., perinatal) were exposed to a number of risk factors for mental ill health, including alterations to the way in which their perinatal care was delivered. Methods A consensus statement was derived from a cross-disciplinary collaboration of experts, whereby evidence from collaborative work on perinatal mental health during the COVID-19 pandemic was synthesised, and priorities were established as recommendations for research, healthcare practice, and policy. Results The synthesis of research focused on the effect of the COVID-19 pandemic on perinatal health outcomes and care practices led to three immediate recommendations: what to retain, what to reinstate, and what to remove from perinatal mental healthcare provision. Longer-term recommendations for action were also made, categorised as follows: Equity and Relational Healthcare; Parity of Esteem in Mental and Physical Healthcare with an Emphasis on Specialist Perinatal Services; and Horizon Scanning for Perinatal Mental Health Research, Policy, & Practice. Discussion The evidence base on the effect of the pandemic on perinatal mental health is growing. This consensus statement synthesises said evidence and makes recommendations for a post-pandemic recovery and re-build of perinatal mental health services and care provision.
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Affiliation(s)
- Leanne Jackson
- Department of Psychology, Institute of Population Health, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Mari Greenfield
- Faculty of Wellbeing, Education and Language Studies, The Open University, Milton Keynes, United Kingdom
- Department of Women & Children’s Health, School of Life Course & Population Sciences, Faculty of Life Sciences & Medicine, King’s College London, London, United Kingdom
| | - Elana Payne
- Department of Psychology, Institute of Population Health, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, United Kingdom
- Department of Women & Children’s Health, School of Life Course & Population Sciences, Faculty of Life Sciences & Medicine, King’s College London, London, United Kingdom
| | - Karen Burgess
- Petals: The Baby Loss Counselling Charity, Cambridge, United Kingdom
| | - Munira Oza
- The Ectopic Pregnancy Trust, London, United Kingdom
| | - Claire Storey
- International Stillbirth Alliance, Bristol, United Kingdom
| | - Siân M. Davies
- Department of Women & Children’s Health, School of Life Course & Population Sciences, Faculty of Life Sciences & Medicine, King’s College London, London, United Kingdom
- School of Psychology, Faculty of Health, Liverpool John Moores University, Liverpool, United Kingdom
| | - Kaat De Backer
- Department of Women & Children’s Health, School of Life Course & Population Sciences, Faculty of Life Sciences & Medicine, King’s College London, London, United Kingdom
| | - Flora E. Kent-Nye
- Department of Women & Children’s Health, School of Life Course & Population Sciences, Faculty of Life Sciences & Medicine, King’s College London, London, United Kingdom
| | - Sabrina Pilav
- Centre for Research in Psychology and Sport Sciences, Health and Wellbeing Research, The University of Hertfordshire, Hatfield, United Kingdom
| | - Semra Worrall
- Department of Psychology, Institute of Population Health, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Laura Bridle
- HELIX Service, Maternal Mental Health Services, King’s College Hospital NHS Foundation Trust, London, United Kingdom
| | - Nina Khazaezadeh
- Chief Midwifery Office, NHS England—London Region, London, United Kingdom
| | - Daghni Rajasingam
- Maternity Services, Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Lauren E. Carson
- Section of Women’s Mental Health, School of Mental Health & Psychological Sciences, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
- Research Development, UK Biobank, Manchester, United Kingdom
| | - Leonardo De Pascalis
- Department of Psychology, Institute of Population Health, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Victoria Fallon
- Department of Psychology, Institute of Population Health, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Julie M. Hartley
- Department of Women & Children’s Health, School of Life Course & Population Sciences, Faculty of Life Sciences & Medicine, King’s College London, London, United Kingdom
| | - Elsa Montgomery
- Division of Methodologies, Department of Midwifery, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King’s College London, London, United Kingdom
| | - Mary Newburn
- Department of Women & Children’s Health, School of Life Course & Population Sciences, Faculty of Life Sciences & Medicine, King’s College London, London, United Kingdom
| | - Claire A. Wilson
- Section of Women’s Mental Health, School of Mental Health & Psychological Sciences, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
- South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Joanne A. Harrold
- Department of Psychology, Institute of Population Health, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Louise M. Howard
- Section of Women’s Mental Health, School of Mental Health & Psychological Sciences, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
- South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Jane Sandall
- Department of Women & Children’s Health, School of Life Course & Population Sciences, Faculty of Life Sciences & Medicine, King’s College London, London, United Kingdom
| | - Laura A. Magee
- Department of Women & Children’s Health, School of Life Course & Population Sciences, Faculty of Life Sciences & Medicine, King’s College London, London, United Kingdom
| | - Kayleigh S. Sheen
- Department of Women & Children’s Health, School of Life Course & Population Sciences, Faculty of Life Sciences & Medicine, King’s College London, London, United Kingdom
- School of Social Sciences, College of Health, Science and Society, University of the West of England Bristol, Bristol, United Kingdom
| | - Sergio A. Silverio
- Department of Women & Children’s Health, School of Life Course & Population Sciences, Faculty of Life Sciences & Medicine, King’s College London, London, United Kingdom
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Silverio SA. " There are lots of new faces this year… I'm not entirely sure when I became one of the old ones": a psycho-ethnography of the self at #PoWESconf five years in. Front Psychol 2024; 14:1280940. [PMID: 38259545 PMCID: PMC10801332 DOI: 10.3389/fpsyg.2023.1280940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 12/20/2023] [Indexed: 01/24/2024] Open
Abstract
Conferences have been discussed as spaces for academic work to extend beyond the confines of one's institution, fostering environments of collaborative working, learning, and social bond-making. The British Psychological Society's Psychology of Women and Equalities Section hosts an annual conference, attended by feminist scholars from around the world. Drawing on auto-ethnography and psycho-biography, this paper presents a 'psycho-ethnography of the self' with reflections centred on: 'Scholarship', 'Feminist Praxis'; '(Safe) Academic Spaces'; and 'Positioning the Self'. This article contributes to a small, but growing body of literature critically reflecting on conferences as spaces for personal and professional development and academic growth.
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Affiliation(s)
- Sergio A. Silverio
- Department of Women and Children’s Health, School of Life Course and Population Sciences, King’s College London, London, United Kingdom
- School of Psychology, Faculty of Health, Liverpool John Moores University, Liverpool, United Kingdom
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12
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Silverio SA, Varman N, Barry Z, Khazaezadeh N, Rajasingam D, Magee LA, Matthew J. Inside the 'imperfect mosaic': Minority ethnic women's qualitative experiences of race and ethnicity during pregnancy, childbirth, and maternity care in the United Kingdom. BMC Public Health 2023; 23:2555. [PMID: 38129856 PMCID: PMC10734065 DOI: 10.1186/s12889-023-17505-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 12/15/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Persistent, high rates of maternal mortality amongst ethnic minorities is one of the UK's starkest examples of racial disparity. With greater risks of adverse outcomes during maternity care, ethnic minority women are subjected to embedded, structural and systemic discrimination throughout the healthcare service. METHODS Fourteen semi-structured interviews were undertaken with minority ethnic women who had recent experience of UK maternity care. Data pertaining to ethnicity and race were subject to iterative, inductive coding, and constant comparison through Grounded Theory Analysis to test a previously established theory: The 'Imperfect Mosaic'. ANALYSIS & FINDINGS A related theory emerged, comprising four themes: 'Stopping Short of Agentic Birth'; 'Silenced and Stigmatised through Tick-Box Care'; 'Anticipating Discrimination and the Need for Advocacy'; and 'Navigating Cultural Differences'. The new theory: Inside the 'Imperfect Mosaic', demonstrates experiences of those who received maternity care which directly mirrors experiences of those who provide care, as seen in the previous theory we set-out to test. However, the current theory is based on more traditional and familiar notions of racial discrimination, rather than the nuanced, subtleties of socio-demographic-based micro-aggressions experienced by healthcare professionals. CONCLUSIONS Our findings suggest the need for the following actions: Prioritisation of bodily autonomy and agency in perinatal physical and mental healthcare; expand awareness of social and cultural issues (i.e., moral injury; cultural safety) within the NHS; and undertake diversity training and support, and follow-up of translation of the training into practice, across (maternal) health services.
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Affiliation(s)
- Sergio A Silverio
- Department of Women & Children's Health, School of Life Course & Population Sciences, Faculty of Life Sciences & Medicine, King's College London, Addison House, Great Maze Pond, Southwark, London, SE1 1UL, UK.
| | - Nila Varman
- Department of Women & Children's Health, School of Life Course & Population Sciences, Faculty of Life Sciences & Medicine, King's College London, Addison House, Great Maze Pond, Southwark, London, SE1 1UL, UK
| | - Zenab Barry
- National Maternity Voices, London, UK
- National Institute of Health and Care Research Applied Research Collaboration [NIHR ARC] South London, King's College Hospital NHS Foundation Trust, Lambeth, London, SE5 9RS, UK
| | - Nina Khazaezadeh
- Chief Midwifery Office, NHS England, Wellington House, 133-155 Waterloo Road, Southwark, London, SE1 8UG, UK
| | - Daghni Rajasingam
- Maternity Services, St. Thomas' Hospital, Guy's and St. Thomas' NHS Foundation Trust, Westminster Bridge Road, Lambeth, London, SE1 7EH, UK
| | - Laura A Magee
- Department of Women & Children's Health, School of Life Course & Population Sciences, Faculty of Life Sciences & Medicine, King's College London, Addison House, Great Maze Pond, Southwark, London, SE1 1UL, UK
| | - Jacqueline Matthew
- Department of Perinatal Imaging & Health, School of Biomedical Engineering & Imaging Sciences, Faculty of Life Sciences & Medicine, King's College London, St. Thomas' Hospital, Westminster Bridge Road, Lambeth, London, SE1 7EH, UK
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13
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Worrall S, Harris EJ, Silverio SA, Fallon V. The identification and measurement of postpartum anxiety in England: A Delphi survey. J Psychiatr Res 2023; 168:381-391. [PMID: 37976556 DOI: 10.1016/j.jpsychires.2023.10.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 08/14/2023] [Accepted: 10/18/2023] [Indexed: 11/19/2023]
Abstract
Postpartum anxiety has negative consequences for both mother and infant, so effective identification and measurement is vital to enable intervention. Despite NICE recommendations to prioritise the measurement of postpartum anxiety in mothers, current clinical measurement in England remains both fragmented and flawed. The Postpartum Specific Anxiety Scale [PSAS] offers an alternative, as it measures maternal-focused anxieties which can enable specifically targeted interventions. However, it is only currently used as a research tool and may require modification for clinical use. To inform modification of the PSAS, nineteen stakeholders from a variety of organisations participated in a two-round Delphi consensus survey to measure its clinical relevance and potential for effective identification of clinical anxiety. Descriptive analyses revealed all subscales of the PSAS scored highly across all domains, excluding Practical Infant Care Anxieties. Analyses also indicated good consensus between stakeholders across specific items, suggesting that the some items on the PSAS are relevant and effective at identifying clinical postpartum anxiety. Participants also expressed a need for a shorter version of the PSAS for clinical use, and that additional items may need including. Future research must now adapt the existing PSAS based on the results of this study and pilot the adapted measure in a clinical population.
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Affiliation(s)
- Semra Worrall
- Department of Psychology, Institute of Population Health, University of Liverpool, UK
| | - Elizabeth J Harris
- Department of Psychology, Institute of Population Health, University of Liverpool, UK
| | - Sergio A Silverio
- Department of Women & Children's Health, School of Life Course & Population Sciences, King's College London, UK.
| | - Victoria Fallon
- Department of Psychology, Institute of Population Health, University of Liverpool, UK
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14
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Gurasashvili J, Silverio SA, Hill M, Peter M, Stafford-Smith B, Lewis C. The disequilibrium of hope: A grounded theory analysis of parents' experiences of receiving a "no primary finding" result from genome sequencing. J Genet Couns 2023. [PMID: 37929616 DOI: 10.1002/jgc4.1818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 10/02/2023] [Accepted: 10/04/2023] [Indexed: 11/07/2023]
Abstract
Genome sequencing (GS) has the potential to reduce the "diagnostic odyssey" that many parents of children with rare undiagnosed conditions experience. While much research has considered the impact of receiving a diagnostic result, research has rarely focused solely on the impact of receiving a "no primary finding" (NPF) result. This study aimed to investigate the experience of parents of children with rare and undiagnosed conditions following an NPF result from GS. Nine parents whose child had an NPF result from GS were recruited through the social media platform of the charity SWAN (Syndromes Without A Name) UK. Semi-structured telephone interviews were conducted, transcribed verbatim, and analyzed using grounded theory. Analysis led to the emergence of two main themes. The first theme "Striving to Solve the Unsolved Puzzle" concerned the experience of striving to end the "diagnostic odyssey." The second theme "Navigating Hope, Lost then Found" plots the trajectory of hope raised by the promise of a new technology, dashed by the NPF, and the eventual return of small and distant hope for the future. Taken together, these themes allowed for a proposed theory: "The Disequilibrium of Hope," which highlights the dynamic and modifiable experience of hope participants experience in their GS journey. These results suggest GS can be an emotional rollercoaster for parents. While hope plays an important role in coping with the day-to-day life of living with a rare disease, careful management of expectations from GS is important during pre-test counseling, and continued follow-up and support are needed beyond result disclosure. An understanding of the disappointment and distress caused by an NPF result is valuable for healthcare professionals in this field to ensure counseling can be tailored. Further research should consider how to support parents after an NPF result.
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Affiliation(s)
- Jana Gurasashvili
- Centre for Medical Education, School of Medicine, Cardiff University, Cardiff, UK
- NHS North Thames Genomic Laboratory Hub, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
- Genetics and Genomic Medicine, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Sergio A Silverio
- Department of Women & Children's Health, School of Life Course & Population Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Melissa Hill
- NHS North Thames Genomic Laboratory Hub, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
- Genetics and Genomic Medicine, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Michelle Peter
- NHS North Thames Genomic Laboratory Hub, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
- Genetics and Genomic Medicine, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Bethany Stafford-Smith
- NHS North Thames Genomic Laboratory Hub, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
- Genetics and Genomic Medicine, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Celine Lewis
- Centre for Medical Education, School of Medicine, Cardiff University, Cardiff, UK
- NHS North Thames Genomic Laboratory Hub, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
- Population, Policy and Practice Department, UCL Great Ormond Street Institute of Child Health, London, UK
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15
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Briley AL, Silverio SA, Shennan AH, Tydeman G. Experiences of Impacted Foetal Head: Findings from a Pragmatic Focus Group Study of Mothers and Midwives. Int J Environ Res Public Health 2023; 20:7009. [PMID: 37947566 PMCID: PMC10647298 DOI: 10.3390/ijerph20217009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 09/29/2023] [Accepted: 10/25/2023] [Indexed: 11/12/2023]
Abstract
INTRODUCTION We aimed to explore the lived experiences of caesarean birth complicated by impaction of the foetal head, for mothers and midwives. METHODS A pragmatic, qualitative, focus group study of mixed-participants was conducted, face-to-face. They were postpartum women (n = 4), midwives (n = 4), and a postpartum midwife (n = 1) who had experience of either providing care for impacted foetal head, and/or had experienced it during their own labour, in Fife, United Kingdom. Data were transcribed and were analysed using template analysis. RESULTS Three main themes emerged through analysis: (i) current knowledge of impacted foetal head; (ii) current management of impacted foetal head; and (iii) experiences and outcomes of impacted foetal head. Each theme was made up of various initial codes when data were analysed inductively. Finally, each theme could be overlaid onto the three core principles of the Tydeman Tube: (1) to improve outcomes for mother and baby in the second stage of labour; (2) to reduce the risk of trauma to mother and baby in complicated births; and (3) to increase respectful care for women in labour; thus allowing for a neat analytic template. CONCLUSION A lack of consensus regarding definition, management, and training were highlighted by the midwives. Women anticipated caesarean birth in late labour as straightforward and were therefore unaware of this potential complication. Women and midwives would welcome any new device to facilitate delivery of the impacted foetal head (IFH) as long as it is fully evaluated prior to widespread introduction. Women were not averse to being part of this evaluation process.
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Affiliation(s)
- Annette L. Briley
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA 5042, Australia;
| | - Sergio A. Silverio
- Department of Women & Children’s Health, School of Life Course & Population Sciences, King’s College London, London SE1 1UL, UK;
- School of Psychology, Faculty of Health, Liverpool John Moores University, Liverpool L3 3AF, UK
| | - Andrew H. Shennan
- Department of Women & Children’s Health, School of Life Course & Population Sciences, King’s College London, London SE1 1UL, UK;
| | - Graham Tydeman
- Maternity Services, Victoria Hospital, NHS Fife, Kirkcaldy KY2 5AH, UK;
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Magee LA, Molteni E, Bowyer V, Bone JN, Boulding H, Khalil A, Mistry HD, Poston L, Silverio SA, Wolfe I, Duncan EL, von Dadelszen P. Author Correction: National surveillance data analysis of COVID-19 vaccine uptake in England by women of reproductive age. Nat Commun 2023; 14:5655. [PMID: 37704620 PMCID: PMC10499900 DOI: 10.1038/s41467-023-41366-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/15/2023] Open
Affiliation(s)
- Laura A Magee
- Department of Women and Children's Health, School of Life Course & Population Science, King's College London, London, UK.
| | - Erika Molteni
- Biomedical Engineering Department, School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Vicky Bowyer
- Department of Twin Research and Genetic Epidemiology, School of Life Course & Population Science, King's College London, London, UK
| | - Jeffrey N Bone
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada
| | - Harriet Boulding
- The Policy Institute at King's, Social Science and Public Policy, King's College London, London, UK
| | - Asma Khalil
- Department of Obstetrics and Gynaecology, St. George's, University of London, London, UK
| | - Hiten D Mistry
- Department of Women and Children's Health, School of Life Course & Population Science, King's College London, London, UK
| | - Lucilla Poston
- Department of Women and Children's Health, School of Life Course & Population Science, King's College London, London, UK
| | - Sergio A Silverio
- Department of Women and Children's Health, School of Life Course & Population Science, King's College London, London, UK
| | - Ingrid Wolfe
- Department of Women and Children's Health, School of Life Course & Population Science, King's College London, London, UK
| | - Emma L Duncan
- Department of Twin Research and Genetic Epidemiology, School of Life Course & Population Science, King's College London, London, UK
| | - Peter von Dadelszen
- Department of Women and Children's Health, School of Life Course & Population Science, King's College London, London, UK
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17
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Silverio SA, Bye A, Hildersley R, Chingara O, Chang YS, Bick D. A longitudinal qualitative study of women's experiences of postnatal care following hypertensive disorders of pregnancy. Women Birth 2023; 36:460-468. [PMID: 36925402 DOI: 10.1016/j.wombi.2023.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 03/06/2023] [Accepted: 03/08/2023] [Indexed: 03/16/2023]
Abstract
PROBLEM There has been little focus on women's views of care and recovery following pregnancy complicated by hypertensive disorders of pregnancy [HDP] despite long-term implications for maternal health. BACKGROUND Increasingly in clinical research, areas of interest include the extent to which women are involved in postnatal care planning, perceived value of routine postnatal contacts, lifestyle behaviour advice, and extent to which ongoing concerns about HDP could be discussed with healthcare professionals. AIM This study explored women's experiences of birth-recovery up to 12 months following HDP. METHODS A longitudinal qualitative study using semi-structured interviews at four and 12 months postpartum. Twenty-four women who each had a form of HDP, were recruited using a maximum variation, purposive sampling strategy from four National Health Service maternity units in London, 21 of whom were interviewed at both time points. Data were collected and analysed by timepoint following a recurrent, cross-sectional cohort approach using template analysis methodology. FINDINGS Four main themes and ten sub-themes were identified. Main themes included: assumptions about blood pressure; perinatal experiences; postnatal care pathways; and managing complex health conditions. DISCUSSION Postnatal care needs to be tailored to women's individual needs following HDP, with ongoing review by relevant clinicians during and beyond the first six weeks. Many women with HDP have ongoing information needs about hypertensive status, treatment and prognoses, and future birth planning. CONCLUSION Policy makers, health providers and funders cannot continue to ignore the need to ensure postnatal services meet the needs of women who have experienced medically complex pregnancies.
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Affiliation(s)
- Sergio A Silverio
- Department of Women & Children's Health, School of Life Course Sciences, Faculty of Life Sciences & Medicine, King's College London, London, United Kingdom
| | - Amanda Bye
- Department of Psychological Medicine, Division of Academic Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Rosanna Hildersley
- Section of Women's Mental Health, Department of Health Service & Population Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Olivia Chingara
- Department of Women & Children's Health, School of Life Course Sciences, Faculty of Life Sciences & Medicine, King's College London, London, United Kingdom
| | - Yan-Shing Chang
- Department of Child & Family Health, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, United Kingdom
| | - Debra Bick
- Warwick Clinical Trials Unit, Warwick Medical School, Faculty of Science, Engineering and Medicine, University of Warwick, Coventry, United Kingdom.
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Ionio C, Ciuffo G, Landoni M, Smorti M, Della Vedova AM, Christiansen P, Fallon V, Silverio SA, Bramante A. The Italian language postpartum specific anxiety scale [PSAS-IT]: translation, psychometric evaluation, and validation. Front Psychiatry 2023; 14:1208613. [PMID: 37621969 PMCID: PMC10445131 DOI: 10.3389/fpsyt.2023.1208613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 07/26/2023] [Indexed: 08/26/2023] Open
Abstract
Introduction While often positive, the lifecourse transition to motherhood is susceptible to the risk for developing mood disorders. Postpartum anxiety has often been overshadowed by other perinatal-specific mental health disorders, such as postpartum depression, and therefore has not been at the forefront or center of as much empirical study. This has meant there is a lack of effective and reliable tools with which to measure it, despite growing evidence suggesting its detrimental impact on mothers, their babies, wider family and social contacts, and on healthcare systems. This current study aimed to translate and validate the Postpartum Specific Anxiety Scale [PSAS] into the Italian language, and to validate the tool for its use in detecting anxiety specific to motherhood. Methods The study (N = 457) comprised 4 stages: English-Italian translation and back-translation to obtain the Italian version [PSAS-IT]; a preliminary pilot study to adapt the PSAS to the characteristics of the Italian population; measurement invariance; and internal reliability of subscales. Results The PSAS-IT demonstrates similar psychometric properties as the original English-language PSAS, with acceptable acceptability, construct and convergent validity, and internal consistency. Confirmatory factor analysis for multiple groups (Italy and United Kingdom) showed that the factor structure of the PSAS was valid for both groups [χ2 (2436) = 4679.481, p < 0.001, TLI = 0.969, CFI =0.972, RMSEA = 0.045, SRMR =0.064]. Discussion The resulting findings offer a reliable measure of postpartum anxiety in Italian language up to six months after birth.
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Affiliation(s)
- Chiara Ionio
- CRIdee, Dipartimento di Psicologia, Facoltà di Psicologia, Università Cattolica del Sacro Cuore, Milan, Italy
| | - Giulia Ciuffo
- CRIdee, Dipartimento di Psicologia, Facoltà di Psicologia, Università Cattolica del Sacro Cuore, Milan, Italy
| | - Marta Landoni
- CRIdee, Dipartimento di Psicologia, Facoltà di Psicologia, Università Cattolica del Sacro Cuore, Milan, Italy
| | - Martina Smorti
- Dipartimento di Patologia Chirurgica, Medica, Molecolare e dell'Area Critica, Università di Pisa, Pisa, Italy
| | - Anna Maria Della Vedova
- Dipartimento di Scienze Cliniche e Sperimentali, Facoltà di Medicina e Chirurgia, Università Degli Studi di Brescia, Brescia, Italy
| | - Paul Christiansen
- Department of Psychology, Institute of Population Health, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Victoria Fallon
- Department of Psychology, Institute of Population Health, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Sergio A. Silverio
- Department of Women & Children’s Health, School of Life Course & Population Sciences, Faculty of Life Sciences & Medicine, King’s College London, London, United Kingdom
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Mashayekh-Amiri S, Jafarabadi MA, Davies SM, Silverio SA, Fallon V, Montazeri M, Mirghafourvand M. Correction: Psychometric evaluation of the postpartum specific anxiety scale - research short-form among Iranian women (PSAS-IR-RSF). BMC Pregnancy Childbirth 2023; 23:565. [PMID: 37537559 PMCID: PMC10399050 DOI: 10.1186/s12884-023-05883-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/05/2023] Open
Affiliation(s)
- Sepideh Mashayekh-Amiri
- Students Research Committee, Midwifery Department, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mohammad Asghari Jafarabadi
- Cabrini Research, Cabrini Health, Malvern, VIC, 3144, Australia
- School of Public Health and Preventative Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, 3800, Australia
- Road Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Siân M Davies
- School of Psychology, Liverpool John Moores University, Byrom Street, Liverpool, L3 3AF, Merseyside, UK
| | - Sergio A Silverio
- Department of Women & Children's Health, School of Life Course & Population Sciences, King's College London, London, SE1 7EH, UK
| | - Victoria Fallon
- Department of Psychology, Institute of Population Health, University of Liverpool, Liverpool, L69 7ZA, UK
| | - Maryam Montazeri
- Midwifery Department, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mojgan Mirghafourvand
- Social Determinants of Health Research Center, Department of Midwifery, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran.
- Menopause Andropause Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
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Mashayekh-Amiri S, Jafarabadi MA, Davies SM, Silverio SA, Fallon V, Montazeri M, Mirghafourvand M. Psychometric evaluation of the postpartum specific anxiety scale - research short-form among iranian women (PSAS-IR-RSF). BMC Pregnancy Childbirth 2023; 23:531. [PMID: 37480013 PMCID: PMC10362772 DOI: 10.1186/s12884-023-05855-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 07/14/2023] [Indexed: 07/23/2023] Open
Abstract
BACKGROUND The increasing prevalence of postpartum anxiety as a common psychological problem affects a large part of women's lives. Despite the existence of tools in this field, but due to the lack of specificity in reflecting postpartum anxiety, it is necessary to have a specific tool to screen it. Since the psychometric evaluation of the Postpartum Specific Anxiety Scale-Research Short-Form (PSAS-RSF) among Iranian women has not been assessed in Iran until now, so we decided to conduct this study with the aim of psychometric evaluation of the PSAS-IR-RSF. METHODS We included 180 women (six weeks to six months postpartum) in the study by random sampling during the period from December 2021 to June 2022. We examined the validity of the PSAS-IR-RSF tool in terms of face, content and construct (through exploratory and confirmatory factor analyses). We used internal consistency and test-retest reliability to determine the reliability of the scale. RESULTS In the present study, content validity index (CVI) and content validity ratio (CVR) of the PSAS-IR-RSF tool were equal to 0.91 and 0.97, respectively. We extracted a four-factor structure through the process of exploratory factor analysis. The values of fitting indices confirmed the validity of the model. Cronbach's alpha coefficient was equal to 0.72 and intra-class correlation coefficient (with 95% confidence interval) was 0.97 (0.98 to 0.93). CONCLUSIONS The Persian version of the PSAS-IR-RSF is a valid and reliable tool for the specific evaluation of postpartum anxiety among Iranian women.
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Affiliation(s)
- Sepideh Mashayekh-Amiri
- Students Research Committee, Midwifery Department, Faculty of Nursing and Midwifery, Tabriz University of Medical sciences, Tabriz, Iran
| | - Mohammad Asghari Jafarabadi
- Cabrini Research, Cabrini Health, Malvern, VIC, 3144, Australia
- School of Public Health and Preventative Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, 3800, Australia
- Road Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Siân M Davies
- School of Psychology, Liverpool John Moores University, Byrom Street, Liverpool, Merseyside, L3 3AF, UK
| | - Sergio A Silverio
- Department of Women & Children's Health, School of Life Course & Population Sciences, King's College London, London, SE1 7EH, UK
| | - Victoria Fallon
- Department of Psychology, Institute of Population Health, University of Liverpool, Liverpool, L69 7ZA, UK
| | - Maryam Montazeri
- Midwifery Department, Faculty of Nursing and Midwifery, Tabriz University of Medical sciences, Tabriz, Iran
| | - Mojgan Mirghafourvand
- Social Determinants of Health Research Center, Department of Midwifery, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran.
- Menopause Andropause Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
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21
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Benton M, Silverio SA, Ismail K. "It feels like medically promoted disordered eating": The psychosocial impact of gestational diabetes mellitus in the perinatal period. PLoS One 2023; 18:e0288395. [PMID: 37478148 PMCID: PMC10361484 DOI: 10.1371/journal.pone.0288395] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 06/23/2023] [Indexed: 07/23/2023] Open
Abstract
BACKGROUND The global prevalence of gestational diabetes mellitus (GDM) is increasing, and it can significantly impact women's psychosocial outcomes in the perinatal period. The aim of this study was to explore the psychosocial impacts including experiences of support for women with GDM in the antenatal and postnatal period. METHODS Semi-structured individual interviews were conducted with women (n = 33) living in the UK, who were either pregnant and recently diagnosed with GDM or had a previous GDM diagnosis within the past three years. Interviews were recorded, transcribed, and analysed using reflexive thematic analysis. FINDINGS Analysis revealed six themes: 1. Diagnostic related frustration; 2. Impact on mental health; 3. The medicalisation of eating; 4. Losing agency to gain control; 5. Sourcing networks of support; 6. Current pregnancy; and future reproductive health. Each theme provides a unique insight into the experiences and psychological strain associated with GDM. From confusion and frustration at diagnosis, to the profound knock-on impact a diagnosis, associated lifestyle changes and medical appointments had on women's mental health, and the perceived medicalisation of their eating behaviours and patterns. CONCLUSION Given the increasing prevalence of GDM and its wide-ranging psychosocial impacts, this study emphasises the need for healthcare professionals to consider the potential implications of GDM on women's psychosocial outcome, and to consider alternative support options outside of the medical system, such as peer support.
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Affiliation(s)
- Madeleine Benton
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Sergio A Silverio
- Department of Women & Children's Health, School of Life Course & Population Sciences, Faculty of Life Sciences & Medicine, King's College London, London, United Kingdom
| | - Khalida Ismail
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
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Mashayekh-Amiri S, Jafarabadi MA, Montazeri M, Fallon V, Silverio SA, Mirghafourvand M. Validation of the Iranian version of the Postpartum Specific Anxiety Scale 12-item research short-form for use during global crises (PSAS-IR-RSF-C). BMC Psychiatry 2023; 23:511. [PMID: 37452292 PMCID: PMC10347867 DOI: 10.1186/s12888-023-04998-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 07/04/2023] [Indexed: 07/18/2023] Open
Abstract
BACKGROUND Due to its high pervasiveness and adversarial consequences, postpartum anxiety has been one of the most worrying public health concerns in the last decade. According to previous research, the occurrence of mental disorders among women in the postpartum period upsurges significantly in the course of universal disasters. The Postpartum Specific Anxiety Scale - Research Short Form - for use in global Crises [PSAS-IR-RSF-C] has not been used in Iran for postpartum women during a health system shock. Consequently, this study was conducted to determine the validity and reliability of the Persian version (PSAS-IR-RSF-C) during the COVID-19 pandemic. METHODS This cross-sectional study was performed with 180 women who were between six weeks and six months after delivery, by random sampling method from December 2021 to June 2022. The validity of the PSAS-RSF-C in terms of face, content, was analyzed, and the construct validity was assessed using exploratory and confirmatory factor analyses. Internal consistency and test-retest reliability of the questionnaire were measured using (Cronbach's alpha, McDonald's ω) and intraclass correlation coefficient (ICC), respectively. RESULTS The content validity index and content validity ratio of the Persian version of the PSAS-IR-RSF-C were 0.96 and 0.98, respectively. A three-factor structure was extracted during the exploratory factor analysis process, and model validity was confirmed by the values of fit indices. Cronbach's alpha coefficient, McDonald's ω and intra-cluster correlation coefficient (95% confidence interval) were 0.74, 0.92 (0.78 to 0.93) and 0.97 (0.93 to 0.98), respectively. CONCLUSIONS For the specific assessment of postpartum anxiety among Iranian women during crises, the Persian version of the PSAS-IR-RSF-C is a valid and reliable tool.
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Affiliation(s)
- Sepideh Mashayekh-Amiri
- Students Research Committee, Midwifery Department, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mohammad Asghari Jafarabadi
- Cabrini Research, Cabrini Health, Melbourne, VIC 3144 Australia
- School of Public Health and Preventative Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC 3004 Australia
- Road Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Maryam Montazeri
- Department of Psychology, Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Victoria Fallon
- Department of Women and Children’s Health, School of Life Course and Population Sciences, King’s College London, London, UK
| | - Sergio A. Silverio
- Social Determinants of Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mojgan Mirghafourvand
- Menopause Andropause Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Khan Z, Vowles Z, Fernandez Turienzo C, Barry Z, Brigante L, Downe S, Easter A, Harding S, McFadden A, Montgomery E, Page L, Rayment-Jones H, Renfrew M, Silverio SA, Spiby H, Villarroel-Williams N, Sandall J. Targeted health and social care interventions for women and infants who are disproportionately impacted by health inequalities in high-income countries: a systematic review. Int J Equity Health 2023; 22:131. [PMID: 37434187 DOI: 10.1186/s12939-023-01948-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 06/29/2023] [Indexed: 07/13/2023] Open
Abstract
BACKGROUND Disadvantaged populations (such as women from minority ethnic groups and those with social complexity) are at an increased risk of poor outcomes and experiences. Inequalities in health outcomes include preterm birth, maternal and perinatal morbidity and mortality, and poor-quality care. The impact of interventions is unclear for this population, in high-income countries (HIC). The review aimed to identify and evaluate the current evidence related to targeted health and social care service interventions in HICs which can improve health inequalities experienced by childbearing women and infants at disproportionate risk of poor outcomes and experiences. METHODS Twelve databases searched for studies across all HICs, from any methodological design. The search concluded on 8/11/22. The inclusion criteria included interventions that targeted disadvantaged populations which provided a component of clinical care that differed from standard maternity care. RESULTS Forty six index studies were included. Countries included Australia, Canada, Chile, Hong Kong, UK and USA. A narrative synthesis was undertaken, and results showed three intervention types: midwifery models of care, interdisciplinary care, and community-centred services. These intervention types have been delivered singularly but also in combination of each other demonstrating overlapping features. Overall, results show interventions had positive associations with primary (maternal, perinatal, and infant mortality) and secondary outcomes (experiences and satisfaction, antenatal care coverage, access to care, quality of care, mode of delivery, analgesia use in labour, preterm birth, low birth weight, breastfeeding, family planning, immunisations) however significance and impact vary. Midwifery models of care took an interpersonal and holistic approach as they focused on continuity of carer, home visiting, culturally and linguistically appropriate care and accessibility. Interdisciplinary care took a structural approach, to coordinate care for women requiring multi-agency health and social services. Community-centred services took a place-based approach with interventions that suited the need of its community and their norms. CONCLUSION Targeted interventions exist in HICs, but these vary according to the context and infrastructure of standard maternity care. Multi-interventional approaches could enhance a targeted approach for at risk populations, in particular combining midwifery models of care with community-centred approaches, to enhance accessibility, earlier engagement, and increased attendance. TRIAL REGISTRATION PROSPERO Registration number: CRD42020218357.
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Affiliation(s)
- Zahra Khan
- Department of Women & Children's Health, King's College London, London, UK.
| | - Zoe Vowles
- Department of Women & Children's Health, King's College London, London, UK
| | | | - Zenab Barry
- Patient and Public Involvement and Engagement, NIHR ARC South London, London, UK
| | | | - Soo Downe
- University of Central Lancashire, Lancashire, UK
| | - Abigail Easter
- Department of Women & Children's Health, King's College London, London, UK
| | - Seeromanie Harding
- Department of Population Health Sciences, King's College London, London, UK
| | | | | | | | | | | | - Sergio A Silverio
- Department of Women & Children's Health, King's College London, London, UK
| | | | | | - Jane Sandall
- Department of Women & Children's Health, King's College London, London, UK
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Jackson L, Davies SM, Podkujko A, Gaspar M, De Pascalis LLD, Harrold JA, Fallon V, Soulsby LK, Silverio SA. The antenatal psychological experiences of women during two phases of the COVID-19 pandemic: A recurrent, cross-sectional, thematic analysis. PLoS One 2023; 18:e0285270. [PMID: 37289809 PMCID: PMC10249846 DOI: 10.1371/journal.pone.0285270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 04/18/2023] [Indexed: 06/10/2023] Open
Abstract
Initial COVID-19-related social distancing restrictions, imposed in the UK in March 2020, and the subsequent lifting of restrictions in May 2020 caused antenatal disruption and stress which exceeded expected vulnerabilities associated with this lifecourse transition. The current study aimed to explore the antenatal psychological experiences of women during different phases of pandemic-related lockdown restrictions in the UK. Semi-structured interviews were held with 24 women about their antenatal experiences: twelve were interviewed after the initial lockdown restrictions (Timepoint 1; T1), and a separate twelve women were interviewed after the subsequent lifting of those restrictions (Timepoint 2; T2). Interviews were transcribed and a recurrent, cross-sectional thematic analysis was conducted. Two themes were identified for each timepoint, and each theme contained sub-themes. T1 themes were: 'A Mindful Pregnancy' and 'It's a Grieving Process', and T2 themes were: 'Coping with Lockdown Restrictions' and 'Robbed of Our Pregnancy'. COVID-19 related social distancing restrictions had an adverse effect on women's mental health during the antenatal period. Feeling trapped, anxious, and abandoned were common at both timepoints. Actively encouraging conversations about mental wellbeing during routine care and adopting a prevention opposed to cure attitude toward implementing additional support provisions may serve to improve antenatal psychological wellbeing during health crises.
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Affiliation(s)
- Leanne Jackson
- Department of Psychology, Institute of Population Health, University of Liverpool, Liverpool, Merseyside, United Kingdom
| | - Siân M. Davies
- School of Psychology, Faculty of Health, Liverpool John Moores University, Liverpool, Merseyside, United Kingdom
- Department of Women & Children’s Health, School of Life Course & Population Sciences, King’s College London, Southwark, London, United Kingdom
| | - Anastasija Podkujko
- Department of Psychology, Institute of Population Health, University of Liverpool, Liverpool, Merseyside, United Kingdom
| | - Monic Gaspar
- Department of Psychology, Institute of Population Health, University of Liverpool, Liverpool, Merseyside, United Kingdom
| | - Leonardo L. D. De Pascalis
- Department of Psychology, Institute of Population Health, University of Liverpool, Liverpool, Merseyside, United Kingdom
| | - Joanne A. Harrold
- Department of Psychology, Institute of Population Health, University of Liverpool, Liverpool, Merseyside, United Kingdom
| | - Victoria Fallon
- Department of Psychology, Institute of Population Health, University of Liverpool, Liverpool, Merseyside, United Kingdom
| | - Laura K. Soulsby
- Department of Psychology, Institute of Population Health, University of Liverpool, Liverpool, Merseyside, United Kingdom
| | - Sergio A. Silverio
- Department of Women & Children’s Health, School of Life Course & Population Sciences, King’s College London, Southwark, London, United Kingdom
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Silverio SA, De Backer K, Brown JM, Easter A, Khazaezadeh N, Rajasingam D, Sandall J, Magee LA. Reflective, pragmatic, and reactive decision-making by maternity service providers during the SARS-CoV-2 pandemic health system shock: a qualitative, grounded theory analysis. BMC Pregnancy Childbirth 2023; 23:368. [PMID: 37210485 DOI: 10.1186/s12884-023-05641-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 04/24/2023] [Indexed: 05/22/2023] Open
Abstract
BACKGROUND Pregnant and postpartum women were identified as having particular vulnerability to severe symptomatology of SARS-CoV-2 infection, so maternity services significantly reconfigured their care provision. We examined the experiences and perceptions of maternity care staff who provided care during the pandemic in South London, United Kingdom - a region of high ethnic diversity with varied levels of social complexity. METHODS We conducted a qualitative interview study, as part of a service evaluation between August and November 2020, using in-depth, semi-structured interviews with a range of staff (N = 29) working in maternity services. Data were analysed using Grounded Theory analysis appropriate to cross-disciplinary health research. ANALYSIS & FINDINGS Maternity healthcare professionals provided their views, experiences, and perceptions of delivering care during the pandemic. Analysis rendered three emergent themes regarding decision-making during reconfigured maternity service provision, organised into pathways: 1) 'Reflective decision-making'; 2) 'Pragmatic decision-making'; and 3) 'Reactive decision-making'. Whilst pragmatic decision-making was found to disrupt care, reactive-decision-making was perceived to devalue the care offered and provided. Alternatively, reflective decision-making, despite the difficult working conditions of the pandemic, was seen to benefit services, with regards to care of high-quality, sustainability of staff, and innovation within the service. CONCLUSIONS Decision-making within maternity care was found to take three forms - where at best changes to services could be innovative, at worst they could cause devaluation in care being delivered, and more often than not, these changes were disruptive. With regard to positive changes, healthcare providers identified staff empowerment, flexible working patterns (both for themselves and collectively as teams), personalised care delivery, and change-making in general, as key areas to capitalise on current and ongoing innovations borne out of the pandemic. Key learnings included a focus on care-related, meaningful listening and engagement of staff at all levels, in order to drive forward high-quality care and avoid care disruption and devaluation.
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Affiliation(s)
- Sergio A Silverio
- Department of Women & Children's Health, School of Life Course & Population Sciences, Faculty of Life Sciences & Medicine, King's College London, 6th Floor Addison House, Great Maze Pond, Southwark, London, SE1 1UL, UK.
| | - Kaat De Backer
- Department of Women & Children's Health, School of Life Course & Population Sciences, Faculty of Life Sciences & Medicine, King's College London, 10th Floor North Wing, St. Thomas' Hospital, Westminster Bridge Road, Lambeth, London, SE1 7EH, UK
| | - Jeremy M Brown
- Health Research Institute, Medical School, Faculty of Health, Social Care & Medicine, Edge Hill University, St. Helen's Road, Ormskirk, L39 4QP, Lancashire, UK
| | - Abigail Easter
- Department of Women & Children's Health, School of Life Course & Population Sciences, Faculty of Life Sciences & Medicine, King's College London, 10th Floor North Wing, St. Thomas' Hospital, Westminster Bridge Road, Lambeth, London, SE1 7EH, UK
| | - Nina Khazaezadeh
- Chief Midwifery Office, NHS England and Improvement, Wellington House, 133-155 Waterloo Road, Southwark, London, SE1 8UG, UK
| | - Daghni Rajasingam
- Maternity Services, St. Thomas' Hospital, Guy's and St. Thomas's NHS Foundation Trust, Westminster Bridge Road, Lambeth, London, SE1 7EH, UK
| | - Jane Sandall
- Department of Women & Children's Health, School of Life Course & Population Sciences, Faculty of Life Sciences & Medicine, King's College London, 10th Floor North Wing, St. Thomas' Hospital, Westminster Bridge Road, Lambeth, London, SE1 7EH, UK
| | - Laura A Magee
- Department of Women & Children's Health, School of Life Course & Population Sciences, Faculty of Life Sciences & Medicine, King's College London, 6th Floor Addison House, Great Maze Pond, Southwark, London, SE1 1UL, UK
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Costas-Ramón N, Silverio SA, Fallon V, Aparicio-García ME. Psychometric evaluation and validation of the Postpartum Specific Anxiety Scale for the Spanish-speaking population: PSAS-ES. Gen Hosp Psychiatry 2023; 83:59-65. [PMID: 37119779 DOI: 10.1016/j.genhosppsych.2023.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 04/18/2023] [Accepted: 04/21/2023] [Indexed: 05/01/2023]
Abstract
OBJECTIVE The transition to motherhood is a period of risk for the development of mood disorders. Postpartum anxiety has not been as thoroughly studied as other emotional disorders despite its impact on mothers and their babies. The absence of standardized programmes for early detection and specific tools for its diagnosis means postpartum anxiety is often underestimated or overshadowed. This study aimed to translate and validate the Postpartum Specific Anxiety Scale [PSAS] for the Spanish population and to analyse its reliability as an exploratory tool for specific anxiety in mothers. METHOD Four stages were followed in this research: translation and back-translation to obtain the Spanish version [PSAS-ES]; preliminary pilot study to explore the comprehensibility and ease of responding the items (n = 53); convergent validity analyses (n = 644); and test-retest reliability (n = 234). RESULTS The PSAS-ES has shown to have good acceptability, convergent validity and high internal consistency with a Cronbach's α coefficient of 0.93 for the overall scale of PSAS. The four factors had good reliability. The results of test-retest was 0.86, indicating excellent stability over time in the first 16 weeks. CONCLUSION The psychometric results show that the PSAS-ES is a valid tool to explore and detect anxiety in Spanish mothers between 0 and 16 weeks postpartum.
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Affiliation(s)
- Natalia Costas-Ramón
- Departamento de Psicología Social, del Trabajo y Diferencial, Facultad de Psicología, Universidad Complutense de Madrid, Madrid, Spain
| | - Sergio A Silverio
- Department of Women & Children's Health, School of Life Course & Population Sciences, King's College London, London, United Kingdom.
| | - Victoria Fallon
- Department of Psychology, Institute of Population Health, University of Liverpool, Liverpool, United Kingdom
| | - Marta E Aparicio-García
- Departamento de Psicología Social, del Trabajo y Diferencial, Facultad de Psicología, Universidad Complutense de Madrid, Madrid, Spain
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Roberts C, Montgomery E, Richens Y, Silverio SA. (Re)activation of survival strategies during pregnancy and childbirth following experiences of childhood sexual abuse. J Reprod Infant Psychol 2023; 41:152-164. [PMID: 34510971 DOI: 10.1080/02646838.2021.1976401] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVES To explore the pregnancy and childbearing experiences of women-survivors of childhood sexual abuse [CSA]. We aimed to generate a theory explaining those experiences for this population (women), this phenomenon (pregnancy and childbirth), and this context (those who have survived CSA). METHOD Participants (N=6) were recruited to semi-structured interviews about their experiences of CSA and subsequent pregnancy and childbirth. Data saturated early, and were analysed using Grounded Theory (appropriate to cross-disciplinary health research). Coding was inductive and iterative, to ensure rigour and achieve thematic saturation. RESULTS Open and focused coding led to the generation of super-categories, which in-turn were collapsed into three distinct, but related themes. These themes were: Chronicity of Childhood (Sexual) Abuse; Pregnancy and Childbirth as Paradoxically (Un)safe Experiences; Enduring Nature of Survival Strategies. The relationship between these themes was explained as the theory of: (Re)activation of Survival Strategies during Pregnancy and Childbirth following Experiences of Childhood Sexual Abuse. CONCLUSION Pregnancy and childbirth can be triggering for women-survivors of CSA. Survival strategies learnt during experiences of CSA can be (re)activated as a way of not only coping, but surviving (the sometimes unconsented) procedures, such as monitoring and physical examinations, as well as the feelings of lack of control and bodily agency.
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Affiliation(s)
- Chelsey Roberts
- Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK
| | - Elsa Montgomery
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | - Yana Richens
- Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK.,Maternity Services, University College London Hospitals NHS Foundation Trust, London, UK
| | - Sergio A Silverio
- Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK.,Department of Women & Children's Health, King's College London, London, UK
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Silverio SA, Karki P, Lakhani S, Alter M, Weinman J, Flynn AC. 'People still want a face and that's where we can fill in': a qualitative study of community pharmacists' experiences of providing healthcare advice about preconception and pregnancy. Int J Pharm Pract 2023; 31:38-45. [PMID: 36472949 DOI: 10.1093/ijpp/riac097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 11/10/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVES This study aimed to explore community pharmacists' practices and attitudes towards the provision of healthcare advice regarding preconception and pregnancy. METHODS A qualitative focus group study was conducted virtually with community pharmacists around urban areas of London in October 2021. A topic guide was utilised to cover pharmacy practice, barriers and confidence in counselling women, education and training and thoughts on how to improve preconception and pregnancy health services. Focus groups were transcribed and analysed using thematic analysis. KEY FINDINGS Eleven community pharmacists participated. Three themes were identified: 'Community Driven Needs'; 'Needs of Community Pharmacists'; 'Shared Needs and Understanding' which were related through a central organising concept of 'Unmet Needs in Pharmacy-led Preconception and Pregnancy Care'. Community pharmacists are frequently consulted by women before and during pregnancy, however, a discord was uncovered between current pharmacy practice and the needs of the community. A clear need was identified for the incorporation of risk minimisation counselling focusing on smoking, alcohol intake and drug use. Education and organisational factors were reported as challenges to providing advice. CONCLUSIONS Community pharmacists can play a pivotal role in providing information and support to women before and during pregnancy. Our findings suggest integration of community pharmacy-led structured counselling may be a useful public health strategy to optimise pregnancy health. Our work highlights educational and organisational barriers which hinder the ability of pharmacists to promote preconception and pregnancy health. These must be addressed, and we provide recommendations for change to both policy and practice.
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Affiliation(s)
- Sergio A Silverio
- Department of Women & Children's Health, School of Life Course & Population Sciences, King's College London, London, UK
| | - Pujan Karki
- Institute of Pharmaceutical Sciences, King's College London, London, UK
| | | | - Marsha Alter
- The Middlesex Pharmaceutical Group of LPCs, London, UK
| | - John Weinman
- Institute of Pharmaceutical Sciences, King's College London, London, UK
| | - Angela C Flynn
- Department of Women & Children's Health, School of Life Course & Population Sciences, King's College London, London, UK.,Department of Nutritional Sciences, School of Life Course & Population Sciences, King's College London, London, UK
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Lovell H, Silverio SA, Story L, Skelton E, Matthew J. Factors which influence ethnic minority women's participation in maternity research: A systematic review of quantitative and qualitative studies. PLoS One 2023; 18:e0282088. [PMID: 36827386 PMCID: PMC9956875 DOI: 10.1371/journal.pone.0282088] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 02/07/2023] [Indexed: 02/26/2023] Open
Abstract
BACKGROUND Women from Black, Asian and mixed ethnicity backgrounds in the UK experience higher rates of maternal and neonatal mortality and morbidity, and report poorer experiences of maternity care. Research is required to understand how to reduce these disparities, however, it is acknowledged these groups of women are under-represented in clinical research. AIM To investigate factors which influence participation in maternity research for women from an ethnic minority background. METHODS A systematic review was conducted to examine influencing factors for research participation. MEDLINE/CINHAL/PsycInfo/EMBASE databases were systematically searched in March 2021 and updated in March 2022. Papers were eligible if they explored maternal research participation and identified a woman's ethnicity in the results. No restrictions were placed on methodology. A convergent integrated approach was used to synthesise findings. FINDINGS A total of 14 papers met the inclusion criteria. Results were divided into eight overarching themes. A personalised approach to recruitment and incorporating culturally sensitive communication and considerations enhanced research participation. Distrust around sharing data, a perception of risk to research participation, and research lacking in personal relevance adversely affected the decision to participate. Large variation existed in the quality of the studies reviewed. CONCLUSIONS Consideration of a woman's culture and background in the design and the delivery of a maternity research study may facilitate participation, particularly when sampling from a specific population. Further research, informed by women from ethnic minority backgrounds is warranted to develop women-centred recommendations for conducting inclusive maternity research. Prospero registration: www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42021261686.
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Affiliation(s)
- Holly Lovell
- Maternity Services, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Sergio A. Silverio
- Department of Women & Children’s Health, School of Life Course & Population Sciences, King’s College London, London, United Kingdom
| | - Lisa Story
- Maternity Services, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
- Department of Women & Children’s Health, School of Life Course & Population Sciences, King’s College London, London, United Kingdom
| | - Emily Skelton
- Division of Radiography and Midwifery, City University of London, London, United Kingdom
| | - Jacqueline Matthew
- Maternity Services, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
- Department of Perinatal Imaging and Health, School of Biomedical Engineering & Imaging Sciences, King’s College London, London, United Kingdom
- * E-mail:
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Magee LA, Molteni E, Bowyer V, Bone JN, Boulding H, Khalil A, Mistry HD, Poston L, Silverio SA, Wolfe I, Duncan EL, von Dadelszen P. National surveillance data analysis of COVID-19 vaccine uptake in England by women of reproductive age. Nat Commun 2023; 14:956. [PMID: 36813760 PMCID: PMC9947170 DOI: 10.1038/s41467-023-36125-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 01/16/2023] [Indexed: 02/24/2023] Open
Abstract
Women of reproductive age are a group of particular concern with regards to vaccine uptake, related to their unique considerations of menstruation, fertility, and pregnancy. To obtain vaccine uptake data specific to this group, we obtained vaccine surveillance data from the Office for National Statistics, linked with COVID-19 vaccination status from the National Immunisation Management Service, England, from 8 Dec 2020 to 15 Feb 2021; data from 13,128,525 such women at population-level, were clustered by age (18-29, 30-39, and 40-49 years), self-defined ethnicity (19 UK government categories), and index of multiple deprivation (IMD, geographically-defined IMD quintiles). Here we show that among women of reproductive age, older age, White ethnicity and being in the least-deprived index of multiple deprivation are each independently associated with higher vaccine uptake, for first and second doses; however, ethnicity exerts the strongest influence (and IMD the weakest). These findings should inform future vaccination public messaging and policy.
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Affiliation(s)
- Laura A Magee
- Department of Women and Children's Health, School of Life Course & Population Science, King's College London, London, UK.
| | - Erika Molteni
- Biomedical Engineering Department, School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Vicky Bowyer
- Department of Twin Research and Genetic Epidemiology, School of Life Course & Population Science, King's College London, London, UK
| | - Jeffrey N Bone
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada
| | - Harriet Boulding
- The Policy Institute at King's, Social Science and Public Policy, King's College London, London, UK
| | - Asma Khalil
- Department of Obstetrics and Gynaecology, St. George's, University of London, London, UK
| | - Hiten D Mistry
- Department of Women and Children's Health, School of Life Course & Population Science, King's College London, London, UK
| | - Lucilla Poston
- Department of Women and Children's Health, School of Life Course & Population Science, King's College London, London, UK
| | - Sergio A Silverio
- Department of Women and Children's Health, School of Life Course & Population Science, King's College London, London, UK
| | - Ingrid Wolfe
- Department of Women and Children's Health, School of Life Course & Population Science, King's College London, London, UK
| | - Emma L Duncan
- Department of Twin Research and Genetic Epidemiology, School of Life Course & Population Science, King's College London, London, UK
| | - Peter von Dadelszen
- Department of Women and Children's Health, School of Life Course & Population Science, King's College London, London, UK
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Silverio SA, Rahman MR, Wilson CA, Catalao R, Lakhani S, Alter M, Khundakar M, Rashed AN, Weinman J, Flynn AC. "There's very little that you can do other than refer them to the doctor if you think they've got postnatal depression": Scoping the potential for perinatal mental health care by community pharmacists. Res Social Adm Pharm 2023; 19:286-292. [PMID: 36272963 DOI: 10.1016/j.sapharm.2022.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 10/08/2022] [Accepted: 10/13/2022] [Indexed: 01/19/2023]
Abstract
BACKGROUND Twenty percent of women in the UK develop perinatal mental health (PMH) problems, which have widespread effects on maternal and child health. Community pharmacists are ideally placed to identify PMH problems and refer to other trained healthcare professionals. OBJECTIVE This study explored community pharmacists' attitudes, current counselling practices, and barriers to providing mental health advice to perinatal women. METHODS A qualitative focus group study was performed virtually with community pharmacists (n = 11), working in urban settings across London. A topic guide was used to cover current counselling practice, barriers to and confidence in counselling women, and thoughts on potential pharmacist-led perinatal mental health services. The focus groups were recorded, transcribed, and analysed using thematic analysis. RESULTS Three themes were identified: Doing Mental Health Care; Willing, but Unable; and Introspection and reflection, which were related through a central organising concept of 'Perinatal mental health care as a new frontier for community pharmacy'. It was found that while community pharmacists provide mental health advice to perinatal women and their partners, they lacked confidence, which was related to a lack of knowledge and inadequate training opportunities. Organisational barriers were identified including a lack of a formal referral pathway to existing mental health services and other trained healthcare professionals. Perceptions of opportunities and recommendations for service improvement and change were also garnered. CONCLUSION This study demonstrates community pharmacists have a potential role within community mental healthcare in identification of PMH problems and providing appropriate advice and support. Upskilling community pharmacists in mental health should be considered to increase knowledge and confidence while formal referral pathways to other trained healthcare professionals and existing services should be established and made available to pharmacists.
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Affiliation(s)
- Sergio A Silverio
- Department of Women & Children's Health, School of Life Course & Population Sciences, King's College London, London, SE1 7EH, UK
| | | | - Claire A Wilson
- Section of Women's Mental Health, King's College London and South London and Maudsley NHS Foundation Trust, London, UK
| | - Raquel Catalao
- South London and Maudsley NHS Foundation Trust and King's College London, London, UK
| | - Shivali Lakhani
- The Middlesex Pharmaceutical Group of LPCs, 1278 High Road, Whetstone, London, N20 9HH, UK
| | - Marsha Alter
- The Middlesex Pharmaceutical Group of LPCs, 1278 High Road, Whetstone, London, N20 9HH, UK
| | - Martina Khundakar
- School of Pharmacy, Newcastle University, King George VI building, King's Road, Newcastle upon Tyne, NE17RU, UK; Pharmacy Department Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, UK
| | - Asia N Rashed
- Institute of Pharmaceutical Sciences, King's College London, London, SE1 9NH, UK; Evelina Pharmacy, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - John Weinman
- Institute of Pharmaceutical Sciences, King's College London, London, SE1 9NH, UK
| | - Angela C Flynn
- Department of Women & Children's Health, School of Life Course & Population Sciences, King's College London, London, SE1 7EH, UK; Department of Nutritional Sciences, School of Life Course & Population Sciences, King's College London, London, SE1 9NH, UK.
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Montgomery E, De Backer K, Easter A, Magee LA, Sandall J, Silverio SA. Navigating uncertainty alone: A grounded theory analysis of women's psycho-social experiences of pregnancy and childbirth during the COVID-19 pandemic in London. Women Birth 2023; 36:e106-e117. [PMID: 35610170 PMCID: PMC9110569 DOI: 10.1016/j.wombi.2022.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 05/05/2022] [Accepted: 05/05/2022] [Indexed: 01/25/2023]
Abstract
PROBLEM Maternity care underwent substantial reconfiguration in the United Kingdom during the COVID-19 pandemic. BACKGROUND COVID-19 posed an unprecedented public health crisis, risking population health and causing a significant health system shock. AIM To explore the psycho-social experiences of women who received maternity care and gave birth in South London during the first 'lockdown'. METHODS We recruited women (N = 23) to semi-structured interviews, conducted virtually. Data were recorded, transcribed, and analysed by hand. A Classical Grounded Theory Analysis was followed including line-by-line coding, focused coding, development of super-categories followed by themes, and finally the generation of a theory. FINDINGS Iterative and inductive analysis generated six emergent themes, sorted into three dyadic pairs: 1 & 2: Lack of relational care vs. Good practice persisting during the pandemic; 3 & 4: Denying the embodied experience of pregnancy and birth vs. Trying to keep everyone safe; and 5 & 6: Removed from support network vs. Importance of being at home as a family. Together, these themes interact to form the theory: 'Navigating uncertainty alone'. DISCUSSION Women's pregnancy and childbirth journeys during the pandemic were reported as having positive and negative experiences which would counteract one-another. Lack of relational care, denial of embodied experiences, and removal from support networks were counterbalanced by good practice which persisted, understanding staff were trying to keep everyone safe, and renewed importance in the family unit. CONCLUSION Pregnancy can be an uncertain time for women. This was compounded by having to navigate their maternity journey alone during the COVID-19 pandemic.
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Affiliation(s)
- Elsa Montgomery
- Department of Midwifery, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King’s College London, London, United Kingdom
| | - Kaat De Backer
- Department of Women & Children’s Health, School of Life Course & Population Sciences, King’s College London, London, United Kingdom
| | - Abigail Easter
- Department of Women & Children’s Health, School of Life Course & Population Sciences, King’s College London, London, United Kingdom
| | - Laura A. Magee
- Department of Women & Children’s Health, School of Life Course & Population Sciences, King’s College London, London, United Kingdom
| | - Jane Sandall
- Department of Women & Children’s Health, School of Life Course & Population Sciences, King’s College London, London, United Kingdom
| | - Sergio A. Silverio
- Department of Women & Children’s Health, School of Life Course & Population Sciences, King’s College London, London, United Kingdom,Correspondence to: Department of Women & Children’s Health, School of Life Course & Population Sciences, King’s College London, Research Office 4, 10th Floor North Wing, St. Thomas’ Hospital, Westminster Bridge Road, Lambeth, London, SE1 7EH, United Kingdom
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Davie P, Bick D, Silverio SA, Chilcot J. Easier, but not easy: Testing a grounded theory of breastfeeding experiences among women with larger birthweight infants. Psychol Health 2023; 38:167-189. [PMID: 34498534 DOI: 10.1080/08870446.2021.1956495] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Grounded Theory has previously been used to explore breastfeeding practices amongst average birthweight infants and these working hypotheses can be 'tested' in new contexts. A pre-existing Grounded Theory was applied to the context of women who gave birth to larger birthweight infants (≥4,000 g) to understand whether perceptions and practices of infant feeding were distinct. DESIGN A nested qualitative study analysed data from N = 10 women with a larger birthweight infant (≥4,000 g). Face-to-face, semi-structured interviews were audio-recorded and transcribed verbatim. Grounded Theory methodology was used to analyse data. RESULTS A pre-existing Grounded Theory of breastfeeding experiences derived from women with average birthweight infants did not hold true among women with larger birthweight infants. An alternative Grounded Theory was therefore proposed comprised of three discrete themes: Infant Ability to Breastfeed; Attenuating Maternal Concerns; and Reality of Breastfeeding. CONCLUSIONS Larger infant birthweight is potentially a protective factor against breastfeeding latch and lactation difficulties. It is associated with alleviating maternal concerns, helping to reduce disparities between expectations of breastfeeding and reality, but does not alleviate the demands breastfeeding places on women. Healthcare professionals help to attenuate women's concerns, however the support needs for women with larger birthweight infants may not differ from existing care recommendations.
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Affiliation(s)
- Philippa Davie
- Health Psychology Section, Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, Guy's Hospital, King's College London, London, UK
| | - Debra Bick
- Clinical Trials in Maternal Health, Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Sergio A Silverio
- Department of Women and Children's Health, Faculty of Life Sciences and Medicine, St Thomas' Hospital, King's College London, London, UK.,Elizabeth Garrett Anderson Institute for Women's Health, Faculty of Population Health Sciences, School of Life and Medical Sciences, University College London, London, UK.,Department of Psychological Sciences, Institute of Life and Human Sciences, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
| | - Joseph Chilcot
- Health Psychology Section, Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, Guy's Hospital, King's College London, London, UK
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Roberts D, Jackson L, Davie P, Zhao C, Harrold JA, Fallon V, Silverio SA. Exploring the reasons why mothers do not breastfeed, to inform and enable better support. Front Glob Womens Health 2023; 4:1148719. [PMID: 37122597 PMCID: PMC10132506 DOI: 10.3389/fgwh.2023.1148719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 03/20/2023] [Indexed: 05/02/2023] Open
Abstract
Introduction Infant and maternal breastfeeding benefits are well documented, globally. Despite efforts to increase global breastfeeding rates, the majority of high-income settings fall short of recommended targets. Breastfeeding rates in the UK are especially poor, and physiological difficulties (e.g., inverted nipples), fail to account for the observed breastfeeding intention-behaviour gap. Method The current online study sought to investigate the infant feeding experiences of 624 UK formula feeding mothers, through open text survey responses. Results A content analysis identified the following clusters of reasons for formula feeding: Feeding Attitudes, Feeding Problems, Mental Health, and Sharing the Load. Discussion Feeding Attitudes explained a large percentage of reasons given for formula feeding. Recommendations are made to improve antenatal breastfeeding education and to develop an intervention with an aim to improve maternal breastfeeding attitudes and subsequent practice. Feeding Problems also explained a large portion of combination feeding and started but stopped infant feeding accounts. The current paper calls for more comprehensive and tailored antenatal breastfeeding education to refine practical breastfeeding skills necessary for successful breastfeeding establishment and maintenance. Mental Health explained relatively small coverage. Suggestions are therefore made to train mental health practitioners on infant feeding with an aim to provide more extensive support, which may serve to disrupt the bidirectional relationship between poor mental health and poor breastfeeding outcomes. Finally, Sharing the Load explained moderate coverage across never breastfed, combination fed, and started but stopped feeding groups. Recommendations are made, in light of these findings, to tighten workplace legislation to protect breastfeeding women.
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Affiliation(s)
- Dean Roberts
- Department of Psychology, Institute of Population Health, University of Liverpool, Liverpool, United Kingdom
| | - Leanne Jackson
- Department of Psychology, Institute of Population Health, University of Liverpool, Liverpool, United Kingdom
- Correspondence: Leanne Jackson
| | - Philippa Davie
- Department of Women & Children’s Health, School of Life Course & Population Sciences, King’s College London, London, United Kingdom
| | - Catherine Zhao
- Department of Nutritional Sciences, School of Life Course & Population Sciences, King’s College London, London, United Kingdom
| | - Joanne A. Harrold
- Department of Psychology, Institute of Population Health, University of Liverpool, Liverpool, United Kingdom
| | - Victoria Fallon
- Department of Psychology, Institute of Population Health, University of Liverpool, Liverpool, United Kingdom
| | - Sergio A. Silverio
- Department of Women & Children’s Health, School of Life Course & Population Sciences, King’s College London, London, United Kingdom
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Vowles Z, Bash-Taqi R, Kamara A, Kuteh M, Silverio SA, Turay I, Peckham S. The effect of becoming a Fistula Advocate on the recovery of women with Obstetric Fistula in Sierra Leone: A qualitative study. PLOS Glob Public Health 2023; 3:e0000765. [PMID: 37043491 PMCID: PMC10096491 DOI: 10.1371/journal.pgph.0000765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 03/09/2023] [Indexed: 04/13/2023]
Abstract
Engaging women affected by Obstetric Fistula as advocates has been proposed as an effective strategy to raise awareness of the condition. Limited literature exists on the experience of those who become advocates. A model of community education, in Sierra Leone, trained women affected by Obstetric Fistula to become volunteer Fistula Advocates. This study explored Advocates' perception of their role and its influence on their recovery and reintegration. This was a qualitative study, undertaken in Sierra Leone, collecting data from 7 Fistula Advocates and 3 Key Informants (with roles in either clinical or outreach care for women with Obstetric Fistula or training and supervision of Advocates), using semi-structured interviews. Data was subject to a thematic analysis and related to a conceptual framework for mental health recovery. Intrinsic factors motivating Advocates to undertake this role were influenced by psycho-social support received and the possibility for financial independence. Advocates used personal stories in their work to define a new identity, change perceptions and reduce stigma. Benefits associated with the interactions and relationships created through providing and receiving peer support were voiced. Surgical treatment was described as an important factor influencing recovery. The Advocates said economic empowerment helped recovery and reintegration, and the voluntary nature of the Advocate role limited the impact of this. Overall Advocates perceived their role positively, reporting psychological, social, and economic benefits. The complexities of recovery from Obstetric Fistula were highlighted and connections drawn between the treatment of physical symptoms, the socio-cultural context and mental health recovery. They described the role positively influencing existing relationships and initiating supportive, empowering social interactions between women affected by Obstetric Fistula and with Non-Governmental Organisation staff and community members. The study offers insights into the potential for community-based approaches to facilitate access to treatment for sensitive and stigmatising health problems and support recovery.
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Affiliation(s)
- Zoë Vowles
- Department of Women & Children's Health, School of Life Course & Population Sciences, King's College London, London, United Kingdom
- St Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
- Department of Health Services Research and Policy, Faculty of Public Health and Policy, The London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | | | - Mabel Kuteh
- Health Poverty Action, Freetown, Sierra Leone
| | - Sergio A Silverio
- Department of Women & Children's Health, School of Life Course & Population Sciences, King's College London, London, United Kingdom
| | | | - Stephen Peckham
- Department of Health Services Research and Policy, Faculty of Public Health and Policy, The London School of Hygiene and Tropical Medicine, London, United Kingdom
- The Centre for Health Service Studies, University of Kent, Canterbury, United Kingdom
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Silverio SA, Memtsa M, Barrett G, Goodhart V, Stephenson J, Jurković D, Hall JA. Emotional experiences of women who access early pregnancy assessment units: a qualitative investigation. J Psychosom Obstet Gynaecol 2022; 43:574-584. [PMID: 36094423 DOI: 10.1080/0167482x.2022.2119958] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Abstract
Purpose: Early pregnancy complications are common and often result in pregnancy loss, which can be emotionally challenging for women. Research on the emotional experiences of those attending Early Pregnancy Assessment Units [EPAUs] is scarce. This analysis explored the emotions which women spontaneously reported when being interviewed about their experiences of using EPAU services.Materials and methods: Semi-structured telephone interviews were conducted with a purposive sample of 38 women. Using Thematic Framework Analysis, we identified six unique emotional typologies which mapped onto women's clinical journeys.Results: Women with ongoing pregnancies were characterized as having: "Anxious Presentation" or "Sustained Anxiety due to Diagnostic Uncertainty", dependent on whether their initial scan result was inconclusive. Women with pregnancy loss had one of four emotional typologies, varying by diagnostic timing and required interventions: "Anxious-Upset"; "Anxious-Upset after Diagnostic Uncertainty"; "Anxious-Upset with Procedural Uncertainty"; "Anxious with Sustained Uncertainty".Conclusions: We provide insights into the distinct emotions associated with different clinical pathways through EPAU services. Our findings could be used to facilitate wider recognition of women's emotional journeys through early pregnancy complications and stimulate research into how best to support women and their partners, in these difficult times.
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Affiliation(s)
- Sergio A Silverio
- Department of Women & Children's Health, King's College London, London, UK.,Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK
| | - Maria Memtsa
- Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK.,Women's Health Services, University College London Hospitals NHS Foundation Trust, London, UK
| | - Geraldine Barrett
- Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK
| | - Venetia Goodhart
- Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK.,Women's Health Services, University College London Hospitals NHS Foundation Trust, London, UK
| | - Judith Stephenson
- Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK
| | - Davor Jurković
- Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK.,Gynaecology Diagnostic and Outpatient Treatment Unit, University College London Hospitals NHS Foundation Trust, London, UK
| | - Jennifer A Hall
- Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK
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Landoni M, Silverio SA, Ionio C, Giordano F. Managing Children's Fears during the COVID-19 Pandemic: Strategies Adopted by Italian Caregivers. Int J Environ Res Public Health 2022; 19:11699. [PMID: 36141968 PMCID: PMC9517545 DOI: 10.3390/ijerph191811699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 09/10/2022] [Accepted: 09/13/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Life-threatening events, such as the COVID-19 pandemic, may generate feelings of insecurity and fear in the affected population, particularly children. Parents' ability to help children cope with negative emotions is essential during challenging periods. The current study aims to analyse the coping strategies adopted by Italian caregivers concerning their children's fears about COVID-19. METHOD An online survey was administered during the Italian lockdown to 649 parents of at least one child aged 5 to 17 years old. Respondents completed the survey for themselves and their children. In addition, a qualitative content analysis of the data from the open-ended question was conducted (N = 569; 87.9% women; MAge = 45 years). RESULTS Several themes were identified. Firstly, families' primary approach was 'communication and meaning-making'. Secondly, another essential strategy was 'the importance of safe space', enabled by keeping routine in place and creating a loving and caring environment. Thirdly, other factors relevant to managing children's fears were 'adaptation', 'religion', 'a positive attitude', and 'humour and hope'. Finally, the last two strategies significant and valuable for Italian families were 'flexibility' and 'maintaining virtual contacts. CONCLUSION During the pandemic COVID-19, parents may have used various strategies to protect their children from stress. Future research could investigate single parents' coping strategies explicitly developed during the COVID-19 lockdown.
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Affiliation(s)
- Marta Landoni
- CriDee Department of Psychology, Università Cattolica del Sacro Cuore, 20123 Milan, Italy
| | - Sergio A. Silverio
- Department of Women & Children’s Health, King’s College London, London SE1 7EH, UK
| | - Chiara Ionio
- CriDee Department of Psychology, Università Cattolica del Sacro Cuore, 20123 Milan, Italy
| | - Francesca Giordano
- RiRes Department of Psychology, Università Cattolica del Sacro Cuore, 20123 Milan, Italy
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Loughnan SA, Gautam R, Silverio SA, Boyle FM, Cassidy J, Ellwood D, Homer C, Horey D, Leisher SH, de Montigny F, Murphy M, O'Donoghue K, Quigley P, Ravaldi C, Sandall J, Storey C, Vannacci A, Wilson AN, Flenady V. Multicountry study protocol of COCOON: COntinuing Care in COVID-19 Outbreak global survey of New, expectant, and bereaved parent experiences. BMJ Open 2022; 12:e061550. [PMID: 36691138 PMCID: PMC9445233 DOI: 10.1136/bmjopen-2022-061550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 07/25/2022] [Indexed: 01/27/2023] Open
Abstract
INTRODUCTION Globally, the COVID-19 pandemic has significantly disrupted the provision of healthcare and efficiency of healthcare systems and is likely to have profound implications for pregnant and postpartum women and their families including those who experience the tragedy of stillbirth or neonatal death. This study aims to understand the psychosocial impact of COVID-19 and the experiences of parents who have accessed maternity, neonatal and bereavement care services during this time. METHODS AND ANALYSIS An international, cross-sectional, online and/or telephone-based/face-to-face survey is being administered across 15 countries and available in 11 languages. New, expectant and bereaved parents during the COVID-19 pandemic will be recruited. Validated psychometric scales will be used to measure psychosocial well-being. Data will be analysed descriptively and by assessing multivariable associations of the outcomes with explanatory factors. In seven of these countries, bereaved parents will be recruited to a nested, qualitative interview study. The data will be analysed using a grounded theory analysis (for each country) and thematic framework analysis (for intercountry comparison) to gain further insights into their experiences. ETHICS AND DISSEMINATION Ethics approval for the multicountry online survey, COCOON, has been granted by the Mater Misericordiae Human Research Ethics Committee in Australia (reference number: AM/MML/63526). Ethics approval for the nested qualitative interview study, PUDDLES, has been granted by the King's College London Biomedical & Health Sciences, Dentistry, Medicine and Natural & Mathematical Sciences Research Ethics Subcommittee (reference number: HR-19/20-19455) in the UK. Local ethics committee approvals were granted in participating countries where required. Results of the study will be published in international peer-reviewed journals and through parent support organisations. Findings will contribute to our understanding of delivering maternity care services, particularly bereavement care, in high-income, lower middle-income and low-income countries during this or future health crises.
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Affiliation(s)
- Siobhan A Loughnan
- NHMRC Centre of Research Excellence in Stillbirth, Mater Research Institute-The University of Queensland, Brisbane, QLD, Australia
| | - Rupesh Gautam
- NHMRC Centre of Research Excellence in Stillbirth, Mater Research Institute-The University of Queensland, Brisbane, QLD, Australia
| | - Sergio A Silverio
- Department of Women & Children's Health, School of Life Course Sciences, King's College London, London, UK
| | - Frances M Boyle
- NHMRC Centre of Research Excellence in Stillbirth, Mater Research Institute-The University of Queensland, Brisbane, QLD, Australia
- Institute for Social Science Research, The University of Queensland, Brisbane, Queensland, Australia
| | | | - David Ellwood
- NHMRC Centre of Research Excellence in Stillbirth, Mater Research Institute-The University of Queensland, Brisbane, QLD, Australia
- School of Medicine and Dentistry, Griffith University, Gold Coast, Queensland, Australia
| | - Caroline Homer
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Victoria, Australia
| | - Dell Horey
- NHMRC Centre of Research Excellence in Stillbirth, Mater Research Institute-The University of Queensland, Brisbane, QLD, Australia
- Department of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
| | | | - Francine de Montigny
- Département des Sciences Infirmières, Université du Québec en Outaouais, Gatineau, Quebec, Canada
| | - Margaret Murphy
- Nursing and Midwifery, University College Cork-National University of Ireland, Cork, Ireland
| | - Keelin O'Donoghue
- Department of Obstetrics and Gynaecology, Cork University Maternity Hospital, University College Cork, Cork, Ireland
| | - Paula Quigley
- International Stillbirth Alliance, Millburn, New Jersey, USA
- DAI Global Health, London, UK
| | - Claudia Ravaldi
- CiaoLapo Foundation for Perinatal Health, Prato, Italy
- PeaRL - Perinatal Research Laboratory, Department of Neurosciences, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, Firenze, Italy
| | - Jane Sandall
- Department of Women & Children's Health, School of Life Course Sciences, King's College London, London, UK
| | - Claire Storey
- International Stillbirth Alliance, Millburn, New Jersey, USA
| | - Alfredo Vannacci
- CiaoLapo Foundation for Perinatal Health, Prato, Italy
- PeaRL - Perinatal Research Laboratory, Department of Neurosciences, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, Firenze, Italy
| | - Alyce N Wilson
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Victoria, Australia
| | - Vicki Flenady
- NHMRC Centre of Research Excellence in Stillbirth, Mater Research Institute-The University of Queensland, Brisbane, QLD, Australia
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De Backer K, Brown JM, Easter A, Khazaezadeh N, Rajasingam D, Sandall J, Magee LA, Silverio SA. Precarity and preparedness during the SARS-CoV-2 pandemic: A qualitative service evaluation of maternity healthcare professionals. Acta Obstet Gynecol Scand 2022; 101:1227-1237. [PMID: 35950575 PMCID: PMC9538337 DOI: 10.1111/aogs.14438] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 07/05/2022] [Accepted: 07/25/2022] [Indexed: 11/28/2022]
Abstract
Introduction The SARS‐CoV‐2 pandemic has devastated populations, posing unprecedented challenges for healthcare services, staff and service‐users. In the UK, rapid reconfiguration of maternity healthcare service provision changed the landscape of antenatal, intrapartum and postnatal care. This study aimed to explore the experiences of maternity services staff who provided maternity care during the SARS‐CoV‐2 pandemic to inform future improvements in care. Material and methods A qualitative interview service evaluation was undertaken at a single maternity service in an NHS Trust, South London. Respondents (n = 29) were recruited using a critical case purposeful sample of maternity services staff. Interviews were conducted using video‐conferencing software, and were transcribed and analyzed using Grounded Theory Analysis appropriate for cross‐disciplinary health research. The focus of analysis was on staff experiences of delivering maternity services and care during the SARS‐CoV‐2 pandemic. Results A theory of “Precarity and Preparedness” was developed, comprising three main emergent themes: “Endemic precarity: A health system under pressure”; “A top‐down approach to managing the health system shock”; and “From un(der)‐prepared to future flourishing”. Conclusions Maternity services in the UK were under significant strain and were inherently precarious. This was exacerbated by the SARS‐CoV‐2 pandemic, which saw further disruption to service provision, fragmentation of care and pre‐existing staff shortages. Positive changes are required to improve staff retention and team cohesion, and ensure patient‐centered care remains at the heart of maternity care.
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Affiliation(s)
- Kaat De Backer
- Department of Women & Children's Health, School of Life Course & Population Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Jeremy M Brown
- Medical School, Health Research Institute, Faculty of Health, Social Care & Medicine, Edge Hill University, Ormskirk, UK
| | - Abigail Easter
- Department of Women & Children's Health, School of Life Course & Population Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | | | - Daghni Rajasingam
- Maternity Services, St. Thomas' Hospital, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Jane Sandall
- Department of Women & Children's Health, School of Life Course & Population Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Laura A Magee
- Department of Women & Children's Health, School of Life Course & Population Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Sergio A Silverio
- Department of Women & Children's Health, School of Life Course & Population Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
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Silverio SA, De Backer K, Dasgupta T, Torres O, Easter A, Khazaezadeh N, Rajasingam D, Wolfe I, Sandall J, Magee LA. On race and ethnicity during a global pandemic: An 'imperfect mosaic' of maternal and child health services in ethnically-diverse South London, United Kingdom. EClinicalMedicine 2022; 48:101433. [PMID: 35783482 PMCID: PMC9249549 DOI: 10.1016/j.eclinm.2022.101433] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 04/11/2022] [Accepted: 04/12/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND The SARS-CoV-2 pandemic has brought racial and ethnic inequity into sharp focus, as Black, Asian, and Minority Ethnic people were reported to have greater clinical vulnerability. During the pandemic, priority was given to ongoing, reconfigured maternity and children's healthcare. This study aimed to understand the intersection between race and ethnicity, and healthcare provision amongst maternity and children's healthcare professionals, during the SARS-CoV-2 pandemic. METHODS A qualitative study consisting of semi-structured interviews (N = 53) was undertaken with maternity (n = 29; August-November 2020) and children's (n = 24; June-July 2021) healthcare professionals from an NHS Trust in ethnically-diverse South London, UK. Data pertinent to ethnicity and race were subject to Grounded Theory Analysis, whereby data was subjected to iterative coding and interpretive analysis. Using this methodology, data are compared between transcripts to generate lower and higher order codes, before super-categories are formed, which are finally worked into themes. The inter-relationship between these themes is interpreted as a final theory. FINDINGS Grounded Theory Analysis led to the theory: An 'Imperfect Mosaic', comprising four themes: (1) 'A System Set in Plaster'; (2) 'The Marginalised Majority'; (3) 'Self-Discharging Responsibility for Change-Making'; and (4) 'Slow Progress, Not No Progress'. The NHS was observed to be brittle, lacking plasticity to deliver change at pace. Overt racism based on skin colour has been replaced by micro-aggressions between in-groups and out-groups, defined not just by ethnicity, but by other social determinants. Contemporaneously, responsibility for health, wellbeing, and psychological safety in the workplace is discharged to, and accepted by, the individual. INTERPRETATION Our findings suggest three practicable solutions: (1) Representation of marginalised groups at all NHS levels; (2) Engagement in cultural humility which extends to other social factors; and (3) Collective action at system and individual levels, including prioritising equity over simplistic notions of equality. FUNDING This service evaluation was supported by the King's College London King's Together Rapid COVID-19 Call, successfully awarded to Laura A. Magee, Sergio A. Silverio, Abigail Easter, & colleagues (reference:- 204823/Z/16/Z), as part of a rapid response call for research proposals. The King's Together Fund is a Wellcome Trust funded initiative.
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Affiliation(s)
- Sergio A. Silverio
- Department of Women & Children's Health, School of Life Course & Population Sciences, Faculty of Life Sciences & Medicine, King's College London, St. Thomas’ Hospital, 10th Floor North Wing, St. Thomas’ Hospital, Westminster Bridge Road, Lambeth, London SE1 7EH, United Kingdom
- Corresponding author.
| | - Kaat De Backer
- Department of Women & Children's Health, School of Life Course & Population Sciences, Faculty of Life Sciences & Medicine, King's College London, St. Thomas’ Hospital, 10th Floor North Wing, St. Thomas’ Hospital, Westminster Bridge Road, Lambeth, London SE1 7EH, United Kingdom
| | - Tisha Dasgupta
- Department of Women & Children's Health, School of Life Course & Population Sciences, Faculty of Life Sciences & Medicine, King's College London, St. Thomas’ Hospital, 10th Floor North Wing, St. Thomas’ Hospital, Westminster Bridge Road, Lambeth, London SE1 7EH, United Kingdom
| | - Ofelia Torres
- Department of Women & Children's Health, School of Life Course & Population Sciences, Faculty of Life Sciences & Medicine, King's College London, St. Thomas’ Hospital, 10th Floor North Wing, St. Thomas’ Hospital, Westminster Bridge Road, Lambeth, London SE1 7EH, United Kingdom
| | - Abigail Easter
- Department of Women & Children's Health, School of Life Course & Population Sciences, Faculty of Life Sciences & Medicine, King's College London, St. Thomas’ Hospital, 10th Floor North Wing, St. Thomas’ Hospital, Westminster Bridge Road, Lambeth, London SE1 7EH, United Kingdom
| | - Nina Khazaezadeh
- Chief Midwifery Office, NHS England and Improvement, Wellington House, 133-155 Waterloo Road, Southwark, London SE1 8UG, United Kingdom
| | - Daghni Rajasingam
- Maternity Services, St. Thomas’ Hospital, Guy's and St. Thomas’ NHS Foundation Trust, Westminster Bridge Road, Lambeth, London SE1 7EH, United Kingdom
| | - Ingrid Wolfe
- Department of Women & Children's Health, School of Life Course & Population Sciences, Faculty of Life Sciences & Medicine, King's College London, St. Thomas’ Hospital, 10th Floor North Wing, St. Thomas’ Hospital, Westminster Bridge Road, Lambeth, London SE1 7EH, United Kingdom
| | - Jane Sandall
- Department of Women & Children's Health, School of Life Course & Population Sciences, Faculty of Life Sciences & Medicine, King's College London, St. Thomas’ Hospital, 10th Floor North Wing, St. Thomas’ Hospital, Westminster Bridge Road, Lambeth, London SE1 7EH, United Kingdom
| | - Laura A. Magee
- Department of Women & Children's Health, School of Life Course & Population Sciences, Faculty of Life Sciences & Medicine, King's College London, St. Thomas’ Hospital, 10th Floor North Wing, St. Thomas’ Hospital, Westminster Bridge Road, Lambeth, London SE1 7EH, United Kingdom
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Stelle I, Bah M, Silverio SA, Verhoef H, Comma E, Prentice AM, Moore SE, Cerami C. Iron supplementation of breastfed Gambian infants from 6 weeks to 6 months of age: protocol for a randomised controlled trial. Wellcome Open Res 2022; 7:16. [PMID: 36874582 PMCID: PMC9975413 DOI: 10.12688/wellcomeopenres.17507.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2021] [Indexed: 11/20/2022] Open
Abstract
Background: A recent analysis showed that plasma iron concentrations decline rapidly from birth in Gambian infants, irrespective of sex or birthweight, to concentrations well below normal expected values for iron-replete children older than two months of age (typically >10 μmol/L). The development and function of neural and immune cells may thus be compromised before the minimum age at which children should receive iron supplementation as per World Health Organisation recommendations. Methods: This study is a two-arm, double-blind, placebo-controlled, randomised superiority trial. Infants will be randomised to receive iron drops (7.5mg/day of iron as ferrous sulphate) or placebo daily for 98 days, to test the impact on serum iron concentrations in healthy, breastfed infants (n = 100) aged 6-10 weeks at enrolment. Participants will be visited daily and supplemented by the field team. Daily health and weekly breastfeeding questionnaires will be administered. Anthropometry, and venous blood and faecal samples will be collected at enrolment and after 98 days of supplementation with serum iron as the primary endpoint. Low birthweight (less than 2.5kg at birth) and infants born prematurely (< 37 weeks) will not be excluded. Formula-fed and infants with any illness will be excluded. An additional study exploring maternal stakeholder perspectives of the intervention will be conducted by means of maternal interviews and four focus group discussions with local stakeholders. Discussion: Most breast-fed Gambian infants have very low circulating iron levels by five months of age. This study will introduce iron supplements much earlier in infancy than has previously been attempted in a low-income setting with the primary aim of increasing serum iron concentration. Trial registration: Clincaltrials.gov ( NCT04751994); 12 th February 2021.
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Affiliation(s)
- Isabella Stelle
- Department of Women and Children's Health, King's College London, 10th Floor North Wing, St. Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK
| | - Mamadou Bah
- Nutrition and Planetary Health Theme, MRC Unit The Gambia @ the London School of Hygiene and Tropical Medicine, PO Box 273, Banjul, The Gambia
- Division of Human Nutrition and Health, Wageningen University, PO Box 17, 6700 AA Wageningen, The Netherlands
| | - Sergio A. Silverio
- Department of Women and Children's Health, King's College London, 10th Floor North Wing, St. Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK
| | - Hans Verhoef
- Division of Human Nutrition and Health, Wageningen University, PO Box 17, 6700 AA Wageningen, The Netherlands
| | - Ebrima Comma
- Nutrition and Planetary Health Theme, MRC Unit The Gambia @ the London School of Hygiene and Tropical Medicine, PO Box 273, Banjul, The Gambia
| | - Andrew M. Prentice
- Nutrition and Planetary Health Theme, MRC Unit The Gambia @ the London School of Hygiene and Tropical Medicine, PO Box 273, Banjul, The Gambia
| | - Sophie E. Moore
- Department of Women and Children's Health, King's College London, 10th Floor North Wing, St. Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK
- Nutrition and Planetary Health Theme, MRC Unit The Gambia @ the London School of Hygiene and Tropical Medicine, PO Box 273, Banjul, The Gambia
| | - Carla Cerami
- Nutrition and Planetary Health Theme, MRC Unit The Gambia @ the London School of Hygiene and Tropical Medicine, PO Box 273, Banjul, The Gambia
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Fallon V, Davies SM, Christiansen P, Harrold JA, Silverio SA. The Postpartum Specific Anxiety Scale: Confirmatory factor analyses and relationships with birth experience. Arch Womens Ment Health 2022; 25:655-665. [PMID: 35488935 PMCID: PMC9055017 DOI: 10.1007/s00737-022-01233-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 04/21/2022] [Indexed: 11/25/2022]
Abstract
The Postpartum Specific Anxiety Scale [PSAS] was developed and validated as a research tool with a four-factor structure; with predictive validity corroborated in studies examining infant-feeding and maternal bonding outcomes. The PSAS has not been examined in relation to birth experiences. We aimed to confirm the PSAS four-factor structure and examine these domains of anxiety in relation to subjective and objective birth experiences. Postpartum mothers (≤ 12-months; N = 500) completed the PSAS alongside measures of subjective birth satisfaction and objective obstetric interventions/complications. Confirmatory factor analyses [CFA] tested eight models, theoretically derived from the preceding exploratory work. Structural equation modelling [SEM] tested associations between each PSAS factor and birth experience variables in the best-fitting model. An identical 51-item four-factor model fits the data well. SEM analyses revealed associations between lower perceptions of quality of intrapartum care and increased maternal competence and attachment anxieties, practical infant care anxieties, and infant safety and welfare anxieties. High subjective stress and negative emotional response to labour were associated with increased psychosocial adjustment to motherhood anxieties. Specific associations were found between neonatal care unit admission and practical infant care anxieties; and infant asphyxia and infant safety and welfare anxieties. Findings confirm construct and convergent validity of the four-factor PSAS and its use in measuring postpartum anxiety. Unique associations were also identified, indicating specific subjective and objective experiences occurring during birth may elicit a differential anxiety response, in that they are related to specific forms of postpartum anxiety which occur during the first postpartum year.
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Affiliation(s)
- Victoria Fallon
- Department of Psychology, Institute of Population Health, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
| | - Siân M Davies
- School of Psychology, Faculty of Health, Liverpool John Moore's University, Liverpool, UK
| | - Paul Christiansen
- Department of Psychology, Institute of Population Health, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
| | - Joanne A Harrold
- Department of Psychology, Institute of Population Health, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
| | - Sergio A Silverio
- Department of Women & Children's Health, School of Life Course & Population Sciences, Faculty of Life Sciences & Medicine, King's College London, 10th Floor North Wing, St. Thomas' Hospital, Westminster Bridge Road, Lambeth, London, SE1 7EH, UK.
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Infante-Gil L, Silverio SA, Fallon V, Wendland J. Postpartum specific anxiety in a French population: Validation of the French version of the Postpartum Specific Anxiety Scale [PSAS-FR]. Perspect Psychiatr Care 2022; 58:418-428. [PMID: 33955561 DOI: 10.1111/ppc.12808] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 03/08/2021] [Indexed: 11/29/2022] Open
Abstract
PURPOSE This study aims to validate the Postpartum-Specific-Anxiety-Scale (PSAS) as a French-language instrument, which assesses maternal and infant-related anxieties during the postpartum period. DESIGN AND METHODS The methodology included six stages: preliminary French translation; selection of most articulate items and back-translation; rectification of discrepancies; pilot study (n = 257); reliability and validity studies (n = 258; n = 874); and test-retest reliability study (n = 231). FINDINGS The PSAS-FR demonstrated good acceptability, high internal consistency of the global scale (Cronbach's α = 0.93), and each of the factors; along with good validity, and test-retest reliability. The receiver operating characteristic analysis suggested a satisfactory screening tool. PRACTICE IMPLICATIONS The PSAS-FR appears to be a valid and reliable tool to screen for postpartum anxieties in the French-speaking population.
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Affiliation(s)
- Lilliam Infante-Gil
- Psychopathology and Health Processes Laboratory, Institute of Psychology, Université de Paris, Paris, France
| | - Sergio A Silverio
- Department of Women & Children's Health, School of Life Course Sciences, King's College London, London, UK.,Department of Psychology, Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Victoria Fallon
- Department of Psychology, Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Jaqueline Wendland
- Psychopathology and Health Processes Laboratory, Institute of Psychology, Université de Paris, Paris, France.,Vivaldi Parent-Infant Mental Health Unit, Pitié-Salpêtrière University Hospital - AP-HP, Paris, France
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Silverio SA, Easter A, Storey C, Jurković D, Sandall J. Preliminary findings on the experiences of care for parents who suffered perinatal bereavement during the COVID-19 pandemic. BMC Pregnancy Childbirth 2021; 21:840. [PMID: 34937548 PMCID: PMC8693591 DOI: 10.1186/s12884-021-04292-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 11/25/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic poses an unprecedented risk to the global population. Maternity care in the UK was subject to many iterations of guidance on how best to reconfigure services to keep women, their families and babies, and healthcare professionals safe. Parents who experience a pregnancy loss or perinatal death require particular care and support. PUDDLES is an international collaboration investigating the experiences of recently bereaved parents who suffered a late miscarriage, stillbirth, or neonatal death during the global COVID-19 pandemic, in seven countries. In this study, we aim to present early findings from qualitative work undertaken with recently bereaved parents in the United Kingdom about how access to healthcare and support services was negotiated during the pandemic. METHODS In-depth semi-structured interviews were undertaken with parents (N = 24) who had suffered a late miscarriage (n = 5; all mothers), stillbirth (n = 16; 13 mothers, 1 father, 1 joint interview involving both parents), or neonatal death (n = 3; all mothers). Data were analysed using a template analysis with the aim of investigating bereaved parents' access to services, care, and networks of support, during the pandemic after their bereavement. RESULTS All parents had experience of utilising reconfigured maternity and/or neonatal, and bereavement care services during the pandemic. The themes utilised in the template analysis were: 1) The Shock & Confusion Associated with Necessary Restrictions to Daily Life; 2) Fragmented Care and Far Away Families; 3) Keeping Safe by Staying Away; and 4) Impersonal Care and Support Through a Screen. Results suggest access to maternity, neonatal, and bereavement care services were all significantly reduced, and parents' experiences were notably affected by service reconfigurations. CONCLUSIONS Our findings, whilst preliminary, are important to document now, to help inform care and service provision as the pandemic continues and to provide learning for ongoing and future health system shocks. We draw conclusions on how to enable development of safe and appropriate services during this pandemic and any future health crises, to best support parents who experience a pregnancy loss or whose babies die.
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Affiliation(s)
- Sergio A Silverio
- Department of Women & Children's Health, School of Life Course & Population Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK.
| | - Abigail Easter
- Department of Women & Children's Health, School of Life Course & Population Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | | | - Davor Jurković
- Gynaecology Diagnostic Outpatient Treatment Unit, University College Hospital, University College London Hospitals NHS Foundation Trust, London, UK
| | - Jane Sandall
- Department of Women & Children's Health, School of Life Course & Population Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
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Memtsa M, Goodhart V, Ambler G, Brocklehurst P, Keeney E, Silverio SA, Anastasiou Z, Round J, Khan N, Hall J, Barrett G, Bender-Atik R, Stephenson J, Jurkovic D. Differences in the organisation of early pregnancy units and the effect of senior clinician presence, volume of patients and weekend opening on emergency hospital admissions: Findings from the VESPA Study. PLoS One 2021; 16:e0260534. [PMID: 34847201 PMCID: PMC8631630 DOI: 10.1371/journal.pone.0260534] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 11/11/2021] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To determine whether the participation of consultant gynaecologists in delivering early pregnancy care results in a lower rate of acute hospital admissions. DESIGN Prospective cohort study and emergency hospital care audit; data were collected as part of the national prospective mixed-methods VESPA study on the "Variations in the organization of EPAUs in the UK and their effects on clinical, Service and PAtient-centred outcomes". SETTING 44 Early Pregnancy Assessment Units (EPAUs) across the UK randomly selected in balanced numbers from eight pre-defined mutually exclusive strata. PARTICIPANTS 6606 pregnant women (≥16 years old) with suspected first trimester pregnancy complications attending the participating EPAUs or Emergency Departments (ED) from December 2016 to July 2017. EXPOSURES Planned and actual senior clinician presence, unit size, and weekend opening. MAIN OUTCOME MEASURES Unplanned admissions to hospital following any visit for investigations or treatment for first trimester complications as a proportion of women attending EPAUs. RESULTS 205/6397 (3.2%; 95% CI 2.8-3.7) women were admitted following their EPAU attendance. The admission rate among 44 units ranged from 0% to 13.7% (median 2.8). Neither planned senior clinician presence (p = 0.874) nor unit volume (p = 0.247) were associated with lower admission rates from EPAU, whilst EPAU opening over the weekend resulted in lower admission rates (p = 0.027). 1445/5464 (26.4%; 95%CI 25.3 to 27.6) women were admitted from ED. There was little evidence of an association with planned senior clinician time (p = 0.280) or unit volume (p = 0.647). Keeping an EPAU open over the weekend for an additional hour was associated with 2.4% (95% CI 0.1% to 4.7%) lower odds of an emergency admission from ED. CONCLUSIONS Involvement of senior clinicians in delivering early pregnancy care has no significant impact on emergency hospital admissions for early pregnancy complications. Weekend opening, however, may be an effective way of reducing emergency admissions from ED.
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Affiliation(s)
- Maria Memtsa
- Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, United Kingdom
| | - Venetia Goodhart
- Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, United Kingdom
| | - Gareth Ambler
- Department of Statistical Science, University College London, London, United Kingdom
| | - Peter Brocklehurst
- Birmingham Clinical Trials Unit, Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Edna Keeney
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Sergio A Silverio
- Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, United Kingdom.,Department of Women and Children's Health, King's College London, London, United Kingdom
| | - Zacharias Anastasiou
- Department of Statistical Science, University College London, London, United Kingdom
| | - Jeff Round
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom.,Institute of Health Economics, Edmonton, Canada
| | - Nazim Khan
- Modelling and Analytical Systems Solutions (MASS) Ltd, Edinburgh, United Kingdom
| | - Jennifer Hall
- Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, United Kingdom
| | - Geraldine Barrett
- Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, United Kingdom
| | | | - Judith Stephenson
- Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, United Kingdom
| | - Davor Jurkovic
- Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, United Kingdom
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Davies SM, Sriskandarajah S, Staneva AS, Boulton HCM, Roberts C, Shaw SH, Silverio SA. Factors influencing ‘burn‐out’ in newly qualified counsellors and psychotherapists: A cross‐cultural, critical review of the literature. Couns and Psychother Res 2021. [DOI: 10.1002/capr.12485] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Siân M. Davies
- School of Psychology Liverpool John Moores University Liverpool UK
- Centre for Women's Mental Health The University of Manchester Manchester UK
- Department of Psychological Sciences University of Liverpool Liverpool UK
| | | | | | | | - Chelsey Roberts
- Therapist and Independent Researcher Tucson USA
- Elizabeth Garrett Anderson Institute for Women's Health University College London London UK
| | | | - Sergio A. Silverio
- Department of Psychological Sciences University of Liverpool Liverpool UK
- Elizabeth Garrett Anderson Institute for Women's Health University College London London UK
- School of Life Course Sciences King’s College London London UK
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Robbins T, Hanlon C, Kelly AH, Gidiri MF, Musiyiwa M, Silverio SA, Shennan AH, Sandall J. Pills and prayers: a comparative qualitative study of community conceptualisations of pre-eclampsia and pluralistic care in Ethiopia, Haiti and Zimbabwe. BMC Pregnancy Childbirth 2021; 21:716. [PMID: 34702209 PMCID: PMC8547033 DOI: 10.1186/s12884-021-04186-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 09/24/2021] [Indexed: 11/11/2022] Open
Abstract
Background Pre-eclampsia is a leading cause of preventable maternal and perinatal deaths globally. While health inequities remain stark, removing financial or structural barriers to care does not necessarily improve uptake of life-saving treatment. Building on existing literature elaborating the sociocultural contexts that shape behaviours around pregnancy and childbirth can identify nuanced influences relating to pre-eclampsia care. Methods We conducted a cross-cultural comparative study exploring lived experiences and understanding of pre-eclampsia in Ethiopia, Haiti and Zimbabwe. Our primary objective was to examine what local understandings of pre-eclampsia might be shared between these three under-resourced settings despite their considerable sociocultural differences. Between August 2018 and January 2020, we conducted 89 in-depth interviews with individuals and 17 focus group discussions (n = 106). We purposively sampled perinatal women, survivors of pre-eclampsia, families of deceased women, partners, older male and female decision-makers, traditional birth attendants, religious and traditional healers, community health workers and facility-based health professionals. Template analysis was conducted to facilitate cross-country comparison drawing on Social Learning Theory and the Health Belief Model. Results Survivors of pre-eclampsia spoke of their uncertainty regarding symptoms and diagnosis. A lack of shared language challenged coherence in interpretations of illness related to pre-eclampsia. Across settings, raised blood pressure in pregnancy was often attributed to psychosocial distress and dietary factors, and eclampsia linked to spiritual manifestations. Pluralistic care was driven by attribution of causes, social norms and expectations relating to alternative care and trust in biomedicine across all three settings. Divergence across the contexts centred around nuances in religious or traditional practices relating to maternal health and pregnancy. Conclusions Engaging faith and traditional caregivers and the wider community offers opportunities to move towards coherent conceptualisations of pre-eclampsia, and hence greater access to potentially life-saving care. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-021-04186-6.
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Affiliation(s)
- Tanya Robbins
- Department of Women & Children's Health, School of Life Course Sciences, King's College London, St Thomas' Hospital, 10th Floor, North Wing, Westminster Bridge Road, London, SE1 7EH, UK.
| | - Charlotte Hanlon
- Centre for Global Mental Health, Health Service and Population Research Department, and WHO Collaborating Centre for Mental Health Research and Training, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,Department of Psychiatry, WHO Collaborating Centre for Mental Health Research and Capacity-Building, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.,Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Ann H Kelly
- Department of Global Health and Social Medicine, King's College London, London, UK
| | - Muchabayiwa Francis Gidiri
- Department of Obstetrics and Gynaecology, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Mickias Musiyiwa
- Department of History, Heritage and Knowledge Systems, Faculty of Arts and Humanities, University of Zimbabwe, Harare, Zimbabwe
| | - Sergio A Silverio
- Department of Women & Children's Health, School of Life Course Sciences, King's College London, St Thomas' Hospital, 10th Floor, North Wing, Westminster Bridge Road, London, SE1 7EH, UK
| | - Andrew H Shennan
- Department of Women & Children's Health, School of Life Course Sciences, King's College London, St Thomas' Hospital, 10th Floor, North Wing, Westminster Bridge Road, London, SE1 7EH, UK
| | - Jane Sandall
- Department of Women & Children's Health, School of Life Course Sciences, King's College London, St Thomas' Hospital, 10th Floor, North Wing, Westminster Bridge Road, London, SE1 7EH, UK
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Rayment-Jones H, Harris J, Harden A, Silverio SA, Turienzo CF, Sandall J. Project20: interpreter services for pregnant women with social risk factors in England: what works, for whom, in what circumstances, and how? Int J Equity Health 2021; 20:233. [PMID: 34689772 PMCID: PMC8543874 DOI: 10.1186/s12939-021-01570-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 10/08/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Black and minority ethnic women and those with social risk factors such as deprivation, refugee and asylum seeker status, homelessness, mental health issues and domestic violence are at a disproportionate risk of poor birth outcomes. Language barriers further exacerbate this risk, with women struggling to access, engage with maternity services and communicate concerns to healthcare professionals. To address the language barrier, many UK maternity services offer telephone interpreter services. This study explores whether or not women with social risk factors find these interpreter services acceptable, accessible and safe, and to suggest solutions to address challenges. METHODS Realist methodology was used to refine previously constructed programme theories about how women with language barriers access and experience interpreter services during their maternity care. Twenty-one longitudinal interviews were undertaken during pregnancy and the postnatal period with eight non-English speaking women and their family members. Interviews were analysed using thematic framework analysis to confirm, refute or refine the programme theories and identify specific contexts, mechanisms and outcomes relating to interpreter services. RESULTS Women with language barriers described difficulties accessing maternity services, a lack of choice of interpreter, suspicion around the level of confidentiality interpreter services provide, and questioned how well professional interpreters were able to interpret what they were trying to relay to the healthcare professional during appointments. This resulted in many women preferring to use a known and trusted family member or friend to interpret for them where possible. Their insights provide detailed insight into how poor-quality interpreter services impact on their ability to disclose risk factors and communicate concerns effectively with their healthcare providers. A refined programme theory puts forward mechanisms to improve their experiences and safety such as regulated, high-quality interpreter services throughout their maternity care, in which women have choice, trust and confidence. CONCLUSIONS The findings of this study contribute to concerns highlighted in previous literature around interpreter services in the wider healthcare arena, particularly around the lack of regulation and access to high-quality interpretation. This is thought to have a significant effect on pregnant women who are living socially complex lives as they are not able to communicate their concerns and access support. This not only impacts on their safety and pregnancy outcomes, but also their wider holistic needs. The refined program theory developed in this study offers insights into the mechanisms of equitable access to appropriate interpreter services for pregnant women with language barriers.
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Affiliation(s)
- Hannah Rayment-Jones
- Department of Women and Children’s Health, Faculty of Life Sciences & Medicine, King’s College London, 10th Floor, North Wing St. Thomas’ Hospital, Westminster Bridge Road, London, SE1 7EH UK
| | - James Harris
- Chelsea and Westminster NHS Foundation Trust, Clinical Research Facility, St Stephen’s Centre, 252 Fulham Road, London, SW109NA UK
| | - Angela Harden
- School of Health Sciences, City, University of London, Northampton Square, London, EC1V 0HB UK
| | - Sergio A. Silverio
- Department of Women and Children’s Health, Faculty of Life Sciences & Medicine, King’s College London, 10th Floor, North Wing St. Thomas’ Hospital, Westminster Bridge Road, London, SE1 7EH UK
| | - Cristina Fernandez Turienzo
- Department of Women and Children’s Health, Faculty of Life Sciences & Medicine, King’s College London, 10th Floor, North Wing St. Thomas’ Hospital, Westminster Bridge Road, London, SE1 7EH UK
| | - Jane Sandall
- Department of Women and Children’s Health, Faculty of Life Sciences & Medicine, King’s College London, 10th Floor, North Wing St. Thomas’ Hospital, Westminster Bridge Road, London, SE1 7EH UK
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Jackson L, De Pascalis L, Harrold JA, Fallon V, Silverio SA. Postpartum women's psychological experiences during the COVID-19 pandemic: a modified recurrent cross-sectional thematic analysis. BMC Pregnancy Childbirth 2021; 21:625. [PMID: 34530772 PMCID: PMC8445650 DOI: 10.1186/s12884-021-04071-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 08/24/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND COVID-19 has placed additional stressors on mothers during an already vulnerable lifecourse transition. Initial social distancing restrictions (Timepoint 1; T1) and initial changes to those social distancing restrictions (Timepoint 2; T2) have disrupted postpartum access to practical and emotional support. This qualitative study explores the postpartum psychological experiences of UK women during different phases of the COVID-19 pandemic and associated 'lockdowns'. METHODS Semi-structured interviews were conducted with 12 women, approximately 30 days after initial social distancing guidelines were imposed in the UK (22 April 2020). A separate 12 women were interviewed approximately 30 days after the initial easing of social distancing restrictions (10 June 2020). Data were transcribed verbatim, uploaded into NVivo for management and analysis, which followed a recurrent cross-sectional approach to thematic analysis. RESULTS Two main themes were identified for T1: 'Motherhood is Much Like Lockdown' and 'A Self-Contained Family Unit'. Each main T1 theme contained two sub-themes. Two main themes were also identified for T2: 'Incongruously Held Views of COVID-19' and 'Mothering Amidst the Pandemic'. Each main T2 theme contained three sub-themes. Comparisons between data gathered at each timepoint identified increased emotional distress over time. Current findings call for the improvement of postpartum care by improving accessibility to social support, and prioritising the re-opening of schools, and face-to-face healthcare appointments and visitation. CONCLUSION Social distancing restrictions associated with COVID-19 have had a cumulative, negative effect on postpartum mental health. Recommendations such as: Allowing mothers to 'bubble' with a primary support provider even at their healthcare appointments; allowing one support partner to attend all necessary healthcare appointments; and providing tailored informational resources, may help to support postpartum emotional wellbeing during this, and similar health crises in the future.
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Affiliation(s)
- Leanne Jackson
- Department of Psychology, Institute of Population Health, Faculty of Health and Life Sciences, University of Liverpool, Eleanor Rathbone Building, Bedford Street South, Liverpool, Merseyside, L69 7ZA, UK.
| | - Leonardo De Pascalis
- Department of Psychology, Institute of Population Health, Faculty of Health and Life Sciences, University of Liverpool, Eleanor Rathbone Building, Bedford Street South, Liverpool, Merseyside, L69 7ZA, UK
| | - Joanne A Harrold
- Department of Psychology, Institute of Population Health, Faculty of Health and Life Sciences, University of Liverpool, Eleanor Rathbone Building, Bedford Street South, Liverpool, Merseyside, L69 7ZA, UK
| | - Victoria Fallon
- Department of Psychology, Institute of Population Health, Faculty of Health and Life Sciences, University of Liverpool, Eleanor Rathbone Building, Bedford Street South, Liverpool, Merseyside, L69 7ZA, UK
| | - Sergio A Silverio
- Department of Women & Children's Health, School of Life Course Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
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