Loureiro Maria Isabel, Goes Ana Rita, Paim da Câmara Gisele, Gonçalves-Pereira Manuel, Maia Teresa, Saboga Nunes Luís
CIESP, Escola Nacional de Saúde Pública, ENSP, Universidade Nova de Lisboa, Portugal.
Glob Health Promot. 2009 Mar;16(1):29-38. doi: 10.1177/1757975908100748.
The perinatal period (shortly before and after birth) is a particularly significant stage, providing a sound base for healthy development. Primary health care should accompany the individual through the entire life cycle, and mental health problems constitute a public health threat that calls for the development of mental health promotion initiatives in primary health care. Responding, in 2004 our team initiated an action research project with the aim of reorganising primary health care during pregnancy and the first year of life. The aim is to enable health professionals to support families in the transition to parenthood, thereby promoting children's mental health. In order to plan this reorganisation, we developed a two-step decision-making process: 1. assessment of antenatal health care; 2. joint reflection concerning the priorities for change. The study goal was to assess the particular characteristics and needs of families during the perinatal period as well as the kind of care they were actually receiving. We designed a cross-sectional quantitative-qualitative study that collected data from users and health professionals using questionnaires and semi-structured interviews. The reflection step took place during a workshop that aimed to analyse the results and discuss priorities. The study confirmed the need to search for mental health problems during pregnancy, particularly to prevent a disturbed mother/child bonding process, and the importance of emphasising issues such as communication, information provision and the adequate availability of health professionals for antenatal care. The findings led to the following conclusions: 1. risk and needs assessment regarding mental health and options for family support should be included in the protocols of antenatal care; 2. primary health care professionals should be enabled to undertake diagnostic work and problem solving related to mental health; 3. collaboration between different levels of health care and between health sector and community resources should be increased.The highly participative decision-making process used led to a selection of priorities and strategies that was meaningful to users and health professionals and should contribute to the implementation and sustainability of changes for mental health promotion.
围产期（出生前后不久）是一个特别重要的阶段，为健康发展奠定了良好基础。初级卫生保健应贯穿个人的整个生命周期，而心理健康问题构成了一种公共卫生威胁，需要在初级卫生保健中开展促进心理健康的举措。作为回应，我们团队在2004年启动了一项行动研究项目，旨在重新组织孕期和婴儿出生后第一年的初级卫生保健。目的是使卫生专业人员能够在家庭向为人父母的角色转变过程中为其提供支持，从而促进儿童的心理健康。为了规划这一重组，我们制定了一个两步决策过程：1. 评估产前保健；2. 就变革重点进行联合反思。该研究的目标是评估围产期家庭的特殊特征和需求以及他们实际接受的护理类型。我们设计了一项横断面定量-定性研究，通过问卷调查和半结构化访谈从用户和卫生专业人员那里收集数据。反思步骤在一个旨在分析结果并讨论重点的研讨会上进行。该研究证实了在孕期筛查心理健康问题的必要性，特别是为了防止母婴关系紊乱，以及强调沟通、信息提供和有足够的卫生专业人员提供产前护理等问题的重要性。研究结果得出以下结论：1. 产前保健方案应包括心理健康风险和需求评估以及家庭支持选项；2. 应使初级卫生保健专业人员能够开展与心理健康相关的诊断工作和问题解决；3. 应加强不同层次卫生保健之间以及卫生部门与社区资源之间的合作。所采用的高度参与式决策过程导致选择了对用户和卫生专业人员有意义的重点和策略，应该有助于促进心理健康的变革的实施和可持续性。
