Rowe Heather J, Wynter Karen H, Burns Joanna K, Fisher Jane R W
Jean Hailes Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
Health Promot Int. 2017 Aug 1;32(4):610-623. doi: 10.1093/heapro/dav110.
Reducing the burden of postnatal maternal mental health problems is an international public health priority. We developed What Were We Thinking (WWWT), a psychoeducation programme for primary postnatal health care that addresses known but neglected risks. We then demonstrated evidence of its effects in a before-and-after controlled study in preventing maternal postnatal mental health problems among women without a psychiatric history participating in the intervention compared to usual care (AOR 0.43; 95% CI 0.21, 0.89) when conducted by specialist nurses. Testing its effectiveness when implemented in routine primary care requires changes at practitioner, organizational and health system levels. This paper describes a programme of translational formative evaluation to inform the protocol for a cluster RCT. Following the UK Medical Research Council (MRC) Guidance for evaluating complex interventions, we conducted a translational formative evaluation using mixed methods. Collection and analysis of postnatal health service documents, semi-structured interviews, group discussions and an online survey were used to investigate service provision, consumers' needs and expectations, clinicians' attitudes and clinical practice, and the implications for health service delivery. Participants were expectant parents, health care providers, health service managers and government policy makers. Results documented current clinical practice, staff training needs, necessary service modifications to standardize advice to parents and include fathers, key priorities and drivers of government health policy, and informed a model of costs and expected health and social outcomes. Implementation of WWWT into routine postnatal care requires adjustments to clinical practice. Staff training, modifications to service opening hours and economic implications for the health system also need to be considered. The MRC Guidance for developing and evaluating complex interventions is a useful framework for conceptualizing and reporting translational formative evaluation, which is an essential step in the evidence trajectory. The results of the evaluation will inform the protocol for a cluster RCT of WWWT and associated health economic evaluation.
减轻产后产妇心理健康问题的负担是一项国际公共卫生重点工作。我们开发了“我们当时在想什么”（WWWT）项目，这是一项针对产后初级保健的心理教育项目，旨在解决已知但被忽视的风险。随后，我们在一项前后对照研究中证明了其效果，即在由专科护士实施干预的情况下，与常规护理相比，该项目能预防无精神病史的产妇出现产后心理健康问题（调整后比值比为0.43；95%置信区间为0.21，0.89）。在常规初级保健中实施该项目并测试其有效性，需要在从业者、组织和卫生系统层面进行变革。本文描述了一项转化性形成性评估计划，为整群随机对照试验的方案提供依据。遵循英国医学研究理事会（MRC）关于评估复杂干预措施的指南，我们采用混合方法进行了转化性形成性评估。通过收集和分析产后健康服务文件、半结构化访谈、小组讨论以及在线调查，来研究服务提供情况、消费者的需求和期望、临床医生的态度和临床实践，以及对卫生服务提供的影响。参与者包括准父母、医疗保健提供者、卫生服务管理者和政府政策制定者。研究结果记录了当前的临床实践、员工培训需求、为使向父母提供的建议标准化并纳入父亲参与所需的服务调整、政府卫生政策的关键优先事项和驱动因素，并为成本模型以及预期的健康和社会结果提供了依据。将WWWT项目纳入常规产后护理需要对临床实践进行调整。还需要考虑员工培训、服务开放时间的调整以及对卫生系统的经济影响。MRC关于开发和评估复杂干预措施的指南是一个有用的框架，可用于构思和报告转化性形成性评估，这是循证过程中的关键一步。评估结果将为WWWT项目的整群随机对照试验方案及相关卫生经济评估提供依据。
