Lowenhoff Catherine, Davison-Fischer Jan, Pike Nick, Appleton Jane V
Oxford Brookes University, Oxford, UK.
Oxford Institute of Nursing, Midwifery and Allied Health Research, Oxford Brookes University, Oxford, UK.
Health Soc Care Community. 2019 Sep;27(5):e824-e836. doi: 10.1111/hsc.12790. Epub 2019 Jul 11.
At least half of the 20% of mothers who experience mental health problems (MHPs) during pregnancy or after birth are not receiving the help they need that will lead to recovery. In order to identify where improvements need to be made, it is necessary to describe exactly what is being done and the barriers and facilitators that compromise or enhance optimal care. The majority of mothers experience mild to moderate anxiety or depression. The expectation is that primary care professionals, such as health visitors (HVs), can provide the support they need that will lead to recovery. The aim of this study was to explore the views of HVs regarding the content and purpose of an intervention to support mothers with MHPs, described as 'listening visits' (LVs). A link to an online survey was offered to the members and champions of the Institute of Health Visiting (n = 9,474) March-May 2016. The survey was completed by 1,599 (17%) of the target population, of whom 85% were offering LVs. The Template for Intervention Description and Replication (TIDieR) checklist was used to provide a framework to describe commonalities and variations in practice. There appeared to be a shared understanding of the rationale for LVs but a lack of agreement about what the intervention should be called, the techniques that should be used and the duration, frequency and expected outcomes of the intervention. Contextual factors such as staff shortages; conflicting priorities; the needs and circumstances of mothers; the capability and motivation of HVs; inadequate training and supervision; and the absence of clear guidance contributed to variations in perceptions and practice. There are many ways in which the HV contribution to the assessment and management of mothers with MHPs could be improved. The intervention delivered by HVs needs to be more clearly articulated. The contextual factors influencing competent and consistent practice also need to be addressed.
在孕期或产后出现心理健康问题（MHP）的母亲中，有20%的人至少一半没有得到能助其康复所需的帮助。为了确定需要改进的地方，有必要准确描述正在采取的措施以及影响最佳护理的障碍和促进因素。大多数母亲经历的是轻度至中度焦虑或抑郁。人们期望诸如健康访视员（HV）等初级保健专业人员能够提供她们康复所需的支持。本研究的目的是探讨健康访视员对一种名为“倾听访视”（LV）的、用于支持有心理健康问题母亲的干预措施的内容和目的的看法。2016年3月至5月，向健康访视学会的成员和倡导者（n = 9474）提供了在线调查链接。目标人群中的1599人（17%）完成了调查，其中85%的人提供倾听访视。干预描述与复制模板（TIDieR）清单被用于提供一个框架，以描述实践中的共性和差异。对于倾听访视的基本原理似乎有共同的理解，但对于该干预措施应被称为什么、应使用的技巧以及干预的时长、频率和预期结果，存在分歧。诸如人员短缺、相互冲突的优先事项、母亲的需求和情况、健康访视员的能力和积极性、培训和监督不足以及缺乏明确指导等背景因素，导致了认知和实践的差异。健康访视员在评估和管理有心理健康问题母亲方面的贡献有很多可以改进的方式。健康访视员提供的干预措施需要更清晰地阐述。影响胜任和一致实践的背景因素也需要得到解决。
