School of Public Health, University College Cork, Western Road, Mardyke, Cork, Ireland; School of Nursing and Midwifery, Aras Moyola, University of Galway, Upper Newcastle, Gaillimh, Ireland.
School of Health Sciences, University of Nottingham, Nottingham NG7 2UH, United Kingdom.
Midwifery. 2023 Mar;118:103581. doi: 10.1016/j.midw.2022.103581. Epub 2022 Dec 24.
Mental health issues in the perinatal period are common, and can have negative consequences for maternal and child health. Healthcare professionals (HCPs) who provide women with perinatal care are well-placed to detect mental health issues and provide support. This study therefore examines HCPs' experiences and perceptions of providing mental health support during the perinatal period, including during the COVID-19 pandemic.
An exploratory realist qualitative study was conducted.
Republic of Ireland PARTICIPANTS: A purposive sampling strategy was employed to recruit HCPs (e.g., general practitioners, midwives, public health nurses, practice nurses, doulas, and breastfeeding counsellors), via professional bodies in Ireland. An invitation to participate was also circulated via Twitter. A total of 18 HCPs participated in semi-structured interviews conducted between 18/8/2020 and 24/5/2021.
Semi-structured interviews were conducted according to a topic guide designed by a multidisciplinary team. Data were analysed using thematic analysis. Four themes were developed: 'Supporting women in healthcare settings,' 'Skills and capacity to provide adequate care,' 'Structural barriers to care provision,' and 'The impact of the COVID-19 pandemic on stress support.'
HCPs reported providing emotional support and advocacy, but highlighted challenges, including limited capacity to address women's concerns, clinical culture and hierarchy, insufficient organisational investment, and social inequities in support access. Some HCPs felt these barriers could lead to additional psychological harm. HCPs also reported that the pandemic had introduced novel stressors and changed the nature of the mental health support they provided.
Interventions incorporating education and physical resources for HCPs, increased investment in specialist perinatal mental health services, increased investment in holistic supports, and changes to address cultural challenges in care environments, may facilitate - or enhance - support for women.
围产期的心理健康问题很常见，会对母婴健康产生负面影响。为围产期妇女提供护理的医疗保健专业人员（HCP）有很好的机会发现心理健康问题并提供支持。因此，本研究调查了 HCP 提供围产期心理健康支持的经验和看法，包括在 COVID-19 大流行期间。
进行了探索性现实主义定性研究。
爱尔兰共和国
通过爱尔兰的专业机构，采用目的性抽样策略招募 HCP（例如全科医生、助产士、公共卫生护士、执业护士、导乐和哺乳顾问）。还通过 Twitter 发布了参加的邀请。共有 18 名 HCP 参加了 2020 年 8 月 18 日至 2021 年 5 月 24 日之间进行的半结构化访谈。
根据由多学科团队设计的主题指南进行半结构化访谈。使用主题分析对数据进行分析。制定了四个主题：“在医疗保健环境中支持妇女”、“提供足够护理的技能和能力”、“提供护理的结构障碍”和“COVID-19 大流行对压力支持的影响”。
HCP 报告提供了情感支持和倡导，但强调了挑战，包括解决妇女关注的能力有限、临床文化和等级制度、组织投资不足以及支持获取方面的社会不平等。一些 HCP 认为这些障碍可能导致额外的心理伤害。HCP 还报告说，大流行带来了新的压力源，并改变了他们提供心理健康支持的性质。
为 HCP 提供教育和物理资源的干预措施、增加对专门围产期心理健康服务的投资、增加对整体支持的投资以及改变以解决护理环境中的文化挑战，可能会促进或增强对妇女的支持。
