Johnson Joanne, Hope Lucy, Jones Lisa, Bradley Eleanor
Herefordshire and Worcestershire Health and Care NHS Trust, Worcestershire, United Kingdom.
College of Health, Life and Environmental Sciences, University of Worcester, Worcester, United Kingdom.
Front Psychiatry. 2023 Jun 12;14:1056987. doi: 10.3389/fpsyt.2023.1056987. eCollection 2023.
In the UK approximately half of women requiring perinatal mental health (PNMH) care do not receive treatment despite having routine contact with midwives (MWs) and health visitors (HVs). Limited research has been undertaken regarding MWs'/HVs' decision-making around referring women for secondary PNMH care. In particular, the impact that the level of local secondary PNMH services may have on MWs'/HVs' referral decisions is unexplored.
To understand MWs'/HVs' decision-making in relation to referring women with identified PNMH problems, to identify barriers and facilitators to effective and timely referrals including any impact of the local secondary PNMH service provision.
Participants were recruited from four National Health Service (NHS) Trusts in England, located across two geographical areas, that provided different types of PNMH services. One area had PNMH services that met National Institute for Health and Care Excellence (NICE) guidelines; the other area had no secondary PNMH services. A sequential mixed methods design was used: In-depth semi-structured interviews with practising MWs/HVs ( = 24) to explore their approach to PNMH referral decision-making, analysed using thematic analysis; Questionnaire offered to all practising MWs/HVs in the two geographical areas to measure factors that may impact on PNMH referral decision-making allowing for statistical comparisons to be made between the professional groups/geographical areas.
Three themes were identified from the interviews that impacted on MWs'/HVs' PNMH referral decision-making: identifying need; education, skills and experience; and referral pathways.Questionnaire response rate 13.1% ( = 99). The most reported facilitators to referral decision-making were a trusted relationship between MWs/HVs and women and routine enquiry about women's mental health; the most reported barriers were stigma associated with mental ill-health and women's perceived fear of child removal.
Fundamental to MWs'/HVs' decision-making was their perceived relationship between themselves and women. Although PNMH service provision is important for women to ensure they receive appropriate PNMH care, service provision appeared less important to MWs'/HVs' referral decision-making than how maternity/health visiting services were delivered. Further important factors to MWs/HVs were to the ability to provide continuity of carer with women allowing MWs/HVs to identify women who would benefit from referral for secondary PNMH care.
在英国，约有一半需要围产期心理健康（PNMH）护理的女性尽管与助产士（MWs）和健康访视员（HVs）有常规接触，但仍未接受治疗。关于MWs/HVs在将女性转介至二级PNMH护理方面的决策，相关研究有限。特别是，当地二级PNMH服务水平可能对MWs/HVs的转介决策产生的影响尚未得到探讨。
了解MWs/HVs在将已确定存在PNMH问题的女性进行转介方面的决策，确定有效及时转介的障碍和促进因素，包括当地二级PNMH服务提供情况的任何影响。
参与者来自英格兰的四个国民健康服务（NHS）信托机构，分布在两个地理区域，提供不同类型的PNMH服务。一个区域的PNMH服务符合国家卫生与临床优化研究所（NICE）的指南；另一个区域没有二级PNMH服务。采用了顺序混合方法设计：对在职MWs/HVs（n = 24）进行深入的半结构化访谈，以探讨他们在PNMH转介决策方面的方法，采用主题分析法进行分析；向两个地理区域的所有在职MWs/HVs发放问卷，以衡量可能影响PNMH转介决策的因素，以便在专业群体/地理区域之间进行统计比较。
从访谈中确定了影响MWs/HVs的PNMH转介决策的三个主题：确定需求；教育、技能和经验；以及转介途径。问卷回复率为13.1%（n = 99）。报告最多的转介决策促进因素是MWs/HVs与女性之间的信任关系以及对女性心理健康的常规询问；报告最多的障碍是与精神疾病相关的耻辱感以及女性对子女被带走的感知恐惧。
MWs/HVs决策的根本在于他们对自身与女性之间关系的认知。虽然PNMH服务的提供对确保女性获得适当的PNMH护理很重要，但与母婴/健康访视服务的提供方式相比，服务提供情况对MWs/HVs的转介决策似乎不那么重要。对MWs/HVs来说，另一个重要因素是能够与女性保持连续护理，使MWs/HVs能够识别出将从转介至二级PNMH护理中受益的女性。
