Webb Rebecca, Ford Elizabeth, Easter Abigail, Shakespeare Judy, Holly Jennifer, Hogg Sally, Coates Rose, Ayers Susan
Centre for Maternal and Child Health Research, School of Health Sciences, City, University of London, UK.
Department of Primary Care and Public Health, Brighton & Sussex Medical School, UK.
BJPsych Open. 2023 Jul 13;9(4):e127. doi: 10.1192/bjo.2023.510.
Perinatal mental health (PMH) problems are a leading cause of maternal death and increase the risk of poor outcomes for women and their families. It is therefore important to identify the barriers and facilitators to implementing and accessing PMH care.
To develop a conceptual framework of barriers and facilitators to PMH care to inform PMH services.
Relevant literature was systematically identified, categorised and mapped onto the framework. The framework was then validated through evaluating confidence with the evidence base and feedback from stakeholders (women and families, health professionals, commissioners and policy makers).
Barriers and facilitators to PMH care were identified at seven levels: individual (e.g. beliefs about mental illness), health professional (e.g. confidence addressing perinatal mental illness), interpersonal (e.g. relationship between women and health professionals), organisational (e.g. continuity of carer), commissioner (e.g. referral pathways), political (e.g. women's economic status) and societal (e.g. stigma). The MATRIx conceptual frameworks provide pictorial representations of 66 barriers and 39 facilitators to PMH care.
The MATRIx frameworks highlight the complex interplay of individual and system-level factors across different stages of the care pathway that influence women accessing PMH care and effective implementation of PMH services. Recommendations are made for health policy and practice. These include using the conceptual frameworks to inform comprehensive, strategic and evidence-based approaches to PMH care; ensuring care is easy to access and flexible; providing culturally sensitive care; adequate funding of services and quality training for health professionals, with protected time to complete it.
围产期心理健康（PMH）问题是孕产妇死亡的主要原因，会增加妇女及其家庭出现不良结局的风险。因此，识别实施和获得PMH护理的障碍和促进因素非常重要。
构建一个PMH护理障碍和促进因素的概念框架，为PMH服务提供参考。
系统识别相关文献，进行分类并映射到该框架上。然后通过评估对证据基础的信心以及利益相关者（妇女及其家庭、卫生专业人员、委托方和政策制定者）的反馈来验证该框架。
在七个层面识别出了PMH护理的障碍和促进因素：个人层面（例如对精神疾病的看法）、卫生专业人员层面（例如应对围产期精神疾病的信心）、人际层面（例如妇女与卫生专业人员之间的关系）、组织层面（例如护理人员的连续性）、委托方层面（例如转诊途径）、政治层面（例如妇女的经济地位）和社会层面（例如耻辱感）。MATRIx概念框架提供了66个PMH护理障碍和39个促进因素的图示。
MATRIx框架突出了护理路径不同阶段中个人和系统层面因素之间的复杂相互作用，这些因素会影响妇女获得PMH护理以及PMH服务的有效实施。针对卫生政策和实践提出了建议。这些建议包括使用概念框架为全面、战略和基于证据的PMH护理方法提供参考；确保护理易于获得且灵活；提供具有文化敏感性的护理；为服务提供充足资金以及为卫生专业人员提供高质量培训，并留出专门时间来完成培训。
