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  • References | MATRIx

    References Atif N, Lovell K, Husain N, Sikander S, Patel V, Rahman A. Barefoot therapists: barriers and facilitators to delivering maternal mental health care through peer volunteers in Pakistan: a qualitative study. Int J Ment Health Syst. 2016;10:24. Mar 15. doi:10.1186/s13033-016-0055-9 ​ Atif N, Nazir H, Zafar S, Chaudhri R, Atiq M, Mullany LC, Rowther AA, Malik A, Surkan PJ and Rahman A (2020) Development of a Psychological Intervention to Address Anxiety During Pregnancy in a Low-Income Country. Front. Psychiatry 10:927. doi: 10.3389/fpsyt.2019.00927 ​ Bina R, Barak A, Posmontier B, Glasser S, Cinamon T. Social workers' perceptions of barriers to interpersonal therapy implementation for treating postpartum depression in a primary care setting in Israel. Health Soc Care Community. 2018;26(1):e75-e84. doi:10.1111/hsc.12479 ​ Bina R. Predictors of postpartum depression service use: A theory-informed, integrative systematic review. Women Birth. 2020;33(1):e24-e32. doi:10.1016/j.wombi.2019.01.006 ​ Boyd RC, Mogul M, Newman D, & Coyne JC. Screening and referral for postpartum depression among low-income women: a qualitative perspective from community health workers. Depression Research and Treatment. 2011. ​ Button S, Thornton A, Lee S, Shakespeare J, Ayers S. Seeking help for perinatal psychological distress: a meta-synthesis of women's experiences. Br J Gen Pract. 2017;67(663):e692-e699. doi:10.3399/bjgp17X692549 ​ Byatt N, Biebel K, Debordes-Jackson G, et al. Community mental health provider reluctance to provide pharmacotherapy may be a barrier to addressing perinatal depression: a preliminary study. Psychiatr Q. 2013;84(2):169-174. doi:10.1007/s11126-012-9236-0 ​ Chartier MJ, Attawar D, Volk JS, Cooper M, Quddus F, McCarthy JA. Postpartum Mental Health Promotion: Perspectives from Mothers and Home Visitors. Public Health Nurs. 2015;32(6):671-679. doi:10.1111/phn.12205 ​ Dennis CL, Chung-Lee L. Postpartum depression help-seeking barriers and maternal treatment preferences: a qualitative systematic review. Birth. 2006;33(4):323-331. doi:10.1111/j.1523-536X.2006.00130.x ​ Doering JJ, Maletta K, Laszewski A, Wichman CL, Hammel J. Needs and challenges of home visitors conducting perinatal depression screening. Infant Ment Health J. 2017;38(4):523-535. doi:10.1002/imhj.21656 ​ Ganann R, Sword W, Newbold KB, Thabane L, Armour L, Kint B. Provider Perspectives on Facilitators and Barriers to Accessible Service Provision for Immigrant Women With Postpartum Depression: A Qualitative Study. Can J Nurs Res. 2019;51(3):191-201. doi:10.1177/0844562119852868 ​ Hadfield H, Wittkowski A. Women's Experiences of Seeking and Receiving Psychological and Psychosocial Interventions for Postpartum Depression: A Systematic Review and Thematic Synthesis of the Qualitative Literature. J Midwifery Womens Health. 2017;62(6):723-736. doi:10.1111/jmwh.12669 ​ Hadfield, H., Glendenning, S., Bee, P. et al. Psychological Therapy for Postnatal Depression in UK Primary Care Mental Health Services: A Qualitative Investigation Using Framework Analysis. J Child Fam Stud 28, 3519–3532 (2019). ​ Hansotte E, Payne SI, Babich SM. Positive postpartum depression screening practices and subsequent mental health treatment for low-income women in Western countries: a systematic literature review. Public Health Rev. 2017;38:3. Published 2017 Jan 31. doi:10.1186/s40985-017-0050-y ​ Jallo N, Salyer J, Ruiz RJ, French E. Perceptions of guided imagery for stress management in pregnant African American women. Arch Psychiatr Nurs. 2015;29(4):249-254. doi:10.1016/j.apnu.2015.04.004 ​ Jones CC, Jomeen J, Hayter M. The impact of peer support in the context of perinatal mental illness: a meta-ethnography. Midwifery. 2014;30(5):491-498. doi:10.1016/j.midw.2013.08.003 ​ Kim JJ, La Porte LM, Adams MG, Gordon TE, Kuendig JM, Silver RK. Obstetric care provider engagement in a perinatal depression screening program. Arch Womens Ment Health. 2009;12(3):167-172. doi:10.1007/s00737-009-0057-6 ​ Lucas G, Olander EK, Ayers S et al. No straight lines – young women’s perceptions of their mental health and wellbeing during and after pregnancy: a systematic review and meta-ethnography. BMC Women's Health 19, 152 (2019). ​ Masood Y, Lovell K, Lunat F, et al. Group psychological intervention for postnatal depression: a nested qualitative study with British South Asian women. BMC Womens Health. 2015;15:109. Published 2015 Nov 25. doi:10.1186/s12905-015-0263-5 ​ Megnin-Viggars O, Symington I, Howard LM, Pilling S. Experience of care for mental health problems in the antenatal or postnatal period for women in the UK: a systematic review and meta-synthesis of qualitative research. Arch Womens Ment Health. 2015;18(6):745-759. doi:10.1007/s00737-015-0548-6 ​ Morrell CJ, Sutcliffe P, Booth A, et al. A systematic review, evidence synthesis and meta-analysis of quantitative and qualitative studies evaluating the clinical effectiveness, the cost-effectiveness, safety and acceptability of interventions to prevent postnatal depression. Health Technol Assess. 2016;20(37):1-414. doi:10.3310/hta20370 ​ Myors KA, Johnson M, Cleary M, Schmied V. Engaging women at risk for poor perinatal mental health outcomes: a mixed-methods study. Int J Ment Health Nurs. 2015;24(3):241-252. doi:10.1111/inm.12109 ​ Nithianandan, N., Gibson-Helm, M., McBride, J. et al. Factors affecting implementation of perinatal mental health screening in women of refugee background. Implementation Sci 11, 150 (2016). ​ Noonan, M., Doody, O., O’Regan, A. et al. Irish general practitioners' view of perinatal mental health in general practice: a qualitative study. BMC Fam Pract 19, 196 (2018). ​ Pugh NE, Hadjistavropoulos HD, Hampton AJD, Bowen A, Williams J. Client experiences of guided internet cognitive behavior therapy for postpartum depression: a qualitative study. Arch Womens Ment Health. 2015;18(2):209-219. doi:10.1007/s00737-014-0449-0 ​ Rowan C, McCourt C, & Bick D. (2010). Provision of perinatal mental health services in two English strategic health authorities: views and perspectives of the multi-professional team. Evidence Based Midwifery, 8(3), 98-106. ​ Smith, M. S., Lawrence, V., Sadler, E., & Easter, A. (2019). Barriers to accessing mental health services for women with perinatal mental illness: systematic review and meta-synthesis of qualitative studies in the UK. BMJ open, 9(1), e024803. ​ Schmied V, Black E, Naidoo N, Dahlen HG, Liamputtong P (2017) Migrant women’s experiences, meanings and ways of dealing with postnatal depression: A meta-ethnographic study. PLoS ONE 12(3): e0172385. ​ Shakespeare J, Blake F, & Garcia J. A qualitative study of the acceptability of routine screening of postnatal women using the Edinburgh Postnatal Depression Scale. British Journal of General Practice. 2003; 53(493), 614-619. ​ Sorsa MA, Kylmä J, Bondas TE. Contemplating Help-Seeking in Perinatal Psychological Distress-A Meta-Ethnography. Int J Environ Res Public Health. 2021;18(10):5226. doi:10.3390/ijerph18105226 ​ Staneva AA, Bogossian F, & Wittkowski A. The experience of psychological distress, depression, and anxiety during pregnancy: A meta-synthesis of qualitative research. Midwifery. 2015; 31(6), 563-573. ​ Watson H, Harrop D, Walton E, Young A, Soltani H. A systematic review of ethnic minority women's experiences of perinatal mental health conditions and services in Europe. PLoS One. 2019;14(1):e0210587. Published 2019 Jan 29. doi:10.1371/journal.pone.0210587 ​ Willey S, Gibson-Helm M, Finch T, East C, Khan N, Boyd L, & Boyle J. Implementing innovative evidence-based perinatal mental health screening for refugee women. Women and Birth. 2018; 31, S8. ​ Williams CJ, Turner KM, Burns A, Evans J, Bennert K. Midwives and women's views on using UK recommended depression case finding questions in antenatal care. Midwifery. 2016;35:39-46. doi:10.1016/j.midw.2016.01.015 ​ Young CA, Burnett H, Ballinger A, et al. Embedded Maternal Mental Health Care in a Pediatric Primary Care Clinic: A Qualitative Exploration of Mothers' Experiences. Acad Pediatr. 2019;19(8):934-941. doi:10.1016/j.acap.2019.08.004 ​

  • Further resources | MATRIx

    Further Resources Recommendations for policy infographic Recommendations for service managers infographic Recommendations for health professionals infographic​ Infographic for women​ Summary report​ Recommendations for commissioners Review 1 publication​ References ​ Perinatal Mental Health Partnership - Matrix videos MATRIx Barriers Framework MATRIx Facilitators Framework

  • Home | MATRIx

    Animation Conceptual Framework MATRIx Informing Perinatal Mental Health Services​ Perinatal M ental Health A ssessment and TR eatment: An Evidence Synthesis and Conceptual Framework of Barriers and Facilitators to I mplementation

  • Conceptual framework | MATRIx

    Conceptual Framework Individual Health Professionals Interpersonal Service Managers Commissioners Policy Makers Society

  • About/Contact | MATRIx

    About MATRIx The MATRIx study is led by researchers at City, University of London in collaboration with experts across the UK. MATRIx reviewed the research evidence on what prevents women who are pregnant or after birth from getting support and treatment they need if they are struggling with emotional or psychological problems. On the basis of these reviews we developed recommendations for healthcare services about how to tackle these barriers to make sure women and families get the help they need. The project involved experts and stakeholders from many different backgrounds and disciplines.​ Aims Identify potential barriers and facilitators to assessment and treatment of perinatal mental health problems across the care pathway, both in terms of women accessing care or treatment, as well as in terms of NHS services implementing new assessment and treatment initiatives. Develop a conceptual framework of barriers and facilitators to implementation that will inform healthcare services and practice, care pathways, and highlight where further research is needed. We screened all search results for relevance and critically appraised the methodology of included papers using Joanna Briggs Critical Appraisal Tools for review 1, and the AMSTAR 2 tool for review 2. Methods Results were analysed using a thematic synthesis and mapping themes onto a systems level model adapted from Ferlie and Shortell’s (2001) Levels of Change framework (e.g. individual level factors, HCP factors, organisational factors and larger system factors) and then grouped to reflect different stages of the care pathway adapted from Goldberg and Huxley’s (1992) Pathways to Care model (e.g. deciding to disclose, assessment, access to care, treatment). Two MATRIx conceptual frameworks were developed that highlight the importance of 66 barriers and 39 facilitators to perinatal mental healthcare at multiple levels that intersect across the care pathway. These conceptual frameworks informed the development of evidence-based recommendations on how to address barriers to ensure that all women are able to access the care and support they need. Recommendations were made for health policy, practice and research. Supporting Organisations Suggested Citation MATRIx study team (2021). Conceptual Framework for Perinatal Mental Health: online tool London, UK. Additional Information Acknowledgements​ We would like to acknowledge our collaborators Agnes Hann, Camilla Rosan, Andrea Sinesi and Clare Thompson for their input throughout the project. Thanks are also due to Nia Roberts who conducted the literature searches for both evidence reviews, and to Nazihah Uddin and Georgina Constantinou who assisted with screening, methodological quality appraisals and data extraction for the reviews. We are very grateful for the advice and oversight of the Study Steering Committee: Professor Jenny Billings (Chair), Dame Professor Cathy Warwick, Kathryn Grant, Dr Fiona Campbell and Dr Sarah Taha. Finally, many thanks to the health professionals, managers, commissioners, parents and other stakeholders who gave us their valuable feedback on the framework.​ Funding This project is funded by the National Institute for Health and Care Research (NIHR) Health Services and Delivery Research programme (NIHR 128068). The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care. Contact Us First Name Last Name Email Write a message Submit Thanks for submitting!

  • Service Managers | MATRIx

    Service Manager Organisational aspects Characteristics of services across care pathway Characteristics of assessment Characteristics of treatment Back to Conceptual Framework

  • Health Professionals | MATRIx

    Health Professionals Health professionals' knowledge​ Getting it right first time​ Health professionals’ attributes​ Back to Conceptual Framework

  • Individual | MATRIx

    Individual Beliefs About Health Services Beliefs About Health Professionals Beliefs About Mental Illness Deciding to Seek Help Fear of Judgement Practical Difficulties Social and Family Life Demographic & Mental Health Factors Back to Conceptual Framework

  • Interpersonal | MATRIx

    Interpersonal Trusting relationship and rapport​ Language barriers​ Shared decision making​ Open and honest communication​ Back to Conceptual Framework

  • Recommendations | MATRIx

    Recommendations Recommendations for policy​ Many elements of the conceptual frameworks can be modified by policy makers and government activity (e.g. workforce provision, healthcare capacity, training etc). Therefore, we recommend policy makers review the frameworks and take comprehensive, strategic and evidence-based efforts to ensure there is an effective system of PMH care. ​ ​ Funding is required to ensure high quality care provision. Therefore, the provision of a comprehensively researched and adequate budget is needed so that all healthcare needs for that financial year can be met. Funding needs to be adequate for service needs and easily accessible. Funding structures may need to be revised depending on the needs of the community in which the service is delivered (e.g. affordable health insurance where free healthcare is not available). ​ ​ The reduction of health inequalities is needed. It is therefore advisable that policy is put in place: (i) improve equality between the sexes/genders by ensuring equal rights for women and men; (ii) in terms of ethnicity, for example changes at the legislative level are needed to protect those who have migrated to a different country from being penalised for accessing healthcare; and (iii) in terms of income, a fair and easily accessible welfare system is needed to prevent health inequalities based on deprivation.​ ​ To see this as in infographic click here Recommendations for practice (service managers) In terms of care, it is recommended that care is co-produced with women and is personalised and culturally appropriate. Increasing the flexibility and accessibility of services should be done through offering home visits and, where this is not possible, providing out-of-hours appointments located in an area with good transport links and an accessible building to allow for pushchairs. In addition, service managers could consider the provision of virtual consultations using web-based platforms, but women should be given the choice about whether virtual consultations are right for them.​ ​ Culturally sensitive care and increased accessibility of care is required for women who are unable to, or have difficulty speaking the country’s official language. This can be done via pictorial aids, the purchase of products such as Language Line, or through collaboration with translation agencies.​ ​ Technology can be a facilitator to PMH services in terms of assessment, referral and intervention. Thus, technology systems should be co-produced with HPs and women to ensure ease of usability and integration into the workflow.​ ​ Where not already implemented, multi-disciplinary teams should be created which facilitates choice and personalised care and ensures an adequate workforce to meet women’s needs. We need to break down silo working and encourage collaborative and joint working within and across services. Collaboration between services is needed with a focus on the identification and building of working relationships and networks with other services (e.g., Citizens Advice Bureau). Furthermore, the building of a coalition of health visitors, midwives, general practitioners, Improving Access to Psychological Therapies practitioners, psychologists and psychiatrists is needed to encourage referral and reduce the risk of women falling out of the care pathway.​ ​ HPs should be provided with high quality training that is delivered face-to-face and incorporates role play simulators where appropriate. This should include training in cultural sensitivity and cross-cultural mental health. Training time for HPs should be built into workloads and be protected.​ ​ To see this as in infographic click here​ Recommendations for practice (health professionals)​ A facilitator to perinatal mental health care was health professionals having good knowledge about perinatal mental health, services and referral pathways. Therefore, health professionals should participate in continuing professional development activities related to perinatal mental health including participating in high quality training. When in contact with women, health professional should listen to women’s concerns and take them seriously. Take the time to address their concerns and take responsibility of that woman to ensure she is referred to appropriate services. Provide assessment in a woman-centred way. Explain questions or wording that women are not clear about. Clearly discuss results with women and explain next steps.​ ​ To see this as in infographic click here Recommendations for women and families We have also designed recommendations for women and families – navigating the system, click here for this infographic.