The Role of Health Visitors in Supporting Maternal & Family Mental Health

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The Role of Health Visitors in Supporting Maternal & Family Mental Health

Chapter 1: Introduction

Maternal mental problems are considered significant public health issues, unsympathetically influencing the whole family. According to the WHO (2015) report, 10% of prenatal women and 13% of postnatal women suffer mental problems. Depression is one of the common mental health illnesses found in these women. On the other hand, as per NHS (2018), 10% of mothers are mentally ill in the United Kingdom. While many organisations, such as the National Society for the Protection of Cruelty to Children's (NSPCC), stated in "All Babies Count" that there are almost 122,000 children under one year who has parent suffering mental health illness. As indicated by Phillimore, Bradby and Brand. (2019), there are many challenges, such as parental responsibilities, which affect mothers or pregnant women mental problems and recovery. 

Maternal mental problems indicate adverse effects on family and child's cognitive, social, emotional, physical and mental development. It is supported by Leonard et al. (2018), as 25% to 50% of children with mentally ill parents may also experience some mental disorders during early developmental stages and adolescence. Due to that reason, the burden on care and health care workers has been increased as supported by Phillimore et al. (2019), as per the National Institute for Clinical Excellence (2018), the role of health visitors such as midwives and nurses as they adopt additional training in public health nursing. The role and responsibilities of health visitors are characterised by therapeutic relationship, which contributes to the health and well-being of mothers and their families. Recent studies show that one in four pregnant women may experience anxiety and depression during pregnancy (Knight and Tuffnell, 2018)

Furthermore, the findings reveal that 48 percent of pregnant women with anxiety problems and 70 percent of those with depression symptoms may have psychological distress during the perinatal period and the first stages of their children's lives (Saccone et al., 2020). As a result of the novel sensations brought on by the baby's presence, anxiety is to be expected during the puerperium.

As per the study by Pearson et al. (2018), during the postnatal period, the positive role of health visitors in health care provision is critical in identifying and developing an early intervention to improve the mother and family mental health state. Therefore, this proposal has considered the role of health visitors in providing care to mothers and families with mental problems. Thus, the primary focus of this research will be maternal and family mental health. 

Aims and Objectives

This research aims to investigate the factors that lead to maternal and family mental health. Similarly, the study aims to understand the role of health visitors, such as nurses and midwives in providing support to maternal and family mental illness. 

Objectives

Following are the research objectives that need to be achieved;

  • To investigate the factors that lead to maternal and family mental health
  • To analyze the role of health visitors in supporting families concerning their maternal and family mental health.
  • To identify the challenges faced by the health visitors while supporting maternal and family mental health.
  • To articulate the strategies that healthcare professionals and healthcare institutes like NHS can opt to maximise the role of health visitors while mitigating the challenges.

Research Questions

  • What difficulties and challenges do health visitors confront when promoting maternal and family mental health?

  • What are the strategies that healthcare professionals and healthcare institutes like NHS can opt to maximise the role of health visitors while mitigating the challenges?

Significance

In the United Kingdom, health visitors' roles and responsibilities have significance in providing health education programmes and health advice. As per the study by Asmussen and Brims (2018), there are various programmes launched by the National Health System, such as the "Healthy Child Programme", which aims to provide leadership at the strategic level to contribute to the development and improvement of pathways and policies to support the delivery of evidence-based and high-quality consistent care for improving mental health. In this regard, it is necessary to figure out the role of nurses and midwives to adopt early intervention and strategies regarding pre and postnatal mental health problems as described by Pearson et al. (2018). While as per Leonard, Linden and Grant (2018), the emotional, mental, and social condition is important to develop the child. Based on this, Peckover and Aston (2018) articulated that these aspects are also important as they influence family members in terms of mental health conditions. Therefore, this research is important to identify the role of health visitors, specifically nurses and midwives to provide safe and effective intervention to address their mental health problems. Understanding and early detection of this symptom severity will enable the UK healthcare industry, particularly the NHS to develop preventative and promotion initiatives for mother and child psychological health.

PEO Framework

Population

Families with prenatal and postnatal problems.

Exposure

Mental health problems due to pregnancy and post-birth in families.

Outcome

Once the challenges faced by health visitors are identified, it is expected that the proposed study will be able to draw a mechanism that will help the health visitors to support maternal and family mental health.


Rationale

Mental health illness in prenatal and postnatal stages of women is common, and it has a significant consequence for the mother and her family (Phillimore et al., 2019). Trumello et al., (2018) has suggested increasing the prevalence of mental health conditions in women with pregnancy and after giving birth to the child. At the same time, it is still unknown to suggest how these mental health conditions of women have been influencing the family mental state (Leonard et al., 2018). In this regard, mental health problems in prenatal and postnatal women manifest themselves exacerbated via emotional state, dissatisfaction, fear, uncertainty and insecurity (Peckover and Aston, 2018). However, these are still unknown to explore because these problems are due to excessive parental responsibilities or the medical consequences of labour or surgeries (Knight and Tuffnell, 2018)

While Van den Bergh et al., (2020) identified the factors, which influence the mother and family emotional and behavioural state, such as communication of health workers and the mother's ability to self-manage the child development. Although, there was no clarity in the role of health visitors in optimising the strategies that can play an important role in supporting the mother and her family with mental health. On the other hand, some strategies can affect the mother and family mental state, such as effective communication, as it is associated with mental health conditions such as depression and stress (Suzuki et al., 2018). While how nurses and midwives implement effective communication, has still many research gaps in psychological conditions (Ridgway et al., 2021). In response, the proposal research seeks to examine the role of health visitors in improving maternal or family mental health through semi-structured interviews with health visitors, particularly nurses as well as midwives.

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Chapter 2: Literature Review

According to randomised control trail conducted by Chaplin et al. (2021), the early intervention and treatment for pre and postnatal mental health problems can make a significant difference in the quality of life of a woman, which can influence the life of family and children. In this regard, Van den Bergh et al. (2020) mentioned that the health visitor could provide health promotion, early intervention, and primary strategies in pre and postnatal periods to overcome mental health problems. Leonard et al. (2018) mentioned that health visitors play a significant role in identifying and supporting women with pre and postnatal mental health problems. Pre and postnatal mental health problems are related to lack of social support, social isolation, mental discords, and reduced communication and behaviour between nurses and women. Although as Pearson et al. (2018) indicate, it influences child health, social-emotional development, attachment with family, and cognitive development. Furthermore, pre and postnatal mental health problems directly affect maternal employment. Therefore, mental health problems in pre and postnatal women are considered a major issue that influences the family's mental state. 

Chaplin et al. (2021) using randomised control trial emphasised the role of health visitors such as nurses and midwives in pre and postnatal management in the community, which is considered their high priority. The study indicated that mental health problems in pre and postnatal mental health affect 10%-15% of women. Although, there are cases that are still undiagnosed. In contrast, Sánchez-Polán et al. (2021) stated that prenatal depression is 51% more common in young mothers. While, postnatal depression, as indicated in the study by Pearson et al. (2018), has 22.4% in new mothers. Although, this study has not cleared whether this depression is due to first time birth or parenthood responsibilities. The study by Howard and Khalifeh (2020) indicated that prenatal mental health problems had been increased in young women since 1990. Hence, there are many factors highlighted in the study to explain these phenomena, which deserve investigation in the future to identify and develop early intervention and strategies to support young women.

On the other hand, Pearson et al. (2018) emphasised that postnatal mental health is a common phenomenon as many researchers have identified several strategies and interventions to treat such as home-based programmes. As highlighted by Teychenne et al. (2021), home-based programs aim to minimise the impacts of postnatal depression on mothers. However, evidence and research are still limited on the effectiveness of care home visits. As per the study by Pearson et al. (2018), health visitors have been involved in preventing postnatal mental health problems by providing the functionality of a therapeutic relationship with the mother and her family. This study has specified the role of public health nurse and psychiatrist nurse. Hence, the role of health visitors such as nurses and midwives are still unknown to address support and care through effective communication and the therapeutic relationship.

Chapter 3: Methodology

Research Philosophy

The following study will employ interpretivist research philosophy. According to Alharahsheh and Pius (2020), interpretivist research philosophy is defined as the principle which emphasises the researcher to perform a specific role in observing the social world. Interpretivist philosophy depends on what researcher's interest and focus on people's subjective experiences. Similarly, interpretivism research philosophy deal with qualitative studies (Alharahsheh and Pius, 2020). In the context of this research, since the aim is to understand the role of health visitors in supporting maternal and family mental health, in which the interviews will be conducted by asking opened-ended questions; therefore, instead of positivism or pragmatism, interpretivism research philosophy will provide more constructive results about the designed research objectives. In this regard, interpretivism research philosophy will further allow the current study to explore the role of health visitors, particularly nurses and midwives, to the fullest, and the influence of maternal mental health on family can be examined easily.

Research Approach

This study will choose the inductive research approach as a research approach. According to Woiceshyn and Daellenbach (2018), inductive and deductive are two different types of research approaches, and researchers use them as per their choice of data collection techniques and method. As the qualitative method has been chosen, no hypothesis will be established. At the same time, this research will not create any theoretical perspective to answer the research mentioned above question. In this regard, this research cannot adopt a deductive approach. However, this research can adopt an inductive research approach due to the qualitative semi interview method. In this context, the reason for choosing the inductive approach is that the research aims to focus on the role of health visitors in providing support and care to prenatal and postnatal women and their families. While it also focuses on the influence of maternal mental health problems on family members. Therefore, this study will be exploring current theories and models and standard guidelines regarding maternal mental health and its influence on families. On the other hand, the reason for choosing the semi-structured interview method is related to insights and in-depth responses from the participants. Therefore, it will be a significant benefit for choosing an inductive approach to ensure the accurate compliance of all research questions.

Research Method

As mentioned above, this research will be using a qualitative research method. As Cardno (2018) defined, qualitative research is one research method that focuses on obtaining data via informal and open-ended communication. At the same time, there seem to be benefits to employing the qualitative approach, such as the ability to obtain in-depth analysis by generating dialogue or proposing open questions of the participants. As Cardno (2018) emphasised, this method enables the participants to respond as per the question asked. Also, the qualitative method enables researchers to construct the answers and responses in various themes to display results per research questions. 

Another advantage of using the qualitative method is explained by Silverman (2020), as it can allow the investigator to analyse participants' insights using published research such as journals, books, and articles. Since, the study will opt for the primary data collection technique, in this regard, this research will collect data by asking open-ended questions from the health visitors, particularly nurses and midwives, about their care and support for parents and families in managing mental problems and barriers linked with it. Furthermore, the responses to these open-ended questions will be analysed with the help of various themes made as per research aims and objectives. As these questions will be answered and analysed qualitatively, this research will choose the qualitative research method. In addition, the use of semi-structured interviews will allow the study to examine the research mentioned above question in depth. On the other hand, this research will also identify the effective strategies and policies by the NHS to ensure women's quality of life by overcoming mental health problems, for which the use of qualitative research becomes significant. 

Data Collection

This research will conduct semi-structured interviews for data collection. Therefore, the primary data collection will be chosen instead of questionnaires, focus group meetings or surveys. Similarly, the semi-structured interviews will be conducted with health visitors who have at least two years of experience in dealing with families and maternal cases with mental health issues. The participants will be asked semi-structured interviews containing questions that will be designed according to the proposed objectives, so that the designed research objectives can be acquainted to the fullest. 

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Sample and Sampling Technique

The sample size for this research will be ten professional health visitors with at least two-year experience in supporting and managing maternal and family mental health problems. The participants will be chosen based on snowball sampling technique. The snowball sampling technique will allow the participants to refer others. For instance, one health visitor having at least two years of experience in the UK will be employed using personal relations and friends circle. After this, the participant will be requested to refer others who possess the same characteristics. As indicated by Parker, Scott and Geddes. (2019) snowball sampling is defined as chain referral sampling, and it is a non-probability sampling technique in which the sample traits are rare to find. Although Audemard (2020) emphasised snowball sampling is a technique in which current subjects provide referrals to recruit more samples or participants required for the research. 

While it is clear that random sampling cannot provide a non-probability technique to recruit participants. Therefore, snowball sampling is chosen to address the small sample size of participants. Although, it can be the researcher's choice to expand the sample size by adopting and identifying referrals in snowball sampling. As a result, the participant in this study will be asked to suggest others who share the same qualities. This saves time and allows for the recruitment of participants who have considerable knowledge and are aligned with the research objectives and research questions.

For the participants' autonomy, the consent form will be sent via email. The consent form will address the aims and objectives of this research. After reading the consent form, participants will have the choice to sign and participate in the data collection of this research. 

Data Analysis

Thematic analysis will be chosen to analyse the responses of participants. As Braun and Clarke (2019) explained, thematic analysis is defined as the method of analysing qualitative data by establishing themes as required and as per research design. This method is usually employed in interview-based research, containing open-ended questions or transcripts. As defined by Castleberry and Nolen (2018), the goal of thematic analysis is to identify themes. For instance, responses in same nature will be aligned as per the themes and the themes will be generated based on the responses. The themes will be Factors lead to Depression, in this theme all the factors outlined by the participants will be outlined along with the supportive studies to ensure the credibility of the responses. Similarly, other themes will be role of health visitors and how they mitigate the outlined challenges, in which the responses will be stated about challenges are mitigated and what strategies are proposed by the different academically published papers.

Therefore, these themes will be utilised to address the research gap or issue by summarising the data collected. In the context of semi-structured interviews, the rationale for choosing thematic analysis is the construction of methodological position, directed to meaning to the participants who participated. In the context of this study, the thematic analysis will allow the study to align the themes as per the research question designed.

Ethical Consideration

Four basic ethical principles come under the research umbrella: confidentiality, beneficence, non-malfeasance and autonomy. Under these principles, this research will aim to minimise the risk of harm to every participant and protect their autonomy by providing informed consent and the right to withdraw from this research. Therefore, this research will allow the participants to make their choice to be part of this research. While this research will also consider the choice of withdrawing from the data collection procedure. On the other hand, this research will not share personal information during the thematic analysis. In this case, this research will store all the necessary information in the university library. Although, the data will be protected under Data Protection Act 1998 (Rumbold and Pierscionek, 2017). Therefore, it will be discarded as soon as the research completes. 

Conclusion

In conclusion, the purpose of this study is to investigate the involvement of health visitors, specifically nurses and midwives, in improving mother and family mental health. Based on the research question, it is expected that this research will conclude the role and responsibilities of health visitors such as nurses and midwives as the main mediator for providing safe and quality care, which ensures all physical and mental state of pre-natal, and postures natal women. On the other hand, the association of maternal mental health with the family member will be answered efficiently by addressing all the factors in terms of social isolation, and social security. Furthermore, this research can expect to analyse the strategies such as effective communication and strong relationship between the nurses and women to mitigate the challenges of health visitors in support to maternal and family mental health problems.  

References

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