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Blair A, Tan A, Homer CSE, Vogel JP. How do postnatal care guidelines in Australia compare to international standards? A scoping review and comparative analysis. BMC Pregnancy Childbirth 2024; 24:121. [PMID: 38336632 PMCID: PMC10854083 DOI: 10.1186/s12884-024-06295-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 01/27/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND There is no single national guideline in Australia on the provision of postnatal care, which means there is potential for significant variation in the standard and quality of care. This review aimed to systematically identify, synthesise, and assess the quality of postnatal care guidelines produced for use in Australia. A second aim was to compare postnatal care recommendations in Australian guidelines to the National Institute for Health and Care Excellence's (NICE) and the World Health Organization's (WHO) postnatal care recommendations, to identify gaps and areas of disagreement. We focussed on recommendations regarding postnatal assessment of the woman or newborn, infant feeding, discharge planning, or community-based care. METHODS A scoping review was undertaken informed by the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for scoping reviews. A database search and a manual search of state and national government health departments, professional associations and research institute websites was performed to identify relevant guidelines and recommendations. Guideline quality was assessed using the AGREE II tool. Guideline recommendations from Australia were mapped to 67 NICE/WHO recommendations. Recommendations that partially agreed, were modified, or in disagreement underwent further analysis. RESULTS A total of 31 Australian postnatal guidelines were identified and overall, these were of moderate- to high-quality. Of the 67 NICE/WHO recommendations, most agreed with the recommendations contained in Australian guidelines. There were five NICE/WHO recommendations with which corresponding Australian recommendations disagreed. There were 12 NICE/WHO recommendations that were commonly modified within Australia's guidelines. There were three NICE/WHO recommendations that did not appear in any Australian guideline. CONCLUSIONS Recommendations from postnatal guidelines in Australia have a high level of agreement with corresponding NICE/WHO recommendations. The few disagreements and modifications found in guideline recommendations - both across Australia's guidelines and between Australia's and the NICE/WHO guidelines - are worrying and warrant further examination, as they may result in different standards of care across Australia. Identified gaps in guidance should be prioritised for inclusion in new or updated guidelines where appropriate.
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Affiliation(s)
- Amanda Blair
- Maternal, Child and Adolescent Health Program, Burnet Institute, 85 Commercial Road, Melbourne, VIC, 3004, Australia.
- Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie Street, Carlton, VIC, 3053, Australia.
| | - Annie Tan
- Maternal, Child and Adolescent Health Program, Burnet Institute, 85 Commercial Road, Melbourne, VIC, 3004, Australia
| | - Caroline S E Homer
- Maternal, Child and Adolescent Health Program, Burnet Institute, 85 Commercial Road, Melbourne, VIC, 3004, Australia
- Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie Street, Carlton, VIC, 3053, Australia
| | - Joshua P Vogel
- Maternal, Child and Adolescent Health Program, Burnet Institute, 85 Commercial Road, Melbourne, VIC, 3004, Australia
- Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie Street, Carlton, VIC, 3053, Australia
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Meldrum K, Andersson E, Wallace V, Webb T, Quigley R, Strivens E, Russell S. Approaches to the development of new screening tools that assess distress in Indigenous peoples: A systematic mixed studies review. PLoS One 2023; 18:e0291141. [PMID: 37682832 PMCID: PMC10490875 DOI: 10.1371/journal.pone.0291141] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 08/08/2023] [Indexed: 09/10/2023] Open
Abstract
This mixed studies review assessed the extent of the literature related to approaches used to develop new tools that screen for distress in Indigenous adults globally. It answered the research question: What qualitative and quantitative approaches are used to develop new screening tools that assess distress in Indigenous peoples globally? CINAHL, Embase, Emcare, Medline, PsychInfo and Scopus databases were systematically searched to identify relevant articles published between January 2000 and February 2023. Articles describing the development of a new screening tool for Indigenous peoples, globally, published in English since 2000 and constituted a full publication of primary research, met the inclusion criteria. Studies underwent quality appraisal using the Mixed-Methods Appraisal Tool. A sequential exploratory design guided data analysis. Synthesis occurred using a two-phase sequential method. Nineteen articles constituted the data set. Articles described the use of qualitative, quantitative, or mixed methods in approximately equal numbers. Overall, qualitative methods were used in early stages of tool development, with mixed and quantitative methods used to pilot and validate them. However, most studies did not follow the theoretical guidelines for tool development, and while validation studies took place in over half of the data set, none adequately assessed construct validity. Sixty percent of the articles were located using citation searches, which suggests database searches were ineffective. Valid tools that screen for distress in Indigenous populations support equitable access to health care. This review found that most screening tools were developed in Australia. However, additional evidence of their validity is needed in addition to a valid diagnostic tool that supports the determination of criterion validity. These needs present important future research opportunities.
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Affiliation(s)
- Kathryn Meldrum
- College of Medicine and Dentistry, James Cook University, Cairns, Queensland, Australia
| | | | - Valda Wallace
- College of Medicine and Dentistry, James Cook University, Cairns, Queensland, Australia
| | - Torres Webb
- College of Medicine and Dentistry, James Cook University, Cairns, Queensland, Australia
| | - Rachel Quigley
- College of Medicine and Dentistry, James Cook University, Cairns, Queensland, Australia
| | - Edward Strivens
- College of Medicine and Dentistry, James Cook University, Cairns, Queensland, Australia
- Queensland Health, Cairns and Hinterland Hospital and Health Service, Cairns, Queensland, Australia
| | - Sarah Russell
- College of Medicine and Dentistry, James Cook University, Cairns, Queensland, Australia
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Carlin E, Ferrari K, Spry EP, Williams M, Atkinson D, Marley JV. Implementation of the ‘Kimberley Mum’s Mood Scale’ across primary health care services in the Kimberley region of Western Australia: A mixed methods assessment. PLoS One 2022; 17:e0273689. [PMID: 36054104 PMCID: PMC9439224 DOI: 10.1371/journal.pone.0273689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 08/13/2022] [Indexed: 11/19/2022] Open
Abstract
The Kimberley Mum’s Mood Scale (KMMS) was co-designed with Aboriginal women and healthcare professionals to improve culturally appropriate screening practices for perinatal depression and anxiety. This paper describes the implementation of the KMMS across the remote Kimberley region of Western Australia from January 2018 to December 2021. We used the Dynamic Sustainability Framework to progress the implementation and assess at the intervention, practice setting and ecological system level using a mixed methods approach to analyse implementation. Rates of administration and results of screening were described using a retrospective audit of electronic medical records. Analyses of KMMS training registry, stakeholder engagement and sustainability initiatives were descriptive. KMMS acceptability was assessed using qualitative descriptive approaches to analyse patient feedback forms (n = 39), healthcare professional surveys (n = 15) and qualitative interviews with healthcare professionals (n = 6). We found a significant increase in overall recorded perinatal screening (pre-implementation: 30.4% v Year 3: 46.5%, P < 0.001) and use of the KMMS (pre-implementation: 16.4% v Year 3: 46.4%, P < 0.001). There was improved fidelity in completing the KMMS (from 2.3% to 61.8%, P < 0.001), with 23.6% of women screened recorded as being at increased risk of depression and anxiety. Most healthcare professionals noted the high levels of perinatal mental health concerns, stress, and trauma that their patients experienced, and identified the KMMS as the most appropriate perinatal screening tool. Aboriginal women reported that it was important for clinics to ask about mood and feelings during the perinatal period, and that the KMMS was appropriate. Aboriginal women consistently reported that it was good to have someone to talk to. This study demonstrates that innovation in perinatal depression and anxiety screening for Aboriginal women is possible and can be implemented into routine clinical care with the support of a sustained multi-year investment and strong partnerships.
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Affiliation(s)
- Emma Carlin
- The Rural Clinical School of Western Australia, The University of Western Australia, Broome, Western Australia, Australia
- Kimberley Aboriginal Medical Services, Broome, Western Australia, Australia
- * E-mail:
| | - Katherine Ferrari
- Kimberley Aboriginal Medical Services, Broome, Western Australia, Australia
| | - Erica P. Spry
- The Rural Clinical School of Western Australia, The University of Western Australia, Broome, Western Australia, Australia
- Kimberley Aboriginal Medical Services, Broome, Western Australia, Australia
| | - Melissa Williams
- Kimberley Population Health Unit, Western Australian Country Health Service, Broome, Western Australia, Australia
| | - David Atkinson
- The Rural Clinical School of Western Australia, The University of Western Australia, Broome, Western Australia, Australia
| | - Julia V. Marley
- The Rural Clinical School of Western Australia, The University of Western Australia, Broome, Western Australia, Australia
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Kiewa J, Meltzer-Brody S, Milgrom J, Bennett E, Mackle T, Guintivano J, Hickie IB, Colodro-Conde L, Medland SE, Martin N, Wray N, Byrne E. Lifetime prevalence and correlates of perinatal depression in a case-cohort study of depression. BMJ Open 2022; 12:e059300. [PMID: 35973706 PMCID: PMC9621163 DOI: 10.1136/bmjopen-2021-059300] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES This study sought to evaluate the prevalence, timing of onset and duration of symptoms of depression in the perinatal period (PND) in women with depression, according to whether they had a history of depression prior to their first perinatal period. We further sought to identify biopsychosocial correlates of perinatal symptoms in women with depression. DESIGN AND SETTING The Australian Genetics of Depression Study is an online case cohort study of the aetiology of depression. For a range of variables, women with depression who report significant perinatal depressive symptoms were compared with women with lifetime depression who did not experience perinatal symptoms. PARTICIPANTS In a large sample of parous women with major depressive disorder (n=7182), we identified two subgroups of PND cases with and without prior depression history (n=2261; n=878, respectively). PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome measure was a positive screen for PND on the lifetime version of the Edinburgh Postnatal Depression Scale. Descriptive measures reported lifetime prevalence, timing of onset and duration of PND symptoms. There were no secondary outcome measures. RESULTS The prevalence of PND among parous women was 70%. The majority of women reported at least one perinatal episode with symptoms both antenatally and postnatally. Of women who experienced depression prior to first pregnancy, PND cases were significantly more likely to report more episodes of depression (OR=1.15 per additional depression episode, 95% CI 1.13 to 1.17, p<0.001), non-European ancestry (OR 1.5, 95% CI 1.0 to 2.1, p=0.03), severe nausea during pregnancy (OR 1.3, 95% CI 1.1 to 1.6, p=0.006) and emotional abuse (OR 1.4, 95% CI 1.1 to 1.7, p=0.005). CONCLUSIONS The majority of parous women with lifetime depression in this study experienced PND, associated with more complex, severe depression. Results highlight the importance of perinatal assessments of depressive symptoms, particularly for women with a history of depression or childhood adverse experiences.
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Affiliation(s)
- Jacqueline Kiewa
- Child Health Research Centre, The University of Queensland Faculty of Medicine and Biomedical Sciences, Brisbane, Queensland, Australia
| | | | - Jeannette Milgrom
- Parent-Infant Research Institute, Heidelberg Heights, Victoria, Australia
- University of Melbourne, Melbourne, Victoria, Australia
| | | | | | - Jerry Guintivano
- Department of Psychiatry, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Ian B Hickie
- Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
| | | | - Sarah E Medland
- QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
| | - Nick Martin
- QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
| | - Naomi Wray
- Institute for Molecular Bioscience, University of Queensland, Brisbane, Queensland, Australia
- Queensland Brain Institute, University of Queensland, Brisbane, Queensland, Australia
| | - Enda Byrne
- Child Health Research Centre, The University of Queensland Faculty of Medicine and Biomedical Sciences, Brisbane, Queensland, Australia
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Patterson K, Sargeant J, Yang S, McGuire-Adams T, Berrang-Ford L, Lwasa S, Communities B, Steele V, Harper SL. Are Indigenous research principles incorporated into maternal health research? A scoping review of the global literature. Soc Sci Med 2021; 292:114629. [PMID: 34896728 DOI: 10.1016/j.socscimed.2021.114629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 11/05/2021] [Accepted: 12/01/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Indigenous women world-wide are diverse and heterogenous, yet many have similar experiences of colonization, land dispossession, and discrimination. These experiences along with inequitable access to, and quality of, maternal healthcare increase adverse maternal health outcomes. To improve health outcomes for Indigenous women, studies must be conducted with Indigenous involvement and reflect Indigenous research principles. Objectives/Aim: The aim of this review was to explore the range, extent, and nature of Indigenous maternal health research and to assess the reporting of Indigenous research principles in the global Indigenous maternal health literature. METHODS Following a systematic scoping review protocol, four scholarly electronic databases were searched. Articles were included if they reported empirical research published between 2000 and 2019 and had a focus on Indigenous maternal health. Descriptive data were extracted from relevant articles and descriptive analysis was conducted. Included articles were also assessed for reporting of Indigenous research principles, including Indigenous involvement, context of colonization, Indigenous conceptualizations of health, community benefits, knowledge dissemination to participants or communities, and policy or intervention recommendations. RESULTS Four-hundred and forty-one articles met the inclusion criteria. While studies were conducted in all continents except Antarctica, less than 3% of articles described research in low-income countries. The most researched topics were access to and quality of maternity care (25%), pregnancy outcome and/or complications (18%), and smoking, alcohol and/or drug use during pregnancy (14%). The most common study design was cross-sectional (49%), and the majority of articles used quantitative methods only (68%). Less than 2% of articles described or reported all Indigenous research principles, and 71% of articles did not report on Indigenous People's involvement. CONCLUSIONS By summarizing the trends in published literature on Indigenous maternal health, we highlight the need for increased geographic representation of Indigenous women, expansion of research to include important but under-researched topics, and meaningful involvement of Indigenous Peoples.
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Affiliation(s)
- Kaitlin Patterson
- Department of Population Medicine, University of Guelph, 50 Stone Road East, Guelph, Ontario, N1G 2W1, Canada.
| | - Jan Sargeant
- Department of Population Medicine, University of Guelph, 50 Stone Road East, Guelph, Ontario, N1G 2W1, Canada.
| | - Seungmi Yang
- Department of Epidemiology, Biostatistics and Occupational Health, Purvis Hall, McGill University, 1020 Pine Avenue West, Montreal, Quebec, H3A 1A2, Canada.
| | - Tricia McGuire-Adams
- Faculty of Education, University of Ottawa, 145 Jean-Jacques-Lussier Private, Ottawa, Ontario, K1N 6N5, Canada
| | - Lea Berrang-Ford
- Priestley International Centre for Climate, University of Leeds, Leeds, LS2 9JT, United Kingdom.
| | - Shuaib Lwasa
- Department of Geography, Geo-Informatics and Climatic Sciences, School of Forestry, Environmental and Geographical Sciences, College of Agricultural and Environmental Sciences, Makerere University, Arts Building, South Wing Ground Floor, P.O Box, 7062, Kampala, Uganda.
| | | | - Vivienne Steele
- Department of Population Medicine, University of Guelph, 50 Stone Road East, Guelph, Ontario, N1G 2W1, Canada.
| | - Sherilee L Harper
- Department of Population Medicine, University of Guelph, 50 Stone Road East, Guelph, Ontario, N1G 2W1, Canada; School of Public Health, Edmonton Clinic Health Academy, University of Alberta, Edmonton, Alberta, T6G 1C9, Canada.
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Chan AW, Reid C, Skeffington P, Gorman E, Marriott R. Experiences of using the Edinburgh Postnatal Depression Scale in the context of antenatal care for Aboriginal mothers: Women and midwives' perspectives. Women Birth 2021; 35:367-377. [PMID: 34531165 DOI: 10.1016/j.wombi.2021.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 08/15/2021] [Accepted: 09/07/2021] [Indexed: 11/16/2022]
Abstract
PROBLEM Routine administration of the Edinburgh Postnatal Depression Scale (EPDS) is intended to promote early detection and preventative support for those who may be at risk of perinatal depression and anxiety. The cultural suitability of the EPDS has not been validated in the Aboriginal Australian context. BACKGROUND Marked differences in health outcomes and service access between Australian Aboriginal and non-Aboriginal women and infants continue to exist. AIM This study aimed to explore the cultural validity of the EPDS through understanding the experiences of Aboriginal women and midwives. METHODS Qualitative data was drawn from semi-structured interviews/yarns with 13 Perth-based Aboriginal antenatal women and 10 non-Aboriginal midwives. FINDINGS Utilising a grounded theory approach, thematic analysis of verbatim transcripts revealed that, surprisingly, women expressed generally favourable views of the EPDS, especially when the relationships between women and midwives were focused on. Midwives, however, expressed reservations about administering the EPDS and used the EPDS as a conversation-starter rather than as a standardised, standalone tool. DISCUSSION In attempt to reconcile conflicting perspectives, analysis of recordings extended to evaluate micro-processes in the interviews. At the process level, it was clear that demand characteristics operated in some interviews, including socially desirable response biases, demand biases and acquiescent response styles. CONCLUSION This highlights the need for researchers and clinicians to be trained in non-leading interview questioning techniques and in yarning methodology. Researchers and clinicians should also be aware of the cognitive biases and demand characteristics that may influence responding, likely perpetuated by dominant forces of a colonised society.
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Affiliation(s)
| | - Corinne Reid
- Victoria University, Australia; Ngangk Yira: Research Centre for Aboriginal Health and Social Equity, Murdoch University, Australia
| | - Petra Skeffington
- Murdoch University, Australia; Ngangk Yira: Research Centre for Aboriginal Health and Social Equity, Murdoch University, Australia
| | | | - Rhonda Marriott
- Murdoch University, Australia; Ngangk Yira: Research Centre for Aboriginal Health and Social Equity, Murdoch University, Australia
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Chan AW, Reid C, Skeffington P, Marriott R. A systematic review of EPDS cultural suitability with Indigenous mothers: a global perspective. Arch Womens Ment Health 2021; 24:353-365. [PMID: 33245435 PMCID: PMC8116293 DOI: 10.1007/s00737-020-01084-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 10/12/2020] [Indexed: 12/20/2022]
Abstract
The Edinburgh Postnatal Depression Scale (EPDS) is used extensively as the "gold standard" perinatal depression and anxiety screening tool. This study contributes to an emerging discussion about the tool's shortcomings, specifically around cultural suitability for use with Indigenous women. A systematic search was conducted in ProQuest, PsycINFO, MEDLINE (Web of Science), PubMed, Scopus, Informit, and CINAHL research databases, and grey literature. The quality of the body of evidence was assessed using the NHMRC Level of Evidence framework. Three studies supported the cultural validation of the EPDS with Indigenous groups in Canada (n = 2) and the USA (n = 1). The remaining eleven Australian studies demonstrated that cultural concerns were suggested by either Indigenous mothers, healthcare professionals (Indigenous and non-Indigenous), or both, though cultural concerns were more weighted from the perspectives of healthcare professionals. The quality of the evidence was not strong, and thus, there is a critical and urgent need for targeted research in this area. This review identified and recommended Indigenous-specific methodologies that can be adopted for more trustworthy, culturally safe, and effective research in this area. Given that the EPDS is currently considered gold standard in routine perinatal mental health screening practice in countries around the world, these findings raise significant concerns. Using culturally relevant research methodologies, such as the use of mixed-methods design, could lay stronger groundwork for further investigation of the broader utility and cultural relevance of the tool.
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Affiliation(s)
- Ai Wen Chan
- School of Psychology, Exercise Science, Chiropractic & Counselling, Murdoch University, Perth, Australia.
| | - Corinne Reid
- Victoria University, Melbourne, Australia.
- Global Health Academy, The University of Edinburgh, Edinburgh, Scotland.
| | - Petra Skeffington
- Psychology, Exercise Science, Chiropractic & Counselling, Murdoch University, Perth, Australia
| | - Rhonda Marriott
- Ngangk Yira Research Centre for Aboriginal Health and Social Equity, Murdoch University, Perth, Australia
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Kotz J, Marriott R, Reid C. The EPDS and Australian Indigenous women: A systematic review of the literature. Women Birth 2021; 34:e128-e134. [DOI: 10.1016/j.wombi.2020.02.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Revised: 12/20/2019] [Accepted: 02/04/2020] [Indexed: 12/14/2022]
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Risk and resilience: a mixed methods investigation of Aboriginal Australian women's perinatal mental health screening assessments. Soc Psychiatry Psychiatr Epidemiol 2021; 56:547-557. [PMID: 33226453 PMCID: PMC8053144 DOI: 10.1007/s00127-020-01986-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Accepted: 11/10/2020] [Indexed: 11/21/2022]
Abstract
PURPOSE To describe the psychosocial protective and risk factors for perinatal mental health identified in a sample of Aboriginal women's Kimberley Mum's Mood Scale (KMMS) assessments and explore the role of these factors in their screening assessment and diagnostic outcome. METHODS We used a mixed methods approach to retrospectively analyse a cross-sectional study dataset of 91 completed KMMS assessments. This included: categorising the clinical notes from the KMMS psychosocial yarn into 'risk' and 'protective' factors and describing these categories, describing the number and type of risk and protective factors associated with different KMMS risk assessment categories (no, low, medium, high), and exploring relationships between these risk and protective factors and diagnosis of perinatal depression and/or anxiety. RESULTS Protective factors were recorded for the vast majority of the women; the most prominent was positive family relationships. When protective and risk factors were stratified by KMMS risk category, women in the higher risk group less commonly had specific protective factors (11-33% high vs 61-100% no risk) and more commonly had risk factors (22-67% high vs 6-28% no risk) than women with lower KMMS assessed risk. The average number of protective factors decreased with increasing KMMS risk category (4.9 ± 1.1 to 1.6 ± 1.3), with the inverse pattern for risk factors (1.1 ± 1.1 to 3.8 ± 1.0). Having protective factors also appeared to reduce the risk of developing clinical depression or anxiety. CONCLUSION Assessing protective factors in mental health screening for perinatal Aboriginal women increases the effectiveness of screening and provides a foundation for the delivery of local structured psychosocial care.
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Carlin E, Spry E, Atkinson D, Marley JV. Why validation is not enough: Setting the scene for the implementation of the Kimberley Mum's Mood Scale. PLoS One 2020; 15:e0234346. [PMID: 32530934 PMCID: PMC7292413 DOI: 10.1371/journal.pone.0234346] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 05/22/2020] [Indexed: 01/15/2023] Open
Abstract
Background The two part Kimberley Mum’s Mood Scale (KMMS) has been developed and validated as a culturally appropriate perinatal depression and anxiety screening tool for Aboriginal women living in the sparsely populated Kimberley region of North West Australia. As part of implementation aspects of user acceptability were explored to improve clinical utilisation of the KMMS. Methods Eighteen health professionals involved in perinatal care participated in an online survey or a qualitative semi-structured interview. Ten Aboriginal women (who held administrative, professional or executive roles) were subsequently interviewed in depth to further explore aspects of KMMS user acceptability. Results Many of the health professionals were not using the second part of the KMMS (the psychosocial discussion tool). Time constraints and a perception that the KMMS is only appropriate for women with literacy issues were identified by health professionals as significant barriers to KMMS uptake. In contrast the Aboriginal women interviewed considered the KMMS to be important for literate Aboriginal women and placed high value on having the time and space to ‘yarn’ with health professionals about issues that are important to them. Conclusion Implementing the KMMS across the Kimberley region requires health professionals to be trained. It also requires strategic engagement with health services to ensure health professionals and mangers understand the rationale and significance of the KMMS and are engaged in its successful implementation.
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Affiliation(s)
- Emma Carlin
- The Rural Clinical School of Western Australia, The University of Western Australia, Broome, Western Australia, Australia
- Kimberley Aboriginal Medical Services, Broome, Western Australia, Australia
- * E-mail:
| | - Erica Spry
- Kimberley Aboriginal Medical Services, Broome, Western Australia, Australia
| | - David Atkinson
- The Rural Clinical School of Western Australia, The University of Western Australia, Broome, Western Australia, Australia
| | - Julia V. Marley
- The Rural Clinical School of Western Australia, The University of Western Australia, Broome, Western Australia, Australia
- Kimberley Aboriginal Medical Services, Broome, Western Australia, Australia
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Carlin E, Blondell SJ, Cadet-James Y, Campbell S, Williams M, Engelke C, Taverner D, Marriott R, Edmonds K, Atkinson D, Marley JV. Study protocol: a clinical trial for improving mental health screening for Aboriginal and Torres Strait Islander pregnant women and mothers of young children using the Kimberley Mum's Mood Scale. BMC Public Health 2019; 19:1521. [PMID: 31727039 PMCID: PMC6857148 DOI: 10.1186/s12889-019-7845-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 10/24/2019] [Indexed: 12/13/2022] Open
Abstract
Background Improving the rates of, and instruments used in, screening for perinatal depression and anxiety among Aboriginal and Torres Strait Islander women are important public health priorities. The Kimberley Mum’s Mood Scale (KMMS) was developed and later validated as an effective and acceptable perinatal depression and anxiety screening tool for the Kimberley region under research conditions. Other regions have expressed interest in using the KMMS with perinatal Aboriginal and Torres Strait Islander women. It is, however, important to re-evaluate the KMMS in a larger Kimberley sample via a real world implementation study, and to test for applicability in other remote and regional environments before recommendations for wider use can be made. This paper outlines the protocol for evaluating the process of implementation and establishing the ‘real world’ validity and acceptability of the KMMS in the Kimberley, Pilbara and Far North Queensland in northern Australia. Methods The study will use a range of quantitative and qualitative methods across all sites. KMMS validation/revalidation internal consistency of Part 1 will be determined using Cronbach’s alpha. Equivalence for identifying risk of depression and anxiety compared to a standard reference assessment will be determined from receiver operating characteristic curves. Sensitivity and specificity will be determined based on these cut-points. Qualitative methods of phenomenology will be used to explore concepts of KMMS user acceptability (women and health professionals). Additional process evaluation methods will collate, assess and report on KMMS quality review data, consultations with health service administrators and management, field notes, and other documentation from the research team. This information will be reported on using the Dynamic Sustainability Framework. Discussion This project is contributing to the important public health priority of screening Aboriginal and Torres Strait Islander women for perinatal depression and anxiety with tools that are meaningful and responsive to cultural and clinical needs. Identifying and addressing barriers to implementation contributes to our understanding of the complexity of improving routine clinical practie. Trial registration The study was registered retrospectively on 15/05/2019 with the Australian and New Zealand Clinical Trial registry (ACTRN12619000580178).
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Affiliation(s)
- Emma Carlin
- The Rural Clinical School of Western Australia, The University of Western Australia, 12 Napier Tce, PO Box 1377, Broome, WA, 6725, Australia. .,Kimberley Aboriginal Medical Services, 12 Napier Tce, PO Box 1377, Broome, WA, 6725, Australia.
| | - Sarah J Blondell
- The Rural Clinical School of Western Australia, The University of Western Australia, 12 Napier Tce, PO Box 1377, Broome, WA, 6725, Australia
| | - Yvonne Cadet-James
- Apunipima Cape York Health Council, 186 McCoombe Street, PO Box 12045, Bungalow, QLD, 4870, Australia
| | - Sandra Campbell
- Centre for Indigenous Health Equity Research, Central Queensland University, Cnr of Shields and Lake Streets, Cairns, QLD, 4870, Australia
| | - Melissa Williams
- Western Australian Country Health Service - Kimberley Population Health Unit, 4/9 Napier Tce (WA 6725 Locked Bag 525), Broome, WA, 6725, Australia
| | - Catherine Engelke
- The Rural Clinical School of Western Australia, The University of Western Australia, 12 Napier Tce, PO Box 1377, Broome, WA, 6725, Australia
| | - Des Taverner
- The Rural Clinical School of Western Australia, The University of Western Australia, 12 Napier Tce, PO Box 1377, Broome, WA, 6725, Australia
| | - Rhonda Marriott
- Ngangk Yira: Murdoch University Research Centre for Aboriginal Health and Social Equity, Murdoch University, 90 South Street, Murdoch, WA, 6150, Australia
| | - Karen Edmonds
- King's College London, 1 Lambeth Palace Road, Waterloo, London, SE1 7EU, UK
| | - David Atkinson
- The Rural Clinical School of Western Australia, The University of Western Australia, 12 Napier Tce, PO Box 1377, Broome, WA, 6725, Australia
| | - Julia V Marley
- The Rural Clinical School of Western Australia, The University of Western Australia, 12 Napier Tce, PO Box 1377, Broome, WA, 6725, Australia.,Kimberley Aboriginal Medical Services, 12 Napier Tce, PO Box 1377, Broome, WA, 6725, Australia
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'Having a Quiet Word': Yarning with Aboriginal Women in the Pilbara Region of Western Australia about Mental Health and Mental Health Screening during the Perinatal Period. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16214253. [PMID: 31683908 PMCID: PMC6862568 DOI: 10.3390/ijerph16214253] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 10/28/2019] [Accepted: 10/31/2019] [Indexed: 11/26/2022]
Abstract
Despite high rates of perinatal depression and anxiety, little is known about how Aboriginal women in Australia experience these disorders and the acceptability of current clinical screening tools. In a 2014 study, the Kimberley Mum’s Mood Scale (KMMS) was validated as an acceptable perinatal depression and anxiety screening tool for Aboriginal women in the Kimberley region of Western Australia. In the current study, we explored if it was appropriate to trial and validate the KMMS with Aboriginal women in the Pilbara. Yarning as a methodology was used to guide interviews with 15 Aboriginal women in the Pilbara who had received maternal and child health care within the last three years. Data were analysed thematically, the results revealing that this cohort of participants shared similar experiences of stress and hardship during the perinatal period. Participants valued the KMMS for its narrative-based approach to screening that explored the individual’s risk and protective factors. While support for the KMMS was apparent, particular qualities of the administering health care professional were viewed as critical to the tool being well received and culturally safe. Building on these findings, we will work with our partner health services in the Pilbara to validate the KMMS with Pilbara Aboriginal women.
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Marley JV, Carlin E, Engelke C. Screening for perinatal depression and predictors of underscreening: findings of the Born in Queensland study. Med J Aust 2019; 211:189-189.e1. [PMID: 31264228 DOI: 10.5694/mja2.50257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Julia V Marley
- Rural Clinical School of Western Australia, University of Western Australia, Broome, WA.,Kimberley Aboriginal Medical Services, Broome, WA
| | - Emma Carlin
- Rural Clinical School of Western Australia, University of Western Australia, Broome, WA.,Kimberley Aboriginal Medical Services, Broome, WA
| | - Catherine Engelke
- Rural Clinical School of Western Australia, University of Western Australia, Kununurra, WA
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Chan AW, Skeffington P, Reid C, Marriott R. Research protocol for the exploration of experiences of Aboriginal Australian mothers and healthcare professionals when using the Edinburgh Postnatal Depression Scale: a process-oriented validation study using triangulated participatory mixed methods. BMJ Open 2018; 8:e022273. [PMID: 30287670 PMCID: PMC6194483 DOI: 10.1136/bmjopen-2018-022273] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Adopting a process-oriented framework for test validation can help to establish whether this tool has the potential to be an acceptable, valid and reliable indicator of depression for mothers and mothers-to-be. This mixed-methods research protocol seeks to explore the views and experiences of Aboriginal mothers and healthcare professionals in relation to the Edinburgh Postnatal Depression Scale (EPDS), and is intended to highlight potential barriers in perinatal mental health conceptualisation, engagement and response style. METHODS AND ANALYSIS Thematic analysis will be applied to interview transcripts of Aboriginal Australian mothers (n=6+) and healthcare professionals (n=6+) to identify key themes. The process-focused validation model will use narratives about experiences of using the EPDS as the priority point of analysis. Item-level data and process-level (experience) data are key phenomenological data. The interview-based narratives will be then compared with EPDS scores to check for points of congruence and divergence. This will be done at two time points, antenatally and postnatally, to assess changes in assessment processes and perceptions. Bridging evidence-based research with clinical practice in an Aboriginal Australian context will be facilitated by an investigation of the perceived cultural relevance and likely clinical effectiveness of EPDS. Such evidence is critical to understanding whether the EPDS fulfils its intended purpose. The guiding principles in designing this research protocol is to benefit the well-being of young Aboriginal families and communities through partnership with Aboriginal women. ETHICS AND DISSEMINATION Ethics approval was obtained from Human Research Ethics Committee of Murdoch University and from Western Australian Aboriginal Health Ethics Committee (WAAHEC). Participating healthcare sites and services have provided letters of support. Results of this study will be submitted for publication in a peer-reviewed journal.
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Affiliation(s)
- Ai Wen Chan
- School of Psychology and Exercise Science, Murdoch University, Perth, Western Australia, Australia
| | - Petra Skeffington
- School of Health Professions, Murdoch University, Perth, Western Australia, Australia
- Ngangk Yira, Research Centre for Aboriginal Health & Social Equity, Murdoch University, Perth, Western Australia, Australia
| | - Corinne Reid
- Ngangk Yira, Research Centre for Aboriginal Health & Social Equity, Murdoch University, Perth, Western Australia, Australia
- School of Health in Social Science, University of Edinburgh, Scotland, UK
| | - Rhonda Marriott
- Ngangk Yira, Research Centre for Aboriginal Health & Social Equity, Murdoch University, Perth, Western Australia, Australia
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Armstrong EM, Ciccone N, Hersh D, Katzenellebogen J, Coffin J, Thompson S, Flicker L, Hayward C, Woods D, McAllister M. Development of the Aboriginal Communication Assessment After Brain Injury (ACAABI): A screening tool for identifying acquired communication disorders in Aboriginal Australians. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2017; 19:297-308. [PMID: 28425776 DOI: 10.1080/17549507.2017.1290136] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 01/30/2017] [Indexed: 06/07/2023]
Abstract
PURPOSE Acquired communication disorders (ACD), following stroke and traumatic brain injury, may not be correctly identified in Aboriginal Australians due to a lack of linguistically and culturally appropriate assessment tools. Within this paper we explore key issues that were considered in the development of the Aboriginal Communication Assessment After Brain Injury (ACAABI) - a screening tool designed to assess the presence of ACD in Aboriginal populations. METHOD A literature review and consultation with key stakeholders were undertaken to explore directions needed to develop a new tool, based on existing tools and recommendations for future developments. RESULT The literature searches revealed no existing screening tool for ACD in these populations, but identified tools in the areas of cognition and social-emotional wellbeing. Articles retrieved described details of the content and style of these tools, with recommendations for the development and administration of a new tool. The findings from the interview and focus group views were consistent with the approach recommended in the literature. CONCLUSIONS There is a need for a screening tool for ACD to be developed but any tool must be informed by knowledge of Aboriginal language, culture and community input in order to be acceptable and valid.
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Affiliation(s)
| | - Natalie Ciccone
- a School of Medical & Health Sciences , Edith Cowan University , Perth , Australia
| | - Deborah Hersh
- a School of Medical & Health Sciences , Edith Cowan University , Perth , Australia
| | - Judith Katzenellebogen
- b University of Western Australia, Telethon Institute for Child Health Research , Perth , Australia
| | - Juli Coffin
- c Office of the Dean, University of Notre Dame , Broome , Australia
| | - Sandra Thompson
- d Western Australian Centre for Rural Health, University of Western Australia , Geraldton , Australia
| | - Leon Flicker
- e Western Australian Centre for Health & Ageing , Centre for Medical Research, University of Western Australia , Perth , Australia
| | - Colleen Hayward
- f Kurongkurl Katitjin, Centre for Indigenous Australian Education and Research, Edith Cowan University , Joondalup , Australia , and
| | - Deborah Woods
- g Geraldton Regional Aboriginal Medical Service , Geraldton , Austarlia
| | - Meaghan McAllister
- a School of Medical & Health Sciences , Edith Cowan University , Perth , Australia
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Marley JV, Kotz J, Engelke C, Williams M, Stephen D, Coutinho S, Trust SK. Validity and Acceptability of Kimberley Mum's Mood Scale to Screen for Perinatal Anxiety and Depression in Remote Aboriginal Health Care Settings. PLoS One 2017; 12:e0168969. [PMID: 28135275 PMCID: PMC5279756 DOI: 10.1371/journal.pone.0168969] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Accepted: 12/10/2016] [Indexed: 01/23/2023] Open
Abstract
Background The Edinburgh Postnatal Depression Scale (EPDS) is widely recommended for perinatal anxiety and depression screening. However, many Aboriginal women find EPDS language complex and confusing, and providers find using it with Aboriginal women challenging. The two part Kimberley Mum’s Mood Scale (KMMS) was developed to improve screening: Part 1 is a Kimberley version of EPDS; Part 2 is a psychosocial tool that enables contextualisation of Part 1 scores. We aimed to determine if KMMS is a valid and acceptable method of identifying Kimberley Aboriginal perinatal women at risk of anxiety or depressive disorders compared to a semi-structured clinical interview. Methods Across 15 sites in the Kimberley, Western Australia, 97 Aboriginal women aged 16 years and older who intended to continue with their pregnancy or had a baby within the previous 12 months were administered the KMMS by trained healthcare providers who provided an overall assessment of no, low, moderate or high risk; 91 participants were then independently assessed by a blinded clinical expert using Diagnostic and Statistical Manual of Mental Disorders, 4th Edition criteria. A qualitative approach was used to determine KMMS’ acceptability. Results Part 1 had high internal consistency (Cronbach’s alpha, 0.89), and overall KMMS risk equivalence for screening for anxiety or depressive disorders was moderate (sensitivity, 83%; specificity, 87%; positive predictive value, 68%). Participants found the process easy and useful, and healthcare providers found KMMS more useful than EPDS. Part 2 allowed healthcare providers to ask questions that gave participants an opportunity to express themselves, resulting in a deeper understanding between them. Conclusion KMMS is an effective tool for identifying Kimberley Aboriginal perinatal women at risk of anxiety and depressive disorders. Adoption of KMMS with culturally safe training and support is likely to improve screening processes, and with further validation may have broader applicability across remote Australia.
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Affiliation(s)
- Julia V. Marley
- The Rural Clinical School of Western Australia, The University of Western Australia, Broome, Western Australia, Australia
- Kimberley Aboriginal Medical Services Ltd, Broome, Western Australia, Australia
- * E-mail:
| | - Jayne Kotz
- School of Psychology and Exercise Science, Murdoch University, Murdoch, Western Australia, Australia
| | - Catherine Engelke
- Kimberley Aboriginal Medical Services Ltd, Broome, Western Australia, Australia
- The Rural Clinical School of Western Australia, The University of Western Australia, Kununurra, Western Australia, Australia
| | - Melissa Williams
- Western Australian County Health Service, Broome, Western Australia, Australia
| | - Donna Stephen
- Kimberley Aboriginal Medical Services Ltd, Broome, Western Australia, Australia
| | - Sudha Coutinho
- Independent Consultant, Broome, Western Australia, Australia
| | - Stephanie K. Trust
- Kimberley Aboriginal Medical Services Ltd, Broome, Western Australia, Australia
- Kununurra Medical, Kununurra, Western Australia, Australia
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