Breastfeeding and Home Visiting

Title: McGinnis, S. Lee, E. Kirkland, K. Miranda-Julian, C. and Greene, R. (2017), Let’s Talk about Breastfeeding: The Importance of Delivering a Message in a Home Visiting Program, American Journal of Health Promotion, DOI: 10.1177/0890117117723802

Research source: https://www.ncbi.nlm.nih.gov/pubmed/28830205

Our Summary: The study aimed to look at the impact that home visiting professionals can have on promoting breastfeeding initiation and its continuation in an at risk population (at risk of poor child health and developmental outcomes).

It looked at 3,521 pregnant mothers and found that:

• Having discussions about breastfeeding early can often support early child and family outcomes;
• Breastfeeding initiation increased by 1.5% where there were more breastfeeding discussions at home visits;
• Breastfeeding continuation during the first 6 months also increased with the percentage of earlier home visits that included breastfeeding;
• If a mother received 1 more additional home visit in the 3^rd month her likelihood of continuing to breastfeed at 6 months increased by 11%;
• If a message was given consistently during regular home visiting, then breastfeeding will in turn be increased;

Messaging campaigns of at least 9 months that are designed and developed with beneficiaries and prospective beneficiaries are more likely to be successful.

Perinatal mental health screening

Title: Howard, LM. Ryan, EG. Trevillion, K. Anderson, F. Bick, D. Bye, A. Byford, S. O’Connor, S. Sands, P. Demilew, J. Milgrom, J. and Pickles, A. (2018), Accuracy of the Whooley questions and the Edinburgh Postnatal Depression Scale in identifying depression and other mental disorders in early pregnancy, The British Journal of Psychiatry, vol. 212 (1), pp 50-56

Research source: https://www.cambridge.org/core/journals/the-british-journal-of-psychiatry/article/accuracy-of-the-whooley-questions-and-the-edinburgh-postnatal-depression-scale-in-identifying-depression-and-other-mental-disorders-in-early-pregnancy/A317DC7FBD645FB34FF8A1D2E2762A5F/core-reader

Publication date: January 2018

Our summary: This study aims to address that there is currently limited evidence on the prevalence and identification of mental health issues in the antenatal period. This is seen as vital to facilitating early treatment, and to the mitigation of adverse outcomes for the mother and the child. It compared the use and the diagnostic accuracy of:

• Depression-screening (Whooley questions);
• Edinburgh Postnatal Depression Scale (EPDS); and
• Structured Clinical Interview DSM-IV-TR.

The results showed that there was an overall rate of 27% found in the population with a breakdown as follows:

11%        Depression
15%        Anxiety disorders
2%          Obsessive-compulsive disorder
0.8%      Post-traumatic stress disorder
2%          Eating disorders
0.3%      Bipolar disorder I
0.3%      Bipolar disorder II
0.7%      Borderline personality

The EPDS ten items appeared to perform better at identifying major depression than the two item Whooley questions (however the difference in accuracy was not large);In addition to this it is argued that:

• The low sensitivity of the Whooley questions may have been due to the variation in relation to the majority of the staff having not been trained in perinatal mental health;
• The Whooley questions are a useful tool for case identification;
• The way the Whooley questions are asked is important in the way that they are accepted;
• There was insufficient evidence to suggest that screening questions should be asked routinely;
• Self-complete is an alternative strategy using a tablet or paper; and
• Women from non-white British groups are less likely to be asked about their mental health (‘inverse care law’ – in which those who are in most need of medical care are less likely to receive it).

Group Family Nurse Partnership RCT (Randomised Controls Trial) and Evaluation

Title: Barnes, J. Stuart, J. Allen, E. Petrou, S. Sturgess, J. Barlow, J. Macdonald, G. Spiby, H. Aistropp, D. Melhuish, E. Kim, S. Pink. J. Datta, J. and Elbourne, D. (2017), Results of the First Steps Study: a randomised controlled trial and economic evaluation of the Group Family Nurse Partnership (gFNP) programme compared with usual care in improving outcomes for high-risk mothers and their children and preventing abuse, Public Health Research, vol. 5 (9), DOI 10.3310/phr05090

Research Source: https://www.ncbi.nlm.nih.gov/pubmed/29172362

Publication date: November 2017

Our Summary: Group Family Nurse Partnership (gFNP) is based on the aims and materials of FNP’s home visiting service. The study aimed to examine whether gFNP in comparison to usual care could reduce risk factors for domestic abuse in a vulnerable group which proved to be cost-effective. This was undertaken by a multi-site randomised controlled parallel group with:

• Expectant mothers aged less than 20 years with one or more previous live births;
• Expectant mothers aged 20-24 with no previous live births and with low educational qualifications.

Parenting was assessed by a self-report measure and an objective measure of maternal sensivity.

The trial did not support the delivery of gFNP as a means of reducing the risk of child abuse or neglect. Only one of the 8 outcomes showed evidence of impact in terms of being more likely to continue breastfeeding up to 8 months (and this has been linked to maternal sensitivity). However, it is argued that it is possible that the service could have an impact on another population (e.g. those not eligible for FNP). Among the learning was:

• Not all sites were able to deliver the recommended number of sessions;
• Slow recruitment led to smaller than ideal numbers;
• Very small groups are not sustainable in terms of cost-effectiveness and lose dynamic interaction;
• Transport or timing issues reduced attendance;
• Those who attended found it reduced isolation, improved their mental health and increased parent capacity.

Reading in the Perinatal Period

Title: Hutton, JS. Lin, L. Gruber, R. Berndsen, J. DeWitt, T. Van Ginkel, JB and Ammerman, RT. (2017), Shared Reading and Television Across the Perinatal Period in Low-SES Households, Clinical Pediatrics, DOI:10.1177/0009922817737077

Research source: https://www.ncbi.nlm.nih.gov/pubmed/29067842

Publication date: October 2017

Our summary: This random control trial compared attitudes and behaviours (planned aged prenatally and then at 2 months) in relation to shared reading and infant TV viewing in the perinatal period, in families where there was low socio-economic status.

It found that the biggest barrier to shared reading after birth was ‘increasing time pressures’. There was also a higher perception of infant TV viewing as being important for healthy development.

On the basis of the findings it is also argued that maternal health literacy (involving cognitive, social and reflective skills) was positively linked to shared reading and negatively with the perceived benefits of infant TV viewing.

Most of the mothers involved in the study were receptive to discussing reading and screen time prenatally. This suggests that there would be benefits in collaboration and sustained guidance by those that support families at this stage (e.g. paediatrics, maternity and health visiting).

Systems Thinking and Public Health

Title: Boswell, J. (2017), The elusive search for the public voice in health policy: the case for ‘systems thinking’, Journal of Health Services Research & Policy, 0 (0) pp 1-2

Research source: http://journals.sagepub.com/doi/abs/10.1177/1355819617739038?ai=1gvoi&mi=3ricys&af=R

Publication date: October 2017

Our summary: The editorial argues that the need for greater public input into policy making is an idea which is hard to argue. However, it has been shown as difficult to be able to deliver in reality, and to define what this engagement should entail. On the basis of Martin et al. 2017 which looks at major health transformation and the public voice shows the ambiguity and confusion that can be caused in reaching this goal, along with the pragmatic pressures. The warning here is that such dynamics can limit and undermine public input into policy.

There has been an emergence of ‘systems thinking’ in this field (e.g. Stewart (2016)) in which a ‘citizen’s eye’ is adopted to outline the different ways in which ‘the public’ encounter the health service e.g. outreach or consultation, committees, as well as protest and activism. This shows the strengths and challenges of different ways of engaging in policy and practice.

The report argues that:

• A rich understanding of local institutions, practices and cultures is needed;
• There is no such thing as a one off ‘one size fits all’ form of public engagement;
• Systems thinking is not a ‘solution’ in that it will not resolve the political environment which surrounds obtaining a public voice in health care;
• That a ‘nuanced and reflexive’ approach along with an unending commitment to tackling the ambiguity of engagement is required.