Effects of Telephone Consultation on Safety, Service Use, Patient Satisfaction, and Workload: Systematic Review and Meta-Analysis of Randomized Trials.

Objective: Telephone consultation (TC) is widely used for its easy access and convenience. This review aimed to assess the effects of TC including triage on safety, service use, patient satisfaction, and health professionals' workload to inform directions for future health service practice. Methods: CENTRAL, MEDLINE, Embase, CINAHL, ProQuest Dissertation & Theses (Health & Medicine), ClinincalTrials.gov, and International Clinical Trial Registry Platform were searched on April 7, 2022. The included were randomized controlled trials that compared TC with standard (face-to-face [F2F]) management or that by another group of call advisers. Cochrane methods were used to select eligible studies, assess the risk of bias, estimate summary effect measure, and grade evidence certainty. Meta-analysis was performed on important outcomes with moderate- or high-quality evidence. Results: Eight studies were included involving 40,002 participants. TC could increase call resolution-proportion of callers' concerns being addressed by telephone advice alone (two studies; high certainty) and reduce F2F contacts with doctors for the first consultation (two studies, moderate certainty) compared with standard management or TC by doctors. None of included studies reported increases in adverse events, including all-cause mortality, acute and emergency department visit, and hospitalization. There was inadequate evidence regarding the effects of TC on patient satisfaction and length of consultation. Conclusion: The findings support the benefits of TC on improving call resolution and reducing F2F contacts with doctors on the day of first management for regular day service; and TC by nurses can provide better effects than that by doctors for out-of-hours service.

A global approach to promoting research and evidence-based practice for community nurses.

Community health nurses world-wide provide health promotion and preventative care, support and guidance as well as clinical care for people with long-term conditions or needing acute care at home and end-of-life care, across all age groups. The importance of health care in the community has been growing globally as health systems recognise both the economic and human need for people to remain in their communities rather than in hospital. Research in community nursing provides evidence to support policy, practice and education. This article describes the global contribution that the International Collaboration for Community Health Nursing makes towards disseminating evidence that could improve the lives and health of communities.

Validation of the Italian version of the Tool to Measure Parenting Self-Efficacy questionnaire using data from an intervention study.

BACKGROUND: Parent self-efficacy (PSE), parents' confidence in their ability to successfully raise their children, has proved to be a powerful direct predictor of specific positive parenting practices. The aim of this study was to validate the Italian version of the Tool to Measure Parenting Self-Efficacy (TOPSE) using data from the questionnaires previously completed in a controlled before-after study conducted in 2015 to evaluate a newsletter programme to help improve parenting. Mothers and fathers of newborns were asked to complete the TOPSE at the child's birth (t0), at 6 months (t1) and at 12 months (t2): 265 TOPSE questionnaires were collected at t0 (43%), 158 at t1 (26%) and 188 at t2 (31%). METHODS: We measured internal reliability using Cronbach's alpha for each of the eight domains of the TOPSE. The intracluster correlation coefficient (ICC) was used to evaluate the external reliability only for parents with more than one child. Responsiveness was measured by testing the ability of the questionnaire to detect differences between groups and times that we expected to be measurable, based on consolidated findings in the literature. Mean scores of PSE improved from t0 to t2 (Hypothesis 1), PSE was lower at baseline for first-time parents than for those with multiple children (Hypothesis 2) and the improvement from t0 to t2 was stronger for first-time parents than for parents with multiple children (Hypothesis 3). RESULTS AND CONCLUSION: Based on our sample of questionnaires, the Italian version of the TOPSE was reliable for almost all of the domains except for Emotion, Self-acceptance and Learning, which could be refined by re-framing or dropping one item. External reliability was moderate, bearing in mind that the questionnaire was repeated at different times over 12 months, during which parents normally change. Responsiveness was good, especially for the Emotion and Empathy domains.

Implementing the Becoming Breastfeeding Friendly initiative in Scotland.

Despite strong policy support in Scotland, United Kingdom, key challenges to scaling up promotion, protection and support for breastfeeding remain. These include low breastfeeding rates and socioeconomic and regional inequalities. The Becoming Breastfeeding-Friendly (BBF) process was implemented to highlight actions that could address these challenges. The Scottish BBF committee employed an iterative process of documentary analysis and evidence reviews supplemented by 18 interviews with key informants. The data were mapped to BBF benchmarks and each gear was scored accordingly. Nineteen draft recommendations addressing policy and practice gaps were prioritised. Ten recommendations were grouped into eight themes, which cross-cut the BBF gears. The process took place from May 2018 to May 2019. The overall BBF Index score for Scotland was 2.4 indicating a strong scaling-up environment for breastfeeding. Five gears were assessed as strong gear strength, and the remaining three were judged as moderate gear strength. Three recommendation themes illuminate strengths and areas for development. The theme 'reinforcing political will' showed effective leadership, strong policies and significant investment in supporting breastfeeding and highlights actions to sustain this. The theme 'strengthening and coordinating breastfeeding messages' revealed a need for coordination between government, health services and the third sector. The theme 'promoting a supportive return to work environment' highlighted that, while employment legislation is not devolved to the Scottish government, action could be taken by employers to optimise an enabling environment for breastfeeding. The BBF process identified strengths and triggered actions to enhance breastfeeding promotion, protection and support in Scotland.

Gearing to success with national breastfeeding programmes: The Becoming Breastfeeding Friendly (BBF) initiative experience.

Evidence-based policy toolboxes are essential for decision makers to effectively invest in and scale up maternal-child health and nutrition programs, and breastfeeding is no exception. This special issue focuses on the experiences implementing the Becoming Breastfeeding Friendly (BBF) toolbox in England, Scotland, and Wales. BBF is an initiative that includes a toolbox for decision making based on the Complex Adaptive System-based Breastfeeding Gear Model. The BBF initiative experience in Great Britain presented in this special issue illustrates how versatile BBF is as it can be readily adapted to the specific application context. In this instance one country, England was trained by the Yale School of Public Health team that developed BBF. England, in turn, trained and assisted Scotland and Wales with the implementation and oversight of BBF in those countries. The positive experience implementing BBF in Great Britain is fully consistent with findings related to this initiative in other countries with contrasting economic, social, political and health care systems; including Germany, Ghana, Mexico, Myanmar, and Samoa. In all instances BBF has led to breastfeeding policy improvements with strong implications for enabling breastfeeding environments including maternity benefits, workforce development, the Baby Friendly Hospital Initiative and behavior change communication campaigns. In conclusion, BBF is a powerful tool to help guide the effective scaling up of evidence-based programmes to advance breastfeeding protection, promotion and support globally.

Print media coverage of breastfeeding in Great Britain: Positive or negative?

Media can be a powerful communication tool to promote breastfeeding, influence mothers' breastfeeding behaviour, create positive social norms and generate support among stakeholders and policymakers for breastfeeding. However, negative stories could deter women from starting or continuing to breastfeed. This study aimed to describe the breadth and focus of the media coverage of breastfeeding and the message frames that are found in three of the most widely read national newspapers and three popular women's magazines in Great Britain over a 12-month period, as part of the Becoming Breastfeeding Friendly in Great Britain (BBF-GB) study. For this retrospective media analysis, 77 articles were identified and 42 were included in the study for coding and analysis. We conducted two content analyses to examine the articles' (1) message framing and (2) alignment with the eight components of an 'enabling breastfeeding environment' using the BBF Gear framework. Articles featuring breastfeeding appear in British newspapers and women's magazines all year round. Twenty-four per cent had a neutral tone, while 59% predominantly focused on the positive aspects or positive social support for breastfeeding, and 17% were predominantly focused on the negative aspects or negative social attitudes towards breastfeeding. The articles mainly focused on personal stories reflecting societal barriers and positive shifts (68%), with 12% presenting an analysis of breastfeeding evidence or barriers. There were fewer references to the legislation (5%) and availability of funding (2%) and support (9%). There was no coverage of national coordination and strategy, evaluation systems, or the political will to raise breastfeeding rates.

Becoming breastfeeding friendly in Great Britain-Does implementation science work?

The Becoming Breastfeeding Friendly (BBF) in Great Britain study was conducted during 2017-2019 comprising three country studies: BBF England, Wales and Scotland. It was part of an international project being coordinated during the same period by the Yale School of Public Health across five world regions to inform countries and guide policies to improve the environment for the promotion, protection and support of breastfeeding. This paper reports on the application of the BBF process that is based on an implementation science approach, across the countries that constitute Great Britain (England, Wales and Scotland). The process involves assessing 54 benchmarks across eight interlocking gears that drive a country's 'engine' towards a sustainable policy approach to supporting, promoting and protecting breastfeeding. It takes a consensus-oriented approach to the evaluation of benchmarks and the development of recommendations. This paper provides a critical overview of how the process was conducted, the findings and recommendations that emerged and how these were managed. We draw on critical theory as a theoretical framework for explaining the different outcomes for each country and some considerations for future action.

Scaling up breastfeeding in England through the Becoming Breastfeeding Friendly initiative (BBF).

Breastfeeding is the most accessible and cost-effective activity available to public health and has been shown to be one of the most effective preventive measures mothers can take to protect their children's health. Despite the well-documented benefits, the UK has one of the lowest breastfeeding rates in the world. The Becoming Breastfeeding Friendly (BBF) toolkit was developed through highly structured technical and academic collaboration, led by Yale University. It provides an evidence-based process to help countries assess their breastfeeding status and readiness to scale up, and identifies concrete measures countries can take to sustainably increase breastfeeding rates, based on data-driven recommendations. BBF is grounded in the Breastfeeding Gear Model complex adaptive systems framework which is made up of eight simultaneous conditions that sustain breastfeeding. In 2018, a committee of multi-agency stakeholders implemented the BBF process in England, collecting evidence to score the 'gear' components of England's breastfeeding environment against 54 benchmarks. The Training and Programme Delivery gear received the highest score, attributable to existing learning outcomes for health professionals and practitioners, peer supporters and specialist services, although there is a need for greater coordination and integration. The lowest scores were given for Promotion and Coordination, Goals and Monitoring due to the lack of a dedicated national strategy for breastfeeding and poor sharing of localised strategies and programmes. The process generated clear recommendations highlighting the need for more robust routine infant feeding data collection and reporting, and the necessity for strengthening leadership, monitoring and oversight to scale up and sustain breastfeeding.

A Nurse Practitioner service designed to address the health needs of children living in housing instability: A non-randomised, concurrent mixed methods study protocol.

In 2019-2020 we conducted a pilot study of a Nurse Practitioner clinic working with housing insecure children (0-18 years) that found high levels of developmental delay, missed immunizations and dental caries. This present non-randomized, concurrent mixed-methods study protocol explains the next phase of the research designed proving proof of concept for a Nurse Practitioner model of care for these vulnerable children. Focusing on identifying and understanding clinic admission processes, tracking referral pathways and uptake, and how many vulnerable children miss potential care and why. This will help us to understand and address gaps in health service delivery for this cohort. DESIGN: The study uses a concurrent mixed- method design where both qualitative and quantitative data are collected during the same period (between January 2021 and March 2022 as per the funding timeline). METHODS: The concurrent mixed-method design will collect data from: A comprehensive assessment tool used by the Nurse Practitioner to evaluate the child accessing specialist homeless services, which assess their mental, physical and social health needs. Documentation about the child's referral needs and uptake by disadvantage families. Interviews with housing insecure families, and staff/managers of the specialist homeless service. A review of Nurse Practitioner case notes. Surveys of families with children accessing the Nurse Practitioner service. DISCUSSION: Addressing the childhood impacts of family homelessness is of global importance. Structural equation modelling, from the surveys and in-depth health assessments along with the thematic analysis of the interviews with parents and staff/managers provide an understanding of the relationships between referral uptake and variables such as education, homelessness and transport accessibility. Investigating the enablers and barriers to the usual health access and our extended referral uptake impacted by family homelessness enables a better understanding of the current health gaps. IMPACT: Just over one fifth of Australian children live with their families in some form of housing instability including homelessness. These children, aged from birth to 18 years, are often disconnected from health and similar social institutions, making them an underserviced population. Our research investigates a Nurse Practitioner services that helps reconnect children with services to help avoid poor long-term health outcomes.

Midwifery knowledge of equitable and culturally safe maternity care for Aboriginal women.

BACKGROUND: The Birthing on Noongar Boodjar project (NHMRC Partnership Project #GNT1076873) investigated Australian Aboriginal women and midwives' views of culturally safe care during childbearing. This paper reports on midwifery knowledge of Aboriginal women's cultural needs, their perceptions of health systems issues, and their ability to provide equitable and culturally safe care. METHOD: A qualitative study framed by an Indigenous methodology and methods which supported inductive, multilayered analyses and consensus-driven interpretations for two clinical midwife data groups (n = 61) drawn from a larger project data set (n = 145) comprising Aboriginal women and midwives. FINDINGS: Midwives demonstrated limited knowledge of Aboriginal women's cultural childbearing requirements, reported inadequate access to cultural education, substituted references to women-centered care in the absence of culturally relevant knowledge and consistently expressed racialized assumptions. Factors identified by midwives as likely to influence the midwifery workforce enabling them to provide culturally safe care for Aboriginal women included more professional development focused on improving understandings of cultural birth practices and health system changes which create safer maternal health care environments for Aboriginal women. CONCLUSIONS: Individual, workforce, and health systems issues impact midwives' capability to meet Aboriginal women's cultural needs. An imperative exists for effective cultural education and improved professional accountability regarding Aboriginal women's perinatal requirements and significant changes in health systems to embed culturally safe woman-centered care models as a means of addressing racism in health care.

Marginalised voices in wound care: Experiences of people who inject drugs living with leg ulceration "The Gutter, the Nick or a Box!!"

Portraying the authentic voice of people who inject drugs (PWID) through narrative means is novel in contemporary literature. The study explored the experiences of PWID living with chronic leg ulceration using qualitative methodology set in a naturalistic paradigm. Led from the perspective of a nurse-researcher in the field of wound management, the study is original from a purist narrative perspective and offers a unique opportunity to gain a rare glimpse into the daily life of PWID as reported in their own words. The methodology chosen was diaries conducted over four weeks, followed by semi-structured interviews. The study was set in North London (UK); participants were recruited from three sites: a general acute NHS hospital, the community and a non-NHS clinical facility. Complete data collection took over 12 months. Open coding was used for word-by-word scrutiny of each diary entry and thematic analysis. The qualitative data software tool NVivo Version-10 was used to support this analysis. Ten participants completed the data collection process: seven males and three females (age range 35-62 years), with heterogeneous socio-economic and cultural backgrounds. The findings revealed the detailed suffering participants endured living with their ulcer: pain, shame and healing were among the emerging themes. The self-blame and punishment triggered by stigma was a detriment to the mental and physical health of participants. Those in contact with specialist wound care services saw a significant improvement in wound healing and this had a positive impact on their wellbeing and their overall outlook on life. This research contributes to science and practice by understanding the lives of PWID living with leg ulceration. It provides a platform from which to engage both generalist and specialist healthcare practitioners and has the potential to inform and improve current service provision of leg ulcer care for this population and to influence medical and social policy-making in this field.

The feasibility of a multi-professional training to improve how health care professionals deliver different news to families during pregnancy and at birth.

BACKGROUND: In the United Kingdom, pregnant women are offered foetal anomaly screening to assess the chance of their baby being born with eleven different conditions. How health care professionals (HCPs) deliver news about a child having a congenital anomaly affects how it is received and processed by parents. We refer to this news as different news. METHODS: We conducted a mixed methods evaluation of a training intervention to improve how HCPs deliver different news. Twenty-six HCPs self-completed pretraining and posttraining questionnaires on skills, knowledge, and attitudes related to delivering different news. Qualitative interviews were conducted with eight HCPs. Quantitative data were analysed using descriptive statistics, the paired t test to compare the pre and post scores and estimate the difference between pre and post scores, and the 95% confidence interval. Qualitative data were analysed using framework analysis guided by the Theoretical Domains Framework (TDF). RESULTS: The training intervention was both feasible and acceptable. HCPs indicated that it enhanced or consolidated their knowledge and skills, covered topics relevant to their practice, and that they would recommend it to colleagues. Participants particularly valued integration of the voice of parents with lived experience in the training. Significant increase in mean scores were observed in confidence to deliver different news (2.81, 95% CI [2.43, 3.19] to 4.28, 95% CI [4.09, 4.47]; p < .001) and skills to deliver different news (3.00, 95% CI [2.64, 3.36] to 4.36, 95% CI [4.13, 4.59]; p < .001). HCPs reported feeling more confident in their ability to provide sensitive, responsive, balanced care to families. CONCLUSIONS: The significant improvements in confidence and skills reported by HCPs suggest that the training may be effective in equipping HCPs to minimize the distress, anxiety, and depression associated with receiving different news. This represents a key aspect of the prevention of mental ill health across the life course.

Acceptability and understanding of the Ages & Stages Questionnaires®, Third Edition, as part of the Healthy Child Programme 2-year health and development review in England: Parent and professional perspectives.

BACKGROUND: The Healthy Child Programme is the universal public health system in England to assess and monitor child health from 0 to 19. Following a review of measures for closer monitoring at age 2 years, the Department of Health for England implemented the Ages & Stages Questionnaires®, Third Edition (ASQ-3™; Hereon, ASQ-3). AIM: The aim of this study was to evaluate the acceptability and understanding of the ASQ-3 in England by health professionals and parents. METHOD: A mixed-methods approach was used. This paper reports on the qualitative data drawn from interviews with 40 parents and 12 focus groups with 85 health professionals. The data were analysed using applied thematic analysis. FINDINGS: Overall, parents and health professionals found the ASQ-3 acceptable and understandable and could use it as a measure at age 2 years. The ability to work in partnership was valued. Some limitations included potential to cause anxiety, concerns around the safety of some of the items, and use of Americanized language. Health professional's training in the use the ASQ-3 was inconsistent. CONCLUSION: The ASQ-3 is an acceptable and understandable measure to use as part of the 2-year assessment with some adaptations to the English context and some standardized training for health professionals.

Associations between social support, mental wellbeing, self-efficacy and technology use in first-time antenatal women: data from the BaBBLeS cohort study.

BACKGROUND: Information and communication technologies are used increasingly to facilitate social networks and support women during the perinatal period. This paper presents data on how technology use affects the association between women's social support and, (i) mental wellbeing and, (ii) self-efficacy in the antenatal period. METHODS: Data were collected as part of an ongoing study - the BaBBLeS study - exploring the effect of a pregnancy and maternity software application (app) on maternal wellbeing and self-efficacy. Between September 2016 and February 2017, we aimed to recruit first-time pregnant women at 12-16 gestation weeks in five maternity sites across England and asked them to complete questionnaires. Outcomes included maternal mental wellbeing (Warwick-Edinburgh Mental Wellbeing Scale), and antenatal self-efficacy (antenatal version of the Tool to Measure Parenting Self-Efficacy). Other variables assessed were perceived social support (Multidimensional Scale of Perceived Social Support), general technology use (adapted from Media and Technology Usage and Attitudes Scale). Potential confounders were age, ethnicity, education, socioeconomic deprivation, employment, relationship status and recruitment site. Linear regression models were developed to analyse the relationship between social support and the outcomes. RESULTS: Participants (n = 492, median age = 28 years) were predominantly white British (64.6%). Half of them had a degree or higher degree (49.3%), most were married/living with a partner (83.6%) and employed (86.2%). Median (LQ-UQ) overall scores were 81.0 (74.0-84.0) for social support (range 12-84), 5.1 (4.7-5.4) for technology use (range 1-6), 54.0 (48.0-60.0) for mental well-being (range 14-70), and 319.0 (295.5-340) for self-efficacy (range 0-360). Social support was significantly associated with antenatal mental well-being adjusting for confounders [adj R2 = 0.13, p < .001]. The addition of technology use did not alter this model [adj R2 = 0.13, p < .001]. Social support was also significantly associated with self-efficacy after adjustment [adj R2 = 0.14, p < .001]; technology had limited impact on this association [adj R2 = 0.13, p < .001]. CONCLUSIONS: Social support is associated with mental well-being and self-efficacy in antenatal first-time mothers. This association was not significantly affected by general technology use as measured in our survey. Future work should investigate whether pregnancy-specific technologies yield greater potential to enhance the perceived social support, wellbeing and self-efficacy of antenatal women.

Encouraging patients to self-care - the preliminary development and validation of the VeLUSET©, a self-efficacy tool for venous leg ulcer patients, aged 60 years and over.

Venous leg ulceration has a high recurrence rate. Patients with healed or frequently recurring venous ulceration are required to perform self-care behaviours to prevent recurrence or promote healing, but evidence suggests that many find these difficult to perform. Bandura's self-efficacy theory is a widely used and robust behaviour change model and underpins many interventions designed to promote self-care in a variety of chronic conditions. By identifying areas where patients may experience difficulty in performing self-care, interventions can be developed to strengthen their self-efficacy beliefs in performing these activities successfully. There are currently a variety of self-efficacy scales available to measure self-efficacy in a variety of conditions; but not a disease-specific scale for use with venous ulcer patients. The aim of this study, therefore, was to develop and validate a disease-specific, patient-focused self-efficacy scale for patients with healed venous leg ulceration. This scale will need further validation studies; however, it is ready for use in clinical practice and will enable practitioners to identify those patients who may need additional support in performing self-care activities to prevent recurrence.

Developing a national mentorship scheme to enhance the contribution of clinical academics to health care.

AIM: To provide a template for developing a national mentoring scheme to enhance the contribution practitioner researchers can make to the quality of health care in England. BACKGROUND: The authors describe the background to and organisation of a mentorship scheme to support those awarded National Institute for Health Research (NIHR) fellowships as part of the Clinical Academic Training (CAT) scheme for nurses, midwives and the allied health professionals in England. DATA SOURCES: The paper draws on relevant policy documents to explain the development of the NIHR mentorship scheme. It also reviews the literature regarding mentoring in nursing and the health professions. REVIEW METHODS: The review was conducted systematically using keywords: mentorship, clinical academic careers, research, nursing research, clinical academic careers, evidence, health care. Databases included PubMed, CINAHL and Google Scholar. An integrated approach was adopted. DISCUSSION: Kirkpatrick's ( 2006 ) four-level evaluation model provided a framework to evaluate the scheme and explore the role of mentorship in supporting NIHR fellows. Preliminary findings from baseline and end-of-year evaluations revealed mentees' expectations of mentorship and its effects on their professional development. Developing a career as a clinical academic can be a challenging journey for novice researchers. In addition, there is a vital need to integrate research with clinical practice. CONCLUSION: Mentoring appears valuable in enabling NIHR fellows to navigate the challenges of demanding clinical roles in England's National Health Service while making a high-level contribution to research. The importance of preparing mentors for their role is well documented in the literature but mentees also need preparation and guidance to manage this important relationship. IMPLICATIONS FOR RESEARCH/PRACTICE: The evaluation has implications for embedding similar schemes across nursing, midwifery and the allied health professions to promote capacity and leadership in clinical academic careers. This study has uniquely identified the need to support mentees as well as mentors in such programmes to ensure the optimal benefit of the programme reaches all participants.

Exploring prevalence and factors associated with postpartum depression among Ukrainian women.

INTRODUCTION: Postpartum depression negatively impacts maternal mental health and child development. The high prevalence of postpartum depression (PPD) in low and lower middle-income countries raises questions about its predictors. This study examines the association between PPD and breastfeeding experience, child death, unresolved pregnancy, forced displacement, COVID-19 pandemic lockdown, marital, and financial status among Ukrainian women. METHODS: This online study recruited 1634 Ukrainian mothers of children aged 0-5 years through non-governmental organizations providing services to them. The Edinburgh Postnatal Depression Scale (EPDS), with a cut-off of ≥13, was used to assess depressive symptoms in the postpartum period. Independent t-tests, chi-squared tests, one-way ANOVA, non-parametric correlations, and logistic regression tests were used to analyze the data. RESULTS: The prevalence of depressive symptoms was 39.0% (n=1631). There was a positive association between EPDS scores and breastfeeding difficulties, pandemic lockdown, and financial difficulties. We did not find an association between PPD symptoms and unresolved pregnancy, death of a child, being affected by COVID-19, and forced displacement. We found that EPDS scores for women who did not experience forced displacement (n=1528) were significantly higher compared to displaced mothers (n=74). CONCLUSIONS: The present study of Ukrainian women shows that women experienced depressive symptoms influenced by various factors including breastfeeding difficulties, pandemic lockdown, and financial difficulties. There is a need for additional research into such factors as unresolved pregnancy, the death of a child, being affected by COVID-19, and forced displacement.

Understanding of perinatal mental health and its psychosocial determinants through Ukrainian women's experience.

INTRODUCTION: Perinatal mental health defines new mothers, their families, and the social, emotional, and cognitive development of their children. The factors contributing to Ukrainian mothers' mental health are not well-defined in the literature. This study aims to explore how Ukrainian women understand mental health and its psychosocial determinants through their perinatal experience. METHODS: This qualitative analysis is part of a larger mixed-methods study exploring perinatal mental health in Ukraine. Five online focus groups (n=30) with Ukrainian mothers of children aged 0-5 years were conducted in June-July 2020. The participants were selected from a pool of 1634 women who completed an online questionnaire and agreed to participate in further research. Informed consent was obtained. The data collected from the focus groups were transcribed verbatim and analyzed thematically using Dedoose software. RESULTS: The study identified two themes. The first theme was: 'Understanding perinatal mental health through women's experience', which covers five subthemes. The second theme was 'Psychosocial determinants of maternal mental health', which includes six subthemes. Overall, women's feelings of guilt, blame, and shame during their perinatal journey are influenced by socio-cultural factors and can lead to mental health problems and reluctance to seek proper help. CONCLUSIONS: The study has identified some factors that can contribute to the enhancement of mental health and well-being of mothers in Ukraine during their perinatal journey. Negative emotions such as guilt, blame, and shame can have a significant impact on their ability to seek the necessary support, and should be addressed by midwives and other healthcare professionals.

Does a free maternity policy in Kenya work? Impact and cost-benefit consideration based on demographic health survey data.

This paper evaluates the overall effect of the Kenyan free maternity policy (FMP) on the main outcomes (early neonatal and neonatal deaths) and intermediate outcomes (delivery through Caesarean Section (CS), skilled birth attendance (SBA), birth in a public hospital and low birth weight (LBW)) using the 2014 Demographic Health Survey. We applied the difference-in-difference (DID) approach to compare births (to the same mothers) happening before and after the start of the policy (June 2013) and a limited cost-benefit analysis (CBA) to assess the net social benefit of the FMP. The probabilities of birth resulting in early neonatal and neonatal mortality are significantly reduced by 17-21% and 19-20%, respectively, after the FMP introduction. The probability of birth happening through CS reduced by 1.7% after implementing the FMP, while that of LBW birth is increased by 3.7% though not statistically significant. SBA and birth in a public facility did not moderate the policy's effects on early neonatal mortality, neonatal mortality, and delivery through CS. They were not significant determinants of the policy effects on the outcomes. There is a significant causal impact of the FMP in reducing the probability of early neonatal and neonatal mortality, but not the delivery through CS. The FMP cost-to-benefit ratio was 21.22, and there were on average 4015 fewer neonatal deaths in 2013/2014 due to the FMP. The net benefits are higher than the costs; thus, there is a need to expand and sustainably fund the FMP to avert more neonatal deaths potentially.

Examining the quality of care across the continuum of maternal care (antenatal, perinatal and postnatal care) under the expanded free maternity policy (Linda Mama Policy) in Kenya: a mixed-methods study.

BACKGROUND: Kenya still faces the challenge of mothers and neonates dying from preventable pregnancy-related complications. The free maternity policy (FMP), implemented in 2013 and expanded in 2017 (Linda Mama Policy (LMP)), sought to address this challenge. This study examines the quality of care (QoC) across the continuum of maternal care under the LMP in Kenya. METHODS: We conducted a convergent parallel mixed-methods study across multiple levels of the Kenyan health system, involving key informant interviews with national stakeholders (n=15), in-depth interviews with county officials and healthcare workers (HCWs) (n=21), exit interview survey with mothers (n=553) who utilised the LMP delivery services, and focus group discussions (n=9) with mothers who returned for postnatal visits (at 6, 10 and 14 weeks). Quantitative data were analysed descriptively, while qualitative data were analysed thematically. All the data were triangulated at the analysis and discussion stage using a framework approach guided by the QoC for maternal and newborns. RESULTS: The results showed that the expanded FMP enhanced maternal care access: geographical, financial and service utilisation. However, the facilities and HCWs bore the brunt of the increased workload and burnout. There was a longer waiting time for the initial visit by the pregnant women because of the enhanced antenatal care package of the LMP. The availability and standards of equipment, supplies and infrastructure still posed challenges. Nurses were multitasking and motivated despite the human resources challenge. Mothers were happy to have received care information; however, there were challenges regarding respect and dignity they received (inadequate food, over-crowding, bed-sharing and lack of privacy), and they experienced physical, verbal and emotional abuse and a lack of attention/care. CONCLUSIONS: Addressing the negative aspects of QoC while strengthening the positives is necessary to achieve the Universal Health Coverage goals through better quality service for every woman.