A realist review of digitally delivered child development assessment and screening tools: Psychometrics and considerations for future use.

BACKGROUND: Developmental screening improves the detection of developmental concerns, yet numerous children are not screened/assessed. Remote child developmental tool administration has been utilized to increase screening and assessment accessibility. METHOD: We conducted a realist review to: (1) identify existing multi-domain child development assessment and screening tools for children 0-5 years; (2) review psychometric data on their digital (i.e., only administered remotely) administration; and (3) explore contextual factors relevant to their digital administration. We searched APA PsycInfo, MEDLINE, CINAHL, and ERIC to identify tools and papers on their psychometrics. We reference-searched included articles and searched Google for relevant grey literature. RESULTS: Of 33 multi-domain child development tools identified in objective one, five tools (in five studies) were delivered digitally and compared to traditional (e.g., paper) delivery (i.e., objective two). Studies evaluated within-group equivalence reliability (k = 2) and between-group equivalence (k = 3). Within-group equivalence reliability was established for the Vineland Adaptive Behavior Scales, and domains (e.g., gross motor) of the Ages and Stages Questionnaires 2nd edition (ASQ-2) and Revised Prescreening Denver Questionnaire (R-PDQ). Between group equivalence was demonstrated for Developmental Neuropsychological Assessment, 2nd Edition (NEPSY-II) subtests and Bayley Scales of Infant and Toddler Development, 3rd edition (Bayley-3) items. In another between group evaluation, web-based and paper versions of the ASQ-2 were deemed generally equivalent. Digital Bayley-3 inter-observer reliability ranged from 0.82 to 1.0. Examiner support, time, tool modifications, family resources, and comfort promotion supported digital administration. CONCLUSION: Digitally delivered ASQ-2, R-PDQ, Vineland, and Bayley-3 and NEPSY-II components show promise for equivalence with traditional administration.

Study protocol for Attachment & Child Health (ATTACHTM) program: promoting vulnerable Children's health at scale.

BACKGROUND: Children's exposure to toxic stress (e.g., parental depression, violence, poverty) predicts developmental and physical health problems resulting in health care system burden. Supporting parents to develop parenting skills can buffer the effects of toxic stress, leading to healthier outcomes for those children. Parenting interventions that focus on promoting parental reflective function (RF), i.e., parents' capacity for insight into their child's and their own thoughts, feelings, and mental states, may understand help reduce societal health inequities stemming from childhood stress exposures. The Attachment and Child Health (ATTACHTM) program has been implemented and tested in seven rapid-cycling pilot studies (n = 64) and found to significantly improve parents' RF in the domains of attachment, parenting quality, immune function, and children's cognitive and motor development. The purpose of the study is to conduct an effectiveness-implementation hybrid (EIH) Type II study of ATTACHTM to assess its impacts in naturalistic, real-world settings delivered by community agencies rather than researchers under more controlled conditions. METHODS: The study is comprised of a quantitative pre/post-test quasi-experimental evaluation of the ATTACHTM program, and a qualitative examination of implementation feasibility using thematic analysis via Normalization Process Theory (NPT). We will work with 100 families and their children (birth to 36-months-old). Study outcomes include: the Parent Child Interaction Teaching Scale to assess parent-child interaction; the Parental Reflective Function and Reflective Function Questionnaires to assess RF; and the Ages and Stages Questionnaire - 3rd edition to examine child development, all administered pre-, post-, and 3-month-delayed post-assessment. Blood samples will be collected pre- and post- assessment to assess immune biomarkers. Further, we will conduct one-on-one interviews with study participants, health and social service providers, and administrators (total n = 60) from each collaborating agency, using NPT to explore perceptions and experiences of intervention uptake, the fidelity assessment tool and e-learning training as well as the benefits, barriers, and challenges to ATTACHTM implementation. DISCUSSION: The proposed study will assess effectiveness and implementation to help understand the delivery of ATTACHTM in community agencies. TRIAL REGISTRATION: Name of registry: https://clinicaltrials.gov/. REGISTRATION NUMBER: NCT04853888 . Date of registration: April 22, 2021.

Fidelity Assessment Checklist Development for Community Nursing Research in Early Childhood.

Nurses play an important role in promoting positive childhood development via early interventions intended to support parenting. Despite recognizing the need to deliver vital parenting programs, monitoring fidelity has largely been ignored. Fidelity refers to the degree to which healthcare programs follow a well-defined set of criteria specifically designed for a particular program model. With increasing demands for early intervention programs to be delivered by non-specialists, rigorous yet pragmatic strategies for maintaining fidelity are needed. This paper describes the step-by-step development and evaluation of a program fidelity measure, using the Attachment and Child Health (ATTACH™) parenting program as an exemplar. The overall quality index for program delivery varied between "very good" to "excellent," with a mean of 4.3/5. Development of checklists like the ATTACH™ fidelity assessment checklist enables the systematic evaluation of program delivery and identification of therapeutic components that enable targeted efforts at improvement. In future, research should examine links between program fidelity and targeted outcomes to ascertain if increased fidelity scores yield more favorable effects of parenting programs.

Assessment of anxiety during pregnancy: are existing multiple anxiety scales suitable and comparable in measuring anxiety during pregnancy?

BACKGROUND: This study examined the performance of multiple anxiety scales in measuring anxiety during pregnancy, an important issue due to the possible effect of pregnancy-related symptoms on the measurement of anxiety. METHODS: Secondary data on anxiety, measured by the State-Trait Anxiety Inventory-State (STAI-S) 20-item and six-item scales, the Edinburgh Postnatal Depression Scale-Anxiety Subscale (EPDS-3A) and the Symptoms Checklist-90-Anxiety Subscale (SCL-90), were obtained from two pregnancy cohort studies. Both cohorts completed the EPDS-3A, while 3341 women completed the STAI-S and 2187 women completed the SCL-90, with 231 women participating in both cohorts. Data were analyzed using confirmatory factor analysis and Spearman correlation. RESULTS: The STAI-6 had adequate model fit, while the STAI-20 and the SCL-90 had inadequate model fit. Model fitness for the EPDS-3A could not be assessed due to its low number of items. The correlation between the STAI-20 and STAI-6 was excellent (r = 0.93). The correlation of EPDS-3A with other anxiety scales was low to moderate (r (STAI-20) = 0.57, r (STAI-6) = 0.53 and r (SCL-90) = 0.44). The correlation of SCL-90 with both STAI-20 and STAI-6 was low (r < 0.50). CONCLUSION: Findings indicate that these scales do not measure anxiety as a single dimension and that these scales are incomparable and may conceptualize anxiety differently.

Improving maternal postpartum mental health screening guidelines requires assessment of post-traumatic stress disorder.

Post-traumatic stress disorder (PTSD) has a prevalence of 4-17% in the postpartum period and, like better known postpartum depression (PPD), is linked to reduced quality maternal-child interactions, decreased maternal sense of life satisfaction and functioning, and negative impacts on child development. Currently, provincial and public health organizations throughout Canada screen new mothers for PPD with the Edinburgh Postpartum Depression Scale, which while laudable does not capture PTSD. PTSD is highly associated with PPD, 65% of women with PTSD also present with PPD, presenting a significant gap in postpartum maternal mental health screening. Numerous self-report PTSD screening questionnaires are available that could be incorporated into routine maternal postpartum mental health care. Furthermore, across Canada, regional differences in availability of maternal mental health screening, services, and programs suggest a gap in one of the tenets of Canadian health care-lack of universality. Not only does Canada require national maternal mental health screening, service and program guidelines, but PTSD screening must be incorporated, in order to identify and treat new mothers experiencing mental health problems.

RéSUMé: Le trouble de stress post-traumatique (TSPT) a une prévalence de 4 à 17 % durant la période post-partum et, comme la très connue dépression post-partum (DPP), est associé à la réduction de la qualité des interactions mère-enfant, à une diminution du sentiment de satisfaction de vie et de fonctionnement de la mère, et a un impact négatif sur le développement des enfants. Actuellement, les organismes de santé publique et provinciales à travers le Canada effectuent un dépistage de la DPP auprès des nouvelles mères à l'aide de l'échelle de dépression post-partum d'Édimbourg qui, quoi que valable, ne détecte pas le TSPT. Il existe une forte corrélation entre le TSPT et la DPP alors que 65 % des femmes souffrant d'un TSPT présentent aussi une DPP, ce qui démontre un manquement significatif dans le dépistage post-partum maternel dans le domaine de la santé mentale. Il y a plusieurs instruments disponibles pour l'auto-évaluation de TSPT, qui pourraient être intégrés dans la routine de dépistage en santé mentale post-partum maternel. De plus, des différences régionales à travers le Canada en ce qui a trait à la disponibilité du dépistage, aux services et aux programmes de santé mentale post-partum maternel démontrent une lacune dans l'un des principes des soins de santé du Canada, soit le manque d'universalité. Le Canada nécessite des directives concernant le dépistage ainsi que les services et les programmes de santé mentale post-partum maternel, mais le dépistage du TSPT doit être standardisé pour permettre l'identification et le traitement des nouvelles mères présentant des problèmes de santé mentale.

Neighbourhood socioeconomic status modifies the association between anxiety and depression during pregnancy and preterm birth: a Community-based Canadian cohort study.

OBJECTIVE: This study examined the association of anxiety alone, depression alone and the presence of both anxiety and depression with preterm birth (PTB) and further examined whether neighbourhood socioeconomic status (SES) modified this association. DESIGN: Cohort study using individual-level data from two community-based prospective pregnancy cohort studies (All Our Families; AOF) and Alberta Pregnancy Outcomes and Nutrition (APrON) and neighbourhood SES data from the 2011 Canadian census. SETTING: Calgary, Alberta, Canada. PARTICIPANTS: Overall, 5538 pregnant women who were <27 weeks of gestation and >15 years old were enrolled in the cohort studies between 2008 and 2012. 3341 women participated in the AOF study and 2187 women participated in the APrON study, with 231 women participated in both studies. Women who participated in both studies were only counted once. PRIMARY AND SECONDARY OUTCOME MEASURES: PTB was defined as delivery prior to 37 weeks of gestation. Depression was defined as an Edinburgh Postnatal Depression Scale (EPDS) score of ≥13, anxiety was defined as an EPDS-anxiety subscale score of ≥6, and the presence of both anxiety and depression was defined as meeting both anxiety and depression definitions. RESULTS: Overall, 7.3% of women delivered preterm infants. The presence of both anxiety and depression, but neither of these conditions alone, was significantly associated with PTB (OR 1.6, 95% CI 1.1 to 2.3) and had significant interaction with neighbourhood deprivation (p=0.004). The predicted probability of PTB for women with both anxiety and depression was 10.0%, which increased to 15.7% if they lived in the most deprived neighbourhoods and decreased to 1.4% if they lived in the least deprived neighbourhoods. CONCLUSIONS: Effects of anxiety and depression on risk of PTB differ depending on where women live. This understanding may guide the identification of women at increased risk for PTB and allocation of resources for early identification and management of anxiety and depression.

Does neighborhood socioeconomic status predict the risk of preterm birth? A community-based Canadian cohort study.

OBJECTIVE: This study developed and internally validated a predictive model for preterm birth (PTB) to examine the ability of neighbourhood socioeconomic status (SES) to predict PTB. DESIGN: Cohort study using individual-level data from two community-based prospective pregnancy cohort studies (All Our Families (AOF) and Alberta Pregnancy Outcomes and Nutrition (APrON)) and neighbourhood SES data from the 2011 Canadian census. SETTING: Calgary, Alberta, Canada. PARTICIPANTS: Pregnant women who were <24 weeks of gestation and >15 years old were enrolled in the cohort studies between 2008 and 2012. Overall, 5297 women participated in at least one of these cohorts: 3341 women participated in the AOF study, 2187 women participated in the APrON study and 231 women participated in both studies. Women who participated in both studies were only counted once. PRIMARY AND SECONDARY OUTCOME MEASURES: PTB (delivery prior to 37 weeks of gestation). RESULTS: The rates of PTB in the least and most deprived neighbourhoods were 7.54% and 10.64%, respectively. Neighbourhood variation in PTB was 0.20, with an intra-class correlation of 5.72%. Neighbourhood SES, combined with individual-level predictors, predicted PTB with an area under the receiver-operating characteristic curve (AUC) of 0.75. The sensitivity was 91.80% at a low-risk threshold, with a high false-positive rate (71.50%), and the sensitivity was 5.70% at a highest risk threshold, with a low false-positive rate (0.90%). An agreement between the predicted and observed PTB demonstrated modest model calibration. Individual-level predictors alone predicted PTB with an AUC of 0.60. CONCLUSION: Although neighbourhood SES combined with individual-level predictors improved the overall prediction of PTB compared with individual-level predictors alone, the detection rate was insufficient for application in clinical or public health practice. A prediction model with better predictive ability is required to effectively find women at high risk of preterm delivery.

Prenatal Maternal Anxiety in South Asia: A Rapid Best-Fit Framework Synthesis.

Background: Most research efforts toward prenatal maternal anxiety has been situated in high-income countries. In contrast, research from low- and middle-income countries has focused on maternal depression and prenatal maternal anxiety in low- and middle-income countries remains poorly understood. Objectives: To examine whether dimensions and attributes of current maternal anxiety assessment tools appropriately capture South Asia women's experiences of perinatal distress during pregnancy. Design: We conducted a rapid review with best fit framework synthesis, as we wished to map study findings to an a priori framework of dimensions measured by prenatal maternal anxiety tools. Data Sources: We searched MEDLINE, PsycINFO, and CINAHL and gray literature in November 2016. Studies were included if published in English, used any study design, and focused on women's experiences of prenatal/antenatal anxiety in South Asia. Review Methods: Study quality was assessed using the Effective Public Health Practice Project Quality Assessment Tool and Critical Appraisal Skills Programme Qualitative Checklist. Study findings were extracted to an a priori framework derived from pregnancy-related anxiety tools. Results: From 4,177 citations, 9 studies with 19,251 women were included. Study findings mapped to the a priori framework apart from body image. A new theme, gender inequality, emerged from the studies and was overtly examined through gender disparity, gender preference of fetus, or domestic violence. Conclusions: Gender inequality and societal acceptability of domestic violence in South Asian women contextualizes the experience of prenatal maternal anxiety. Pregnancy-related anxiety tools should include domains related to gender inequality to better understand their influence on pregnancy outcomes.

Nursing Child Assessment Satellite Training Parent-Child Interaction Scales: Comparing American and Canadian Normative and High-Risk Samples.

PURPOSE: Many nurses rely on the American Nursing Child Assessment Satellite Training (NCAST) Parent-Child Interaction (PCI) Teaching and Feeding Scales to identify and target interventions for families affected by severe/chronic stressors (e.g. postpartum depression (PPD), intimate partner violence (IPV), low-income). However, the NCAST Database that provides normative data for comparisons may not apply to Canadian families. The purpose of this study was to compare NCAST PCI scores in Canadian and American samples and to assess the reliability of the NCAST PCI Scales in Canadian samples. METHODS: This secondary analysis employed independent samples t-tests (p < 0.005) to compare PCI between the American NCAST Database and Canadian high-risk (families with PPD, exposure to IPV or low-income) and community samples. Cronbach's alphas were calculated for the Canadian and American samples. RESULTS: In both American and Canadian samples, belonging to a high-risk population reduced parents' abilities to engage in sensitive and responsive caregiving (i.e. healthy serve and return relationships) as measured by the PCI Scales. NCAST Database mothers were more effective at executing caregiving responsibilities during PCI compared to the Canadian community sample, while infants belonging to the Canadian community sample provided clearer cues to caregivers during PCI compared to those of the NCAST Database. Internal consistency coefficients for the Canadian samples were generally acceptable. CONCLUSIONS: The NCAST Database can be reliably used for assessing PCI in normative and high-risk Canadian families. PRACTICAL IMPLICATIONS: Canadian nurses can be assured that the PCI Scales adequately identify risks and can help target interventions to promote optimal parent-child relationships and ultimately child development.

Low-Income Children, Adolescents, and Caregivers Facing Respiratory Problems: Support Needs and Preferences.

UNLABELLED: Burdens of poverty are often compounded by respiratory problems. This study aimed to identify the support needs and intervention preferences for low-income families facing this challenge. DESIGN AND METHODS: Interviews were conducted in two Canadian provinces with low-income children/adolescents (n=32) diagnosed with respiratory health problems and their parents or family caregiver (n=37). RESULTS: These vulnerable children and parents described non-supportive interactions with some health service providers and inadequate information. They reported isolation and support deficits, exacerbated by limited resources and health restrictions. Children/adolescents felt isolated and excluded and wanted to connect with peers. Group or dyadic level support, delivered by peers and health professionals, was desired. The importance of logistics to enhance accessibility and appeal of group or dyadic support interventions was clearly identified. CONCLUSIONS: The findings of this study reveal that low-income children and their families encounter challenges to accessing support and to utilizing support resources. PRACTICE IMPLICATIONS: Partnerships with low-income children/adolescents and family caregivers in provision of education and social support can combat isolation and ignorance. Reducing inequities for this high risk population could be achieved by providing support from experienced peers, in combination with health professional guidance, and knowledge about pulmonary health.

The Alberta Pregnancy Outcomes and Nutrition (APrON) cohort study: rationale and methods.

The Alberta Pregnancy Outcomes and Nutrition (APrON) study is an ongoing prospective cohort study that recruits pregnant women early in pregnancy and, as of 2012, is following up their infants to 3 years of age. It has currently enrolled approximately 5000 Canadians (2000 pregnant women, their offspring and many of their partners). The primary aims of the APrON study were to determine the relationships between maternal nutrient intake and status, before, during and after gestation, and (1) maternal mood; (2) birth and obstetric outcomes; and (3) infant neurodevelopment. We have collected comprehensive maternal nutrition, anthropometric, biological and mental health data at multiple points in the pregnancy and the post-partum period, as well as obstetrical, birth, health and neurodevelopmental outcomes of these pregnancies. The study continues to follow the infants through to 36 months of age. The current report describes the study design and methods, and findings of some pilot work. The APrON study is a significant resource with opportunities for collaboration.

Attachment and caregiver-infant interaction: a review of observational-assessment tools.

The relationship between maternal-infant interaction and attachment quality to infant developmental outcomes has long been established. As children mature, problems stemming from troubled caregiver-infant relations may result in referral to mental health or child protection services. The accurate and appropriate assessment of attachment is critical for early recognition of problematic relations and for informing suitable treatment modalities. Evaluating the quality of attachment poses a challenge for researchers and clinicians seeking to explore the association between infant development and the quality of early caregiving experiences. Although providing a definitive answer to the question of which of these assessment procedures is the single universal standard for measuring attachment quantity is beyond the scope of this article, readers will be provided with a description and comparison of strengths and limitations of the most commonly used measures of attachment, including the Strange Situation Procedure (M.D.S. Ainsworth, M.C. Blehar, E. Waters, & S. Wall, 1978), Attachment Q-Sort (E. Waters & K.E. Deane, 1985), Toddler Attachment Sort (TAS-45; J. Kirkland, D. Bimler, A. Drawneek, M. McKim, & A. Scholmerich, 2004), CARE-Index (P. Crittenden, 1985), Atypical Maternal Behavior Instrument for Assessment and Classification (AMBIANCE; E. Bronfman, E. Parsons, & K. Lyons-Ruth, 1999), Massie-Campbell Scale of Mother-Infant Attachment Indicators During Stress Scale (Attachment During Stress Scale; H.N. Massie & B.K. Campbell, 1983), and the Risky Situation Procedure (D. Paquette & M. Bigras, 2010).

Maternal depression, family functioning and children's longitudinal development.

Analysis of data from the Canadian National Longitudinal Survey of Children and Youth reveals that 6% of children are born to mothers who experienced symptoms of depression during their first 2 years of life. The prevalence rises steadily until children are 10 years of age when it reaches 9%, and thereafter remains relatively stable. Children of depressed mothers are at increased risk of having low receptive vocabulary and displaying inattention or physical aggression at ages 4 to 5 years, only partially attributable to family demographic factors, family functioning and parenting qualities. Maternal depression occurring when the child was 2 to 3 years of age, was a risk factor for anxiety in 10 and 11 year olds. Timing or duration of maternal depression had no effect on math achievement. The risk of poor child outcome was greatest for mothers who experienced depression continuously or when their child was 2 to 3 years or older. Nurses need to assess and intervene to reduce the impact of depression on mothers and their children's development, well beyond the postpartum period.

Support needs and preferences of young adolescents with asthma and allergies: "just no one really seems to understand".

The objectives of this study were to identify support needs, support resources, and support barriers for young adolescents with asthma and allergies and to describe preferences for an accessible support intervention. Adolescents (N = 57) completed a survey questionnaire. Eight young adolescents, 10 parents, and 5 older adolescents participated in separate group interviews. Young adolescents' challenges included transition to self-care, balancing restrictions with safety, social isolation, and loneliness. Young teens recommended supportive networks facilitated by older adolescent peers and wanted to meet with other young adolescents living with asthma and allergies online and share information, advice, and encouragement with them.

Online solutions to support needs and preferences of parents of children with asthma and allergies.

Many families of children with asthma and allergies experience support deficits and isolation. However, support interventions have not been designed to meet their needs. Consequently, parents' intervention preferences were elicited, and an online peer support group intervention was designed based on these preferences and piloted in the study described. In-depth interviews with 44 parents elicited preferences for support interventions for both children and parents. Many said they felt alone and wanted support from others in similar situations. Based on the parents' preferences for accessible online peer support groups, a pilot online intervention was designed and implemented. Parents received information and reassurance from other parents in peer support sessions. Parents appreciated the accessibility and anonymity of the online support group. This innovative online peer support intervention, informed by parents' preferences, could be adapted and tested in intervention trials and guide programs and practice for families affected by asthma, allergies, and other chronic conditions.

Where there is smoke, there is stress: low-income women identify support needs and preferences for smoking reduction.

Efforts to assist low-income women with tobacco reduction and cessation have typically not been informed by assessment of their needs and wishes. This multi-site qualitative study focused on assessing 64 low-income women's support needs and intervention preferences. These women were interested in smoking cessation, but identified many barriers and needed appropriate supports. However, available smoking cessation programs did not address underlying conditions, such as income instability and stress. The support recommended was psychosocial (e.g., buddy and group support), included self-care (e.g., nutrition, activity, and personal time), and reflected their social-economic circumstances (e.g., free cessation aids and child care).

A support intervention to promote health and coping among homeless youths.

Homeless youths are often vulnerable to limited support resources and loneliness. Peers are a potent source of social support. A support intervention for homeless youths was designed to optimize peer influence and was pilot tested. The intervention was based on an initial assessment of support needs and intervention preferences from the perspective of 36 homeless youths and 27 service providers. Based on the results, a 20-week pilot intervention program was designed, consisting of 4 support groups, optional one-on-one support, group recreational activities, and meals. Support was provided by professional and peer mentors, including formerly homeless youths. A total of 56 homeless youths aged 16 to 24 took part. Participants completed pre-, mid-, and post-test quantitative measures and qualitative interviews. In spite of challenges due primarily to attrition, the youths reported enhanced health behaviours, improved mental well-being, decreased loneliness, expanded social network, increased coping skills, enhanced self-efficacy, and diminished use of drugs and alcohol. Further research could focus on replication at other sites with a larger sample.

Cervical cancer screening practices among university women.

OBJECTIVE: To assess predictors of young women's intentions to be screened for cervical cancer. DESIGN: A descriptive, correlational, cross-sectional study using the Theory of Planned Behavior (TPB). PARTICIPANTS: A total of 904 young women (mean age=20.7 years; SD=1.77) participated in an online cervical cancer screening survey. METHOD: A web-based survey (WebCT) was used to survey young women, 25 years of age or less, attending a university in eastern Canada. Descriptive, correlational, and logistic regression statistics were calculated. RESULTS: Findings indicated that social norms (perceptions about whether or not people close to them think Pap screening is important) and perceived behavioral control (perceptions about personal resources or barriers to receiving a Pap test) were significantly related to young women's intentions to be screened. CONCLUSION: Strategies to promote cervical cancer screening among young university women need to recognize the impact of social norms and perceived barriers on Pap screening intentions in this population.

Researching reducing health disparities: mixed-methods approaches.

There is a pressing need for assessment and intervention research focused on reducing health disparities. In our research program, the use of mixed methods has enhanced assessment of the mediating impacts of social support on the health of vulnerable populations and enabled the design and testing of support interventions. This paper highlights the benefits and challenges of mixed methods for investigating inequities; and, illustrates the application of mixed methods in two exemplar studies focused on vulnerable populations in Canada. Qualitative methods fostered in-depth understanding of vulnerable populations' support needs, support resources, intervention preferences, and satisfaction with intervention strategies and impacts. Quantitative methods documented the effectiveness and outcomes of intervention strategies, and enhanced the reliability and validity of assessments and interventions. The researchers demonstrate that participatory strategies are needed to make studies more relevant to reducing health disparities, contextually appropriate, and empowering.

Canadian mothers' perceived support needs during postpartum depression.

OBJECTIVE: To assess the support needs, support resources, barriers to support, and preferences for support intervention for women with postpartum depression. DESIGN: Multisite, exploratory, descriptive study in which qualitative data were collected on support needs, the availability of resources, perceived barriers to support, and preferences for support of women who have experienced symptoms of postpartum depression. PARTICIPANTS AND SETTING: Conducted in Alberta and New Brunswick; mothers were interviewed individually (Alberta, n= 24; New Brunswick, n= 17) and in groups (Alberta, n= 5; New Brunswick, n= 6). RESULTS: For most mothers, one-on-one support was preferred when postpartum depression is recognized. Group support should be available once the mothers start to feel better and are able to comfortably interact with other mothers in a group format. This suite of alternatives needs to be underpinned by concerted public education efforts.