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BACKGROUND: COVID-19 vaccines were key to controlling the pandemic and vaccination has been discussed extensively by the media and the public since 2020. We aimed to explore parents' attitudes towards routine childhood vaccination since COVID-19 and how the pandemic impacted their experiences of getting their child vaccinated. METHODS: We used a mixed-methods approach-involving a questionnaire survey followed by focus groups. We partnered with The Mosaic Community Trust, an ethnic minority women's group based in a deprived area of North-West London, United Kingdom (UK) with historically low childhood vaccine uptake. Descriptive findings from the questionnaires were reported and chi-square analyses performed to examine differences by ethnicity. Thematic analysis of the free-text questionnaire responses and focus groups was undertaken, guided by the COM-B model of Capability, Opportunity, and Motivation. RESULTS: Between Jun-Oct 2022, 518 parents completed the questionnaire (25% from ethnic minorities). Between March-May 2023 we held four focus groups with 22 parents (45% from ethnic minorities). Most parents (>90%) thought routine childhood vaccines for children were important. Over a third (38%) of all parents reported having more questions about childhood vaccines since COVID-19, though among parents belonging to an ethnicity group other than white, 59% said they had more questions compared to those of any white ethnicity group (30%, (p = <0.0001)). Difficulties accessing vaccine appointments were commoner reasons for children's vaccinations being delayed than parents increased concerns about vaccines. Since COVID-19 some parents felt vaccinations were even more important, and a very small minority felt the pandemic had made them mistrust vaccinations. CONCLUSION: Following COVID-19, we found parents remain confident in childhood vaccines. However, some parents, particularly from ethnic minority groups may have more questions about childhood vaccines than pre-pandemic. Post COVID-19, to address declining vaccine uptake, parents need easy access to healthcare professionals to answer questions about childhood vaccinations.
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Vacunas contra la COVID-19 , COVID-19 , Grupos Focales , Padres , Vacunación , Humanos , COVID-19/prevención & control , COVID-19/epidemiología , COVID-19/psicología , Padres/psicología , Femenino , Masculino , Vacunas contra la COVID-19/uso terapéutico , Vacunas contra la COVID-19/administración & dosificación , Encuestas y Cuestionarios , Reino Unido/epidemiología , Adulto , Vacunación/psicología , Niño , SARS-CoV-2 , Pandemias/prevención & control , Persona de Mediana Edad , Conocimientos, Actitudes y Práctica en Salud , PreescolarRESUMEN
OBJECTIVES: An effective vaccine for chicken pox has been included in immunisation schedules since the 1990s. In the UK the recommendation for routine inclusion came in November 2023; it has not yet been implemented. We explored paediatricians' attitudes towards the vaccine and their personal and professional use; as this has been shown to be an influential factor in parents' vaccine decision making. METHODS: We conducted a cross-sectional online survey using a structured questionnaire exploring attitudes and knowledge towards the chicken pox vaccine of UK based paediatricians between June and September 2023. RESULTS: We received 272 responses, 211 female (78%), 228 based in England (85%) with remainder in Wales (23), Scotland (8) and Northern Ireland (9); 150 (56%) reporting practicing paediatrics <10 years. The majority (n = 207; 78%) agreed that the chicken pox vaccine should be included in the UK routine schedule. Half the cohort, 52% (n = 135), reported having their own children vaccinated against chicken pox, 73% of those with appropriately aged children. Most, 86% (n = 225), recommended the vaccine to family and friends routinely or when asked; however, 42% (n = 108) did not feel able to advise patients' parents due to insufficient information. Of those who do not recommend the vaccine to family and friends, 22 (59%) reported insufficient information to discuss in a professional setting. Of those who did not think it should be included, or were unsure, 38/55 (69%) also felt they had insufficient information to advise parents regarding the vaccine. CONCLUSIONS: Whilst many paediatricians choose to vaccinate their children and agreed the chicken pox vaccine should be added to the routine schedule, the proportion disagreeing is not insignificant. Targeted education to improve paediatricians' knowledge of the chicken pox vaccine and their confidence discussing it should be implemented prior to the national roll out.
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BACKGROUND: To ensure that children with life-limiting conditions (LLC) and their families have access to a palliative care pathway from diagnosis to death and bereavement, a better understanding of the challenges experienced by paediatric healthcare professionals caring for children with LLC is needed. AIM: To explore the barriers paediatricians face in initiating and implementing palliative and end-of-life care for children with LLC. METHODS: Due to the challenges of COVID-19, the study was performed as a service evaluation using semi-structured interviews and an online questionnaire with consultant paediatricians in general paediatrics, community paediatrics and multiple subspecialties at a UK children's hospital between December 2020 and August 2021. Twelve interviews and 18 online questionnaires were completed. Interviews were analysed using reflexive thematic analysis, and descriptive statistics were used for questionnaire responses. RESULTS: Recurring themes from both data sets were further analysed and five themes were developed: (1) Problems with the leadership of palliative and end-of-life care; (2) Problems with preparing advanced care plans; (3) Lack of training in paediatric palliative care and advanced communication; (4) Problems communicating with families; and (5) Lack of recognition of children with LLC and high-profile cases. CONCLUSIONS: We found that the barriers to effective palliative and end-of-life planning are multifaceted and pervasive, so healthcare professionals must establish clearer pathways to overcome them. Approaches suggested included (1) discussing palliative care for children with LLC at professional encounters, for example, departmental meetings, peer-review meetings and morbidity and mortality meetings and (2) advanced communication training in palliative and end-of-life care.
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BACKGROUND: Varicella (chickenpox) is a highly contagious disease caused by the varicella-zoster virus. Although typically mild, varicella can cause complications leading to severe illness and even death. Safe and effective varicella vaccines are available. The Joint Committee on Vaccination and Immunisation has reviewed the evidence and recommended the introduction of varicella vaccine into the UK's routine childhood immunisation schedule. OBJECTIVES: To explore UK healthcare professionals' (HCPs) knowledge and attitudes towards varicella vaccination, its introduction to the UK routine childhood immunisation schedule, and their preferences for how it should be delivered. DESIGN: We conducted an online cross-sectional survey exploring HCPs' attitudes towards varicella, varicella vaccine, and their preferences for delivery of the vaccine between August and September 2022 prior to the recommendation that varicella vaccine should be introduced. PARTICIPANTS: 91 HCPs working in the UK (81 % nurses/health visitors, 9 % doctors, 10 % researcher/other, mean age 48.7 years). RESULTS: All respondents agreed or strongly agreed that vaccines are important for a child's health. However, only 58% agreed or strongly agreed that chicken pox was a disease serious enough to warrant vaccination. Gaps in knowledge about varicella were revealed: 21.0% of respondents disagreed or were unsure that chickenpox can cause serious complications, while 41.8% were unsure or did not believe chickenpox was serious enough to vaccinate against. After receiving some basic information about chickenpox and the vaccine, almost half of the HCPs (47.3%) in our survey would prefer to administer the varicella vaccine combined with MMR. CONCLUSIONS: Given the positive influence of HCPs on parents' decisions to vaccinate their children, it is important to understand HCPs' views regarding the introduction of varicella vaccine into the routine schedule. Our findings highlighted areas for training and HCPs' preferences which will have implications for policy and practice when the vaccine is introduced.
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Vacuna contra la Varicela , Varicela , Niño , Humanos , Persona de Mediana Edad , Actitud del Personal de Salud , Varicela/prevención & control , Vacuna contra la Varicela/uso terapéutico , Estudios Transversales , Reino Unido , Vacunación , Vacunas AtenuadasAsunto(s)
Sarampión , Humanos , Lactante , Sarampión/epidemiología , Sarampión/prevención & control , Vacunación , Vacuna AntisarampiónRESUMEN
PURPOSE: Despite substantial vaccination progress, persistent measles outbreaks challenge global elimination efforts, particularly within healthcare settings. In this paper, we critically review the factors contributing to measles outbreak and effective control measures for nosocomial transmission of measles. METHODS: We systematically searched electronic databases for articles up to 17th May, 2023. This was performed by two independent reviewers, with any disagreements resolved by a third reviewer. We also searched governmental and international health agencies for relevant studies. RESULTS: Forty relevant articles were systematically reviewed, revealing key factors fuelling measles outbreak in healthcare settings, including high transmissibility capability; high intensity exposure; delayed care; failure to use protective equipment and implement control measures; vaccine failure; unclear immunisation history and lack of registries; and lacking recommendation on healthcare workers' (HCWs) measles vaccination. To combat these challenges, successful control strategies were identified which include early notification of outbreak and contact tracing; triaging all cases and setting up dedicated isolation unit; strengthening protective equipment use and physical measures; improving case detection; determining immunity status of HCWs; establishing policy for measles vaccination for HCWs; management of exposed personnel; and developing a pre-incident response plan. CONCLUSION: A coordinated and comprehensive approach is essential to promptly identify and manage measles cases within healthcare settings, necessitating multifactorial strategies tailored to individual settings. These findings provide a valuable foundation for refining strategies to achieve and maintain measles elimination status in healthcare environments.
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Infección Hospitalaria , Brotes de Enfermedades , Sarampión , Sarampión/prevención & control , Sarampión/epidemiología , Sarampión/transmisión , Humanos , Infección Hospitalaria/prevención & control , Brotes de Enfermedades/prevención & control , Personal de Salud , Vacunación , Control de Infecciones/métodos , Vacuna Antisarampión/administración & dosificaciónRESUMEN
BACKGROUND: Childhood immunisation is a critically important public health initiative. However, since most vaccines are administered by injection, it is associated with considerable pain and distress. Despite evidence demonstrating the efficacy of various pain management strategies, the frequency with which these are used during routine infant vaccinations in UK practice is unknown. AIM: This study aimed to explore primary care practice nurses' (PNs) use of evidence-based pain management strategies during infant immunisation, as well as barriers to evidence-based practice. METHODS: A questionnaire was developed and distributed to nurses throughout the UK via convenience sampling in paper and online formats. Questions assessed the frequency of pain management intervention use during infant immunisation and barriers to their use. FINDINGS: A total of 255 questionnaire responses were received. Over 90% (n = 226) of respondents never used topical anaesthetics or sweet solutions during immunisations, while 41.9% advised breastfeeding occasionally (n = 103). Parent-/caregiver-led distraction was the most frequently used intervention, with most nurses using it occasionally (47.9%, n = 116) or often (30.6%, n = 74). Most practices had no immunisation pain management policy (81.1%, n = 184), and most PNs' previous training had not included pain management (86.9%, n = 186). Barriers to intervention use included lack of time, knowledge and resources. Excluding distraction, pain management strategies were infrequently or never used during infant immunisation. Key barriers to using evidence-based strategies were lack of time, knowledge and resources.
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Manejo del Dolor , Enfermería de Atención Primaria , Lactante , Humanos , Niño , Estudios Transversales , Inmunización , Vacunación , Dolor , Reino UnidoRESUMEN
Background: In the UK, a robust childhood immunisation programme ensures children are offered protection against serious infections; identifying inequalities in vaccination coverage is essential. This is one of the first data linkage studies to examine coverage of primary, as well as pre-school booster and second dose of MMR vaccines, in children receiving support from social care services across Wales. Methods: By accessing records held within the Secure Anonymised Information Linkage (SAIL) Databank, vaccination status of children receiving social care and support between April 2016 and March 2021 (n = 24,540) was ascertained. This was achieved through linkage of the Children Receiving Care and Support (CRCS) Census and National Community Child Health Database which holds vaccination records for all children in Wales registered for NHS care. This sample was split into three groups - those children who had never been recorded on the Child Protection Register (CPR) or as 'Looked After' but in CRCS (n = 12,480), children ever on the CPR (n = 6,225) and those ever recorded as 'Looked After' but who were never on the CPR (n = 5,840). The comparison group of children and young people (CYP) never receiving welfare support consisted of 624,905 children. Results: Children receiving care or support were more likely to be up-to-date with all six vaccines (no recorded vaccines: 0.6-6.3%) compared to children in the comparison group (no recorded vaccines: 3-10.3%). However, of those who were vaccinated, they were less likely to be vaccinated in a timely manner; both early (5.2% vs. 22.2%; margin of error [ME] = 0.52, 95% CI [confidence interval] = -0.18 - -0.17, p < 0.001) and delayed vaccinations were more common (62.7% vs. 71.3%; ME = 0.58, 95% CI = 0.08-0.09, p < 0.001). Validation of the CRCS immunisation flag showed moderate levels of accuracy. Around 70% of immunisation flags were correct across all three groups. Discussion: Findings suggest a positive association between receiving services under a care and support plan and being up-to-date with immunisations; children receiving support under a care and support plan were more likely to have experienced early or late vaccinations, demonstrating that there is still more inter-disciplinary co-ordination and planning needed to improve these outcomes. Thus, identifying inequalities in vaccination coverage is essential to target interventions and to prioritise geographic areas for catch-up.
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Cobertura de Vacunación , Vacunación , Humanos , Niño , Preescolar , Adolescente , Gales , Vacuna contra el Sarampión-Parotiditis-Rubéola/uso terapéutico , Bases de Datos FactualesRESUMEN
INTRODUCTION: Health visiting is a long-established, nationally implemented programme that works with other services at a local level to improve the health and well-being of children and families. To maximise the impact and efficiency of the health visiting programme, policy-makers and commissioners need robust evidence on the costs and benefits of different levels and types of health visiting, for different families, in different local contexts. METHODS AND ANALYSIS: This mixed-methods study will analyse individual-level health visiting data for 2018/2019 and 2019/2020 linked with longitudinal data from children's social care, hospitals and schools to estimate the association of number and type of health visiting contacts with a range of children and maternal outcomes. We will also use aggregate local authority data to estimate the association between local models of health visiting and area-level outcomes. Outcomes will include hospitalisations, breast feeding, vaccination, childhood obesity and maternal mental health. Where possible, outcomes will be valued in monetary terms, and we will compare total costs to total benefits of different health visiting service delivery models. Qualitative case studies and extensive stakeholder input will help explain the quantitative analyses and interpret the results in the context of local policy, practice and circumstance. ETHICS AND DISSEMINATION: The University College London Research Ethics Committee approved this study (ref 20561/002). Results will be submitted for publication in a peer-reviewed journal and findings will be shared and debated with national policy-makers, commissioners and managers of health visiting services, health visitors and parents.
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Obesidad Infantil , Salud Pública , Niño , Humanos , Familia , Inglaterra , PadresRESUMEN
OBJECTIVES: To explore acceptability of and preferences for the introduction of varicella vaccination to the UK childhood immunisation schedule. DESIGN: We conducted an online cross-sectional survey exploring parental attitudes towards vaccines in general, and varicella vaccine specifically, and their preferences for how the vaccine should be administered. PARTICIPANTS: 596 parents (76.3% female, 23.3% male, 0.4% other; mean age 33.4 years) whose youngest child was aged 0-5 years. MAIN OUTCOME MEASURES: Willingness to accept the vaccine for their child and preferences for how the vaccine should be administered (in combination with the MMR vaccine [MMRV], on the same day as the MMR vaccine but as a separate injection [MMR + V], on a separate additional visit). RESULTS: 74.0% of parents (95% CI 70.2% to 77.5%) were extremely/somewhat likely to accept a varicella vaccine for their child if one became available, 18.3% (95% CI 15.3% to 21.8%) were extremely/somewhat unlikely to accept it and 7.7% (95% CI 5.7% to 10.2%) were neither likely nor unlikely. Reasons provided by parents likely to accept the vaccine included protection from complications of chickenpox, trust in the vaccine/healthcare professionals, and wanting their child to avoid their personal experience of chickenpox. Reasons provided by parents who were unlikely included chickenpox not being a serious illness, concern about side effects, and believing it is preferable to catch chickenpox as a child rather than as an adult. A combined MMRV vaccination or additional visit to the surgery were preferred over an additional injection at the same visit. CONCLUSIONS: Most parents would accept a varicella vaccination. These findings highlight parents' preferences for varicella vaccine administration, information needed to inform vaccine policy and practice and development of a communication strategy.
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Varicela , Vacunas Virales , Niño , Adulto , Humanos , Masculino , Femenino , Lactante , Varicela/prevención & control , Vacuna contra el Sarampión-Parotiditis-Rubéola , Estudios Transversales , Vacuna contra la Varicela , Vacunas Combinadas , Vacunación , Vacunas Atenuadas , Padres , Reino UnidoRESUMEN
INTRODUCTION: Call and recall systems provide actionable intelligence to improve equity and timeliness of childhood vaccinations, which have been disrupted during the COVID-19 pandemic. We will evaluate the effectiveness, fidelity and sustainability of a data-enabled quality improvement programme delivered in primary care using an Active Patient Link Immunisation (APL-Imms) call and recall system to improve timeliness and equity of uptake in a multiethnic disadvantaged urban population. We will use qualitative methods to evaluate programme delivery, focusing on uptake and use, implementation barriers and service improvements for clinical and non-clinical primary care staff, its fidelity and sustainability. METHODS AND ANALYSIS: This is a mixed-methods observational study in 284 general practices in north east London (NEL). The target population will be preschool-aged children eligible to receive diphtheria, tetanus and pertussis (DTaP) or measles, mumps and rubella (MMR) vaccinations and registered with an NEL general practice. The intervention comprises an in-practice call and recall tool, facilitation and training, and financial incentives. The quantitative evaluation will include interrupted time Series analyses and Slope Index of Inequality. The primary outcomes will be the proportion of children receiving at least one dose of a DTaP-containing or MMR vaccination defined, respectively, as administered between age 6 weeks and 6 months or between 12 and 18 months of age. The qualitative evaluation will involve a 'Think Aloud' method and semistructured interviews of stakeholders to assess impact, fidelity and sustainability of the APL-Imms tool, and fidelity of the implementation by facilitators. ETHICS AND DISSEMINATION: The research team has been granted permission from data controllers in participating practices to use deidentified data for audit purposes. As findings will be specific to the local context, research ethics approval is not required. Results will be disseminated in a peer-reviewed journal and to stakeholders, including parents, health providers and commissioners.
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COVID-19 , Sarampión , Rubéola (Sarampión Alemán) , Niño , Preescolar , Humanos , Recién Nacido , Pandemias , Mejoramiento de la Calidad , COVID-19/epidemiología , COVID-19/prevención & control , Vacunación , Rubéola (Sarampión Alemán)/prevención & control , Estudios Observacionales como AsuntoRESUMEN
BACKGROUND: Care of young children with neurodevelopmental disorders (NDD) is a major component of paediatric outpatient practice. However, cross-country practice reviews to date have been limited, and available data demonstrate missed opportunities for early identification, particularly in vulnerable population subgroups. METHODS: Multicountry review of national paediatric body guidance related to developmental surveillance, early identification and early childhood intervention together with review of outpatient paediatrician practices for developmental assessment of children aged 0-5 years with/at risk of NDDs. Review included five countries with comparable nationalised universal child healthcare systems (ie, Australia, Canada, New Zealand, Sweden and the UK). Data were collected using a combination of published and grey literature review, supplemented by additional local sources with descriptive review of relevant data points. RESULTS: Countries had broadly similar systems for early identification of young children with NDDs alongside universal child health surveillance. However, variation existed in national paediatric guidance, paediatric developmental training and practice, including variable roles of paediatricians in developmental surveillance at primary care level. Data on coverage of developmental surveillance, content and quality of paediatric development assessment practices were notably lacking. CONCLUSION: Paediatricians play an important role in ensuring equitable access to early identification and intervention for young children with/at risk of NDDs. However, strengthening paediatric outpatient care of children with NDD requires clearer guidance across contexts; training that is responsive to shifting roles within interdisciplinary models of developmental assessment and improved data to enhance equity and quality of developmental assessment for children with/at risk of NDDs.
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Trastornos del Neurodesarrollo , Pacientes Ambulatorios , Niño , Humanos , Preescolar , Australia , Pediatras , Medición de RiesgoRESUMEN
This study aimed to explore women's experiences of support and care received from maternity healthcare professionals for perinatal low mood or depression, and healthcare professionals' experiences of providing support and care for women experiencing perinatal low mood or depression. In this qualitative study, face-to-face individual semistructured interviews and focus groups were conducted with 15 women and 19 healthcare professionals living or working in Yorkshire and the Humber, England in 2019. Thematic analysis was used to analyze the qualitative data. The following themes were identified: (1) lack of standardization in identification and support for perinatal low mood and depression; (2) unclear and nonstandardized pathways for perinatal low mood and depression; and (3) enablers and barriers of receiving support and care for perinatal low mood and depression. Providing training opportunities for healthcare professionals, especially midwives, may be helpful for filling the gray area for women who do not need a referral to mental health services but require support from healthcare professionals. Improving the variety of psychological therapies for the treatment of perinatal depression may also be helpful to meet women's expectations of treatments.
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Servicios de Salud Mental , Partería , Femenino , Embarazo , Humanos , Depresión/terapia , Investigación Cualitativa , Grupos Focales , Atención a la SaludRESUMEN
INTRODUCTION: Despite increasing prevalence, European family homelessness remains under-researched. METHODS: A retrospective review was performed of homeless children attending a paediatric emergency department in Dublin, Ireland, from 1 January 2017 to 31 December 2020. Comparison was made with a random cohort of 1500 non-homeless paediatric attendances in 2019. Homelessness was defined using the European Typology of Homelessness and Housing Exclusion, including those with addresses of no fixed abode, government homeless accommodation and certain residential settings. The objectives were to compare presentations between homeless and non-homeless children. We were interested in determining differences regarding demographics, healthcare utilisation, clinical presentation and outcomes. RESULTS: Of 197 437 attendances 3138 (1.59%) were homeless. Compared with the non homeless, homeless children were less likely to be ethnically Irish (37.4% vs 74.6%, p<0.001) or have been born in Ireland (82.3% vs 96.2%, p<0.001). Irish Travellers (3% vs 0.8%), Roma (22.5% vs 2.4%) and black (21.1% vs 4.2%) ethnicities were over-represented (p<0.001) in the homeless cohort.Homeless children were younger (age <12 months: 26% vs 16%; p<0.001), less likely to be fully vaccinated (73.6% vs 81.9%, p<0.001) and have registered general practitioners (89.7% vs 95.8%, p<0.001). They were more likely to represent within 2 weeks (15.9% vs 10.5%, p<0.001), and use ambulance transportation (13.2% vs 6.7%, p<0.001). Homeless children had lower acuity presentations (triage category 4-5: 47.2% vs 40.7%, p<0.001) and fewer admissions (5.9% vs 8.4%, p<0.001) than non-homeless children. DISCUSSION: Infants, Irish Travellers, Roma and black ethnicities were over-represented in homeless presentations. Homeless children had increased reliance on emergency services for primary healthcare needs.
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Jóvenes sin Hogar , Personas con Mala Vivienda , Niño , Servicio de Urgencia en Hospital , Humanos , Lactante , Irlanda/epidemiología , Estudios RetrospectivosRESUMEN
BACKGROUND: Delayed primary vaccination is one of the strongest predictors of subsequent incomplete immunisation. Identifying children at risk of such delay may enable targeting of interventions, thus decreasing vaccine-preventable illness. OBJECTIVES: To explore socio-demographic factors associated with delayed receipt of the Diphtheria, Tetanus and Pertussis (DTP) vaccine. METHODS: We included 1,782 children, born between 2000 and 2001, participating in the Millennium Cohort Study (MCS) and resident in Wales, whose parents gave consent for linkage to National Community Child Health Database records at the age seven years contact. We examined child, maternal, family and area characteristics associated with delayed receipt of the first dose of the DTP vaccine. RESULTS: 98.6% received the first dose of DTP. The majority, 79.6% (n = 1,429) received it on time (between 8 and 12 weeks of age), 14.2% (n = 251) received it early (prior to 8 weeks of age) and 4.8% (n = 79) were delayed (after 12 weeks of age); 1.4% (n = 23) never received it. Delayed primary vaccination was more likely among children with older natural siblings (risk ratio 3.82, 95% confidence interval (1.97, 7.38)), children admitted to special/intensive care (3.15, (1.65, 5.99)), those whose birth weight was > 4Kg (2.02, (1.09, 3.73)) and boys (1.53, (1.01, 2.31)). There was a reduced risk of delayed vaccination with increasing maternal age (0.73, (0.53, 1.00) per 5 year increase) and for babies born to graduate mothers (0.27, (0.08, 0.90)). CONCLUSIONS: Although the majority of infants were vaccinated in a timely manner, identification of infants at increased risk of early or delayed vaccination will enable targeting of interventions to facilitate timely immunisation. This is to our knowledge the first study exploring individual level socio-demographic factors associated with delayed primary vaccination in the UK and demonstrates the benefits of linking cohort data to routinely-collected child health data.
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Vacuna contra Difteria, Tétanos y Tos Ferina , Vacunación , Niño , Preescolar , Estudios de Cohortes , Etnicidad , Femenino , Humanos , Inmunización , Esquemas de Inmunización , Lactante , MasculinoRESUMEN
BACKGROUND: Behavioural activation (BA) is recommended by the National Institute for Health and Care Excellence guidelines for the treatment of perinatal depression; however, there is limited evidence about whether it is effective when delivered by non-mental health specialists (NMHS) in a perinatal setting in the UK. AIMS: This study aimed to adapt a BA intervention manual and guided self-help booklet intended for delivery by NMHSs for the treatment of perinatal depression. METHOD: Interviews were conducted with 15 women and 19 healthcare professionals (HCP) within the first study element. Four experience-based co-design (EBCD) workshops were held, with the involvement of 14 women and three HCPs, to modify the BA documents for the specific needs of perinatal women. Thematic analysis was used to analyse the data. FINDINGS: The findings from the study elements were presented with themes. The co-designers (women and HCPs) pointed out that having sleeping problems, changes in appetite, feeling exhausted and feeling emotional, may be experienced by non-depressed mothers as well during pregnancy or in the postpartum period, especially around the fourth day after giving birth. Therefore, it was important to differentiate these feelings from depression. The women also wanted to see an example for each activity before being asked to do it. Having examples would help them to see the possibilities before creating their own diary sheets or tables of activities. CONCLUSIONS: Aside of the tool adaptation, the findings of this study provide a foundation to assess the effectiveness of the adapted intervention in a subsequent feasibility trial.
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Depresión , Trastorno Depresivo , Terapia Conductista , Depresión/terapia , Trastorno Depresivo/terapia , Femenino , Humanos , Madres/psicología , Periodo Posparto , EmbarazoRESUMEN
OBJECTIVE: Nearly half of all cases of perinatal depression are not detected, despite routine appointments with healthcare professionals (HCP) during pregnancy and after childbirth. Early identification of perinatal depression is crucial to provide the required support and offer timely treatment. This study aimed to explore women's experiences of perinatal depression to help identification and management of perinatal depression by HCPs. DESIGN: Theoretical perspective of symbolic interactionism and methodological design of ethnography was adopted. Face-to-face individual interviews were used. Thematic analysis was conducted to analyse interview data. PARTICIPANTS: Fifteen women who had experienced perinatal depression in the last five years were interviewed. FINDINGS: Three themes were identified: 1) Getting closer to the perinatal depression; 2) Decision to disclose or hide real feelings; 3) Hidden face of perinatal depression. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Findings demonstrate the importance of HCPs' attitudes towards women, as if women perceive they being dismissed or neglected by HCPs, may have an impact on women refraining from disclosing their feelings.
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Depresión Posparto , Trastorno Depresivo , Parto Obstétrico , Depresión/diagnóstico , Depresión Posparto/diagnóstico , Revelación , Femenino , Humanos , Embarazo , Investigación CualitativaRESUMEN
BACKGROUND: Debate is ongoing about mandating COVID-19 vaccination to maximise uptake. Policymakers must consider whether to mandate, for how long, and in which contexts, taking into account not only legal and ethical questions but also public opinion. Implementing mandates among populations who oppose them could be counterproductive. METHODS: Qualitative telephone interviews (Feb-May 2021) with British adults explored views on vaccine passports and mandatory vaccination. Participants (n = 50) were purposively selected from respondents to a probability-based national survey of attitudes to COVID-19 vaccination, to include those expressing vaccine-hesitancy. Data were analysed thematically. FINDINGS: Six themes were identified in participants' narratives concerning mandates: (i) mandates are a necessary and proportionate response for some occupations to protect the vulnerable and facilitate the resumption of free movement; (ii) mandates undermine autonomy and choice; (iii) mandates represent an over-reach of state power; (iv) mandates could potentially create 'vaccine apartheid'; (v) the importance of context and framing; and (vi) mandates present considerable feasibility challenges. Those refusing vaccination tended to argue strongly against mandates. However, those in favour of vaccination also expressed concerns about freedom of choice, state coercion and social divisiveness. DISCUSSION: To our knowledge, this is the first in-depth UK study of public views on COVID-19 vaccine mandates. It does not assess support for different mandates but explores emotions, principles and reasoning underpinning views. Our data suggest that debate around mandates can arouse strong concerns and could entrench scepticism. Policymakers should proceed with caution. While surveys can provide snapshots of opinion on mandates, views are complex and further consultation is needed regarding specific scenarios.