Healthcare professionals' views on the accessibility and acceptability of perinatal mental health services for South Asian and Black women: a qualitative study.

BACKGROUND: Perinatal mental illness affects one third of new and expectant mothers. Individuals from ethnic minority groups experience higher rates of mental health problems and higher suicide rates. Despite this, women from ethnic minorities-Black and South Asian women in particular-are less likely to receive support from mental health services in the perinatal period. Healthcare professionals (HCPs) who have contact with women during this period have a unique perspective, and their views may provide insights to understand and remedy this health inequality. This study aimed to identify healthcare professionals' views on the current accessibility and acceptability of perinatal mental health services, and ways of improving services by addressing the barriers for these women. METHODS: Semi-structured interviews were conducted with twenty-four healthcare professionals who work with patients in the perinatal period. Purposive sampling was used to select HCPs from a range of different professions (including mental health staff, midwifery, primary care, social care). The data were analysed using Framework Analysis. RESULTS: Three main themes were identified from the data: (1) lack of awareness and understanding of perinatal mental illness and service structure in both healthcare professionals and patients; (2) patients' relationships with family, friends and healthcare professionals can both hinder and facilitate access to services; (3) healthcare professionals encourage raising awareness, flexibility, developing shared understandings and questioning assumptions to improve the accessibility and acceptability of services. CONCLUSION: Key insights into explaining and remedying the health inequalities observed between ethnic groups were proposed by healthcare professionals. Recommendations included sharing information; taking steps to ensure each woman was considered as an individual in her relationship with her culture, ethnicity and childrearing practices; and healthcare professionals addressing their possible unconscious biases through engaging in personal reflexive practices. Reasons these are currently not being implemented deserve further research, and the potential of novel roles such as peer support workers in bridging the space between ideals and practice needs further investigation.

Exploring Black and South Asian women's experiences of help-seeking and engagement in perinatal mental health services in the UK.

Background and aims: In the United Kingdom (UK), Black and South Asian women are less likely than White British women to access support from perinatal mental health services, despite experiencing similar, or higher, levels of distress. This inequality needs to be understood and remedied. The aim of this study was to answer two questions: how do Black and South Asian women experience (1) access to perinatal mental health services and (2) care received from perinatal mental health services? Method: Semi-structured interviews were conducted with Black and South Asian women (n = 37), including four women who were interviewed with an interpreter. Interviews were recorded and transcribed line-by-line. Data were analyzed using framework analysis, by an ethnically diverse multidisciplinary team of clinicians, researchers and people with lived experience of perinatal mental illness. Results: Participants described a complex interplay of factors that impacted on seeking, and receiving help, and benefiting from services. Four themes emerged that captured the highly varied experiences of individuals: (1) Self-identity, social expectations and different attributions of distress deter help-seeking; (2) Hidden and disorganized services impede getting support; (3) The role of curiosity, kindness and flexibility in making women feel heard, accepted and supported by clinicians; (4) A shared cultural background may support or hinder trust and rapport. Conclusion: Women described a wide range of experiences and a complex interplay of factors impacting access to, and experience of, services. Women described services as giving them strength and also leaving them disappointed and confused about where to get help. The main barriers to access were attributions related to mental distress, stigma, mistrust and lack of visibility of services, and organizational gaps in the referral process. These findings describe that many women feel heard, and supported by services, reporting that services provide a high quality of care that was inclusive of diverse experiences and understandings of mental health problems. Transparency around what PMHS are, and what support is available would improve the accessibility of PMHS.

Acceptability and feasibility of using avatar-based virtual world software as an adjunct to clinical interventions, training, and reflective practice in a medium secure setting: A qualitative interview study.

BACKGROUND: Relationships are at the core of recovery, particularly in secure services where patients have usually had difficulties with authority figures and can have mentalisation deficits. Early indications are that avatar-based virtual world software may help facilitate communication and emotional expression. AIMS: To establish the feasibility of using avatar-based virtual world software in a medium secure hospital, adjunctive to standard staff-patient interactions during clinical interventions and staff activities including reflective practice and training; to explore patient, staff participant and facilitator experiences using it. METHODS: Use of the software was offered across an 89-bedded unit as an optional adjunct to clinical interventions, reflective practice and training sessions. Qualitative data were collected using semi-structured interviews and analysed using thematic analysis. Volunteer sampling was used. Five patients volunteered and were matched with an equal number of staff facilitators and participants. RESULTS: Eighty four sessions were completed using the avatar software with between 1 and 11 participant(s) per session, totalling 347 participant sessions. No adverse events occurred relatable to the sessions. An overarching theme of 'adding value' emerged, encompassing subthemes such as 'concrete visual presence and imagery', 'mentalisation processes' and 'enhanced focus, depth and problem solving'. Experiences of added value were affected by moderators which were 'power and relationship dynamics', the 'ability to use software', 'practical processes' and 'literacy'. CONCLUSIONS: Avatar software is feasible to implement, acceptable to patients and staff and may offer an opportunity to aid mentalisation and reflection. By definition, everyone engaging in this study was a volunteer, even an enthusiast, so it would now be useful to extend evaluation to those who need some encouragement to use avatar software. Research to quantify benefits and establish the cost impact is now indicated, as our findings show it may offer a novel way of connecting with hard-to-reach patient groups.

A qualitative study exploring the support needs of newly qualified nurses and their experiences of an online peer support intervention.

BACKGROUND: In the transitional period following registration, newly qualified nurses may feel socially isolated and easily overwhelmed by increases in accountability, workplace pressures and the psychological demands of the role. Such experiences place them at risk of burnout and leaving the profession. AIMS: To explore newly qualified nurses' support needs and their experiences of an online peer support intervention. METHOD: Eighteen newly qualified nurses participated in online peer support groups. After 3 months participants took part in interviews exploring their support needs and experiences of the groups. Eight one-to one interviews were conducted between October 2019 and January 2020. Qualitative thematic analysis was used. FINDINGS: Two themes identified were; "The Support needs of newly qualified nurses" with two subthemes, "The role of the newly qualified nurse" and "Unmet support needs"; "The online experience" with three subthemes, "Barriers to participation", "Anticipated benefits" and "Unmet expectations". CONCLUSION: Our findings suggested that there is insufficient support for newly qualified nurses. The newly qualified nurses wanted to use online support to help manage their stress. However, the organisation of online peer support needs careful consideration to ensure participation can be beneficial. IMPACT STATEMENT: Online support requires careful design and clear support from employing organisations to promote improved transition experiences. Further research should focus on evaluating adjusted online support interventions.

Exploring newly qualified nurses' experiences of support and perceptions of peer support online: A qualitative study.

AIMS AND OBJECTIVES: To explore newly qualified nurses' support needs and their perceptions of online peer support. BACKGROUND: The experience of being a newly qualified nurse is stressful and isolating. Support from colleagues and peers can enhance perceptions of competence and confidence in newly qualified nurses, improve well-being and aid retention. However, despite initiatives such as preceptorship, support needs may remain unmet in busy clinical environments. Online support has potential to offer a partial solution to professional isolation, but there is a lack of research into how technology can support nurses' emotional and social well-being. DESIGN: A qualitative exploratory study was designed, employing semi-structured focus groups, analysed using thematic analysis. The study is reported in accordance with the COnsolidated criteria for REporting Qualitative research checklist. METHODS: Eight focus groups, supplemented by one individual interview, were conducted with newly qualified nurses between June 2018-January 2019. FINDINGS: Two main themes arose. The first was Drowning, a lot of the time with two sub-themes: (i) Feelings and emotions about being a Newly Qualified Nurse: 'Absolutely terrified' and (ii) Support within the role: 'Somebody you can count on'. The second was Potential advantages and disadvantages of online modality: 'Somebody is going to get in that phone!' which included three sub-themes (i) Potential advantages, (ii) Potential disadvantages and (iii) Preferences and recommendations. CONCLUSIONS: This study demonstrates that if barriers can be overcome, then online support has potential to contribute to newly qualified nurses' well-being. Further research is needed to explore technical and ethical issues around online support and evaluate its effectiveness for newly qualified nurses. RELEVANCE TO CLINICAL PRACTICE: Online support has the potential to add to existing strategies to support nurses during stressful times. This may be particularly relevant when many staff are working under increased pressure due to the COVID-19 pandemic.

Using technology to support the emotional and social well-being of nurses: A scoping review.

AIMS: (a) To review the literature on the use of technology to offer emotional and social support to nurses; (b) to identify and evaluate gaps in the research; (c) to assess whether a systematic review would be valuable and (d) to make recommendations for future research. DESIGN: A robust methodological scoping framework was used as the basis for this review design. A manualized systematic approach to quality appraisal was implemented. DATA SOURCES: Between 11-12 June 2018, five databases were searched. A search of the grey literature was conducted alongside hand searching reference lists of included studies. REVIEW METHODS: Two researchers conducted the literature search, data extraction and quality appraisal. Three searches were conducted, combining nursing and technological terms. A narrative review approach to knowledge synthesis was used to compare and evaluate included studies. RESULTS: Eleven articles were retrieved. Results are presented under three subheadings: (a) text messaging and messenger apps; (b) social media and online forums; and (c) online interventions accessible via PC, smartphone and tablet. All included studies described how such provision could be beneficial; decreasing stress, isolation and anxiety and fostering a sense of community. CONCLUSION: The review identified a dearth of research into how technology can support the well-being of nurses. A high proportion of studies were based on student nurse populations using small sample sizes, therefore further research is needed. IMPACT: Technology may offer a sustainable and accessible means of providing support for nurses who find it difficult to communicate in person due to time pressures at work. It is important that the psychological well-being of nurses is seriously addressed as more nurses are now leaving than joining the profession. Online interventions may offer a sustainable and accessible means of providing support for busy nursing staff who have difficulty finding time to communicate with one another face-to-face. Nurse retention is an international issue linked to quality of patient care. There are financial implications for healthcare providers who compensate for the workforce deficit by employing costly agency staff. This scoping review aims to map and evaluate the available literature on technology-mediated support for the emotional and social well-being of nurses. Recommendations for future research, policy and practice will be offered from the findings of the review.

The Effects of Maternal Mirroring on the Development of Infant Social Expressiveness: The Case of Infant Cleft Lip.

Parent-infant social interactions start early in development, with infants showing active communicative expressions by just two months. A key question is how this social capacity develops. Maternal mirroring of infant expressions is considered an important, intuitive, parenting response, but evidence is sparse in the first two months concerning the conditions under which mirroring occurs and its developmental sequelae, including in clinical samples where the infant's social expressiveness may be affected. We investigated these questions by comparing the development of mother-infant interactions between a sample where the infant had cleft lip and a normal, unaffected, comparison sample. We videotaped dyads in their homes five times from one to ten weeks and used a microanalytic coding scheme for maternal and infant behaviours, including infant social expressions, and maternal mirroring and marking responses. We also recorded maternal gaze to the infant, using eye-tracking glasses. Although infants with cleft lip did show communicative behaviours, the rate of their development was slower than in comparison infants. This group difference was mediated by a lower rate of mirroring of infant expressions by mothers of infants with cleft lip; this effect was, in turn, partly accounted for by reduced gaze to the infant's mouth, although the clarity of infant social expressions (indexed by cleft severity) and maternal self-blame regarding the cleft were also influential. Results indicate the robustness of parent-infant interactions but also their sensitivity to specific variations in interactants' appearance and behaviour. Parental mirroring appears critical in infant social development, likely supported by the mirror neuron system and underlying clinical and, possibly, cultural differences in infant behaviour. These findings suggest new avenues for clinical intervention.

Maternal gaze to the infant face: Effects of infant age and facial configuration during mother-infant engagement in the first nine weeks.

BACKGROUND: Adult gaze plays an important role in early infant development, and infants are highly sensitive to its presence and direction. Little is known, however, about how adults look at infants while interacting with them. Using eye-tracking technology, this study investigated maternal gaze during naturalistic interactions, and how it was influenced by infant age, focusing on the transition from the first to the second month when social expressiveness emerges, and by infant facial configuration, focusing on the effect of cleft lip. METHODS: Thirty infants (10 with a cleft lip), and their mothers, were seen at 1, 3, 5, 7, and 9 weeks. Mothers were asked to interact with their infants while wearing eye-tracking glasses. Fixation duration and count were calculated for general (infant face, body, and surrounding environment), and infant facial (eyes, mouth, other) areas. RESULTS: At all ages, mothers gazed almost exclusively towards their infant's face, but this was reduced in the presence of a cleft lip. Within the infant's face, the eyes attracted the greatest attention, for all mothers, at all ages. From the first to the second month, all mothers increased their visual attention towards their infant's mouth. Regardless of infant age, the presence of a cleft lip was associated with decreased maternal gaze to the infant's mouth. CONCLUSIONS: This study provides novel findings concerning maternal gaze to infant faces during naturalistic interactions. Maternal gaze changes with infant age, in line with established shifts in social development, and according to infant facial configuration. Decreased gaze to the mouth area associated with infant cleft lip might affect maternal responsiveness, and suggests new dimensions to target in supporting these mothers.