Barriers and facilitators to implementing perinatal mental health care in health and social care settings: a systematic review

Webb, Rebecca; Uddin, Nazihah; Ford, Elizabeth; Easter, Abigail; Shakespeare, Judy; Roberts, Nia; Alderdice, Fiona; Coates, Rose; Hogg, Sally; Cheyne, Helen; Ayers, Susan; team, MATRIx study

doi:10.1016/s2215-0366(20)30467-3

Cited by 68 publications

(70 citation statements)

References 59 publications

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“…In absence thereof, our findings highlight the importance of healthcare professionals who show cultural awareness and humility to overcome this lack of representation in the workforce. This reinforces findings from the existing research regarding racial and ethnic disparities in accessing healthcare and treatment [ 11 – 15 ]. Women highlighted the need to provide healthcare staff with cultural awareness so as they can support women to facilitate access to services as well as the overall experience within them.…”

Section: Discussionsupporting

confidence: 85%

A qualitative study of minority ethnic women’s experiences of access to and engagement with perinatal mental health care

Pilav

Backer

Easter

et al. 2022

BMC Pregnancy Childbirth

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Background Approximately one in five women will experience mental health difficulties in the perinatal period. However, for a large group of women, symptoms of adverse perinatal mental health remain undetected and untreated. This is even more so for women of ethnic minority background, who face a variety of barriers which prevents them from accessing appropriate perinatal mental health care. Aims To explore minority ethnic women’s experiences of access to and engagement with perinatal mental health care. Methods Semi-structured interviews were conducted with 18 women who had been diagnosed with perinatal mental health difficulties and who were supported in the community by a specialist perinatal mental health service in South London, United Kingdom. Women who self-identified as being from a minority ethnic group were purposefully selected. Data were transcribed verbatim, uploaded into NVivo for management and analysis, which was conducted using reflective thematic analysis. Results Three distinct overarching themes were identified, each with two or three subthemes: ‘Expectations and Experiences of Womanhood as an Ethnic Minority’ (Shame and Guilt in Motherhood; Women as Caregivers; Perceived to Be Strong and Often Dismissed), ‘Family and Community Influences’ (Blind Faith in the Medical Profession; Family and Community Beliefs about Mental Health and Care; Intergenerational Trauma and Family Dynamics) and ‘Cultural Understanding, Empowerment, and Validation’ (The Importance of Understanding Cultural Differences; The Power of Validation, Reassurance, and Support). Conclusion Women of ethnic minority background identified barriers to accessing and engaging with perinatal mental health support on an individual, familial, community and societal level. Perinatal mental health services should be aware ethnic minority women might present with mental health difficulties in different ways and embrace principles of cultural humility and co-production to fully meet these women’s perinatal mental health needs.

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Section: Discussionsupporting

confidence: 85%

A qualitative study of minority ethnic women’s experiences of access to and engagement with perinatal mental health care

Pilav

Backer

Easter

et al. 2022

BMC Pregnancy Childbirth

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“…[20,21] A key question is therefore whether adult mental health specialists should be better integrated into children's social care. [54] Timely access to mental health services for women at risk of care proceedings would likely reduce the need for proceedings and improve outcomes for women and their families. The threshold for accessing specialist mental health support is high and more effort should be made to accelerate access for parents at risk of social care intervention.…”

Section: Implications For Policy and Practicementioning

confidence: 99%

Mental health service use among mothers involved in public family law proceedings: linked data cohort study in South London 2007-2019

Pearson¹,

Grant²,

Wijlaars³

et al. 2021

Preprint

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Background Research in England suggests a high burden of mental health problems and substance misuse among women whose children enter care. Family courts therefore need to consider timely support for parental mental health and likely time to recovery within public family law proceedings concerning placement of a child into care (‘care proceedings’). We report population-based evidence from linked, routinely collected, de-identified records on the type and severity of maternal mental health problems in relation to care proceedings. Methods We linked family court data and mental health service records for 2137 (66%) of women involved in care proceedings between 2007-2019 in the South London and Maudsley NHS Mental Health Trust (SLaM) catchment area. We compared their mental health service use and risk of dying with 17,096 female matched controls who accessed SLaM between 2007 and 2019, aged 16-55 years old. Results Most women (79%) were known to SLaM before care proceedings began. Compared to the matched controls, women had higher rates of schizophrenia spectrum disorders (19% vs 11% matched controls), personality disorders (21% vs 11%), and substance misuse (33% vs 12%). They were more likely to be admitted to a SLaM inpatient unit (27% vs 14%) or to be sectioned under the Mental Health Act (19% vs 8%). Finally, women had a 2.15 (95% CI: 1.68 to 2.74) times greater hazard of dying, compared with the matched controls, adjusted for age. Conclusions Given the high prevalence and severity of mental health problems among women involved in care proceedings, family law and social care policy is needed to ensure adequate and timely treatment for parent mental health problems. The increased risk of dying among those accessing mental health services highlights the critical need for post-proceeding services to ensure parents whose children enter care continue to receive support after care proceedings conclude.

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“…HIT could improve the quality of care by reducing paperwork, reducing medical errors, minimizing repetitive medical tests, enabling the collaboration of medical professionals over long distances, and reducing the cost of treatment of chronically ill patients [ 6 ]. In addition, HIT can increase patients’ empowerment by helping them develop self-awareness of NCDs [ 7 , 8 ].…”

Section: Introductionmentioning

confidence: 99%

“…Frameworks have helped understand the implementation processes of various topics. For example, Webb et al [ 8 ] integrated the level theory by Ferlie and Shortell to understand perinatal mental health care, and Esponda et al used the Consolidated Framework for Implementation Research (CFIR) [ 26 ] to analyze mental health implementation [ 27 ]. However, determinant frameworks have been used scarcely in understanding HIT implementation.…”

Section: Introductionmentioning

confidence: 99%

Using an Integrated Framework to Investigate the Facilitators and Barriers of Health Information Technology Implementation in Noncommunicable Disease Management: Systematic Review

Sung¹,

He²,

Zhou³

et al. 2022

J Med Internet Res

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Background Noncommunicable disease (NCD) management is critical for reducing attributable health burdens. Although health information technology (HIT) is a crucial strategy to improve chronic disease management, many health care systems have failed in implementing HIT. There has been a lack of research on the implementation process of HIT for chronic disease management. Objective We aimed to identify the barriers and facilitators of HIT implementation, analyze how these factors influence the implementation process, and identify key areas for future action. We will develop a framework for understanding implementation determinants to synthesize available evidence. Methods We conducted a systematic review to understand the barriers and facilitators of the implementation process. We searched MEDLINE, Cochrane, Embase, Scopus, and CINAHL for studies published between database inception and May 5, 2022. Original studies involving HIT-related interventions for NCD management published in peer-reviewed journals were included. Studies that did not discuss relevant outcome measures or did not have direct contact with or observation of stakeholders were excluded. The analysis was conducted in 2 parts. In part 1, we analyzed how the intrinsic attributes of HIT interventions affect the successfulness of implementation by using the intervention domain of the Consolidated Framework for Implementation Research (CFIR). In part 2, we focused on the extrinsic factors of HIT using an integrated framework, which was developed based on the CFIR and the levels of change framework by Ferlie and Shortell. Results We identified 51 papers with qualitative, mixed-method, and cross-sectional methodologies. Included studies were heterogeneous regarding disease populations and HIT interventions. In part 1, having a relative advantage over existing health care systems was the most prominent intrinsic facilitator (eg, convenience, improvement in quality of care, and increase in access). Poor usability was the most noted intrinsic barrier of HIT. In part 2, we mapped the various factors of implementation to the integrated framework (the coordinates are shown as level of change-CFIR). The key barriers to the extrinsic factors of HIT included health literacy and lack of digital skills (individual-characteristics of individuals). The key facilitators included physicians’ suggestions, cooperation (interpersonal-process), integration into a workflow, and adequate management of data (organizational-inner setting). The importance of health data security was identified. Self-efficacy issues of patients and organizational readiness for implementation were highlighted. Conclusions Internal factors of HIT and external human factors of implementation interplay in HIT implementation for chronic disease management. Strategies for improvement include ensuring HIT has a relative advantage over existing health care; tackling usability issues; and addressing underlying socioeconomic, interpersonal, and organizational conditions. Further research should focus on studying various stakeholders, such as service providers and administrative workforces; various disease populations, such as those with obesity and mental diseases; and various countries, including low- and middle-income countries.

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Barriers and facilitators to implementing perinatal mental health care in health and social care settings: a systematic review

Cited by 68 publications

References 59 publications

A qualitative study of minority ethnic women’s experiences of access to and engagement with perinatal mental health care

A qualitative study of minority ethnic women’s experiences of access to and engagement with perinatal mental health care

Mental health service use among mothers involved in public family law proceedings: linked data cohort study in South London 2007-2019

Using an Integrated Framework to Investigate the Facilitators and Barriers of Health Information Technology Implementation in Noncommunicable Disease Management: Systematic Review

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