The feasibility of an objective measure of the parent-child relationship in health visiting practice: assessment of the Maternal Postnatal Attachment Scale

Abstract

Background: Positive parent infant relationships are key to achieving long term child outcomes. Identifying parents who may need support is difficult because of a lack of robust assessment tools. Working in partnership with health services we piloted the Maternal Postnatal Attachment Scale (MPAS) in a deprived, multi-ethnic urban community in Bradford, UK. The pilot aimed to assess the clinical utility of MPAS to identify need for support: Was it administered to a representative group of women? Is MPAS valid for this population? Methods: Data were linked to a cohort study in the pilot area (Born in Bradford’s Better Start - BiBBS). Chi Square tests assessed sample representativeness (age, ethnicity, parity, English language, education, deprivation). Exploratory factor analysis explored MPAS’ validity. Results: 563 women in BiBBS were eligible, 210 (37%) completed MPAS. No differences were found between completers and non-completers, suggestive of a representative sample. In total, 336 women completed MPAS in the pilot. MPAS had ceiling effects and a satisfactory factor structure could not be identified, indicating poor psychometric properties Conclusions: Health visitors were successful in administering MPAS to a representative sample, but poor psychometric robustness indicates that MPAS is unsuitable for routine use in this setting. A gap for such a measure remains.

Implementing the Maternal Postnatal Attachment Scale (MPAS) in universal services: Qualitative interviews with health visitors

“…Other studies have focussed on utility for health visiting but included limited validation of the tool. This qualitative study and its complementary quantitative study ( Dunn et al , 2022 ) provides evidence on the clinical utility of MPAS that is both methodologically rigorous and grounded in real world clinical practice. Together they revealed concerns about the utility of the tool in practice in this community.…”

“…Health visitors interviewed felt that the parent-infant relationship was important, and generally considered assessment of the parent-infant relationship to be an important part of practice. However, quantitative findings showed that only half of mothers (52%) of the 833 mothers who had a 3-4-month health visitor contact during the pilot had been offered the MPAS ( Dunn et al , 2022 ). Whilst this showed that they can integrate an assessment of the parent-infant relationship into their practice, the large number of significant challenges identified in interviews is likely to contribute to the relatively low uptake.…”

“…However, there is a lack of robust measures validated in the UK, and recent reviews have concluded that none of the available measures are recommended for clinical use due to inadequate evidence on the psychometric properties and clinical utility ( Mathews et al , 2019 ; Wittkowski et al , 2020 ). A detailed overview of these measurement approaches is provided in Dunn et al (2022) .…”

“…MPAS is a self-complete measure of maternal affect towards the infant, designed to be completed by mothers of infants between birth and 12 months. Further information on the tool is provided in Dunn et al (2022) . The 3–4 month health visitor contact is offered as an additional universal contact by health visiting in Bradford (it is not nationally mandated) and was identified as a clinically useful and feasible time-point for assessment.…”

“…This is the second of two linked papers describing the quantitative and qualitative findings. The first ( Dunn et al , 2022 ) presented an introduction to MPAS and quantitative findings on the measure’s psychometric properties and the number of health visitors who used the tool, the number of eligible women and rates of completion over the study period. Findings showed that the tool has limited validity for assessing mothers’ affective bond to their infant, suggesting that it is not robust enough to recommend ongoing use in the Bradford context.…”