University of Worcester Worcester Research and Publications

A mixed methods study to understand perinatal mental healthcare referral decisions among midwives and health visitors in the UK

Johnson, J., Hope, Lucy, Jones, Lisa ORCID: and Bradley, Eleanor ORCID: (2023) A mixed methods study to understand perinatal mental healthcare referral decisions among midwives and health visitors in the UK. Frontiers in Psychiatry, 14. 1056987.. ISSN Online: 1664-0640

[img] Text
Manuscript May 2023 final.docx
Restricted to Repository staff only

Download (754kB) | Request a copy
fpsyt-14-1056987.pdf - Published Version
Available under License Creative Commons Attribution.

Download (1MB) | Preview


Background: In the UK approximately half of women requiring perinatal mental health (PNMH) care do not receive treatment despite having routine contact with midwives (MWs) and health visitors (HVs). Limited research has been undertaken regarding MWs’/HVs’ decision-making around referring women for secondary PNMH care. In particular, the impact that the level of local secondary PNMH services may have on MWs’/HVs’ referral decisions is unexplored.
Aim: To understand MWs’/HVs’ decision-making in relation to referring women with identified PNMH problems, to identify barriers and facilitators to effective and timely referrals including any impact of the local secondary PNMH service provision.
Methods: Participants were recruited from four National Health Service (NHS) Trusts in England, located across two geographical areas, that provided different types of PNMH services. One area had PNMH services that met National Institute for Health and Care Excellence (NICE) guidelines; the other area had no secondary PNMH services. A sequential mixed methods design was used: In-depth semi-structured interviews with practising MWs/HVs (n=24) to explore their approach to PNMH referral decision-making, analysed using thematic analysis; Questionnaire offered to all practising MWs/HVs in the two geographical areas to measure factors that may impact on PNMH referral decision-making allowing for statistical comparisons to be made between the professional groups/geographical areas.
1. Findings: Three themes were identified from the interviews that impacted on
MWs’/HVs’ PNMH referral decision-making: identifying need; education, skills and experience; and referral pathways.
Questionnaire response rate 13.1% (n=99). The most reported facilitators to referral decision-making were a trusted relationship between MWs/HVs and women and routine enquiry about women’s mental health; the most reported barriers were stigma associated with mental ill-health and women’s perceived fear of child removal.
Conclusion: Fundamental to MWs’/HVs’ decision-making was their perceived relationship between themselves and women. Although PNMH service provision is important for women to ensure they receive appropriate PNMH care, service provision appeared less important to MWs’/HVs’ referral decision-making than how maternity/health visiting services were delivered. Further important factors to MWs/HVs were to the ability to provide continuity of carer with women allowing MWs/HVs to identify women who would benefit from referral for secondary PNMH care.

Item Type: Article
Additional Information:

© 2023 Johnson, Hope, Jones, and Bradley.
This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

Uncontrolled Discrete Keywords: health visiting, midwifery mixed methods, perinatal mental health, referral and consultation, referral decision making, surveys and questionnaires
Divisions: College of Health, Life and Environmental Sciences > School of Nursing and Midwifery
Related URLs:
Copyright Info: Open Access article
Depositing User: Eleanor Bradley
Date Deposited: 06 Jul 2023 12:00
Last Modified: 06 Jul 2023 12:00

Actions (login required)

View Item View Item
Worcester Research and Publications is powered by EPrints 3 which is developed by the School of Electronics and Computer Science at the University of Southampton. More information and software credits.