为妇女提供围产期心理健康护理和治疗的障碍和促进因素概念框架:MATRIx 证据综述。

Rebecca Webb, Elizabeth Ford, Judy Shakespeare, Abigail Easter, Fiona Alderdice, Jennifer Holly, Rose Coates, Sally Hogg, Helen Cheyne, Sarah McMullen, Simon Gilbody, Debra Salmon, Susan Ayers
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引用次数: 0

摘要

背景:围产期精神健康问题可能发生在孕期或产后,而精神疾病是导致孕产妇死亡的主要原因。因此,确定实施和获得围产期心理保健的障碍和促进因素非常重要:我们的研究目标是建立一个围产期心理保健(定义为识别、评估、护理和治疗)的障碍和促进因素的概念框架,为围产期心理保健服务提供信息:方法:我们进行了两篇系统性综述,以综合以下方面的证据:综述 1:实施围产期心理保健的障碍和促进因素;综述 2:妇女获得围产期心理保健的障碍。研究结果被用于建立一个概念框架,然后通过与利益相关者的协商对其进行完善:数据来源:对 MEDLINE、EMBASE、PsychInfo 和 CINAHL 进行了预先计划的检索。综述 2 还包括 Scopus 和 Cochrane 系统性综述数据库:在综述 1 中,如果研究探讨了实施围产期心理保健的障碍或促进因素,则将其纳入其中。在综述 2 中,如果系统性综述研究了妇女寻求帮助、获得帮助和参与围产期心理保健的障碍和促进因素,并且采用了系统性检索策略,则会被纳入其中。检索中仅发现了定性论文。采用主题综合法对结果进行分析,并将主题映射到一个有理论依据的多层次模型上,然后进行分组,以反映护理路径的不同阶段:综述 1 包括 46 项研究。大多数研究都是在收入较高的国家进行的,质量良好,偏倚风险较低。综述 2 包括 32 篇系统综述。大部分研究在收入较高的国家进行,评估结果的可信度较低。围产期心理保健的障碍和促进因素共分为七个层面:个人因素(如对精神疾病的看法);医疗专业人员因素(如应对围产期精神疾病的信心);人际因素(如妇女与医疗专业人员之间的关系);组织因素(如护理人员的连续性);专员因素(如转诊途径);政治因素(如妇女的经济状况);以及社会因素(如耻辱感)。这些因素在护理路径的不同阶段对围产期心理健康护理产生了影响。对综述的结果进行归纳后,我们建立了两个 MATRIx 概念框架,分别针对(1)围产期精神健康护理的障碍和(2)围产期精神健康护理的促进因素。这些概念框架提供了 66 种障碍和 39 种促进因素的图示,这些障碍和促进因素在整个护理路径和不同层面上相互交叉:在综述 1 中,只有 10% 的摘要经过了双重筛选,10% 的收录论文由两名审稿人进行了方法学评估。综述 2 中收录的大部分综述被评定为结果可信度较低(14 篇)或极低(5 篇)。两篇综述均只收录了发表在学术期刊上的英文论文:MATRIx框架强调了在护理路径的不同阶段,影响妇女获得围产期心理健康护理和围产期心理健康服务有效实施的个人和系统层面因素的复杂相互作用:这些建议包括:利用概念框架为围产期精神健康护理提供全面的、战略性的和循证的方法;确保护理的便捷性和灵活性;提供文化敏感性护理;为服务提供充足的资金;为卫生专业人员提供高质量的培训,并保护他们的培训时间:今后的工作:还需要进一步研究特定群体(如父亲、移民或低收入国家的群体)获得围产期心理保健服务的情况:该试验注册为 PROSPERO:(R1)CRD42019142854;(R2)CRD42020193107:该奖项由英国国家健康与护理研究所(NIHR)的健康与社会护理服务研究项目(NIHR奖项编号:NIHR 128068)资助,全文发表于《健康与社会护理服务研究》第12卷第2期。更多奖项信息,请参阅 NIHR Funding and Awards 网站。
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Conceptual framework on barriers and facilitators to implementing perinatal mental health care and treatment for women: the MATRIx evidence synthesis.

Background: Perinatal mental health difficulties can occur during pregnancy or after birth and mental illness is a leading cause of maternal death. It is therefore important to identify the barriers and facilitators to implementing and accessing perinatal mental health care.

Objectives: Our research objective was to develop a conceptual framework of barriers and facilitators to perinatal mental health care (defined as identification, assessment, care and treatment) to inform perinatal mental health services.

Methods: Two systematic reviews were conducted to synthesise the evidence on: Review 1 barriers and facilitators to implementing perinatal mental health care; and Review 2 barriers to women accessing perinatal mental health care. Results were used to develop a conceptual framework which was then refined through consultations with stakeholders.

Data sources: Pre-planned searches were conducted on MEDLINE, EMBASE, PsychInfo and CINAHL. Review 2 also included Scopus and the Cochrane Database of Systematic Reviews.

Review methods: In Review 1, studies were included if they examined barriers or facilitators to implementing perinatal mental health care. In Review 2, systematic reviews were included if they examined barriers and facilitators to women seeking help, accessing help and engaging in perinatal mental health care; and they used systematic search strategies. Only qualitative papers were identified from the searches. Results were analysed using thematic synthesis and themes were mapped on to a theoretically informed multi-level model then grouped to reflect different stages of the care pathway.

Results: Review 1 included 46 studies. Most were carried out in higher income countries and evaluated as good quality with low risk of bias. Review 2 included 32 systematic reviews. Most were carried out in higher income countries and evaluated as having low confidence in the results. Barriers and facilitators to perinatal mental health care were identified at seven levels: Individual (e.g. beliefs about mental illness); Health professional (e.g. confidence addressing perinatal mental illness); Interpersonal (e.g. relationship between women and health professionals); Organisational (e.g. continuity of carer); Commissioner (e.g. referral pathways); Political (e.g. women's economic status); and Societal (e.g. stigma). These factors impacted on perinatal mental health care at different stages of the care pathway. Results from reviews were synthesised to develop two MATRIx conceptual frameworks of the (1) barriers and (2) facilitators to perinatal mental health care. These provide pictorial representations of 66 barriers and 39 facilitators that intersect across the care pathway and at different levels.

Limitations: In Review 1 only 10% of abstracts were double screened and 10% of included papers methodologically appraised by two reviewers. The majority of reviews included in Review 2 were evaluated as having low (n = 14) or critically low (n = 5) confidence in their results. Both reviews only included papers published in academic journals and written in English.

Conclusions: The MATRIx frameworks highlight the complex interplay of individual and system level factors across different stages of the care pathway that influence women accessing perinatal mental health care and effective implementation of perinatal mental health services.

Recommendations for health policy and practice: These include using the conceptual frameworks to inform comprehensive, strategic and evidence-based approaches to perinatal mental health care; ensuring care is easy to access and flexible; providing culturally sensitive care; adequate funding of services; and quality training for health professionals with protected time to do it.

Future work: Further research is needed to examine access to perinatal mental health care for specific groups, such as fathers, immigrants or those in lower income countries.

Trial registration: This trial is registered as PROSPERO: (R1) CRD42019142854; (R2) CRD42020193107.

Funding: This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR 128068) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 2. See the NIHR Funding and Awards website for further award information.

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