Screening immigrant mothers for postpartum depression: Development and feasibility of an educational intervention for nurses in the child health services

Postpartum depression (PPD) is a major public health problem, which immigrant mothers are at particular risk of being affected by. Routine screening is implemented by many countries to increase identification, but research suggests that health care professionals (HCPs) experience screening of immigrant mothers as challenging. The overall aim of this thesis was therefore to develop an evidence-based educational intervention for Child Health Services (CHS) nurses in screening immigrant mothers for postpartum depression, and to test its feasibility. Study A and Study B were qualitative interview studies with 13 participants each, Study C was a systematic review including eight papers and Study D had a one-group pretest-posttest experimental design with 30 participants. In Study A the CHS nurses’ experiences of identifying signs of PPD in non-Swedish-speaking immigrant mothers showed that a transcultural caring relationship needed to be established to enable assessment of the mother’s mood. The nurses relied on their tacit knowledge when identifying signs of PPD and cultural knowledge was used to filter their impressions. Perceived lack of cultural competence, when trying to get the mother to disclose her feelings and accept external support, caused frustration. The findings in Study B showed that non-native-speaking immigrant mothers felt confirmed as a person when participating in screening for PPD, although the condition itself was unclear to most mothers. Cultural beliefs about mental ill health, negative expectations connected to their perceived value as a woman, shame at not being grateful enough for their new life, fear of the Child Protective Services and negative experiences of the interaction during the screening challenged them in speaking about their mood. In Study C the HCPs’ synthesized experiences of identifying signs of and screening immigrant mothers for PPD showed fear of missing mothers with signs of PPD, feeling uncomfortable in the cross-cultural setting and frustrated in handling difficulties associated with communication, translated versions of the screening scale and cultural implications of PPD. Based on the findings in Study A, Study B and Study C, previous research and theoretical frameworks, an educational intervention for CHS nurses in screening immigrant mother for PPD was developed and tested for feasibility (Study D). The CHS nurses were 100% satisfied with the different training sessions in the intervention and 93% of them stated that the intervention to a high degree improved their ability to meet the requirements linked to the work task. The intervention was found to be feasible but required minor adjustments to the sessions on the use of interpreters and on tacit knowledge, as well as the practical training sessions. The material requires adjustment and further evaluation. In conclusion, this thesis contributes to the development of evidence-based clinical guidelines involving interpreters and translated versions of the EPDS which may facilitate the screening of immigrant mothers for PPD.