How can primary and community care services work together to support women with Perinatal Anxiety (PNA)? A qualitative study

Problem

Perinatal anxiety (PNA) occurs during pregnancy and up to 12 months post-partum. PNA affects more than 21% of women worldwide and can have a negative impact on mothers, children and their families. The National Institute for Health and Care Excellence (NICE) guidance recommends psychological and/or pharmacological therapy to manage PNA. NICE has identified evidence gaps around non-pharmacological interventions as a research priority.

Approach

In this presentation, I will discuss perspectives from PNA stakeholders about acceptability, accessibility and appropriateness of non-pharmacological PNA interventions. I will explore how healthcare and VCSE services can work together to support women with PNA in both primary and community settings and build local networks which creates stability for services.

Ethical approval granted by Keele University Research Ethics Committee. A patient advisory group (PAG) was involved throughout. Semi-structured interviews were conducted with four groups: women with lived experience of PNA, healthcare professionals (HCPs), voluntary, community and social enterprise (VCSE) Perinatal Mental Health (PMH) organisation representatives and commissioners of PMH services. Study recruitment via social media and PMH networks. Topic guide modified iteratively throughout data analysis.

Interviews were digitally recorded, transcribed and anonymised. Analysis was conducted thematically using principles of constant comparison, with themes agreed through discussion within the research team and the PAG.

Findings

30 interviews were conducted: 13 women with lived experience of PNA, 10 HCPs from a variety of professional backgrounds, 4 representatives from VCSE PMH organisations and 3 commissioners of PMH services.

Experiences of PNA vary, therefore a personalised approach is needed to support women with PNA. Barriers to help-seeking include stigma and fear of negative repercussions after disclosure, along with challenges accessing healthcare-based services.

Some women express a preference to access support from VCSE PMH organisations rather than healthcare services. Representatives from VCSE PMH organisations and commissioners reflected that VCSE organisations are often well integrated within local communities, and are able to offer flexible, tailored and accessible support for women in an informal setting. HCPs and representatives from VCSE PMH organisations agreed that effective collaboration between healthcare and VCSE services provides women with greater choice and reduces gaps in care.

Consequences

Women choose to seek a variety of different support options; more than is currently recommended by NICE. Healthcare and local VCSE PMH services should work together to develop sustainable and effective working relationships to improve care for PNA. HCPs should be aware of local VCSE PMH organisations as management options for women with PNA.

Despite supporting many women with PNA, funding streams for VCSE PMH services are often short term, resulting in instability. There is currently an evidence gap for the effectiveness of interventions delivered by VCSE PMH services, which could facilitate longer-term, more stable commissioning for these organisations.