Heather Rowe PhD MAPHA Jane Fisher PhD MAPPS Key Centre for Women’s Health in Society
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Transcript of Heather Rowe PhD MAPHA Jane Fisher PhD MAPPS Key Centre for Women’s Health in Society
Evaluation of a Evaluation of a complex mental complex mental
health promotion health promotion intervention:intervention:revealing and revealing and
reinforcing health reinforcing health inequalities?inequalities?Heather Rowe PhD MAPHAHeather Rowe PhD MAPHA
Jane Fisher PhD MAPPSJane Fisher PhD MAPPSKey Centre for Women’s Health in SocietyKey Centre for Women’s Health in Society
Melbourne School of Population HealthMelbourne School of Population HealthFaculty of Medicine Dentistry and Health SciencesFaculty of Medicine Dentistry and Health Sciences
University of MelbourneUniversity of MelbourneVictoria Victoria
AUSTRALIAAUSTRALIA
AcknowledgementsAcknowledgements
• FundingFunding– beyondbluebeyondblue the National Depression Initiative the National Depression Initiative– Australian Government Department of Family Australian Government Department of Family
Housing Community Services and Indigenous Housing Community Services and Indigenous Affairs Affairs
• Research Assistance Research Assistance – Lauren MathesonLauren Matheson– Daria BodzakDaria Bodzak– Karen WynterKaren Wynter
• Nurse recruitersNurse recruiters• Families who participatedFamilies who participated
PEPP PEPP a complex a complex
interventionintervention– QuestionQuestion
• Postpartum mental healthPostpartum mental health• Psychosocial factors Psychosocial factors
– SettingSetting• Primary health carePrimary health care• Maternal and Child Health NursesMaternal and Child Health Nurses
– PopulationPopulation• UniversalUniversal• Mothers fathers and first newbornsMothers fathers and first newborns
– InterventionIntervention• PreventativePreventative• Trained facilitators; group programTrained facilitators; group program
• InnovativeInnovative• Evidence basedEvidence based
– PartnerPartner• renegotiating the household workloadrenegotiating the household workload
– Baby Baby • dysregulated sleepdysregulated sleep• inconsolable cryinginconsolable crying
• Non-psychiatric languageNon-psychiatric language• Established health promotion modelEstablished health promotion model
– Timing and salienceTiming and salience• Building local capacityBuilding local capacity
– Mental health Mental health – Evidence for practiceEvidence for practice
Aims of PEPPAims of PEPP
ToTo• Promote confidencePromote confidence• Reduce distressReduce distress• Decrease incidence of postnatal Decrease incidence of postnatal
depressiondepression
EvidenceEvidence• RCT?RCT?• Diffusion of innovationDiffusion of innovation• ContaminationContamination• Cluster RCT?Cluster RCT?• Evaluation designEvaluation design
– CBA – controlled before-and-after designCBA – controlled before-and-after design– 6 settings6 settings
• 3 metropolitan3 metropolitan• 3 rural3 rural
– Maternal and Child Health Nurse recruitersMaternal and Child Health Nurse recruiters– 3 trained PEPP facilitators3 trained PEPP facilitators
Standard care Standard care groupgroup
Program (PEPP) Program (PEPP) groupgroup
Recruitment Recruitment First home visitFirst home visit
Baseline data collectionBaseline data collectionBaby age 2 weeksBaby age 2 weeks
Follow-up data Follow-up data collectioncollection
Baby age 6 monthsBaby age 6 months
Recruitment Recruitment First home visitFirst home visit
Baseline data collectionBaseline data collectionBaby age 2 weeksBaby age 2 weeks
Participation in PEPPParticipation in PEPP PEPP seminars in each PEPP seminars in each LGALGA
Follow up data collectionFollow up data collectionBaby age 6 monthsBaby age 6 months
6 month outcome data compared6 month outcome data compared
Trial design
MeasuresMeasures- men and women- men and women
Computer assisted telephone interviewsComputer assisted telephone interviews• BaselineBaseline
– Sociodemographic; psychiatric history; Sociodemographic; psychiatric history; current mood (Edinburgh scale); partner current mood (Edinburgh scale); partner relationship; baby behaviours; relationship; baby behaviours; standardised measuresstandardised measures
• OutcomeOutcome– PrimaryPrimary
• Diagnoses of common mental disorders: Diagnoses of common mental disorders: anxiety and depression (DSM IV)anxiety and depression (DSM IV)
– SecondarySecondary• Partner relationshipPartner relationship• Baby behaviourBaby behaviour
Standard care Standard care groupgroup
Program (PEPP) Program (PEPP) groupgroup
Recruitment Recruitment First home visitFirst home visit
Baseline data collectionBaseline data collectionBaby age 2 weeksBaby age 2 weeks
Follow-up data Follow-up data collectioncollection
Baby age 6 monthsBaby age 6 months
Recruitment Recruitment First home visitFirst home visit
Baseline data collectionBaseline data collectionBaby age 2 weeksBaby age 2 weeks
Participation in PEPPParticipation in PEPP PEPP seminars in each PEPP seminars in each LGALGA
Follow up data collectionFollow up data collectionBaby age 6 monthsBaby age 6 months
6 month outcome data compared6 month outcome data compared
Trial design
Baseline Baseline characteristiccharacteristic
Standard Standard carecare
n=209n=209
InterventioInterventionn
n=182n=182
pp
Recruitment Recruitment 92%92% 78%78% <.01<.01
Age (years)Age (years) 30.230.2 31.531.5 <.05<.05
Australian bornAustralian born 86.6%86.6% 87.4%87.4%
English English languagelanguage
94.3%94.3% 98.4%98.4% <.05<.05
MarriedMarried 70.8%70.8% 71.4%71.4%
University University degreedegree
45.9%45.9% 66.5%66.5% <.00<.0011
Psychiatric Psychiatric historyhistory
8.1%8.1% 13.2%13.2% <.05<.05
Current moodCurrent mood 5.85.8 5.95.9
Partner Partner relationshiprelationship
33.333.3 32.832.8
Baby behaviourBaby behaviour 95.695.6 105.7105.7 <.05<.05
Baseline Baseline characteristiccharacteristic
Did not Did not attendattend
n=75n=75
AttendedAttended
n=107n=107pp
Age (years)Age (years) 30.230.2 32.432.4 <.01<.01
Australian bornAustralian born 89.3%89.3% 86.0%86.0%
English English languagelanguage
97.3%97.3% 99.0%99.0%
MarriedMarried 64.0%64.0% 76.6%76.6% <.01<.01
University University degreedegree
57.3%57.3% 72.9%72.9% <.00<.0011
Psychiatric Psychiatric historyhistory
16.0%16.0% 11.2%11.2% <.05<.05
Current moodCurrent mood 5.75.7 6.26.2
Partner Partner relationshiprelationship
33.033.0 32.632.6
Baby behaviourBaby behaviour 95.695.6 105.7105.7 <.05<.05
ConclusionsConclusions
• Model of evaluationModel of evaluation– Strength of evidenceStrength of evidence– Quality of evidenceQuality of evidence
• Model of health promotionModel of health promotion– Reach of interventionReach of intervention– Innovative mediaInnovative media