Professor Jane Fisher
Dr Heather Rowe
Jean Hailes Research Unit, School of Public Health and Preventive Medicine, Monash University
Project completion year
‘What Were We Thinking’ (WWWT) is a structured, evidence-based psycho-educational program addressing two modifiable risks for perinatal mental health problems in women:
- management of unsettled infant behaviour
- renegotiation of roles and needs in the intimate partnership.
Providing information and learning opportunities to small groups of mothers, fathers and their newborns in a face-to-face program format facilitated by a skilled maternal and child health professional can be effective in reducing the incidence of common perinatal mental disorders and is valued by new parents. This web-based resource aims to promote confidence and reduce distress in first-time parents. It is underpinned by a gender-informed, social determinants, theoretical model of perinatal mental health, and is novel in its inclusion of women, men and their babies.
This project undertook an evaluation of the WWWT online resource. The specific objective of the investigation was to evaluate the salience, relevance, comprehensibility and usefulness of it for parents in the context of their needs for information, support and services after the birth of a first baby. The researchers sought new parents’ views about preferred resources to optimise psychological adjustment to the birth of a first baby.
Key project findings and main outcomes
Nulliparous pregnant women and their partners were recruited at antenatal education classes held at the Royal Women’s Hospital and Frances Perry House in Melbourne and Goulburn Valley Hospital in Shepparton. Participants completed a brief sociodemographic survey, and took part in one of seven single-sex small group discussions or five individual interviews (for participants unable to attend a group).
Phase 1: Antenatal discussion groups
Most participants (n=33, 87 per cent) had little or no personal experience of infant care. Participants reported that they used a variety of information sources including books, magazines, television, friends and family, the internet, DVDs, the hospital and healthcare professionals. They indicated that it would be useful to have access to a ‘one stop shop’ or resource where comprehensive information on baby care and adjustments to family life could be accessed easily. A high value was placed on family and friends who were already parents as sources of information and support.
There were mixed views about whether or not health professionals should ask new parents about their emotional health. In general, the female participants articulated greater comfort than the male participants in talking to health professionals about their emotional needs. Many of the men reported that they would not want to discuss their emotional health with a health professional and would do so only if the health professional thought there was a problem and if there were no other competing priorities, such as a crying baby or other pressing family responsibilities. Men generally believed that part of their role as a father and partner was to set their own needs aside in service of the needs of their partner and the baby. Men also expressed concerns about whether health professionals, including GPs and maternal and child health nurses, were qualified to ask about emotional health.
Phase 2: Post-natal telephone interviews
Most participants described the experience of having and caring for a baby in positive terms. However, they also reported that infant care could sometimes be challenging and overwhelming, particularly if they had insufficient knowledge or skills to respond to feeding or settling difficulties.
As they had done during pregnancy, participants identified friends and family, health care professionals, books, health services, television, DVDs, magazines and the internet as important sources of information.
Nine (35 per cent of) participants (seven women and two men) had visited the WWWT site since the birth of their baby, on average 1.7 times. Some reported that it was difficult to find the time to log on, locate the site, navigate through and read the material, and one respondent commented that she would prefer printed versions of pages to be available.
The research findings confirm that parents have high needs for life-stage specific information, new skills and support in the early months after the birth of a first baby. New parents seek to have these needs met from both personal and professional sources, and would like to have high quality, consistent, reliable, useable information resources more readily available. There are practical constraints against using the internet as a primary resource, in particular having limited uninterrupted periods of time to explore and read material on a site even if it meets the criteria of being evidence-based and user-friendly. Nevertheless, WWWT was regarded as a valuable resource with content salient to this life stage.
The findings of this research confirm that WWWT is salient, relevant and comprehensible to parents of first infants, but that it does not on its own meet new parents’ needs for information about infant care and relationship adjustments. It is not a substitute for face-to-face health care including mental health promotion activities and the direct active learning opportunities they provide. However, it appears to be a valuable extra resource to include as a supplement to individual clinical care and for ongoing reference, in particular for parents with older infants. It confirms the need for further work to extend group-based education for parents beyond the antenatal period into the early postpartum when parents’ learning needs are high.
1 Rowe HJ, Fisher JRW. Development of a universal psycho-educational intervention to prevent common postpartum mental disorders in primiparous mothers: a multiple method approach. BMC Public Health 2010, 10: 499
2 Fisher JRW, Wynter K, Rowe HJ. Innovative psycho-educational program to prevent common postpartum mental disorders in primiparous women: a before and after controlled study. BMC Public Health 2010, 10: 432