A complex postnatal mental health intervention: Australian translational formative evaluation

Area of Science:

• Public Health
• Maternal Mental Health
• Health Services Research

Background:

• Postnatal maternal mental health problems are a significant public health concern.
• The What Were We Thinking (WWWT) program targets neglected risks in primary postnatal care.
• Previous studies showed WWWT's effectiveness when delivered by specialist nurses.

Purpose of the Study:

• To describe a translational formative evaluation to inform a cluster randomized controlled trial (RCT) protocol for WWWT implementation.
• To assess feasibility and identify necessary adjustments for integrating WWWT into routine primary care.
• To align the intervention with practitioner, organizational, and health system requirements.

Main Methods:

• Mixed-methods approach following UK Medical Research Council (MRC) guidance for complex interventions.
• Analysis of service documents, semi-structured interviews, group discussions, and an online survey.
• Involved expectant parents, healthcare providers, managers, and policymakers.

Main Results:

• Documented current clinical practices, identified staff training needs, and outlined necessary service modifications.
• Highlighted the importance of standardizing advice, including fathers, and considering government policy drivers.
• Informed a cost model and projected health and social outcomes.

Conclusions:

• Implementing WWWT into routine care necessitates clinical practice adjustments, staff training, and service modifications.
• Economic implications for the health system require careful consideration.
• Translational formative evaluation is crucial for developing complex interventions and informing future RCTs.