Abstract
BackgroundA randomized controlled trial evaluated the effect of telephone-based peer support on preventing postpartum depression (PPD) among high-risk mothers. The results indicated that support provided by peer volunteers may be an effective preventative strategy. The purpose of this paper is to outline the process of developing, implementing, maintaining, and evaluating the peer support program that we used in this PPD prevention trial.MethodsThe peer support program had been used successfully in a pilot trial and a previous breastfeeding peer support trial. Based on our experience and lessons learned, we developed a 4-phase, 12-step approach so that the peer support model could be copied and used by different health providers in various settings. We will use the PPD prevention trial to demonstrate the suggested steps.ResultsThe trial aim to prevent the onset of PPD was established. Peer volunteers who previously experienced and recovered from self-reported PPD were recruited and attended a four-hour training session. Volunteers were screened and those identified as appropriate to provide support to postpartum mothers were selected. Women who scored more than 9 on the Edinburgh Postnatal Depression Scale within the first two weeks after childbirth were recruited to participate in the trial and proactive, individualized, telephone-based peer support (mother-to-mother) was provided to those randomized to the intervention group. Peer volunteers maintained the intervention, supported other volunteers, and evaluated the telephone-based support program. Possible negative effects of the intervention were assessed. An in-depth assessment of maternal perspectives of the program at 12 weeks postpartum was performed.ConclusionsThe 4-phase, 12-step approach delineated in this paper provides clear and concise guidelines for health professionals to follow in creating and implementing community-based, peer-support interventions with the potential to prevent PPD.Trial registrationCurrent Controlled Trials ISRCTN68337727.
Highlights
IntroductionTO PEER SUPPORT a) What is a peer volunteer? b) Peer volunteer qualities, skills, and expectations c) Peer volunteer role, discussion themes, and frequently II: BENEFITS OF PEER SUPPORT a) Mothers Helping Mothers Model b) Emotional, informational, and validation/appraisal support c) Benefits of peer support III: RELATIONSHIP DEVELOPMENT a) Getting connected b) Staying connected c) Developing a relationship with the mother IV: TECHNIQUES FOR EFFECTIVE TELEPHONE SUPPORT a) Empathetic listening and reflection b) Using open-ended questions c) Listening to more than the words d) Problem-solving and exploring options V: GENERAL POSTPARTUM DEPRESSION INFORMATION a) What is postpartum depression? b) Incidence, symptoms, and different presentation of postpartum depression c) Causes of postpartum depression d) Detection and treatment of postpartum depression VI: THE HELPING PROCESS a) The relationship between feelings, behaviors, and thoughts b) The Three-Step Helping Process c) Helping the mother to develop a support system d) Common maternal difficulties VII: REFERRAL TO PROFESSIONAL SERVICES a) What constitutes and emergency b) Child abuse, child neglect, domestic violence c) Possible mental health professional referral sources d) What the partner can do communication skills were deemed inadequate, who demonstrated difficulties participating in discussions about PPD, or who showed evidence of unresolved PPD were excluded from the peer support program
Phase I: develop the intervention Step 1: establish the aim of the project Peer support interventions have been used for a variety of health-related topics including transitional stressors, chronic disease, and health promotion [28]
Informed consent was given by all participants, both the peer volunteers and the atrisk mothers to whom they provided support
Summary
TO PEER SUPPORT a) What is a peer volunteer? b) Peer volunteer qualities, skills, and expectations c) Peer volunteer role, discussion themes, and frequently II: BENEFITS OF PEER SUPPORT a) Mothers Helping Mothers Model b) Emotional, informational, and validation/appraisal support c) Benefits of peer support III: RELATIONSHIP DEVELOPMENT a) Getting connected b) Staying connected c) Developing a relationship with the mother IV: TECHNIQUES FOR EFFECTIVE TELEPHONE SUPPORT a) Empathetic listening and reflection b) Using open-ended questions c) Listening to more than the words d) Problem-solving and exploring options V: GENERAL POSTPARTUM DEPRESSION INFORMATION a) What is postpartum depression? b) Incidence, symptoms, and different presentation of postpartum depression c) Causes of postpartum depression d) Detection and treatment of postpartum depression VI: THE HELPING PROCESS a) The relationship between feelings, behaviors, and thoughts b) The Three-Step Helping Process c) Helping the mother to develop a support system d) Common maternal difficulties VII: REFERRAL TO PROFESSIONAL SERVICES a) What constitutes and emergency b) Child abuse, child neglect, domestic violence c) Possible mental health professional referral sources d) What the partner can do communication skills were deemed inadequate, who demonstrated difficulties participating in discussions about PPD, or who showed evidence of unresolved PPD were excluded from the peer support program. Of those who attended the training, 175 (85.8%) were accepted as peer volunteers and matched with at least one new mother in the trial. A randomized controlled trial evaluated the effect of telephone-based peer support on preventing postpartum depression (PPD) among high-risk mothers. PPD is linked to poor cognitive functioning, behavioral inhibition, and emotional maladjustment in infants and children [13,14,15] Despite these negative outcomes, PPD often remains undetected due to maternal reluctance to disclose symptoms of depression and seek treatment even when they are in frequent contact with health professionals [16]
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