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