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Title: A study of equity within health visiting postnatal depression policy and services
Author: Almond, Palo
ISNI:       0000 0001 3418 1928
Awarding Body: University of Southampton
Current Institution: University of Southampton
Date of Award: 2008
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Abstract Postnatal depression (PND) is a psychiatric condition that is estimated to affect 15% of postnatal women. Health visitors (HVs) are the key public health professionals involved in its early detection and treating its mild to moderate forms. It has been suggested that some HVs do not assess women for PND and consequently these women do not get the care they need. Equally other women have clearly been shown to benefit from the advice and treatment they get when HVs have discovered PND. Such inequalities are unfair and unjust since they might be avoidable. Unfair and unjust inequality is known as inequity. This study was designed to examine the factors that promote or hinder equity in health visiting PND services and it was anticipated that in doing so a greater understanding ofthe concept and nature of equity in service provision and access to services would be achieved. A qualitative case study approach was used to study one PCTs health visiting PND service. HVs were observed doing 21 home visits to antenatal and postnatal women. Post-observation interviews were conducted with 16 HVs. Nine Bengali women and 12 English women were interviewed. Additionally 10 interviews were conducted with health visiting managers and other personnel involved in the health visiting PND service. In total, 51 interviews were conducted. Documentary data in the form ofthe PCTs PND Strategy Policy were used in two principal ways. Firstly, they provided contextual information, and secondly they provided a framework for the interviews and sampling the observations. The policy documents underwent a critical analysis and the remaining data were analysed using Ritchie and Spencer's (1994) Framework Analysis method. The findings 'revealed that despite the existence ofa policy to provide 'equal and ' equitable' health visiting PND services, many factors led to inequity in service provision. Whilst PND training had been provided to all HVs, it was inadequate in preparing them to detect and manage PND in Bengali women or understand fully the needs of English women from low socio-economic backgrounds. Problems in the policy process led to a situation where managers and HVs were not always aware that the policy to detect and manage PND in all women was active. Furthermore, ambiguous reference was made in policy documentation implying that groups such as minority ethnic women, were issues for future consideration. Constraints such as the lack of appropriate training, other pressing priorities, and the scarcity ofculturally appropriate resources, made it'difficult to provide an equitable service to all women. The research makes a contribution to knowledge by improving understanding of the nature of equity and equality and PND, particularly from the perspectives of lower socio-economic English women and Bengali women. The findings from the policy analysis process will also facilitate the development of policy and culturally sensitive HV practice and the enhancement ofPND services. Ritchie J, Spencer L. (1994). Qualitative data analysis for applied research In Bryman A, Burgess RG (Eds). Analysing Qualitative Data. Routledge. London
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available
Keywords: RT Nursing