Group Psychological Intervention for Postnatal Depression

A Nested Qualitative Study With British South Asian Women

Yumna Masood; Karina Lovell; Farah Lunat; Najia Atif; Waquas Waheed; Atif Rahman; Rahena Mossabir; Nasim Chaudhry; Nusrat Husain

Disclosures

BMC Womens Health. 2015;15(109) 

In This Article

Methods

This study aims to explore a wide range of views and experiences of British South Asian women which quantitative methods do not often allow to be explored in detail.[23] In contrast, qualitative methods for data collection are sensitive to the unique personal experiences, perceptions, beliefs, and meanings related to individuals and therefore believed to be the most appropriate method to be employed within this study.[24] Qualitative analysis also offers an accessible and theoretically flexible approach to analysing qualitative data.[24] One of the strengths of this approach is that it enables the researcher to focus on identifying themes and patterns of behaviours.[25]

Recruitment

A total of 83 women with a confirmed diagnosis of depression using the Clinical Interview Schedule-Revised (CISR) interview[26] took part in the RCT. These women were of South Asian origin as defined by the Office of National Statistics (ONS) (ONS is the recognised national statistical institute for the UK providing official statistics), over the age of 16 years, and living with their babies. The PHP programme was offered to 42 British South Asian women who were randomly allocated to the intervention arm of the randomised controlled trial (RCT). The women were recruited between 2012 and 2013 from multiple sites in Manchester and Lancashire, including General Practices and Children Centres, and were organised into 4 groups for evaluation of the PHP. The programme was delivered at the local Sure Start children's centre over a 12-week period by trained research staff. Of the 42 women who were randomised to the PHP group intervention, 20 were randomly selected using the random number tables and were invited for qualitative interviews. A total of 20 women were contacted for obtaining informed consent, 17 agreed to take part, whilst three could not be contacted. Five of the participating women were from the Manchester intervention group and the remaining 12 were from the Lancashire intervention group. The interviews took place at the participants' homes as most did not have access to alternative child care arrangements.

Procedure

In-depth interviews were conducted with the participants using a topic guide. The topic guide for this study was developed and informed by both existing literature in this area and an earlier feasibility study.[22] The key areas explored were reasons for participation, barriers to receiving the intervention, and perception of the intervention process including participants' initial expectations and reflections. The interviews explored participants' views on how the PHP sessions took place, the format and frequency of the sessions, the characteristics of the facilitator, the use of handouts and other session materials, and the acceptability of the delivery of the intervention. Each interview lasted approximately 45 min and was conducted in the participant's preferred language; all the interviews were carried out in the Urdu language. Later these interviews were translated into English. The analysis and coding process was also carried out in English.

Ethics Approval

The study was approved by the North West Research Ethics Committee (10/H1005/62).

Analysis

Interviews were transcribed verbatim, anonymised, and analysed using thematic analysis.[27] Thematic analysis is a flexible approach where, in contrast to other qualitative methods, the researcher is attached to a theoretical framework.[28] Thematic analysis is appropriate for use in a multi-method context where the qualitative element of enquiry is framed by prior work consistent with the present study which is embedded in a larger randomised controlled trial. The complete interview recordings were listened to and the corresponding transcripts were read over multiple times for familiarization.[29] A code book was maintained to keep the process of coding systematic and intact. Specific events, thoughts, and actions were coded or identified as themes on the basis of their ability to "capture something important in relation to the overall research question" (,[27] p.82) by the researcher, YM. The researcher did not try to fit the codes into existing code frameworks. The coding process aimed to identify themes that were internally homogenous, externally homogenous, and had explanatory power. This involved an iterative process comparing themes against transcript data in order to ensure that the emerging structure of themes continued to be grounded only in the data set. Ultimately, the data collection process ended due to thematic saturation (where no additional themes were achieved).[28] Participants' responses were first analysed on a semantic level, whilst the main themes were developed at the second stage, involving latent analysis of how coherently and adequately the themes represented the meaning of the data as a whole.[27] Themes and sub-themes were reviewed between the researcher (YM) and the supervisor (KL) before the analysis was finalized.

processing....