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

Results

A total of 17 women took part in the qualitative interviews; the age range was 20–45 years. The sample characteristics are described in Table 1.

Motivators to Participate in the Positive Health Programme (PHP)

Most of the women stated overcoming depression through a better understanding of their mental health issues, enhancing their confidence, meeting other women in similar situations, and sharing experiences as the major motivating factors for participation in the programme.

Yes, definitely! I wanted to come out of depression and wanted to meet new people because to me loneliness was the main reason of my depression. And to me, if there are other women who are lonely, they should meet up and join these groups. Because of these you get to know about other people and their situations. (ID 3)

Barriers to Attendance and Commitment

The sessions were held during the mornings which most participants found convenient since it did not impact their daily chores. Furthermore they had the support of their family members.

No, there was no issues, no problems. My husband is really supportive and he allowed me to go and join these groups. (ID 3)

However, a few participants mentioned restrictions from their husbands because they could not comprehend the need for the intervention. At times the husbands were not informed about the sessions or were not told of the nature of the sessions for fear they would not allow the participants to attend.

My husband did not want me to go; he did not let me go anywhere. I had to look after my children, but he just wanted me to sit with him and talk to him. (ID 2)
My husband didn't know that I was going to these classes. I used to be home before he came back from his work. (ID 9)

The participants considered the absence of childcare arrangements as a potential barrier to attending the sessions.

And we were offered a crèche facility; I used to take him there; otherwise it would have been really difficult for me. (ID 13)

Most of the participants did not drive and relied on family members for transport arrangements to and from the centre. Having transport expenses paid by the programme was appreciated by all the participants because it reduced the burden of transportation expenses on the participants.

Yes, there was the issue of travelling. I cannot drive and my husband was admitted to the hospital. But then they said they would pay me, so I continued with the classes. (ID 1)

Most of the participants reported difficulty in completing the between-session work due to excessive domestic responsibilities. However, all participants did realise that between-session work was important for improving their psychosocial well-being.

The homework was useful but my children were young and I couldn't do that much. I tried but I could not do that much. (ID 11)

Understanding of Cultural and Linguistic Needs

Group facilitators conducting the sessions were of South Asian origin which enabled them to communicate in the participants' first language (Urdu) resulting in increased group engagement and participation.

She spoke in Urdu and I had no problems. If she had spoken in English then I might have had some problems and I would have not even attended. (ID 3)

Some of the participants expressed concerns over not being able to read the handouts due to lack of English reading skills. This resulted in their dependence on other group members and facilitators to understand the handout content. It was suggested that the handouts be translated into the participants' first language to make them useful for the readers.

For me it was ok. I did not have any problem; but I feel for women who could not read English handouts need to be written in Urdu. These women felt that they were depending on us or the facilitator for guidance. (ID 4)

The participants appreciated the facilitator's knowledge and understanding of their socio-cultural dynamics which enabled the facilitators to relate to the participating women's culturally specific issues and address them in the sessions sensitively.

Because she understood what we go through, how our culture is, and how our belief systems are. She could understand us better than anyone else. (ID 5)

Most importantly, facilitators' skills such as the ability to listen and empathise, encouraging and non-judgemental attitude were recognized as important, facilitating open and honest discussions within the groups.

…the main thing is that she listened to all of us. There were times that we did not want to talk and we were shy or hesitant; but she was very encouraging. She made us feel that it is ok and we can open up. She gave me the courage to speak openly about my feelings. She appreciated us all to be more involved and this made us open and be more communicative to others. (ID12)

Participation in Group Sessions

A group-based intervention was appreciated and supported by nearly all the participants. They felt that the group allowed them to share information, and understand and explore solutions to their problems from each other's perspectives. The mothers felt that the group was the only platform where they had an opportunity to express their emotions and feelings in a safe environment and this is something they are often not able to do with their own families.

… the best thing was I did not know anyone;. Sometimes you don't want to discuss your personal matters with people you know. (ID13)

However, some participants felt reluctant to disclose personal issues in group settings due to fear of breach of confidentiality. It was suggested by some of the participants to incorporate some individual sessions in between group sessions.

In individual sessions, one can talk about problems which can't be discussed in a group. And for groups we can share and learn from each other. (ID12)

Open discussions were nonetheless much favoured within the group as these offered flexibility along with giving the opportunity to practise assertiveness skills they had acquired during the sessions. Some participants preferred storytelling activities, which allowed them to talk about issues and explore solutions indirectly, without attracting attention.

I think open discussion was good and felt discussions helped in overcoming my anxieties and shyness. To me, these open discussions gave me the confidence to interact and overcome my depression. (ID8)

Feeling Confident and Empowered

All the sessions were found useful by the participants as they reported overall improved wellbeing. They felt better able to deal with their day-to-day tasks. They also reported enhanced self-esteem, being more proactive, and being able to manage stress more effectively. They also spoke about embracing and adopting a positive view of life.

I am more relaxed and confident. Earlier, I could not speak and even go out of my house; now I go out with my friends and feel that I can learn new things as well. (ID6)

Learning positive thinking strategies and coping skills, along with group participation and a good relationship with the facilitator were reported as the most important factors for facilitating change.

Um…it's the classes and the therapist. My life segments are still there but I have changed my thought process. I have a coping strategy for my problems. (ID10)

Most of the women reported being able to manage their everyday life more easily than before. The overall change was noted when dealing with children, family members, and oneself. Coping skills incorporated techniques for stress and time management as well as relaxation techniques.

Yes, it has. I am managing my family with less stress; I have realized and have gained the knowledge of overcoming my tension when I am dealing with my children and husband. I tell them I can do only so much at a time and they shouldn't be expecting a lot from me. (ID2)

Suggestions for Improvement

A majority of the participants highlighted the need for such interventions to be ongoing as according to them psychosocial problems are deep-rooted and require much longer interventions.

Well, because it takes time to recover and then I might encounter some more issues in my life for which I might need guidance and assistance. You know, we are alone here; there is no one with whom to share and discuss our issues. (ID6)

Some participants suggested follow-up or 'top-up' sessions to motivate them to continue using the strategies learnt in the sessions and also as an opportunity to discuss additional issues and concerns with the facilitator.

Well, I thought the sessions went by too quickly and 12 weeks were not enough. I would have liked more sessions later because if something was missed or someone did not pick up something, at least they could have gone back and asked. (ID14)

One of the participants indicated health professionals' lack of awareness of issues specific to ethnic minority communities and suggested that professionals such as GPs and nurse practitioners should be given culture-specific training.

Yes, what happened was, when I went to see my nurse um…they did not give me any direction where to go. I think GPs should be more involved, but these sessions were really good. (ID13)

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