In Australia, up to one in five postnatal women experience depression or anxiety in the first year, yet fewer than half seek help and even fewer receive adequate treatment. Data varies regarding the prevalence of postnatal depression and anxiety in rural areas, with some studies suggesting an increased likelihood and others recognising no difference. However, postnatal women living in regional, rural and remote communities often lack access to coordinated specialist services and trained mental health workers. Internet-based, self-paced therapies can facilitate moving evidence-based interventions into practical health service delivery, including reaching populations in regional, rural and remote communities.
Yet, the burning question for Keryl de Haan, the Clinical Leader for Perinatal Infant Mental Health for Murrumbidgee Local Health District (MLHD) was, what are the barriers to isolated, rural mums engaging with online treatments? Despite being available, the online treatments were not being accessed by isolated mums. Surety of the answers needed to be embedded in research.
Determined to respect the new mums and to find solutions that would be of benefit to them, Keryl forged a valuable partnership with researchers from Charles Sturt University. The team identified the NSW Health Translational Grant scheme as a source of financial support and were successful in their second attempt to attract funding. The research team was further enhanced through partnerships with the Parent Infant Research Institute and other clinicians in Western New South Wales Local Health District. Governance of the research was supported through a diverse steering committee including a mum with experience of postnatal depression. This member was invaluable in guiding the research team to ensure communication with the participants avoided academic jargon and was sensitive to new mums.
Both quantitative and qualitative data was gathered to identify the issues for rural mums. During each stage of the research the clinicians and steering committee became more comfortable with the concepts of research and actively participated in attracting participants, gathering and analysing the data, and writing the report.
The outcomes were unexpected and much more complex than anticipated. The MumMood Booster program, used in this research, was evidence-based but the team was relieved to have this confirmed through the quantitative data.
It was the qualitative data that provided the unexpected outcomes. It was the aspect of the research that really engaged the research team. Team members were impressed by the willingness of the new mums to share their experiences and were moved by the stories. It was a revelation that many of the new mums did not understand that what they had experienced was depression. Even new mums who were midwives did not have the insight to understand that their struggles and distress were depression. Subsequently, they did not reach out for treatment.
Child and family health nurses, mental health clinicians and managers from rural areas were included as participants in the data gathering to understand their experiences and perspectives. As well as providing rich insight into their experiences, these health professionals were exposed to research and what that involves, further building a research culture in small rural communities. The research team heard of unreliable internet access, the absence of technology to demonstrate online treatments to the new mums, a wide variation in technology-related skills and a variety of approaches to gathering information to enable a diagnosis of depression.
Through the development of a strong and collaborative partnership between practitioners, researchers, new mums and industry, answers have emerged about to the barriers and facilitators to the uptake of online treatments by isolated, rural women. The collaborations continue onto the next phase of the research.