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A cross-sectional study of early identification of postpartum depression: implications for primary care providers from The Ontario Mother & Infant Survey.

https://arctichealth.org/en/permalink/ahliterature190608
Source
BMC Fam Pract. 2002 Apr 11;3:5
Publication Type
Article
Date
Apr-11-2002
Author
Susan Watt
Wendy Sword
Paul Krueger
Debbie Sheehan
Author Affiliation
School of Social Work, McMaster University, Hamilton, ON, Canada. wattms@mcmaster.ca
Source
BMC Fam Pract. 2002 Apr 11;3:5
Date
Apr-11-2002
Language
English
Publication Type
Article
Keywords
Analysis of Variance
Cross-Sectional Studies
Depression, Postpartum - diagnosis - epidemiology
Female
Humans
Income
Infant, Newborn
Length of Stay
Logistic Models
Ontario - epidemiology
Risk factors
Social Support
Abstract
This survey's objective was to provide planning information by examining utilization patterns, health outcomes and costs associated with existing practices in the management of postpartum women and their infants. In particular, this paper looks at a subgroup of women who score >or= 12 on the Edinburgh Postnatal Depression Survey (EPDS).
The design is cross-sectional with follow-up at four weeks after postpartum hospital discharge. Five Ontario hospitals, chosen for their varied size, practice characteristics, and geographic location, provided the setting for the study. The subjects were 875 women who had uncomplicated vaginal deliveries of live singleton infants. The main outcome measures were the EPDS, the Duke UNC Functional Social Support Questionnaire and the Health and Social Services Utilization Questionnaire.
EPDS scores of >or= 12 were found in 4.3 to 15.2% of otherwise healthy women. None of these women were being treated for postpartum depression. Best predictors of an EPDS score of >or= 12 were lack: of confident support, lack of affective support, household income of
Notes
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PubMed ID
11950393 View in PubMed
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The effect of delivery method on breastfeeding initiation from the The Ontario Mother and Infant Study (TOMIS) III.

https://arctichealth.org/en/permalink/ahliterature122390
Source
J Obstet Gynecol Neonatal Nurs. 2012 Nov-Dec;41(6):728-37
Publication Type
Article
Author
Susan Watt
Wendy Sword
Debbie Sheehan
Gary Foster
Lehana Thabane
Paul Krueger
Christine Kurtz Landy
Author Affiliation
School of Social Work, McMaster University, Hamilton, ON, Canada. wattms@mcmaster.ca
Source
J Obstet Gynecol Neonatal Nurs. 2012 Nov-Dec;41(6):728-37
Language
English
Publication Type
Article
Keywords
Adult
Breast Feeding - statistics & numerical data
Cesarean Section - statistics & numerical data
Cross-Sectional Studies
Delivery, Obstetric - methods
Evaluation Studies as Topic
Female
Gestational Age
Health Behavior
Health Knowledge, Attitudes, Practice
Humans
Infant Welfare
Infant, Newborn
Male
Mother-Child Relations
Ontario
Postpartum Period - physiology
Pregnancy
Questionnaires
Risk factors
Term Birth
Time Factors
Young Adult
Abstract
To report on the relationship between delivery method (cesarean vs. vaginal) and type (planned vs. unplanned) and breastfeeding initiation in hospital and continuation to 6 weeks postpartum as self-reported by study participants.
Quantitative sequential mixed methods design.
Women were recruited from 11 hospital sites in Ontario, Canada.
Participants included 2,560 women age 16 years or older who delivered live, full-term, singleton infants.
Data were collected from an in-hospital questionnaire, hospital records, and a 6-week postpartum interview.
Ninety-two percent of women reported initiating breastfeeding, and 74% continued to 6 weeks. The method of delivery, when defined as cesarean versus vaginal, was not a determining factor in breastfeeding initiation in hospital or in the early postdischarge period. An unexpected delivery method (i.e., unplanned cesarean or instrument-assisted vaginal deliveries) was associated, at a statistically significant level, with an increased likelihood of initiating breastfeeding and continuation to 6 weeks postdischarge.
Breastfeeding can be considered a coping strategy that serves to normalize an abnormal experience and allows the individual to once again assume control. These unexpected results warrant further investigation to understand why women make the decision to initiate breastfeeding, why they choose to continue breastfeeding, and how they can be supported to achieve exclusive breastfeeding as recommended for infants in the first 6 months.
PubMed ID
22823063 View in PubMed
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The impact of a new universal postpartum program on breastfeeding outcomes.

https://arctichealth.org/en/permalink/ahliterature166898
Source
J Hum Lact. 2006 Nov;22(4):398-408
Publication Type
Article
Date
Nov-2006
Author
Debbie Sheehan
Susan Watt
Paul Krueger
Wendy Sword
Author Affiliation
Family Health Division, City of Hamilton Public Health Services, Dundas, ON, Canada.
Source
J Hum Lact. 2006 Nov;22(4):398-408
Date
Nov-2006
Language
English
Publication Type
Article
Keywords
Adult
Ambulatory Care - methods - statistics & numerical data
Breast Feeding - epidemiology - statistics & numerical data
Female
House Calls - statistics & numerical data
Humans
Infant
Infant Care - methods - statistics & numerical data
Infant, Newborn
Length of Stay
Mothers - psychology
Ontario
Postnatal Care - methods
Postpartum Period
Time Factors
Weaning
Abstract
The Ontario Mother and Infant Study II examined changes in postpartum health outcomes, including breastfeeding initiation and discontinuation, for mothers and their infants and compared these results to data collected prior to the initiation of the Universal Hospital Stay and Postpartum Home Visiting Program policy change in 1998. Data were collected using cross-sectional surveys before discharge and at 4 weeks postdischarge. Ninety percent of the women surveyed at 4 weeks postpartum initiated breastfeeding. Of these, 84% were still breastfeeding at 4 weeks postpartum. None of the 3 major program components-extended length of stay, a postpartum phone call from a public health worker, or a postpartum in-home visit-were associated with breastfeeding continuation to 4 weeks. Discontinuation before 4 weeks postdischarge was associated with maternal attitudes toward breastfeeding, formula feeding or supplementation in hospital, infant readmission, and use of walk-in clinics for infant care.
PubMed ID
17062785 View in PubMed
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Implementation of a health care policy: an analysis of barriers and facilitators to practice change.

https://arctichealth.org/en/permalink/ahliterature173320
Source
BMC Health Serv Res. 2005;5:53
Publication Type
Article
Date
2005
Author
Susan Watt
Wendy Sword
Paul Krueger
Author Affiliation
School of Social Work, McMaster University, Hamilton, Ontario, Canada. wattms@mcmaster.ca
Source
BMC Health Serv Res. 2005;5:53
Date
2005
Language
English
Publication Type
Article
Keywords
Adult
Continuity of Patient Care - economics
Female
Focus Groups
Health Plan Implementation
Health Policy
Humans
Length of Stay - economics
Obstetrics and Gynecology Department, Hospital - economics - trends
Ontario
Organizational Innovation
Organizational Policy
Postnatal Care - economics
Program Development
Program Evaluation
Universal Coverage
Abstract
Governments often create policies that rely on implementation by arms length organizations and require practice changes on the part of different segments of the health care system without understanding the differences in and complexities of these agencies. In 2000, in response to publicity about the shortening length of postpartum hospital stay, the Ontario government created a universal program offering up to a 60-hour postpartum stay and a public health follow-up to mothers and newborn infants. The purpose of this paper is to examine how a health policy initiative was implemented in two different parts of a health care system and to analyze the barriers and facilitators to achieving practice change.
The data reported came from two studies of postpartum health and service use in Ontario Canada. Data were collected from newly delivered mothers who had uncomplicated vaginal deliveries. The study samples were drawn from the same five purposefully selected hospitals for both studies. Questionnaires prior to discharge and structured telephone interviews at 4-weeks post discharge were used to collect data before and after policy implementation. Qualitative data were collected using focus groups with hospital and community-based health care practitioners and administrators at each site.
In both studies, the respondents reflected a population of women who experienced an "average" or non-eventful hospital-based, singleton vaginal delivery. The findings of the second study demonstrated wide variance in implementation of the offer of a 60-hour stay among the sites and focus groups revealed that none of the hospitals acknowledged the 60-hour stay as an official policy. The uptake of the offer of a 60-hour stay was unrelated to the rate of offer. The percentage of women with a hospital stay of less than 25 hours and the number with the guideline that the call be within 48 hours of hospital discharge. Public health telephone contact was high although variable in relation to compliance the guideline that the call be within 48 hours of hospital discharge. Home visits were offered at consistently high rates.
Policy enactment is sometimes inadequate to stimulate practice changes in health care. Policy as a tool for practice change must thoughtfully address the organizational, professional, and social contexts within which the policy is to be implemented. These contexts can either facilitate or block implementation. Our examination of Ontario's universal postpartum program provides an example of differential implementation of a common policy intended to change post-natal care practices that reflects the differential influence of context on implementation.
Notes
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PubMed ID
16102173 View in PubMed
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Implementation, uptake, and impact of a provincial postpartum program.

https://arctichealth.org/en/permalink/ahliterature178380
Source
Can J Nurs Res. 2004 Jun;36(2):60-82
Publication Type
Article
Date
Jun-2004
Author
Wendy Sword
Susan Watt
Paul Krueger
Author Affiliation
School of Nursing, McMaster University, Ontario, Canada.
Source
Can J Nurs Res. 2004 Jun;36(2):60-82
Date
Jun-2004
Language
English
Publication Type
Article
Keywords
Adult
Canada
Community Health Nursing - organization & administration
Continuity of Patient Care - organization & administration
Female
Health Care Surveys
Humans
Infant, Newborn
Maternal-Child Nursing - organization & administration
Patient satisfaction
Postnatal Care - organization & administration
Program Evaluation
Abstract
This paper examines implementation and uptake of the Hospital Stay and Postpartum Home Visiting Program at 5 sites in the Canadian province of Ontario using a cross-sectional survey. It also examines concomitant changes in satisfaction with services and maternal and infant health indicators by comparing the findings of this survey, administered after policy implementation, with those of a previous survey. In both surveys, data were collected via a self-administered in-hospital questionnaire and a structured telephone interview at 4 weeks post-discharge. There were statistically significant differences in implementation of the 60-hour hospital-stay option across sites, with between 11.7% and 81.2% of women having been offered an extended stay. However, there were no significant differences in acceptance rates (21.1-39.4%) among those women given this option. There were no statistically significant differences in the offer of a home visit by a public health nurse (91.5-96.6%), but there were significant differences in uptake of a visit. Between 21.1% and 39.4% of those women who were offered a home visit accepted. When compared to the previous survey findings, there were few changes in client satisfaction with services and health indicators following program implementation.This study raises questions about the utility of the postpartum program as currently implemented and highlights the need for further research.
PubMed ID
15369165 View in PubMed
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Learning needs of postpartum women: does socioeconomic status matter?

https://arctichealth.org/en/permalink/ahliterature174568
Source
Birth. 2005 Jun;32(2):86-92
Publication Type
Article
Date
Jun-2005
Author
Wendy Sword
Susan Watt
Author Affiliation
School of Nursing, McMaster University, Hamilton, Ontario, Canada.
Source
Birth. 2005 Jun;32(2):86-92
Date
Jun-2005
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Attitude to Health
Breast Feeding
Female
Humans
Ontario
Patient Education as Topic
Postpartum Period
Questionnaires
Socioeconomic Factors
Time Factors
Abstract
Little is known about how information needs change over time in the early postpartum period or about how these needs might differ given socioeconomic circumstances. This study's aim was to examine women's concerns at the time of hospital discharge and unmet learning needs as self-identified at 4 weeks after discharge.
Data were collected as part of a cross-sectional survey of postpartum health outcomes, service use, and costs of care in the first 4 weeks after postpartum hospital discharge. Recruitment of 250 women was conducted from each of 5 hospitals in Ontario, Canada (n = 1,250). Women who had given vaginal birth to a single live infant, and who were being discharged at the same time as their infant, assuming care of their infant, competent to give consent, and able to communicate in one of the study languages were eligible. Participants completed a self-report questionnaire in hospital; 890 (71.2%) took part in a structured telephone interview 4 weeks after hospital discharge.
Approximately 17 percent of participants were of low socioeconomic status. Breastfeeding and signs of infant illness were the most frequently identified concerns by women, regardless of their socioeconomic status. Signs of infant illness and infant care/behavior were the main unmet learning needs. Although few differences in identified concerns were evident, women of low socioeconomic status were significantly more likely to report unmet learning needs related to 9 of 10 topics compared with women of higher socioeconomic status. For most topics, significantly more women of both groups identified learning needs 4 weeks after discharge compared with the number who identified corresponding concerns while in hospital.
It is important to ensure that new mothers are adequately informed about topics important to them while in hospital. The findings highlight the need for accessible and appropriate community-based information resources for women in the postpartum period, especially for those of low socioeconomic status.
PubMed ID
15918864 View in PubMed
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The Ontario Mother and Infant Study (TOMIS) III: a multi-site cohort study of the impact of delivery method on health, service use, and costs of care in the first postpartum year.

https://arctichealth.org/en/permalink/ahliterature151302
Source
BMC Pregnancy Childbirth. 2009;9:16
Publication Type
Article
Date
2009
Author
Wendy Sword
Susan Watt
Paul Krueger
Lehana Thabane
Christine Kurtz Landy
Dan Farine
Marilyn Swinton
Author Affiliation
School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada. sword@mcmaster.ca
Source
BMC Pregnancy Childbirth. 2009;9:16
Date
2009
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Cesarean Section - economics
Delivery, Obstetric - economics - methods
Depression, Postpartum - epidemiology
Female
Health Care Costs
Health Services - utilization
Health Status Indicators
Humans
Infant, Newborn
Ontario - epidemiology
Outcome Assessment (Health Care)
Postpartum Period
Pregnancy
Prospective Studies
Research Design
Abstract
The caesarean section rate continues to rise globally. A caesarean section is inarguably the preferred method of delivery when there is good evidence that a vaginal delivery may unduly risk the health of a woman or her infant. Any decisions about delivery method in the absence of clear medical indication should be based on knowledge of outcomes associated with different childbirth methods. However, there is lack of sold evidence of the short-term and long-term risks and benefits of a planned caesarean delivery compared to a planned vaginal delivery. It also is important to consider the economic aspects of caesarean sections, but very little attention has been given to health care system costs that take into account services used by women for themselves and their infants following hospital discharge.
The Ontario Mother and Infant Study III is a prospective cohort study to examine relationships between method of delivery and maternal and infant health, service utilization, and cost of care at three time points during the year following postpartum hospital discharge. Over 2500 women were recruited from 11 hospitals across the province of Ontario, Canada, with data collection occurring between April 2006 and October 2008. Participants completed a self-report questionnaire in hospital and structured telephone interviews at 6 weeks, 6 months, and 12 months after discharge. Data will be analyzed using generalized estimating equation, a special generalized linear models technique. A qualitative descriptive component supplements the survey approach, with the goal of assisting in interpretation of data and providing explanations for trends in the findings.
The findings can be incorporated into patient counselling and discussions about the advantages and disadvantages of different delivery methods, potentially leading to changes in preferences and practices. In addition, the findings will be useful to hospital- and community-based postpartum care providers, managers, and administrators in guiding risk assessment and early intervention strategies. Finally, the research findings can provide the basis for policy modification and implementation strategies to improve outcomes and reduce costs of care.
Notes
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PubMed ID
19397827 View in PubMed
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Postpartum health, service needs, and access to care experiences of immigrant and Canadian-born women.

https://arctichealth.org/en/permalink/ahliterature166532
Source
J Obstet Gynecol Neonatal Nurs. 2006 Nov-Dec;35(6):717-27
Publication Type
Article
Author
Wendy Sword
Susan Watt
Paul Krueger
Author Affiliation
School of Nursing, McMaster University, Hamilton, Ontario, Canada. sword@fhs.csu.mcmaster.ca
Source
J Obstet Gynecol Neonatal Nurs. 2006 Nov-Dec;35(6):717-27
Language
English
Publication Type
Article
Keywords
Adult
Attitude to Health - ethnology
Chi-Square Distribution
Cross-Sectional Studies
Depression, Postpartum - diagnosis - ethnology
Emigration and Immigration
Female
Health Services Accessibility - organization & administration
Health Services Needs and Demand - organization & administration
Health Status Indicators
Humans
Marital status
Mothers - education - psychology - statistics & numerical data
Nursing Methodology Research
Ontario
Patient Discharge
Patient Education as Topic - organization & administration
Postnatal Care - organization & administration - psychology
Postpartum Period - ethnology
Questionnaires
Residence Characteristics
Social Support
Socioeconomic Factors
Abstract
To describe immigrant women's postpartum health, service needs, access to services, and service use during the first 4 weeks following hospital discharge compared to women born in Canada.
Data were collected as part of a larger cross-sectional study.
Women were recruited from 5 hospitals purposefully selected to provide a diverse sample.
A sample of 1,250 women following vaginal delivery of a healthy infant; approximately 31% were born outside of Canada.
Self-reported health status, postpartum depression, postpartum needs, access to services, service use.
Immigrant women were significantly more likely than Canadian-born women to have low family incomes, low social support, poorer health, possible postpartum depression, learning needs that were unmet in hospital, and a need for financial assistance. However, they were less likely to be able to get financial aid, household help, and reassurance/support. There were no differences between groups in ability to get care for health concerns.
Health care professionals should attend not only to the basic postpartum health needs of immigrant women but also to their income and support needs by ensuring effective interventions and referral mechanisms.
Notes
Comment In: J Obstet Gynecol Neonatal Nurs. 2007 Mar-Apr;36(2):172-3; author reply 17317371519
PubMed ID
17105636 View in PubMed
Less detail

Predictors of acceptance of a postpartum public health nurse home visit: findings from an Ontario survey.

https://arctichealth.org/en/permalink/ahliterature168401
Source
Can J Public Health. 2006 May-Jun;97(3):191-6
Publication Type
Article
Author
Wendy A Sword
Paul D Krueger
M Susan Watt
Author Affiliation
School of Nursing, McMaster University, Hamilton, ON. sword@mcmaster.ca
Source
Can J Public Health. 2006 May-Jun;97(3):191-6
Language
English
Publication Type
Article
Keywords
Adult
Community Health Nursing - statistics & numerical data
Cross-Sectional Studies
Female
Health Care Surveys
Health Knowledge, Attitudes, Practice
Humans
Mothers - education - psychology
Ontario
Patient Acceptance of Health Care - statistics & numerical data
Postnatal Care - utilization
Pregnancy
Program Evaluation
Public Health Nursing - statistics & numerical data
Questionnaires
Abstract
To determine 1) rates of offer and uptake of a home visit provided through Ontario's universal Hospital Stay and Postpartum Home Visiting Program, and 2) predictors of acceptance of a home visit.
Women were eligible to participate if they had given birth vaginally to a live singleton infant, were being discharged with the infant to their care, were competent to give consent, and could communicate in one of the four study languages. A self-report questionnaire was used to collect data from 1,250 women recruited from five hospitals across the province; 890 (71.2%) women completed a structured telephone interview 4 weeks following discharge.
Most women (81.4% to 97.8%) reported having received a telephone call from a public health nurse, although not necessarily within 48 hours of discharge. While the offer of a home visit reportedly was high across sites, there were statistically significant differences in rates of acceptance (40.8% to 76.2%). Important predictors of acceptance were first live birth, lower social support, lower maternal rating of services in labour and delivery, poorer maternal self-reported health, probable postpartum depression, lower maternal rating of services on the postpartum unit, and breastfeeding initiation.
The home visiting component of the universal program is reaching most women through telephone follow-up. However, rates of acceptance of a home visit differed greatly across study sites. The findings suggest that it is women with specific problems or needs who are accepting a visit. Further research is necessary to guide the development of evidence-based programs and policies regarding postpartum nurse home visits.
PubMed ID
16827404 View in PubMed
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Support needs and preferences of young adolescents with asthma and allergies: "just no one really seems to understand".

https://arctichealth.org/en/permalink/ahliterature121309
Source
J Pediatr Nurs. 2012 Oct;27(5):479-90
Publication Type
Article
Date
Oct-2012
Author
Miriam Stewart
Nicole Letourneau
Jeffrey R Masuda
Sharon Anderson
Lisa Cicutto
Shawna McGhan
Susan Watt
Author Affiliation
University of Alberta, Edmonton, Alberta, Canada.
Source
J Pediatr Nurs. 2012 Oct;27(5):479-90
Date
Oct-2012
Language
English
Publication Type
Article
Keywords
Adolescent
Asthma - psychology - therapy
Canada
Child
Decision Making
Female
Health Services Accessibility
Health services needs and demand
Humans
Hypersensitivity - psychology - therapy
Internet
Interviews as Topic
Male
Parents - psychology
Peer Group
Questionnaires
Self Care
Social Support
Abstract
The objectives of this study were to identify support needs, support resources, and support barriers for young adolescents with asthma and allergies and to describe preferences for an accessible support intervention. Adolescents (N = 57) completed a survey questionnaire. Eight young adolescents, 10 parents, and 5 older adolescents participated in separate group interviews. Young adolescents' challenges included transition to self-care, balancing restrictions with safety, social isolation, and loneliness. Young teens recommended supportive networks facilitated by older adolescent peers and wanted to meet with other young adolescents living with asthma and allergies online and share information, advice, and encouragement with them.
PubMed ID
22920659 View in PubMed
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