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Papers by rose coates

Psychological Assessment, Aug 1, 2017

To demonstrate validity, questionnaires should measure the same construct in different groups and... more To demonstrate validity, questionnaires should measure the same construct in different groups and across time. The Edinburgh Postnatal Depression Scale (EPDS) was designed as a unidimensional scale, but factor analyses of the EPDS have been equivocal, and demonstrate other structures: this may be due to sample characteristics and timing of administration. We aimed to examine the factor structure of the EPDS in pregnancy and postpartum at four time-points in a large population-based sample. We carried out exploratory and confirmatory factor analysis on the Avon Longitudinal Study of Parents and Children sample (n = 11,195-12,166) randomly split in two. We used data from 18 and 32 weeks pregnancy gestation; and 8 weeks and 8 months postpartum. A three-factor solution was optimal at all time-points, showing the clearest factor structure and best model fit: Depression (four items) accounted for 43.5-47.2% of the variance; anhedonia (two items) 10.5-11.1%; and anxiety (three items) 8.3-9.4% of the variance. Internal reliability of subscales was good at all time points (Cronbach's alphas: .73-.78). The EPDS appears to measure three related factors of depression, anhedonia and anxiety and has a stable structure in pregnancy and the first postnatal year.

Journal of Interprofessional Care, Nov 28, 2022

Background: Specialised diabetes teams, specifically certified nurse and dietitian diabetes educa... more Background: Specialised diabetes teams, specifically certified nurse and dietitian diabetes educator teams, are being integrated part-time into primary care to provide better care and support for Canadians living with diabetes. This practice model is being implemented throughout Canada in an effort to increase patient access to diabetes education, self-management training, and support. Interprofessional collaboration can have positive effects on both health processes and patient health outcomes, but few studies have explored how health professionals are introduced to and transition into this kind of interprofessional work. Method: Data from 18 interviews with diabetes educators, 16 primary care physicians, 23 educators' reflective journals, and 10 quarterly debriefing sessions were coded and analysed using a directed content analysis approach, facilitated by NVIVO software. Results: Four major themes emerged related to challenges faced, strategies adopted, and benefits observed during this transition into interprofessional collaboration between diabetes educators and primary care physicians: (a) negotiating space, place, and role; (b) fostering working relationships; (c) performing collectively; and (d) enhancing knowledge exchange. Conclusions: Our findings provide insight into how healthcare professionals who have not traditionally worked together in primary care are collaborating to integrate health services essential for diabetes management. Based on the experiences and personal reflections of participants, establishing new ways of working requires negotiating space and place to practice, role clarification, and frequent and effective modes of formal and informal communication to nurture the development of trust and mutual respect, which are vital to success.

BMJ Open

Perinatal mental health (PMH) problems are common and can have an adverse impact on women and the... more Perinatal mental health (PMH) problems are common and can have an adverse impact on women and their families. However, research suggests that a substantial proportion of women with PMH problems do not access care.ObjectivesTo synthesise the results from previous systematic reviews of barriers and facilitators to women to seeking help, accessing help, and engaging in PMH care, and to suggest recommendations for clinical practice and policy.DesignA meta-review of systematic reviews.Review methodsSeven databases were searched and reviewed using a Preferred Reporting Items for Systematic Reviews and Meta Analyses search strategy. Studies that focused on the views of women seeking help and accessing PMH care were included. Data were analysed using thematic synthesis. Assessing the Methodological Quality of Systematic Reviews-2 was used to assess review methodology. To improve validity of results, a qualitative sensitivity analysis was conducted to assess whether themes remained consisten...

BJPsych Open

Background Perinatal mental health (PMH) problems are a leading cause of maternal death and incre... more Background Perinatal mental health (PMH) problems are a leading cause of maternal death and increase the risk of poor outcomes for women and their families. It is therefore important to identify the barriers and facilitators to implementing and accessing PMH care. Aims To develop a conceptual framework of barriers and facilitators to PMH care to inform PMH services. Method Relevant literature was systematically identified, categorised and mapped onto the framework. The framework was then validated through evaluating confidence with the evidence base and feedback from stakeholders (women and families, health professionals, commissioners and policy makers). Results Barriers and facilitators to PMH care were identified at seven levels: individual (e.g. beliefs about mental illness), health professional (e.g. confidence addressing perinatal mental illness), interpersonal (e.g. relationship between women and health professionals), organisational (e.g. continuity of carer), commissioner (...

Behaviour Research and Therapy, 2011

Postnatal debriefing is offered by 78% of maternity services in the UK despite little evidence fr... more Postnatal debriefing is offered by 78% of maternity services in the UK despite little evidence from randomized controlled trials (RCTs) that it is effective. RCTs in this area have applied debriefing as a prophylactic to all or high risk women, rather than as a treatment for women who request it. This pragmatic trial therefore evaluated existing postnatal debriefing services that provide debriefing as a treatment for women who request it. Forty-six women who met criterion A for post-traumatic stress disorder (PTSD) and requested debriefing 1.3 to 72.2 months (median 16 weeks) postpartum completed measures of depression, PTSD, support and negative appraisals of the birth before and one month after debriefing. Women were compared with others who gave birth in the same hospitals during the same time period (n=34), who met criterion A for PTSD but had not requested debriefing. Results showed PTSD symptoms reduced over time in both groups but greater decreases were observed in women who attended debriefing. Debriefing also led to reduction in negative appraisals but did not affect symptoms of depression. Therefore, results suggest providing debriefing as a treatment to women who request or are referred to it may help to reduce symptoms of PTSD.

Journal of Affective Disorders, 2011

Background Research and screening of anxiety in the perinatal period is hampered by a lack of psy... more Background Research and screening of anxiety in the perinatal period is hampered by a lack of psychometric data on self-report anxiety measures used in perinatal populations. This paper aimed to review self-report measures that have been validated with perinatal women. Methods A systematic search was carried out of four electronic databases. Additional papers were obtained through searching identified articles. Thirty studies were identified that reported validation of an anxiety measure with perinatal women. Results Most commonly validated self-report measures were the General Health Questionnaire (GHQ), State Trait Anxiety Inventory (STAI), and Hospital Anxiety and Depression Scales (HADS). Of the 30 studies included, 11 used a clinical interview to provide criterion validity. Remaining studies reported one or more other forms of validity (factorial, discriminant, concurrent and predictive) or reliability. The STAI shows criterion, discriminant and predictive validity and may be most useful for research purposes as a specific measure of anxiety. The Kessler 10 (K-10) may be the best short screening measure due to its ability to differentiate anxiety disorders. The Depression Anxiety Stress Scales 21 (DASS-21) measures multiple types of distress, shows appropriate content, and remains to be validated against clinical interview in perinatal populations. Limitations Nineteen studies did not report sensitivity or specificity data. The early stages of research into perinatal anxiety, the multitude of measures in use, and methodological differences restrict comparison of measures across studies. Conclusion There is a need for further validation of self-report measures of anxiety in the perinatal period to enable accurate screening and detection of anxiety symptoms and disorders.

Mental health problems in pregnancy and the postnatal period can have long-term negative effects ... more Mental health problems in pregnancy and the postnatal period can have long-term negative effects on women and their children. A key barrier to helping women in this period is the low level of identification of mental health problems. Depression has commonly been screened for using the Whooley Questions or Edinburgh Postnatal Depression Scale (EPDS) but women may experience a broad range of symptoms of distress not captured by these measures. The research reported in this dissertation was designed to address several aims. The first strand aimed to explore women’s experiences of postnatal mental health problems and how they conceptualise their symptoms. The focus of the first qualitative study was the lived experience of 17 women who had experienced psychological distress in the first postnatal year, and used interpretative phenomenological analysis. The second qualitative study used thematic analysis with the same sample to explore different symptoms of distress and women’s experienc...

Timely and comprehensive, this is the first book to offer synthesis and analysis of the current s... more Timely and comprehensive, this is the first book to offer synthesis and analysis of the current state of research and practice in early identification of perinatal mental health difficulties while also sketching out future screening ...

Journal of Affective Disorders, Mar 1, 2023

BJOG: An International Journal of Obstetrics & Gynaecology, 2021

Sir, We read this topical debate with interest. We understand that this side of the debate only p... more Sir, We read this topical debate with interest. We understand that this side of the debate only presents the arguments for offering induction of labour (IoL) at term; however, we would like to correct some of the inaccurate assertions about our review that were cited as evidence in the authors’ argument. The authors’ state that ‘. . . anecdotal descriptions of “long, painful and risky” [induction of labour] are not echoed in qualitative research themes.’ Our review reported that in half of the included studies women described being unprepared for the length of time that their induced labour would take. According to good practice in qualitative analysis, we checked for contrasting cases, and reported that only one woman, across all the studies included, reported being shocked that the induction process was quick, having believed it would take a long time. The description of ‘long’ was largely corroborated in our review. Furthermore, six out of seven studies of inpatient IoL, reported...

Best Practice & Research Clinical Obstetrics & Gynaecology

Pilot and Feasibility Studies

Background: The aim was to assess the feasibility of conducting a randomised controlled trial (RC... more Background: The aim was to assess the feasibility of conducting a randomised controlled trial (RCT) of induction of labour comparing use of two methods in the outpatient setting. Methods: An open-label feasibility RCT was conducted in two UK maternity units from October 2017 to March 2019. Women aged ≥ 16 years, undergoing induction of labour (IOL) at term, with intact membranes and deemed suitable for outpatient IOL according to local guidelines were considered eligible. They were randomised to cervical ripening balloon catheter (CRB) or vaginal dinoprostone (Propess). The participants completed a questionnaire and a subgroup underwent detailed interview. Service use and cost data were collected via the Adult Service Use Schedule (AD-SUS). Women who declined to participate were requested to complete a decliners' questionnaire. Results: During the study period, 274 eligible women were identified. Two hundred thirty (83.9%) were approached for participation of whom 84/230 (36.5%) agreed and 146 did not. Of these, 38 were randomised to Propess (n = 20) and CRB (n = 18). Decliner data were collected for 93 women. The reasons for declining were declining IOL (n = 22), preference for inpatient IOL (n = 22) and preference for a specific method, Propess (n = 19). The intended sample size of 120 was not reached due to restrictive criteria for suitability for outpatient IOL, participant preference for Propess and shortage of research staff. The intervention as randomised was received by 29/38 (76%) women. Spontaneous vaginal delivery was observed in 9/20 (45%) women in the dinoprostone group and 11/18 (61%) women in the CRB group. Severe maternal adverse events were recorded in one woman in each group. All babies were born with good condition and all except one (37/38, 97.4%) remained with the mother after delivery. No deaths were recorded. − 21% of women in the dinoprostone group were re-admitted prior to diagnosis of active labour compared to 12% in the CRB group.

BackgroundThe aim was to assess the feasibility of conducting a randomised controlled trial (RCT)... more BackgroundThe aim was to assess the feasibility of conducting a randomised controlled trial (RCT) of induction of labour comparing use of two methods in the out-patient setting.MethodsAn open-label feasibility RCT was conducted in two UK maternity units from October 2017 to March 2019. Women aged ≥16 years, undergoing Induction of labour (IoL) at term, with intact membranes and deemed suitable for out-patient IoL according to local guidelines were considered eligible. They were randomised to cervical ripening balloon catheter (CRB) or vaginal Dinoprostone (Propess). The participants completed a questionnaire and a sub-group underwent detailed interview. Health economics data were collected. Women who declined to participate were also requested to complete a decliners’ questionnaire.ResultsDuring the study period 274 eligible women were identified. 230 (83.9%) were approached for participation of whom 84 (36.5%) agreed. Of these, 38 were randomised to Propess (n=20) and CRB (n=18). T...

Journal of Reproductive and Infant Psychology

Journal of Interprofessional Care

This multi-method evaluation assessed the perceived impact of interprofessional workshops targeti... more This multi-method evaluation assessed the perceived impact of interprofessional workshops targeting enhanced collaboration between healthcare professionals who care for women during and after pregnancy. Current policy recommends partnership working to improve care for women and babies, however, there is little interprofessional education in this area. Five one-day workshops were delivered to 18 healthcare professionals (47.4% of the 38 healthcare professionals registered). The workshop was evaluated through: questionnaires before and after the workshop measuring attitudes and willingness towards collaboration; observations of the workshops by a researcher and follow-up interviews 2 months' post-workshop to explore changes in practice. Workshops were attended by midwives, health visitors (trained nurses specialising in community care for children 0-5 years), dieticians, nurses, a general practitioner and a breastfeeding specialist. Attitudes and willingness to participate in interprofessional collaborative practice improved after the workshop. Observations made at the workshop included engaged participants who reported numerous barriers towards collaboration. Follow-up contact with 12 participants identified several examples of collaboration in practice resulting from workshop attendance. In summary, these findings suggests that the workshops influenced attendees to change their practice towards more collaborative working. Future work needs to confirm these results with more participants.

Midwifery

Women's experiences of induction of labour: qualitative systematic review and thematic synthesis.