A qualitative meta-synthesis: public health nurses role in the identification and management of perinatal mental health problems

Aim. To report findings of a systematic review and meta-synthesis of qualitative studies exploring public health nurses' perceptions and experiences of identifying and managing women with perinatal mental health (PMH) problems. Background. Public health nurses play a key role in supporting women who experience PMH problems and several qualitative studies have explored their role. Design. Systematic review and meta-synthesis Data sources. A comprehensive search was developed and multiple databases were searched from 2000-2015. Review methods. Studies that employed qualitative methods to explore experiences of public health nurses in identifying and managing women with PMH problems were included. Two reviewers independently assessed the methodological quality of studies. Themes, concepts and interpretations were extracted and synthesized using the process of thematic analysis. Results. Fifteen papers including 14 unique qualitative studies were included. Two overarching themes were identified: 'conceptualization and detection of PMH problems' and 'barriers and facilitators to management'. The former of these comprised several subthemes including the use of formal screening tools vs. clinical intuition and challenges encountered in detection. The latter theme, barriers to management included availability of referral pathways and time. In terms of facilitators, training, public health nursing interventions, support groups and referral pathways were identified as factors that optimize management. Conclusions. Public health nurses use a variety of methods to identify women with PMH problems. However, several support structures are needed to optimize management including access to appropriate referral pathways, support groups and relationship continuity.