A mixed methods review to develop and confirm a framework for assessing midwifery practice in perinatal mental health

Aim: To ascertain whether a new framework examining midwifery practice in perinatal mental health (PMH) is supported by the research literature. Background: The identification and care of women with PMH problems is increasingly considered part of midwifery practice. Research suggests that many midwives lack knowledge, skills and confidence. It would be useful to be able to determine barriers and facilitators to effective clinical practice. The authors propose a framework comprising five potentially measurable domains which have an impact on midwives' ability to identify, assess and care for women with PMH problems. Design: This mixed-methods review uses an innovative qualitative convergent design based on framework synthesis. Data sources: Relevant electronic databases were searched for the period from January 2007-December 2016; 33 studies from nine countries met the inclusion criteria. Review methods: Study quality was assessed using critical appraisal tools. Study findings were mapped onto the five domains of the framework: knowledge, confidence, attitudes, illness perception and infrastructure. Findings were then synthesized for each domain. Results: All five domains are substantially represented in the literature, thus supporting the proposed framework. Several sub-domains and relationships between domains were identified. Varying levels of knowledge, confidence, attitudes and illness perceptions were found; evidence suggests that midwives benefit from further training within these domains. Features of organizational infrastructure act as barriers or facilitators to effective care; these need to be addressed at organizational level. Conclusion: The proposed framework was confirmed and can be used to inform practice, policy and research.