Responding to the Challenges of Working in Multicultural Communities 22/07/2018 Responding to the Challenges of Working in Multicultural Communities Abi Sobowale Health Visitor, Jordanthorpe Health Centre, Sheffield Introduce Self and topic Postnatal Depression Conference : Wednesday 10 July 2002 The National Exhibition Centre, Birmingham

Challenges & Solutions Sheffield Population Profile-Service Provision The Challenges … National Local Solutions-Background - (1987- 2000) Workshops-March 2000 Maternal Mental Health Conference Nov.2000 Evaluation of a ‘Punjabi Postnatal Screening Questionnaire-Bhatti-Ali (1999)(Sheffield & Bradford) Consumer Involvement – ‘Screening Cards’

Sheffield Ethnic Minority Grouping Sheffield Demography Sheffield Ethnic Minority Grouping This chart breaks down 5.03% (25225 people) from a total population of 501202 (475977 white population)

The Challenges National Health Service Then & Now. Health & Social Providers. PCT- Objectives – Providing ‘Quality Service’ Quality Service? = Accessible, Acceptable, Appropriate, Equal,Efficient and Effective (Maxwell 1984). (to meet the needs of diverse community & Improve health Care for ethnic communities)

National Service Frameworks for Mental Health – DOH 1999 Health authorities to develop protocols for the management of PND. Early identification, management in primary care, more specialist treatment in secondary care as required. Capacity building in primary care to ensure HVs & midwives are able to deal with PND.

Consultation With Colleagues Focus Group (2/3/00) Maternal Mental Health Conference (30/11/00) Focus Group (8/11/01)

Statement Of The Problem Local & national gap in service provision A need for a culturally appropriate & accurate detection tool Women of non western culture

The Solutions? Screening for PND since 1987! Health Visitors’ Training ! Employment of language specific practitioners! National Solution Anticipated Local Solution Attempted Workshop March 2000 Conference November 2000 A Search for a culturally appropriate screening tool – Research Project Development of the ‘Screening Cards’

Postnatal depression in South Asian Women A Search For A Culturally Appropriate & Accurate Detection Tool Two possible tools identified -Punjabi version of the EPDS (Clifford et all 999). Punjabi Postnatal Screening Questionnaire (PPNSQ) (Bhatti-Ali 1999). HAZ Fellowship. Preliminary Validation of the PPNSQ undertaken - (April 2001-March 2002) 100 women (60 + 40).

The Punjabi Postnatal Depression Screening Questionnaire (PPNSQ) Bhatti-Ali (1999) Developed in order to screen for PND in Asian women A 16 item questionnaire developed from The EPDS (Cox 1987 ) The Hospital Anxiety & Depression Scale (HADS: Zigmond & Snaith1983) Zung’s Self Rating Depression Scale (Zung 1965, 1986) Beck Depression Inventory (BDI: Beck et al 1961)

Postnatal Depression In South Asian Women Sheffield In collaboration with Bradford (Sure Start Barkerend)

Research Methods Sample : 100 women (Sheffield (60) & Bradford (40) at 6 weeks postnatal Data Collection – Questionnaire Post Questionnaire Interview Independent Mental Health Assessment Focus Groups Data Analysis – Statistical Packages for Social Sciences (SPSS) & Atlas/ti

Post Questionnaire Interview All of the women were asked some pre-determined questions about their views on: Postnatal depression (PND) in general to include any previous knowledge. Clarity of the questions, and their understanding. Content of the questionnaire. Screening The use of interpreter/link worker General Comment Appropriateness of the question on ‘self harm’

Qualitative Results The following categories emerged from analysis of the qualitative data. ‘Limited or no knowledge’ of postnatal depression in the target group and amongst the south Asian community in general---need for education (education education) The role of women in the family and cultural expectations Views on screening for postnatal depression Views on the PPNSQ as a screening too, Views on the questions and the inclusion of a question on self harm Language and implication for service delivery Baby gender and family dynamics The use of link workers

Frequency of Answers to Individual Questions by the Frequency of Scores Response Yes No Felt so unhappy that you have ended up crying 36 64 Getting anxious or depressed Felt sad or miserable 35 65 Blamed yourself for anything going wrong 33 67 Found yourself getting upset over little things 32 68 Worried about things that don't worry you much normally So worried that you have had difficulty sleeping 25 75 Felt that everything you do to be a bother/hassle Felt weak and helpless 24 76 Question

Frequency of Answers to Individual Questions by the Frequency of Scores Response Yes No Able to laugh at funny situations 89 11 Been able to concentrate on what you are doing 82 18 Able to look forward to things as you always have 78 22 Felt scared or panicky 21 79 Felt yourself worthless 15 85 Felt that something bad is going to happen to you 9 91 Thought about harming yourself at all 6 94 Question

Question on Self Harm!

Research Findings The PPNSQ acceptable to subjects and practitioners, readability clarity and user friendly. Different components gave consistent results The results suggest that the PPNSQ may be useful in excluding PND but is no substitute for clinical assessment in suspected cases. Further study will ensure a rigorous evaluation of reliability and validity of the questionnaire.

User Involvement & Development of the ‘Mental Health Assessment Cards. Immediate Solution Required The Women In the Study Health Visitors & Link Workers Development of the ‘screening cards’ Initially in Urdu In Bengali, Somali, Arabic and Chinese

Aim To develop a visual tool that will help practitioners and clients to identify the symptoms of psychological distress and enable an early recognition of postnatal depression in Arabic, Bengali, Chinese, Somali & Urdu.. To involve local women and practitioners in the planning, development, piloting and evaluation of the ‘picture cards’. These are illustrated cards depicting socio, physical and psychological health (symptoms). Pictures together with a non-wordy style of writing in appropriate languages.

Key Actions Development of culturally acceptable illustrations Pilot amongst local women Individually & In Groups Translation Process Piloting in different languages Evaluation

Front Page

Personal Details

Antenatal-Postnatal

Chinese

Negative Emotions!

Sleep or No Sleep!

Social Interactions

Hassle?

Alone

Fed Up?

Help & Support

Eating Habit

You want to...

Aches & Pains?

Somatisation!

Life for Living?

Support System

Back Page

Postnatal Depression Knows No Social, Economical Or Cultural Boundaries. PND has been identified & described in different cultures!

Strengths of the ‘Booklet’ User Involvement as local women were involved with design. Flexibility of use at practitioners’ discretion. Based on pictures, illustration and a non wordy style of writing. Useful without any special training or qualification. Produced in English & relevant languages (Arabic, Bengali, Punjabi, Urdu Somali & Chinese.) Useful for literate & illiterate clients (patients). Innovative.

The End - Thanks for listening 22/07/2018 The End - Thanks for listening Abi Sobowale Health Visitor, Jordanthorpe Health Centre, Sheffield Introduce Self and topic Postnatal Depression Conference Wednesday, 10 July 2002 The National Exhibition Centre, Birmingham