1. 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

2. Challenges & Solutions
Sheffield Population Profile-Service Provision
The Challenges …
National
Local
Solutions-Background - ( ) 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’

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

4. 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)

5. 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.

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

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

8. 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’

9. 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 ( ).

10. 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)

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

12. 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

13. 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’

14. 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

15. 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

16. 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

17. Question on Self Harm!

18. 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.

19. 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

20. 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.

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

22. Front Page

23. Personal Details

24. Antenatal-Postnatal

25. Chinese

26. Negative Emotions!

27. Sleep or No Sleep!

28. Social Interactions

29. Hassle?

30. Alone

31. Fed Up?

32. Help & Support

33. Eating Habit

34. You want to...

35. Aches & Pains?

36. Somatisation!

37. Life for Living?

38. Support System

39. Back Page

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

41. 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.

42. 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