Exploring engagement in an antenatal psychosocial intervention for the prevention of postnatal depression

The aim of this thesis was to investigate engagement in the antenatal psychosocial intervention 'Preparing for Parenthood' designed to reduce postnatal depression, run within the current maternity system, to identify factors predictive of engagement. The quantitative study investigated three components of health-promotion behaviour: health locus of control, social support and negative life events within an ongoing randomised controlled trial (RCT). Women were identified as at risk of postnatal depression by a screening questionnaire, 'Pregnancy and You', at 15-20 weeks gestation (n=400). A baseline assessment was completed 4 weeks later (n=292). Women who wished to have the opportunity to attend the intervention were randomised to an intervention (n=103) or control condition (n=106). The intervention consisted of six, 2-hour sessions held every week preceded by an initial introductory meeting and followed by a postnatal reunion session at the Leicester General hospital, run by two female course leaders whose backgrounds were in mental health. An outcome assessment of measures of engagement was completed at 3 months postnatally with all willing participants. In a qualitative study (n=82), the procedures used followed that of the quantitative study where appropriate. The same psychosocial intervention (n=15) was implemented. The outcome interview was completed between two and three months postnatally and consisted of 9 questions (n=12). Analysis using the grounded theory technique identified two main categories of themes, clustering at either the screening stage or at the intervention stage itself. Seven themes were identified as influential in initiating engagement with the intervention; and eight themes were identified as being influential in maintaining engagement with the intervention. It was concluded that actual health-promotion behaviour was not predictable using the three hypothesised measures of prediction, in this population, and for this intervention. The findings of the qualitative study enabled potential improvements to the intervention to be identified as possible ways of gaining and maintaining participant interest, and therefore engagement.