Abstract
Between one in 10 and one in five individuals experience a perinatal mental health problem either during pregnancy or in the postnatal period. It is estimated perinatal obsessive-compulsive disorder (PNOCD) impacts 22% of individuals during or after pregnancy. Effective evidence based treatments, such as Cognitive Behavioural Therapy, do exist. However, often PNOCD is under-recognised and under-diagnosed, and there are issues of inequity in access to support. This thesis presents mixed-methods research focused on understanding the barriers and facilitators to accessing evidence-based psychological therapies (EBPT) for mental health problems, with a focus on PNOCD. Recommendations were generated for improving access to EBPT for PNOCD. A co-production group, comprising of five mothers who had experienced PNOCD contributed to the body of work presented, providing input into the design, data collection, and analysis of the studies. First, a systematic review and meta-synthesis was conducted of collated qualitative literature on barriers and facilitators to accessing EBPT for common mental health problems in the primary care context. Following this, semi-structured interviews were conducted with seven mothers with self-identified PNOCD to identify the barriers and facilitators to accessing EBPT. The results were used to create a comprehensive set of barriers. In the third study, these barriers were shared with more than 200 healthcare professionals across England in a survey study. Professionals ranked the barriers with respect to their importance and amenability to change. Finally, the top-rated barriers from the survey were discussed in two deliberative workshops with a range of 18 healthcare professionals in order to develop recommendations for how to improve access to EBPT for PNOCD.Findings from the four components of the thesis demonstrate that there are attitudinal, knowledge, systemic and relational barriers and facilitators experienced when accessing EBPT for common mental health problems, including PNOCD. Stigma was identified as a pertinent barrier across different common mental health problems. The second and third studies demonstrated that both mothers and professionals agree that parent attitudes and awareness of PNOCD impacted parents’ access to appropriate support. Healthcare professionals’ awareness of PNOCD, and to what extent they prioritised and had the capacity to discuss PNOCD, was also highlighted as a barrier to access. The key recommendations for improving access to EBPT for PNOCD include awareness-raising initiatives to increase knowledge of PNOCD in the perinatal 3 and pre-conception population. Additionally, training packages are recommended for healthcare professionals to increase understanding, recognition of, and appropriate treatment referral for PNOCD.
| Date of Award | Sept 2024 |
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| Original language | English |
| Awarding Institution |
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| Supervisor | Liz Ford (Supervisor), Clio Berry (Supervisor) & Clara Strauss (Supervisor) |