Self-reported competence among advanced practice nursing students in Denmark, Finland and Norway: a cross-sectional multicentre study.

BACKGROUND: The health care systems in the Nordic countries and worldwide are under pressure due to increased longevity and a shortage of nurses. Providing nurses with a high level of education, such as advanced practice nursing, is of great importance to ensure effective, safe and high-quality care. AIM: The aim of this study was to investigate self-reported competence using the Nurse Professional Competence Scale Short-Form for the first time among master's students of advanced practice nursing in the Nordic countries and to relate the findings to age, work obligations, child-rearing responsibilities, level of education and clinical nursing experience. METHODS: A multicentre, cross-sectional design was used in this study conducted at five universities in Denmark, Finland and Norway. The Nurse Professional Competence Scale Short-Form consisting of six competence areas was used with a maximum score of 7 per item for the analysis of single items and a transformed scale from 14.3 to 100 for analysing the competence areas (higher score equals higher self-reported competence). Descriptive and comparative statistics were used to analyse the data. RESULTS: The highest mean score was found for the competence area 'Value-based nursing care'. Students living with home-dwelling children (≤ 18 years) reported significantly higher competence in 'Nursing care', while students ≥33 years reported significantly higher competence in 'Nursing care' and 'Value-based nursing care'. No significant differences were found between students working and those not working alongside their studies, between students with and without further nursing-related education, or between students with long and short experience as nurses. CONCLUSIONS: The findings from this study might help to further develop curricula in advanced practice nursing master's programmes to ensure high-quality nursing and sustainable health care in the future. Future high-quality master's programmes might benefit from systematic collaboration between Nordic higher education institutions as also Sweden is planning master's programme. Higher age, having children at home and working while studying should not be considered causes for concern.

"I'm still the person I am. Not the body it has become." An active but challenging life with cervical dystonia.

BACKGROUND: Improvement of activity and participation for the disabled and chronically ill is an important aim of rehabilitation. Cervical dystonia is a neurological movement disorder characterized by involuntary contractions of the neck muscles. Until now, research has identified factors contributing to disability rather than factors which may make it easier to be active and participate in the community. OBJECTIVE: Explore and describe perceived experiences of activity and participation in daily life as experienced by persons with cervical dystonia. METHODS: Sixteen informants participated in this semi-structured interview study. Inductive qualitative content analysis was performed to understand and interpret experiences shared by the informants. RESULTS: Results from the analysis generated two themes "An active life" and "A challenging life" and six sub-themes: Using helpful coping strategies, Accepting a new life situation, Adhering to BT treatment, Facing the negative impact of stress, Experiencing a negative self-image and Suffering from pain and fatigue. CONCLUSIONS: Our results support the importance of actions using a rehabilitation approach that consider both motor and non-motor symptoms. Future studies should compare the effects of physiotherapy taking into account wishes and challenges in patients' everyday life versus traditional physiotherapy addressing mostly the motor disorder.

Nursing Students' Attitudes Toward Technology: Multicenter Cross-Sectional Study.

BACKGROUND: The growing presence of digital technologies in health care requires the health workforce to have proficiency in subjects such as informatics. This has implications in the education of nursing students, as their preparedness to use these technologies in clinical situations is something that course administrators need to consider. Thus, students' attitudes toward technology could be investigated to assess their needs regarding this proficiency. OBJECTIVE: This study aims to investigate attitudes (enthusiasm and anxiety) toward technology among nursing students and to identify factors associated with those attitudes. METHODS: Nursing students at 2 universities in Sweden and 1 university in Poland were invited to answer a questionnaire. Data about attitudes (anxiety and enthusiasm) toward technology, eHealth literacy, electronic device skills, and frequency of using electronic devices and sociodemographic data were collected. Descriptive statistics were used to characterize the data. The Spearman rank correlation coefficient and Mann-Whitney U test were used for statistical inferences. RESULTS: In total, 646 students answered the questionnaire-342 (52.9%) from the Swedish sites and 304 (47.1%) from the Polish site. It was observed that the students' technology enthusiasm (techEnthusiasm) was on the higher end of the Technophilia instrument (score range 1-5): 3.83 (SD 0.90), 3.62 (SD 0.94), and 4.04 (SD 0.78) for the whole sample, Swedish students, and Polish students, respectively. Technology anxiety (techAnxiety) was on the midrange of the Technophilia instrument: 2.48 (SD 0.96), 2.37 (SD 1), and 2.60 (SD 0.89) for the whole sample, Swedish students, and Polish students, respectively. Regarding techEnthusiasm among the nursing students, a negative correlation with age was found for the Swedish sample (P<.001; ρSwedish=-0.201) who were generally older than the Polish sample, and positive correlations with the eHealth Literacy Scale score (P<.001; ρall=0.265; ρSwedish=0.190; ρPolish=0.352) and with the perceived skill in using computer devices (P<.001; ρall=0.360; ρSwedish=0.341; ρPolish=0.309) were found for the Swedish, Polish, and total samples. Regarding techAnxiety among the nursing students, a positive correlation with age was found in the Swedish sample (P<.001; ρSwedish=0.184), and negative correlations with eHealth Literacy Scale score (P<.001; ρall=-0.196; ρSwedish=-0.262; ρPolish=-0.133) and with the perceived skill in using computer devices (P<.001; ρall=-0.209; ρSwedish=-0.347; ρPolish=-0.134) were found for the Swedish, Polish, and total samples and with the semester only for the Swedish sample (P<.001; ρSwedish=-0.124). Gender differences were found regarding techAnxiety in the Swedish sample, with women exhibiting a higher mean score than men (2.451, SD 1.014 and 1.987, SD 0.854, respectively). CONCLUSIONS: This study highlights nursing students' techEnthusiasm and techAnxiety, emphasizing correlations with various factors. With health care's increasing reliance on technology, integrating health technology-related topics into education is crucial for future professionals to address health care challenges effectively. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.2196/14643.

Voluntary first responders' experiences of being dispatched to suspected out-of-hospital cardiac arrest in rural areas: an interview study.

BACKGROUND: Out-of-hospital cardiac arrest (OHCA) is a leading cause of death, and survival outcomes vary across countries and regions. To improve survival, the European Resuscitation Council Guidelines encourage the implementation of technologies like smartphone applications to alert voluntary first responders (VFRs) who are near a suspected OHCA. VFRs are of great importance in the ´chain of survival´, but there is still a lack of knowledge about their experiences; especially of those operating in rural areas. Understanding those experiences is crucial in developing appropriate interventions to train, encourage, and safeguard VFRs in their mission. Therefore, the aim of this study was to describe VFRs´ experiences of being dispatched to suspected OHCA in rural areas. METHODS: The study used an inductive design. The data were collected using individual interviews with 16 VFRs and analysed using qualitative content analysis. RESULTS: The results are presented in terms of six generic categories ''Being motivated and prepared'', ''Having strategies to undertake the mission'', ''Collaborating with others'', ''Being ethically aware'', ''Supporting the family members'', and ''Coping with the mission'', which formed the basis of the main category 'Desire to save lives and help others'. The findings showed that VFRs had a genuine desire to contribute to save lives in this rural area. Regardless of the circumstances, they were prepared to leave everything and act to the best for the victim and their family members. In theirs' missions they collaborated with others at the scene and were guided by ethics while they acted in complex circumstances. CONCLUSIONS: VFRs dispatched in rural areas express a desire to save lives. In their missions, they acted in complex situations and experienced both emotional and ethical challenges. The design, implementation, and evaluation of support interventions directed at VFRs should be prioritised, especially in rural areas, as it can contribute to more people becoming and remaining VFRs, which in turn could contribute to sustainable development.

Women's experiences of psychological treatment and psychosocial interventions for postpartum depression: a qualitative systematic review and meta-synthesis.

BACKGROUND: To provide a comprehensive, systematic evaluation of the literature on experiences of psychological interventions for postpartum depression (PPD) in women. Depression is one of the most common postpartum mental disorders. Studies have identified that psychological interventions reduce depressive symptoms. However, less is known about the experiences of women who have received such treatments. METHODS: A systematic review of the literature was conducted by searching five databases (CINAHL, Cochrane Library, EMBASE, Medline, PsycINFO), in August 2022. Studies with qualitative methodology examining women's experiences of professional treatment for PPD were included and checked for methodological quality. Eight studies (total N = 255) contributed to the findings, which were synthesized using thematic synthesis. Confidence in the synthesized evidence was assessed with GRADE CERQual. FINDINGS: The women had received cognitive behavioral therapy (5 studies) or supportive home visits (3 studies). Treatments were individual or group-based. Two main themes were identified: Circumstances and expectations, and Experiences of treatment, with six descriptive themes. Establishing a good relationship to their health professional was important for the women, regardless of treatment model. They also expressed that they wanted to be able to choose the type and format of treatment. The women were satisfied with the support and treatment received and expressed that their emotional well-being had been improved as well as the relationship to their infant. CONCLUSION: The findings can be helpful to develop and tailor patient-centered care for women who are experiencing postnatal depression.

Self-Reported eHealth literacy among nursing students in Sweden and Poland: The eNursEd cross-sectional multicentre study.

This study aimed to provide an understanding of nursing students' self-reported eHealth literacy in Sweden and Poland. This cross-sectional multicentre study collected data via a questionnaire in three universities in Sweden and Poland. Descriptive statistics, the Spearman's Rank Correlation Coefficient, Mann-Whitney U, and Kruskal-Wallis tests were used to analyse different data types. Age (in the Polish sample), semester, perceived computer or laptop skills, and frequency of health-related Internet searches were associated with eHealth literacy. No gender differences were evidenced in regard to the eHealth literacy. Regarding attitudes about eHealth, students generally agreed on the importance of eHealth and technical aspects of their education. The importance of integrating eHealth literacy skills in the curricula and the need to encourage the improvement of these skills for both students and personnel are highlighted, as is the importance of identifying students with lacking computer skills.

The Effect of Antenatal Education on Expectant Fathers' Attitudes toward Breastfeeding and Attachment to the Fetus.

BACKGROUND: This study explores the effect of antenatal education on fathers' attitudes toward: (i) breastfeeding and (ii) attachment to the fetus. A secondary aim is to explore the relationship of fathers' demographic and the psycho-emotional characteristics that come with breastfeeding and attachment. METHODS: This is a longitudinal study involving a group of 216 Greek expectant fathers who participated with their partners in an antenatal educational program performed by midwives in Athens, Greece (September 2020-November 2021). The Iowa Infant Feeding Attitudes Scale (IIFAS) and Paternal Antenatal Attachment Scale (PAAS) were administered at two time points: (a) 24th-28th gestation week and (b) 34th-38th gestation week. The T-test and Univariate Analyses of Variance (ANOVA) were performed. RESULTS: The expectant fathers' scores show that breastfeeding intention/exclusivity and prenatal attachment to the fetus were higher after their participation in the antenatal education program, but the difference was not statistically insignificant. Expectant fathers with a cohabitation agreement (p = 0.026), who felt very much supported by their partners (p = 0.001) and had no relationship difficulties with their partners (p < 0.001), as well as those who reported being very happy during pregnancy (p < 0.001), showed greater paternal antenatal attachment to the fetus. CONCLUSIONS: Although the difference was statistically insignificant, antenatal education appears to have an impact on paternal breastfeeding attitudes and antenatal attachment to the fetus. Additionally, several paternal characteristics were associated with greater antenatal attachment. Future research should be directed toward the investigation of additional factors that impact antenatal-paternal attachment and breastfeeding attitudes so that effective education programs can be designed.

Group antenatal care compared with standard antenatal care for Somali-Swedish women: a historically controlled evaluation of the Hooyo Project.

OBJECTIVES: Comparing language-supported group antenatal care (gANC) and standard antenatal care (sANC) for Somali-born women in Sweden, measuring overall ratings of care and emotional well-being, and testing the feasibility of the outcome measures. DESIGN: A quasi-experimental trial with one intervention and one historical control group, nested in an intervention development and feasibility study. SETTING: Midwifery-led antenatal care clinic in a mid-sized Swedish town. PARTICIPANTS: Pregnant Somali-born women (<25 gestational weeks); 64 women in gANC and 81 in sANC. INTERVENTION: Language-supported gANC (2017-2019). Participants were offered seven 60-minute group sessions with other Somali-born women led by one to two midwives, in addition to 15-30 min individual appointments with their designated midwife. OUTCOMES: Primary outcomes were women's overall ratings of antenatal care and emotional well-being (Edinburgh Postnatal Depression Scale (EPDS)) in gestational week ≥35 and 2 months post partum. Secondary outcomes were specific care experiences, information received, social support, knowledge of pregnancy danger signs and obstetric outcomes. RESULTS: Recruitment and retention of participants were challenging. Of eligible women, 39.3% (n=106) declined to participate. No relevant differences regarding overall ratings of antenatal care between the groups were detected (late pregnancy OR 1.42, 95% CI 0.50 to 4.16 and 6-8 weeks post partum OR 2.71, 95% CI 0.88 to 9.41). The reduction in mean EPDS score was greater in the intervention group when adjusting for differences at baseline (mean difference -1.89; 95% CI -3.73 to -0.07). Women in gANC were happier with received pregnancy and birth information, for example, caesarean section where 94.9% (n=37) believed the information was sufficient compared with 17.5% (n=7) in standard care (p<0.001) in late pregnancy. CONCLUSIONS: This evaluation suggests potential for language-supported gANC to improve knowledge acquisition among pregnant Somali-born women with residence in Sweden ˂10 years. An adequately powered randomised trial is needed to evaluate the effectiveness of the intervention. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov Registry (NCT03879200).

Group antenatal care (gANC) for Somali-speaking women in Sweden - a process evaluation.

BACKGROUND: Language supported group antenatal care (gANC) for Somali-born women was implemented in a Swedish public ANC clinic. The women were offered seven 60-min sessions, facilitated by midwives and starting with a presentation of a selected topic, with an additional 15-min individual appointment before or after. The aim of this study was to assess the feasibility for participants and midwives of implementing The Hooyo ("mother" in Somali) gANC intervention, including implementation, mechanisms of impact and contextual factors. METHODS: A process evaluation was performed, using The Medical Research Council (MRC) guidelines for evaluating complex interventions as a framework. A range of qualitative and quantitative data sources were used including observations (n = 9), complementary, in-depth and key-informant interviews (women n = 6, midwives n = 4, interpreters and research assistants n = 3) and questionnaire data (women n = 44; midwives n = 8). RESULTS: Language-supported gANC offered more comprehensive ANC that seemed to correspond to existing needs of the participants and could address knowledge gaps related to pregnancy, birth and the Swedish health care system. The majority of women thought listening to other pregnant women was valuable (91%), felt comfortable in the group (98%) and supported by the other women (79%), and they said that gANC suited them (79%). The intervention seemed to enhance knowledge and cultural understanding among midwives, thus contributing to more women-centred care. The intervention was not successful at involving partners in ANC. CONCLUSIONS: The Hooyo gANC intervention was acceptable to the Somali women and to midwives, but did not lead to greater participation by fathers-to-be. The main mechanisms of impact were more comprehensive ANC and enhanced mutual cultural understanding. The position of women was strengthened in the groups, and the way in which the midwives expanded their understanding of the participants and their narratives was promising. To be feasible at a large scale, gANC might require further adaptations and the "othering" of women in risk groups should be avoided. TRIAL REGISTRATION: The study was registered in ClinicalTrials.gov (Identifier: NCT03879200).

A qualitative study of Swedish fathers' experiences of becoming a father during the COVID-19 pandemic.

INTRODUCTION: Expectant fathers want to participate in perinatal care. COVID-19 policies restrict their access to care, but it is unknown how these policies have affected them. The aim of this study is to explore the perinatal care given to and wanted by expectant and new fathers during the COVID-19 pandemic in Sweden. METHODS: The current study used an inductive qualitative design where 14 expectant or new fathers participated in a video- or telephone-based semi-structured interview. Interviews lasted 20 minutes, on average. The collected data were analyzed using content analysis. RESULTS: Two main themes were reported: 1) 'Being left out, but trying to remain positive', and 2) immediate consequences related to restrictions. Expectant fathers were not able to attend as many perinatal visits as they wanted to, due to the COVID-19 restrictions on non-birthing parents. Expectant fathers regretted and felt discouraged that they could not support their partner during visits and not follow their baby's growth and development. Furthermore, they faced uncertainties and stress regarding whether or not they could attend the birth of their child. Fathers reported how their exclusion negatively impacted the entire family. CONCLUSIONS: Expectant and new fathers felt that their level of participation in prenatal care was negatively impacted by the Swedish policies imposed on them during the COVID-19 pandemic. Fathers were physically and emotionally excluded, resulting in receiving little direct care support, and lacked companionship with other parents. Fathers provided suggestions and alternatives on how to increase their participation with individual midwives and from an organizational level.

Self-reported mental health status of pregnant women in Sweden during the COVID-19 pandemic: a cross-sectional survey.

BACKGROUND: The COVID-19 pandemic has contributed to unprecedented worries and challenges for pregnant women due to social restrictions and changes in maternity care provision. We aimed to investigate the mental health impact of COVID-19 pandemic on pregnant women in Sweden and explore factors associated with poor perinatal mental health in this specific context. METHOD: This was a nation-wide cross-sectional survey of pregnant women living in Sweden. Validated questionnaires were distributed through non-profit organizations´ websites and social media channels from May 2020 to February 2021. Perinatal depression, anxiety, and acute stress reaction were assessed using the Edinburgh Postnatal Depression Scale (EPDS), Generalized Anxiety Disorder-7 (GAD-7) and Impact Event Scale (Revised) (IES-R), respectively. Sociodemographic characteristics and self-perceived mental well-being were also obtained. Factors associated with mental health outcomes were analyzed using multivariate logistic regression model. RESULTS: Among a total of 470 participants, 43.2% (n = 203) reported depression (EPDS ≥13), 25.7% (n = 121) moderate to severe anxiety (GAD-7 score ≥ 10), and 23.7% (n = 110) moderate to severe acute stress reaction (IES-R ≥ 33). 27.4% participants (n = 129) expressed concerns regarding their mental well-being during the pandemic. Pregnant mothers who had sick family members reported poorer mental health outcomes than those who did not (median [Interquartile range (IQR)] EPDS scores: 14.0 [8.75-18.0] vs 11.0 [6.25-15.0], p < .001; median (IQR) GAD7 scores: 7.0 [4.0-12.25] vs 6.0 [3.0-9.0], p = .003); median (IQR) IES-R scores: 20.0 [9.0-38.0] vs 15.0 [7.0-30.0], p = .048). Logistic regression analyses revealed that risk factors for poor mental health outcomes were having a sick family member with any illness, unemployment, and experiencing a substantially stressful life event. Having a higher educational level and a younger age during the pandemic were protective. CONCLUSION: Depression and anxiety were highly prevalent among pregnant women in Sweden during the COVID-19 pandemic, indicating a need for professional mental health support for this vulnerable group of population. Unemployment was an associated risk factor whereas younger age and higher educational level were protective suggesting an important role of socio-economic factors in modulating the impact of COVID-19 pandemic on perinatal mental health.

Nursing students' experiences of applying problem-based learning to train the core competence teamwork and collaboration: An interview study.

AIM: To explore nursing students' experiences of applying problem-based learning to train the core competence teamwork and collaboration. DESIGN: The study used a qualitative descriptive design. METHOD: The data were collected using individual interviews with a purposive sample of 11 students and analysed using inductive qualitative content analysis. RESULTS: The students' experiences of applying problem-based learning to train the core competence teamwork and collaboration were described in two generic categories: prerequisites to train teamwork and collaboration and abilities practised in the base group. The generic category "prerequisites to train teamwork and collaboration" includes three subcategories: previous experience and education, composition of the base group, and common goals and values in the base group. The generic category "abilities practised in the base group" includes four subcategories: taking personal responsibility, practising role distribution and leadership, developing communication skills and creating togetherness in the base group.

Registered nurse preceptors' perceptions of changes in the organisation of clinical placements in psychiatric care for undergraduate nursing students: A mixed-methods study.

AIM: The aim of this study was to investigate the perceptions of registered nurse (RN) preceptors working in psychiatric care concerning the organisation of clinical placements and their own preceptor role with undergraduate nursing students. BACKGROUND: Clinical placements play a central role in undergraduate nursing education, and it is crucial that psychiatric care clinical placements are of high quality. METHODS: The RNs' perceptions before and after the introduction of changes in the organisation of clinical placements were compared. A total of 103 surveys with quantitative and qualitative data were returned, from 59 RN preceptors at baseline and 44 RN preceptors at follow-up. Data were analysed with non-parametrical statistics and qualitative content analysis. RESULTS: The majority of RN preceptors perceived the changes to have been beneficial, but there was still a desire for the students to have more time in their psychiatric care clinical placements according to the RN preceptors. At follow-up, significantly more RN preceptors perceived that they had an intentional pedagogical foundation for their precepting. CONCLUSIONS: We conclude that the changes introduced into the clinical placement are beneficial, but there is still need for further improvement in relation to the amount of time student nurses spend in psychiatric clinical placements and in the opportunities provided for RN preceptors to attend preceptor preparation courses.

Nursing students' experiences of what influences achievement of learning outcomes in a problem-based learning context: A qualitative descriptive study.

AIM: This study aimed to describe nursing students' experiences of what facilitate or impede the achievement of learning outcomes in PBL-based nursing education. DESIGN: A qualitative descriptive design was used. METHODS: Data were collected from individual semi-structured interviews with 18 undergraduate nursing students in Sweden and were analysed using Burnard's qualitative content analysis. RESULTS: The results were organized into three categories: (a) understanding of the required level of knowledge depth (b) tutor's engagement and (c) student base group interactions. These categories represent essential components of PBL that could either facilitate or impede students' achievement of learning outcomes in nursing education. To improve the students' opportunities to achieve the learning outcomes, proper introduction of and a continuous education on PBL as a pedagogical method provided both to students and tutors should be considered important.

Impacted family equality, self-confidence and loneliness: a cross-sectional study of first-time and multi-time fathers' satisfaction with prenatal and postnatal father groups in Sweden.

BACKGROUND: Fathers often feel secondary or invisible in traditional parent groups. Gender-specific parent groups, referred to as father groups, may be inclusive spaces for fathers to discuss their transition into parenthood. OBJECTIVE: To quantitatively assess fathers' perceptions and satisfaction of father groups in Sweden during the prenatal and postnatal periods. METHOD: A cross-sectional quantitative study design was used to report fathers' satisfaction of father groups, including how the groups impacted their personal outcomes, as well as their relationship with their partner and child. Further analyses were completed on if their depressive symptoms, via EPDS, and/or parity affected their satisfaction and personal outcomes. SETTING AND PARTICIPANTS: Fathers were recruited through father group leaders, who then provided the researchers with their contact information. In total, 87 fathers were contacted via email and 67 fathers from two geographical areas, including urban and suburban settings, completed the survey. FINDINGS: Most fathers had a university education, a good household economy and were married/cohabiting, while almost 60% were first-time fathers and almost 25% had depressive symptoms. Overall, fathers were generally satisfied with both the prenatal and postnatal father groups, although fathers attended prenatal father groups to a lesser extent. The participants rated the father groups as moderately impacting their equality in the family, self-confidence, feelings of loneliness, social network and being able to express their own opinions, as well as positively affected their relationship with their partner and child, respectively. While there were no differences based on fathers' parity, those who self-estimated depressive symptoms were less satisfied and rated the father groups less impactfully. Father groups may help encourage fathers to meet policy goals, such as childrearing equality, and can be an important arena for screening fathers for depression.

Older persons' experience of eHealth services in home health care: A meta-ethnography eHealth services in home health care.

This study aimed to describe older persons' experiences of eHealth services in home health care. A meta-ethnographic approach was applied, and a systematic literature search was conducted in three databases. In total, 11 articles were included and analysed, which resulted in two themes and six sub-themes. The results show that for older persons to use the eHealth services, they must provide some additional value compared to current contacts with healthcare professionals. Those with regular healthcare contact do not experience the eHealth service as adding anything to the care they already receive. The introduction of eHealth services involves learning how to use the new technology, and some older persons experience the technology as motivating and inspiring. The eHealth service makes some feel safer while some do not trust the technology. In order to make the best use of eHealth services, it is important that the services are adjusted not only to each person's needs but also to their personal capabilities and resources, while the older person must feel valued as an active partner in the care process. Thus, when using eHealth services, the older person's perspective needs to be given priority and decisions should not only be based on organizational considerations.

Mental health of Urban Mothers (MUM) study: a multicentre randomised controlled trial, study protocol.

INTRODUCTION: Mental health disorders are common during pregnancy and the postnatal period and can have serious adverse effects on women and their children. The consequences for global mental health due to COVID-19 are likely to be significant and may have a long-term impact on the global burden of disease. Besides physical vulnerability, pregnant women are at increased risk of mental health problems such as anxiety, depression and post-traumatic stress disorder due to the consequences of social distancing. It can result in altered healthcare routines, less support from the family and friends, and in some cases, partners not being allowed to be present during prenatal visits, labour and delivery. Higher than expected, rates of perinatal anxiety and depression have been already reported during the pandemic. Pregnant women may also feel insecure and worried about the effects of COVID-19 on their unborn child if they get infected during pregnancy. Today, young urban women are used to using internet services frequently and efficiently. Therefore, providing mental health support to pregnant women via internet may be effective in ameliorating their anxiety/depression, reducing the risk of serious mental health disorders, and lead to improved maternal and perinatal outcomes. OVERARCHING AIM: Our aim is to explore the effectiveness of a web-based psychosocial peer-to-peer support intervention in reducing the risk and severity of perinatal mental health disorders and preventing adverse pregnancy outcomes among pregnant women living in metropolitan urban settings. METHODS AND ANALYSIS: We plan to conduct a multicentre prospective randomised controlled trial, Mental health of Urban Mothers trial. Pregnant women living in large metropolitan cities will be recruited using internet-based application through non-profit organisations' websites. The women who consent will be randomised to receive a web-based peer-to-peer support intervention or usual care. Data will be analysed to identify the effects of intervention on Edinburgh Postnatal Depression Score and Generalised Anxiety Disorder 7 scores as well as pregnancy outcomes. The impact of COVID-19 pandemic on maternal stress will be assesed using Impact Event Scale-R. Any differences in outcomes between cities will be addressed in subgroup analyses. ETHICS AND DISSEMINATION: The study will be conducted according to the principles of Good Clinical Practice and will follow the ethical principles of the Declaration of Helsinki. The study protocol has been approved by the ethical review board of Chinese University of Hong Kong (IRB number 2019-8170) and Shanghai Center for Women's and Children's Health (international review board (IRB) number 2020-F001-12). The results will be disseminated at national and international scientific conferences, published in peer-reviewed medical journals and spread to the public through social media, news outlets and podcasts. TRIAL REGISTRATION NUMBER: NCT04363177; Trial sponsor Karolinska Institute, CLINTEC, Stockholm, Sweden.

Care-seeking behavior and disclosure on self-reported mental health among young women in urban Shanghai, China.

Mental health is a major public health concern in China. Help-seeking behavior typically does not involve professionals. Aim of the study was to assess Shanghai women's care-seeking behavior for common mental health disorders. Using an online survey, fielding questions regarding perinatal mental health status and help-seeking behavior. A total of 487 women participated. One fifth of participants reporting badwell-being did not seek help for mental distress. A total of 82.2 percent seek online support. A majority entrusted in family and avoided professional contact. Mother-in-laws were the least trusted source of support. Shanghai women avoid seeking professional help for mental health issues. Friends, spouses, and online resources are preferred venues.

Rationale, development and feasibility of group antenatal care for immigrant women in Sweden: a study protocol for the Hooyo Project.

INTRODUCTION: Somali-born women comprise a large group of immigrant women of childbearing age in Sweden, with increased risks for perinatal morbidity and mortality and poor experiences of care, despite the goal of providing equitable healthcare for the entire population. Rethinking how care is provided may help to improve outcomes. OVERALL AIM: To develop and test the acceptability, feasibility and immediate impacts of group antenatal care for Somali-born immigrant women, in an effort to improve experiences of antenatal care, knowledge about childbearing and the Swedish healthcare system, emotional well-being and ultimately, pregnancy outcomes. This protocol describes the rationale, planning and development of the study. METHODS AND ANALYSIS: An intervention development and feasibility study. Phase I includes needs assessment and development of contextual understanding using focus group discussions. In phase II, the intervention and evaluation tools, based on core values for quality care and person-centred care, are developed. Phase III includes the historically controlled evaluation in which relevant outcome measures are compared for women receiving individual care (2016-2018) and women receiving group antenatal care (2018-2019): care satisfaction (Migrant Friendly Maternity Care Questionnaire), emotional well-being (Edinburgh Postnatal Depression Scale), social support, childbirth fear, knowledge of Swedish maternity care, delivery outcomes. Phase IV includes the process evaluation, investigate process, feasibility and mechanisms of impact using field notes, observations, interviews and questionnaires. All phases are conducted in collaboration with a stakeholder reference group. ETHICS AND DISSEMINATION: The study is approved by the Regional Ethical Review Board, Stockholm, Sweden. Participants receive information about the study and their right to decline/withdraw without consequences. Consent is given prior to enrolment. Findings will be disseminated at antenatal care units, national/international conferences, through publications in peer-reviewed journals, seminars involving stakeholders, practitioners, community and via the project website. Participating women will receive a summary of results in their language.

Antenatal care for Somali-born women in Sweden: Perspectives from mothers, fathers and midwives.

OBJECTIVE: To explore Somali-born parents' experiences of antenatal care in Sweden, antenatal care midwives' experiences of caring for Somali-born parents, and their respective ideas about group antenatal care for Somali-born parents. DESIGN: Eight focus group discussions with 2-8 participants in each were conducted, three with Somali-born mothers, two with fathers and three with antenatal care midwives. The transcribed text was analysed using Attride-Stirling's tool "Thematic networks". SETTING: Two towns in mid-Sweden and a suburb of the capital city of Sweden. PARTICIPANTS: Mothers (n = 16), fathers (n = 13) and midwives (n = 7) were recruited using purposeful sampling. FINDINGS: Somali-born mothers and fathers in Sweden were content with many aspects of antenatal care, but they also faced barriers. Challenges in the midwife-parent encounter related to tailoring of care to individual needs, dealing with stereotypes, addressing varied levels of health literacy, overcoming communication barriers and enabling partner involvement. Health system challenges related to accessibility of care, limited resources, and the need for clear, but flexible routines and supportive structures for parent education. Midwives confirmed these challenges and tried to address them but sometimes lacked the support, resources and tools to do so. Mothers, fathers and midwives thought that language-supported group antenatal care might help to improve communication, provide mutual support and enable better dialogue, but they were concerned that group care should still allow privacy when needed and not stereotype families according to their country of birth. KEY CONCLUSIONS: ANC interventions targeting inequalities between migrants and non-migrants may benefit from embracing a person-centred approach, as a means to counteract stereotypes, misunderstandings and prejudice. Group antenatal care has the potential to provide a platform for person-centred care and has other potential benefits in providing high-quality antenatal care for sub-groups that tend to receive less or poor quality care. Further research on how to address stereotypes and implicit bias in maternity care in the Swedish context is needed.