A realist review of digitally delivered child development assessment and screening tools: Psychometrics and considerations for future use.

BACKGROUND: Developmental screening improves the detection of developmental concerns, yet numerous children are not screened/assessed. Remote child developmental tool administration has been utilized to increase screening and assessment accessibility. METHOD: We conducted a realist review to: (1) identify existing multi-domain child development assessment and screening tools for children 0-5 years; (2) review psychometric data on their digital (i.e., only administered remotely) administration; and (3) explore contextual factors relevant to their digital administration. We searched APA PsycInfo, MEDLINE, CINAHL, and ERIC to identify tools and papers on their psychometrics. We reference-searched included articles and searched Google for relevant grey literature. RESULTS: Of 33 multi-domain child development tools identified in objective one, five tools (in five studies) were delivered digitally and compared to traditional (e.g., paper) delivery (i.e., objective two). Studies evaluated within-group equivalence reliability (k = 2) and between-group equivalence (k = 3). Within-group equivalence reliability was established for the Vineland Adaptive Behavior Scales, and domains (e.g., gross motor) of the Ages and Stages Questionnaires 2nd edition (ASQ-2) and Revised Prescreening Denver Questionnaire (R-PDQ). Between group equivalence was demonstrated for Developmental Neuropsychological Assessment, 2nd Edition (NEPSY-II) subtests and Bayley Scales of Infant and Toddler Development, 3rd edition (Bayley-3) items. In another between group evaluation, web-based and paper versions of the ASQ-2 were deemed generally equivalent. Digital Bayley-3 inter-observer reliability ranged from 0.82 to 1.0. Examiner support, time, tool modifications, family resources, and comfort promotion supported digital administration. CONCLUSION: Digitally delivered ASQ-2, R-PDQ, Vineland, and Bayley-3 and NEPSY-II components show promise for equivalence with traditional administration.

Impacts of Parental Technoference on Parent-Child Relationships and Child Health and Developmental Outcomes: A Scoping Review.

Parental technological immersion during parenting activities has been shown to alter parent-child interactions. This concept, referred to as parental technoference, has the potential to affect parent-child relationships and children's health and development. This scoping review utilized the Joanna Briggs Institute (JBI) methodology to identify, describe, and summarize: (a) evidence of parental technoference on parent-child relationships, and children's health and development; (b) definitions and measurements of parental technoference; (c) research designs and methodologies used to investigate parental technoference; and (d) literature gaps. We searched MEDLINE, APA PsycInfo, Cochrane Central Register of Controlled Trials, Cochrane Database for Systematic Reviews, JBI EBP Database, Embase, CINAHL, and Scopus, as well as the reference lists of included studies for literature on parental technology use during parenting and parent-child interactions and its effects on parent-child relationships, and children's health and development. Sixty-four studies, found in 61 publications, met the review criteria. The effect of parental technoference on parent-child relationships was most studied, and findings demonstrated that parents recognized, and researchers observed, changes in parents' and children's behaviors. Adolescent self-reported mental health concerns and maladaptive technological behaviors (e.g., cyberbullying) were associated with more parental technoference, and findings highlighted safety concerns for children. Other aspects of children's development, although less studied, were also negatively impacted by parental technoference. No significant associations were found between parental technoference and children's medical and physiological health, yet these associations were the least studied. Additional research is needed to understand these associations and evaluate interventions designed to mitigate technoference harms.

Recruitment and Retention Strategies for Parents Experiencing Vulnerability: Lessons from an Online Parenting Program.

BACKGROUND: Supportive parenting programs can promote parent-child interactions and children's development. However, families experiencing vulnerability (e.g., low socioeconomic status) report barriers (e.g., transportation, distrust of researchers) to research participation, and attrition rates of 40% and higher have been reported in parenting research. In response, we conducted a longitudinal evaluation of a digital parenting program in a major metropolitan centre in western Canada and retained 99% of our sample. AIM: Review recruitment and retention strategies employed in the First Pathways study and evaluate associations between sociodemographic (e.g., income) and psychosocial (e.g., parental depression) factors with recruitment and retention strategies. METHODS AND FINDINGS: In collaboration with community agencies, we commenced recruitment of 100 families experiencing vulnerability (e.g., low-income) in June 2021. We utilized strategies to engage staff (e.g., presentations, gift cards, updates) and employed snowball sampling. Families recruited through community agencies were significantly more likely to experience vulnerability (e.g., low income and education, high adverse experiences) compared to families in the snowball sample. We incorporated strategies to minimize participant burden (e.g., choice of online or in-person meetings), promoted rapport (e.g., holiday texts, nonjudgmental environment), incorporated trauma-informed practices (e.g., sensitive inquiry), and demonstrated appreciation for participants' contributions (i.e., honorarium). Family experiences of vulnerability (i.e., low income, depressive symptoms, adversity) were correlated with higher participant rescheduling. CONCLUSION: Nurses need knowledge of strategies to promote equitable access to research for families experiencing vulnerability. Digital programs with protocols designed to establish rapport, include trauma-informed practices, and minimize participant burden will likely optimize participation and retention.

History of "Serve and Return" and a Synthesis of the Literature on Its Impacts on Children's Health and Development.

Parent/caregiver sensitivity and responsiveness are important for children's health and development. The "serve and return" metaphor was created to help providers and caregivers understand the importance of sensitive and responsive early caregiving. In this review, we explain the concept of "serve and return", outline historical and theoretical principles that culminated in this metaphor, highlight parent and child constructs associated with "serve and return" interactions, and synthesize literature on sensitive and responsive caregiving and children's health and developmental outcomes. Nurses and other healthcare professionals in public policy, clinical, community, education, and research roles need knowledge of "serve and return" interactions.

Breastfeeding self-efficacy predicts breastmilk feeding in preterm infants at discharge from the neonatal intensive care unit.

AIM: To examine the association between breastfeeding self-efficacy (BSE) and breastmilk feeding at discharge from the neonatal intensive care unit among mothers of preterm infants. DESIGN: Secondary analysis of the Family Integrated Care (FICare) cluster randomized controlled trial. METHODS: Data from 221 mothers of preterm infants who participated in the standard care group of the trial were analysed. BSE at admission was assessed using the modified Breastfeeding Self-Efficacy Scale-Short Form (BSES-SF). Breastmilk feeding was assessed using 24 hr maternal recall at discharge. RESULTS: Mothers who were exclusively breastmilk feeing their infants at discharge had statistically significantly higher mean BSES-SF scores at admission (68.4, SD = 13.7) than those providing a combination of breastmilk and formula or only formula (59.6, SD = 14.7; p < .001). Multivariable logistic regression showed that higher BSE at admission, maternal birth in Canada, and absence of diabetes were statistically significant predictors of exclusive breastmilk feeding at discharge.

What Do We Know About Interventions to Prevent Low Back Injury and Pain Among Nurses and Nursing Students? A Scoping Review.

STUDY BACKGROUND: Back injuries are common among nurses worldwide with lifetime prevalence of lower back pain ranging from 35% to 80%, making nursing a profession at great risk for back injuries. PURPOSE: This systematic scoping review explored and mapped existing evidence regarding the prevention of low back injury and pain among nurses and nursing students. METHODS: Using a scoping review methodology, six databases were searched initially in September 2017 and updated June 2020. Studies investigating interventions designed to reduce back injuries and pain among regulated nurses and student nurses, published in peer-review journals and written in English, were eligible for inclusion in this review. Quantitative, qualitative, and mixed methods studies of regulated nurses, nursing students, and nursing aides were included. Two independent reviewers screened, critically analysed studies using a quality appraisal tool, extracted data, and performed quality appraisals. RESULTS: Two searches yielded 3,079 abstracts and after title, abstract and screening, our final synthesis was based on 48 research studies. CONCLUSIONS: Forty years of research has demonstrated improvements in quality over time, the efficacy of interventions to prevent back injury and pain remains unclear, given the lack of high-quality studies. Further research, using multi-dimensional approaches and rigorous study designs, are needed.

Effect of Play2Sleep on mother-reported and father-reported infant sleep: a sequential explanatory mixed-methods study of a randomized controlled trial.

STUDY OBJECTIVES: This study evaluated the effect on infant sleep of a novel intervention (Play2Sleep) that combined infant sleep information with self-modeled video feedback on parent-infant interactions. METHODS: An explanatory sequential mixed-methods design consisting of a randomized controlled trial with 63 mother-father-infant triads randomized to Play2Sleep or comparison home visit interventions was used. We used repeated measures analysis of covariance to detect changes in infant night wakings, nocturnal wakefulness, and sleep durations and Wilcoxon signed rank test to evaluate changes in perception of infant sleep problems. Family interviews (n = 20) were used to explain the quantitative findings and analyzed qualitatively using thematic analysis. RESULTS: Play2Sleep was effective in reducing maternal-reported infant wakefulness, F(1,55) = 5.33, P = .03, partial η2 = .09, and the number of paternal-reported naps, F(1,58) = 4.90, P = .03, partial η2 = .08. Parents in the Play2Sleep group reported significant improvements in problematic infant sleep that were not observed in the comparison group; however, Play2Sleep was not effective in reducing the number of parent-reported night wakings. Information overwhelm, learning infant cues, and working together with a subtheme of father involvement were key qualitative themes developed to explain the quantitative results. Unplanned exploratory analyses revealed a significant improvement in maternal depression symptoms in the Play2Sleep group. CONCLUSIONS: This study suggests Play2Sleep could improve infant sleep by promoting parental awareness of infant cues and father involvement and improving maternal depression. Additional research is needed to determine the optimal number and timing of sessions. CLINICAL TRIAL REGISTRATION: Registry: ClinicalTrials.gov; Name: Play2Sleep: Using Play to Improve Sleep; URL: https://clinicaltrials.gov/ct2/show/NCT02742155; Identifier: NCT02742155. CITATION: Keys EM, Benzies KM, Kirk VG, Duffett-Leger L. Effect of Play2Sleep on mother-reported and father-reported infant sleep: a sequential explanatory mixed-methods study of a randomized controlled trial. J Clin Sleep Med. 2022;18(2):439-452.

Using wearable and mobile technology to measure and promote healthy sleep behaviors in adolescents: a scoping review protocol.

OBJECTIVE: The objective of this scoping review is to map the evidence related to how consumer-targeted wearable and mobile technology is being used to measure and/or promote sleep among adolescents. INTRODUCTION: Sleep is a key component of physical and mental health and is required for healthy development in adolescence. Efforts to improve insufficient and poor-quality sleep among adolescents have resulted in limited and temporary enhancements in sleep habits. Since good sleep hygiene is established through the development of daily routines, wearable technology offers a potential solution by providing real-time feedback, allowing adolescents to monitor and manage their sleep habits. INCLUSION CRITERIA: Studies that focus on adolescents between 13 and 24 years who use mobile or wearable technology to measure and/or promote sleep health will be considered for inclusion. METHODS: Using a scoping methodology, the authors will conduct a review of studies on the use of commercially available, wearable technology or mobile devices designed to measure and/or improve sleep among adolescents. Literature searched will include published primary studies, reviews, and dissertations from database inception to present. Databases searched will include MEDLINE, Embase, PsycINFO, CINAHL, CENTRAL, SPORTDiscus, JBI Evidence Synthesis, Cochrane Database of Systematic Reviews, Scopus, and ProQuest Dissertations and Theses. The search will be conducted using identified keywords and indexed terms, and studies will be limited to the English language. Data extracted will include study population, methods, description of sleep technology reported, sleep outcomes, and strategies used to promote healthy sleep behaviors. Quality assessment of included studies will be conducted to facilitate data mapping and synthesis.

The role of education on Cancer amenable mortality among non-Hispanic blacks & non-Hispanic whites in the United States (1989-2018).

BACKGROUND: Cancer mortality in the U.S. has fallen in recent decades; however, individuals with lower levels of education experienced a smaller decline than more highly educated individuals. This analysis aimed to measure the influence of education lower than a high school diploma, on cancer amenable mortality among Non-Hispanic Whites (NHW) and Non-Hispanic Blacks (NHB) in the U.S. from 1989 to 2018. METHODS: We analyzed data from 8.2 million death certificates of men and women who died from cancer between 1989 and 2018. We examined 5-year and calendar period intervals, as well as annual percent changes (APC). APC was adjusted for each combination of sex, educational level, and race categories (8 models) to separate the general trend from the effects of age. RESULTS: Our study demonstrated an increasing mortality gap between the least and the most educated NHW and NHB males and females who died from all cancers combined and for most other cancer types included in this study. The gap between the least and the most educated was broader among NHW males and females than among NHB males and females, respectively, for most malignancies. CONCLUSIONS: In summary, we reported an increasing gap in the age-adjusted cancer mortality among the most and the least educated NHW and NHB between 25 and 74 years of age. We demonstrated that although NHB exhibited the greatest age-adjusted mortality rates for most cancer locations, the gap between the most and the least educated was shown for NHW.

Exploring Informational Needs of Parents of Children with Intestinal Failure: A Thematic Analysis.

PURPOSE: Information seeking has been observed to be important for the coping and empowerment of parents of children with rare diseases. This study was conducted to understand the education needs of families of children with pediatric intestinal failure (IF) and how technology might be effectively leveraged to address these needs. DESIGN AND METHODS: A qualitative methodology using thematic analysis was utilized. Purposeful sampling was adopted to recruit 10 parents/caregivers of children with IF. Participants participated in a 1:1 semi-structured interview. Interviews were recorded, transcribed and themes identified through open and focused coding. RESULTS: Four themes emerged: (1) reliable electronic or printed information resources relevant to their child's unique needs were lacking; (2) an educational program with in-person and hands-on learning was preferred for transition to home; (3) practical and relatable information was valued over medical knowledge as children's needs evolved; and (4) creation of electronic resources would be useful for information seeking and sharing. CONCLUSION: To cope with the responsibilities of caring for a child with IF, participants sought information beyond what they received. Participants preferred a blended approach of care team discussions and electronic tools for receiving knowledge and skills. Parents' connections with other caregivers was important for practical day-to-day management information, as well as supporting their well-being. PRACTICE IMPLICATIONS: Development and implementation of accessible digital resources with emphasis on practical information is required. Beyond medical and practical informational needs, building resilience and supporting psychologic needs for parents/caregivers of children with IF emerged as important needs to address.

Parenting apps review: in search of good quality apps.

BACKGROUND: Parenting can be challenging, and in this digital age, first-time parents actively access mobile applications or "apps" to adjust to their new roles. Apps are now technologically-savvy parents' go-to tool for accessing information, tracking their babies' development, editing and sharing photos, and much more. While apps have the potential to make parenting easier, the abundance of low-quality apps makes the process of finding a reliable one arduous for parents. Therefore, the objective of this app review paper was to provide a list of quality parenting apps that parents can use. METHODS: The Google Play Store was searched on June 1st, 2018 for available parenting apps using 18 search terms: mum, mom, mommy, mama, mother, father, dad, daddy, papa, newborn, baby, infant, kid, child, children, family, parent, and parenting. The eligible apps (n=16) were evaluated on engagement, functionality, aesthetics, and information domains using Mobile App Rating Scale (MARS). RESULTS: The authors identified 4,300 free apps on the initial search, of which n=16 apps were included in the review. All 16 apps were freely available to the public on Google Play Store. Most apps (n=13) were also available on the iOS platform. All eligible apps had a privacy policy, and half of the apps contained advertisements. Most apps (n=12) were updated within the last year and received 4.5 or above ratings from users. Babybrains app, developed by a neuroscientist, had the lowest number of downloads (one thousand) whereas, BabyCenter, a commercial app, had the highest number of downloads (ten million). A majority of apps (n=11) received MARS scores between 4.2 and 4.4/5, with four apps received highest MARS score of 4.5/5, and one app received the lowest MARS rating of 4/5. CONCLUSIONS: Apps play an increasingly important role in supporting new parents in their first year of parenthood due to convenience and ease of accessibility. Health care professionals are in an ideal position to support technologically savvy parents in locating good quality apps; therefore, they should support the evaluation of existing parenting apps to ensure that the parents are presented with the up to date and best options.

Using Play to Improve Infant Sleep: A Mixed Methods Protocol to Evaluate the Effectiveness of the Play2Sleep Intervention.

BACKGROUND: One in four Canadian families struggle with infant sleep disturbances. The aim of this study is to evaluate Play2Sleep in families of infants with sleep disturbances. In addition to parental education on infant sleep, Play2Sleep uses examples from a video-recorded, structured play session with mothers and fathers separately to provide feedback on parent-infant interactions and their infant's sleep-related social cues. The quantitative phase will answer the research question: Does one dose of Play2Sleep delivered during a home visit with mothers and fathers of infants aged 5 months reduce night wakings at age 7 months? The qualitative phase will answer the research question: What are parental perceptions of family experiences, processes, and contexts related to Play2Sleep and infant sleep? The overarching mixed methods research question is as follows: How do parental perceptions of family experiences, processes, and contexts related to infant sleep explain the effectiveness of Play2Sleep? METHOD AND ANALYSIS: An explanatory sequential mixed methods design will be used. In the quantitative phase, a randomized controlled trial and RM-ANOVA will compare night wakings in infants whose parents receive Play2Sleep versus standard public health nursing information. Sixty English-speaking families (mothers and fathers) of full-term, healthy, singleton, 5-month-old infants who perceive that their infant has sleep disturbances will be recruited. The primary outcome measure will be change in the number of night wakings reported by parents. The qualitative component will use thematic analysis of family interviews to describe parental perceptions and experiences of infant sleep. Mixed methods integration will use qualitative findings to explain quantitative results. DISCUSSION: Play2Sleep is a novel approach that combines information about infant sleep with personalized feedback on parent-infant interactions and infant cues. Including fathers and mixed methods should capture complex family experiences of infant sleep disturbances and Play2Sleep. If effective, Play2Sleep has possible application for preventing infant sleep disturbance and tailoring for other populations. CLINICAL TRIAL REGISTRATION: www.ClinicalTrials.gov, identifier: NCT02742155. Registered on 2016 April 23.

Postpartum depression is a family affair: addressing the impact on mothers, fathers, and children.

The purpose of this paper is to present research on the effects of postpartum depression (PPD) on mothers, fathers, and children that point to a re-conceptualization of PPD as a mental health condition that affects the whole family. As such, the objectives of this paper are to discuss: (1) the incidence and effects of PPD on mothers and fathers; (2) common predictors of PPD in mothers and fathers, and (3) the effects of PPD on parenting and parent-child relationships, and (4) the effects of PPD on children's health, and their cognitive and social-emotional development. Finally, the implications for screening and intervention if depression is re-conceptualized as a condition of the family are discussed.

Support intervention needs and preferences of fathers affected by postpartum depression.

The effect of postpartum depression (PPD) on mothers has been extensively studied. But even though up to 50% of men whose partners suffer from PPD also have depressive symptoms, little is known about the impact of maternal PPD on fathers. Depressive symptoms are likely to decrease fathers' ability to provide maternal support. Children with 2 depressed parents are at significantly greater risk for poor developmental outcomes than those with 1 affected parent. The objective of this Canada-wide exploratory/descriptive study was to describe the support needs and preferences for support of fathers whose partners have had PPD. Qualitative methods and community-based research approaches were used, and one-to-one telephone interviews were conducted between 2009 and 2011 with a total of 40 fathers. Fathers desired support from both formal (professional) and informal (friends and family) sources and noted that ideal support interventions should cover a number of key topics including information on PPD and practical tips on how to cope with their partner's PPD. Fathers reported that the ideal PPD intervention program does not favor any one setup and, to reach the full spectrum of parents, the program must be multitiered, accessible, and as flexible as funding allows.

Effect of home-based peer support on maternal-infant interactions among women with postpartum depression: a randomized, controlled trial.

Approximately 15% of new mothers experience postpartum depression, representing the most common source of maternal morbidity post-delivery. Postpartum depression may impair maternal-infant interactions, contributing to poor developmental outcomes in the offspring of mothers with depression. The purpose of this study was to test the effectiveness of home-based peer support that included maternal-infant interaction teaching for mothers with symptoms of postpartum depression and their infants. Mothers with postpartum depression were randomly assigned to control (n = 33) or intervention groups (n = 27). Intervention group mothers received 12 weeks of home-based peer support that included maternal-infant interaction teaching; peers were mothers who had recovered from postpartum depression and were trained to provide support. Data were collected from all mothers at baseline, as well as 6 and 12 weeks' post-randomization. Contrary to the hypothesized direction of relationships, results favoured the control group. A significant difference between the groups was observed for one of the two measures of maternal-infant interactions. Several other measures favoured the control group, including mothers' depressive symptoms and social support scores. No significant treatment effects were observed in infant IQ scores or diurnal salivary cortisol levels in mothers or infants. The findings suggest that maternal-infant interaction teaching by peers is not well received by mothers with postpartum depression and might be more optimally delivered by professional nurses.

Maternal depressive symptoms and parenting of children from birth to 12 years.

Maternal depression, especially in the early years of child development, affects parenting behaviors that have been repeatedly linked to poor outcomes in children. However, recurrent maternal depression may be a more potent predictor of parenting than depression that only occurs in the early years. Longitudinal population data were used to examine the influence of depression in the first 2 years postpartum alone or in combination with recurrent episodes of depression on self-reported parenting behaviors known to influence children's development. Growth curve hierarchical linear modeling was used to examine the relationships among depression in the early years, recurrent depression, and parenting during children's first 12 years of life. Findings revealed that 63% of the depressed mothers reported recurrent episodes of depression. Self-reported parenting behaviors characterized by positive forms of discipline, firmness, and consistency were related to recurrent episodes of depression, whereas warmth and nurturant parenting behaviors were unaffected by recurrent episodes.

The role of paternal support in the behavioural development of children exposed to postpartum depression.

Fathers' ability and availability to provide social support to their depressed partners and thus promote their children's development and success may be influenced by their workforce participation, health, and years of education.This study of 626 children and their families examined the influence of fathers' characteristics on their children's behavioural development, when exposed to maternal postpartum depression, taking into account known covariates, including sex of the child, family structure, number of children in the household, annual income, and family functioning. For the behavioural outcomes of anxiety, hyperactivity, and aggression, fathers' workforce participation during the children's first 2 years of life significantly predicted their development over the next 10 years. Most notably, weekend work by fathers was a risk factor, particularly for boys.Thus fathers' characteristics related to their ability and availability to provide social support for their depressed partner appear to predict children's developmental success.

Contextual factors influencing the evolution of nurses' roles in a primary health care clinic.

OBJECTIVES: The purpose of the research was to explore the everyday experiences and responses of stakeholders of a university-sponsored nurse-managed clinic (CHC) in regard to how nurses' roles in the clinic changed over time and the factors that influenced this change. DESIGN AND SAMPLE: The research used a qualitative interpretive description design to interpret participants' accounts of their experience and perspectives as constructed narratives. The participants (N=23) included clients, community members who were volunteers at the CHC, staff of other community agencies or organizations, and nursing or social work students who had a clinical learning experience at the CHC. MEASURES: Data collection involved two interviews, one semistructured, face-to-face interview at the location selected by the participant, and a group interview held in a boardroom at the CHC. Each interview lasted approximately 60-90 min. RESULTS: The research findings revealed the profound effects of the social, political, and economic context in determining nurses' roles within a nurse-managed primary health care clinic. The evolution of nursing roles occurred in reaction to these effects, causing the nurses within the CHC to juggle their priorities and commitments. CONCLUSIONS: The study provides a contemporary example of the political activism work of nurses that is often invisible and illustrates how the commitment of primary health care nurses to social justice contributes in a significant way to the resolution of health inequities experienced by marginalized populations.

Cervical cancer screening practices among university women.

OBJECTIVE: To assess predictors of young women's intentions to be screened for cervical cancer. DESIGN: A descriptive, correlational, cross-sectional study using the Theory of Planned Behavior (TPB). PARTICIPANTS: A total of 904 young women (mean age=20.7 years; SD=1.77) participated in an online cervical cancer screening survey. METHOD: A web-based survey (WebCT) was used to survey young women, 25 years of age or less, attending a university in eastern Canada. Descriptive, correlational, and logistic regression statistics were calculated. RESULTS: Findings indicated that social norms (perceptions about whether or not people close to them think Pap screening is important) and perceived behavioral control (perceptions about personal resources or barriers to receiving a Pap test) were significantly related to young women's intentions to be screened. CONCLUSION: Strategies to promote cervical cancer screening among young university women need to recognize the impact of social norms and perceived barriers on Pap screening intentions in this population.

Canadian mothers' perceived support needs during postpartum depression.

OBJECTIVE: To assess the support needs, support resources, barriers to support, and preferences for support intervention for women with postpartum depression. DESIGN: Multisite, exploratory, descriptive study in which qualitative data were collected on support needs, the availability of resources, perceived barriers to support, and preferences for support of women who have experienced symptoms of postpartum depression. PARTICIPANTS AND SETTING: Conducted in Alberta and New Brunswick; mothers were interviewed individually (Alberta, n= 24; New Brunswick, n= 17) and in groups (Alberta, n= 5; New Brunswick, n= 6). RESULTS: For most mothers, one-on-one support was preferred when postpartum depression is recognized. Group support should be available once the mothers start to feel better and are able to comfortably interact with other mothers in a group format. This suite of alternatives needs to be underpinned by concerted public education efforts.