Is there room for mothers' agency in the choice to breastfeed? A qualitative analysis of mothers' views on messages promoting breastfeeding in Quebec.

INTRODUCTION: This exploratory cross-sectional study focuses on the experiences of mothers regarding health messages promoting breastfeeding. The objective is to describe the content and context in which messages are conveyed. METHODS: A total of 944 new mothers responded to a questionnaire (15-31 January 2021) on their perception of health messages promoting breastfeeding and their feeling of agreement towards these messages, their intention to breastfeed, incentives received, and their relationship with the professionals. Frequencies were carried out for all non-textual data and textual data were analyzed using content thematic analysis. The recruitment was made through social media and snowball effect. RESULTS: Most of the respondents reported wanting to breastfeed; 91% breastfed their child, 80.8% participants agreed with the messages they received, and 67.9% of respondents strongly agreeing that breastfeeding was the best choice for their child. Moreover, the content of the messages could sometimes be judgmental and coercive, leading to emotions such as guilt. Sixty-two women also reported a lack of support when they expressed their desire or their need to feed their baby in other ways (e.g. breastmilk with bottles or formulas). CONCLUSIONS: The perceived issue of breastfeeding messages was not the content itself, but the way in which information was conveyed. Failure to take mothers' difficulties into account and failure to present alternatives to breastfeeding were seen as major issues by women. This study highlights the importance of rethinking the way in which information is provided by professionals, in order to reinforce the autonomy of new mothers regarding the feeding of their child.

Itinéraires thérapeutiques et accès aux soins en santé mentale : une ethnographie au Burkina Faso.

INTRODUCTION: In Burkina Faso, there is a lack of studies on perceptions of existing mental healthcare systems. This limits understanding patients’ treatment pathways and barriers to care utilization. As in many countries in sub-Saharan Africa, this lack of information contributes to the difficulty of health systems to adapt the available care to patients’ realities and needs. PURPOSE OF RESEARCH: In this study, participant observations were made in different care settings in the city of Bobo-Dioulasso. Seven focus groups and 25 individual interviews were conducted to question knowledge, perception, and use of existing services. Different actors were interviewed: patients, caregivers, family members and key informants. The data were subjected to a descriptive thematic analysis. RESULTS: Three systems of care were identified: 1) psychiatric care was associated with a diagnostic function and the management of serious pathologies, or ones triggered by “natural” causes, 2) traditional care was seen as having a healing function for “supernatural” pathologies, but was associated with a risk of fraud, and 3) informal care provided by the family was identified as the mainstay of the therapeutic pathways. CONCLUSIONS: This study reveals that through the diversity of resources consulted, the family members represent the main provider of care. Also, financial constraints constitute the main obstacle to seeking care. These findings lead us to make recommendations regarding the development of public policies at the national level as well as regarding the organization of health services in the city of Bobo-Dioulasso.

Évaluer les besoins des femmes enceintes : une étude-pilote du dispositif Ariane.

INTRODUCTION: The organization of perinatal prevention in France is based on a system of universalism. Maternal and child protection services are thus open to all, at the risk of excluding people who do not know where or how to find them. Targeted preventive corrective measures, based on risk factors, correct some of this inequity but create other negative effects. PURPOSE OF RESEARCH: This article presents an innovative social protocol in public health: the Ariane systematic prenatal contact. It is based on the principle of proportionate universalism. Ariane consists of a text message and a phone call at the beginning of pregnancy. Aimed at all pregnant women, it allows information to be transmitted orally on public systems of prevention and support for parents. It also makes it possible to assess the needs of families, along eight axes. METHOD: This article presents the results of the pilot study of this system, conducted in Moselle. In total, 14 midwiwes ant 11 parturients who were contacted during their pregnancy participated in post-project interviews. RESULTS: The results show a very high level of acceptability of the calls by all parties. According to the midwives, Ariane has made it possible to increase the relevance of the identification, making it possible to move from a prevention logic based on criteria to a prevention logic based on the needs of families. The contact was easy, according to both the women and the clinicians. CONCLUSION: Our results show that the Ariane protocol make possible to establish a relationship of trust between the families and the services. Implications for outreach policies are also presented in this article.

[Preventing child abuse risk factors: A study of the ease of French professionals working in early prevention]. / Intervenir sur les facteurs de risque de maltraitance infantile : quelle aisance chez les professionnels français de prévention précoce ?

Research on child abuse prevention has been limited for the last forty years to the experimental field. While we know how home visiting interventions can help limit situations of child abuse, we do not know how these results can be replicated in routine care situations. The objective of this study was to identify, in French public services, how prevention professionals approach child abuse risk factors with families, and with what degree of ease. The results show that, beyond a form of versatility that allows them to discuss a wide range of topics with families, prevention workers are very uncomfortable dealing with topics of family intimacy, psychopathology, or child abuse. The political implications are discussed.

[Maternal and child protection services at home. Results from a national study.] / Les interventions à domicile en Protection maternelle et infantile. Résultats d'une étude nationale.

Maternal and child protection services ("PMI") are French universal services providing prevention and health promotion services to parents and their newborn children up to the age of 6. They specifically offer home visitation services in order to reach families that could not be seen otherwise. This paper presents the results of a national survey describing these home visitation services and their local implantation. Sixty French ?départements? (59%), constituting the territorial unit for the PMI answered the survey. The results point out that family reach remains a challenge for these services. Organizational issues represent the main barrier to implement and deliver home visitation with sufficient reach and quality. The services now provide home visitation based on risk factors, while the universality of services seems to be no longer guaranteed. The number of tasks that the nurses have been charged with can explain these difficulties, as well as the lack of financial and human resources.

[Effects of the homecare assistance program on maternal and child protection services.] / Effets du programme d'accompagnement du retour à domicile sur les pratiques des services de protection maternelle et infantile.

In 2010, the French Ministry of Health started the implementation of the "PRADO" process, which constitutes a way to finance two early post-partum home visits by midwives. These two visits occur between the third and twelfth day of the newborn child. However, this PRADO program has come as a supplementary service, while the Maternal and child protection services ("PMI") were already in charge of home visitation in early postpartum up to the child's sixth birthday. Through a qualitative survey, this study aimed at evaluating the effect of the implementation of the PRADO program over the PMI structure and home visitation intervention. The results suggest an important lack of coordination between these services that appear to be in competition with each other, while both financed by public funding. The PMI services expressed their feeling that families were less well served in early postpartum, with these two services.

An intervention strategy for improving residential environment and positive mental health among public housing tenants: rationale, design and methods of Flash on my neighborhood!

BACKGROUND: In Canada, public housing programs are an important part of governmental strategies to fight poverty and public exclusion. The Flash on my neighborhood! project is a four-year multiphase community-based participatory action research strategy currently implemented in six public housing developments (n = 1009 households) across the province of Québec, Canada. The goal is to reduce the mental health disparities faced by these public housing tenants compared to the general population, while identifying which environmental and policy changes are needed to turn public housing settings into healthier environments. METHODS: The protocol involves three successive, interconnected phases: 1) Strengths and needs assessment, including community outreach and recruitment of tenants to collaborate as peer researchers, an exploratory qualitative component (photovoice), a systematic neighborhood observation, and a household survey; 2) Action plan development, including a community forum and interactive capacity-building and discussion sessions; 3) Action plan implementation and monitoring. The entire intervention is evaluated using a mixed-method design, framed within a multiple case study perspective. Throughout the project and particularly in the evaluation phase, data will be collected to record a) contextual factors (tenants' previous experience of participation, history of public housing development, etc.); b) activities that took place and elements from the action plan that were implemented; and c) short- and medium-term outcomes (objective and perceived improvements in the quality of the residential setting, both physically and in terms of mental health and social capital). DISCUSSION: The study will provide unprecedented evidence-based information on the key ingredients of a collective intervention process associated with the increased collective empowerment and positive mental health of public housing tenants.

Assessing a change mechanism in a randomized home-visiting trial: Reducing disrupted maternal communication decreases infant disorganization.

Although randomized interventions trials have been shown to reduce the incidence of disorganized attachment, no studies to date have identified the mechanisms of change responsible for such reductions. Maternal sensitivity has been assessed in various studies and shown to change with intervention, but in the only study to formally assess mediation, changes in maternal sensitivity did not mediate changes in infant security of attachment (Cicchetti, Rogosch, & Toth, 2006). Primary aims of the current randomized controlled intervention trial in a high-risk population were to fill gaps in the literature by assessing whether the intervention (a) reduced disorganization, (b) reduced disrupted maternal communication, and (c) whether reductions in disrupted maternal communication mediated changes in infant disorganization. The results indicated that, compared to controls (n = 52), both infant disorganization and disrupted maternal communication were significantly reduced in the intervention group (n = 65) that received regular home-visiting during pregnancy and the first year of life. Furthermore, reductions in disrupted maternal communication partially accounted for the observed reductions in infant disorganization compared to randomized controls. The results are discussed in relation to the societal cost effectiveness of early attachment-informed interventions for mothers and infants, as well as the importance of formally assessing underlying mechanisms of change in order to improve and appropriately target preventive interventions.

BEST PRACTICE IN INDIVIDUAL SUPERVISION OF PSYCHOLOGISTS WORKING IN THE FRENCH CAPEDP PREVENTIVE PERINATAL HOME-VISITING PROGRAM: RESULTS OF A DELPHI CONSENSUS PROCESS.

Individual supervision of home-visiting professionals has proved to be a key element for perinatal home-visiting programs. Although studies have been published concerning quality criteria for supervision in North American contexts, little is known about this subject in other national settings. In the context of the CAPEDP program (Compétences parentales et Attachement dans la Petite Enfance: Diminution des risques liés aux troubles de santé mentale et Promotion de la résilience; Parental Skills and Attachment in Early Childhood: Reducing Mental Health Risks and Promoting Resilience), the first randomized controlled perinatal mental health promotion research program to take place in France, this article describes the results of a study using the Delphi consensus method to identify the program supervisors' points of view concerning best practice for the individual supervision of home visitors involved in such programs. The final 18 recommendations could be grouped into four general themes: the organization and setting of supervision sessions; supervisor competencies; relationship between supervisor and supervisee; and supervisor intervention strategies within the supervision process. The quality criteria identified in this perinatal home-visiting program in the French cultural context underline the importance of clinical supervision and not just reflective supervision when working with families with multiple, highly complex needs.

Predictors of Study Attrition in a Randomized Controlled Trial Evaluating a Perinatal Home-Visiting Program with Mothers with Psychosocial Vulnerabilities.

OBJECTIVE: Randomised controlled trials evaluating perinatal home-visiting programs are frequently confronted with the problem of high attrition rates. The aim of the present study is to identify predictors of study attrition in a trial evaluating a perinatal home-visiting program in France. MATERIALS AND METHODS: CAPEDP is a French randomized trial comparing a perinatal home-visiting program using psychologists versus usual care (N = 440). The first assessment was at inclusion into the trial at the 27th week of pregnancy and the final assessment when the child reached the age of two. Attrition rates were calculated at 3 and 24 months postpartum. Stepwise logistic regression was used to identify predictors of early (between inclusion and 3 months postpartum) and later (between 3 and 24 months postpartum) attrition among social, psychological and parenting factors. RESULTS: Attrition rates were 17% and 63% at 3 and 24 months respectively. At 24 months, there was significantly more attrition in the control arm (70.6%) compared to the intervention arm (55.2%). Five independent predictors of early attrition were identified: having already had an abortion; having greater attachment insecurity as measured with the Vulnerable Attachment Style Questionnaire (VASQ); having lower global severity of psychiatric symptoms as assessed with the Symptom Check-List (SCL-90) at inclusion, being neither currently employed nor studying; and declaring no tobacco consumption during pregnancy. Being randomized into the control arm, having undergone early parental loss before age 11 and having lower global severity of psychiatric symptoms (SCL-90) at 3 months postpartum were the only variables associated with later attrition. CONCLUSION: This study provides key information for identifying mothers who may require specific support to avoid study attrition in trials evaluating a home-visiting program.

French version of the Brief Infant-Toddler Social and Emotional Assessment questionnaire-BITSEA.

OBJECTIVE: The aim of the present study was to examine the psychometric properties of the French version of the Brief Infant-Toddler Social and Emotional Assessment (BITSEA). METHODS: The sample consisted of 589 low-risk infants aged 12-36 months and their parents. Parents completed the BITSEA, the Child Behavior Checklist 1½-5 (CBCL - 18 months to 5 years version), and the Parenting Stress Index - Short Form (PSI-SF). RESULTS: Multitrait-multimethod and confirmatory factor analyses revealed adequate psychometric properties for the French version of the BITSEA. Scores on the BITSEA Problem scale were positively correlated to all CBCL and PSI-SF subscales, whereas negative correlations were found between BITSEA Competence scale and CBCL and PSI-SF subscales. The BITSEA Problem score significantly increased with level of parental worry, examined through a single-item question that is part of the BITSEA. CONCLUSION: Findings support the validity of the French version of the BITSEA. However, additional work on the clinical validity of the BITSEA, including with at-risk children, is warranted.

Psychological distress in French college students: demographic, economic and social stressors. Results from the 2010 National Health Barometer.

BACKGROUND: Psychological distress (PD) in students is under-investigated, since its prevalence can be high in certain subgroups of students and it has been seen to be associated with other mental health issues and academic achievement. In a sample of French college students, this study investigated factors associated with PD, and looked more closely at the impact of social and interpersonal variables. METHODS: Data were extracted from the 2010 French "National Health Barometer". 946 students were interviewed. Mental health was assessed using the MH-5 five-item scale. RESULTS: The PD rate in this sample was 13.8% (7.2% in males, 19.5% in females). Low income, nonsexual assault in the last 12 months, studying law and low social participation were associated with PD in multivariate analyses. CONCLUSIONS: French students show specific characteristics that are discussed in order to explain the relatively low rate of PD observed. The impact of loneliness and social isolation are a major focus for preventive policies based on community resources and early detection of the symptoms of PD.

Impact of a manualized multifocal perinatal home-visiting program using psychologists on postnatal depression: the CAPEDP randomized controlled trial.

CONTEXT: Postnatal maternal depression (PND) is a significant risk factor for infant mental health. Although often targeted alongside other factors in perinatal home-visiting programs with vulnerable families, little impact on PND has been observed. OBJECTIVE: This study evaluates the impact on PND symptomatology of a multifocal perinatal home-visiting intervention using psychologists in a sample of women presenting risk factors associated with infant mental health difficulties. METHODS: 440 primiparous women were recruited at their seventh month of pregnancy. All were future first-time mothers, under 26, with at least one of three additional psychosocial risk factors: low educational level, low income, or planning to raise the child without the father. The intervention consisted of intensive multifocal home visits through to the child's second birthday. The control group received care as usual. PND symptomatology was assessed at baseline and three months after birth using the Edinburgh Postnatal Depression Scale (EPDS). RESULTS: At three months postpartum, mean (SD) EPDS scores were 9.4 (5.4) for the control group and 8.6 (5.4) for the intervention group (p = 0.18). The difference between the mean EPDS scores was 0.85 (95% CI: 0.35; 1.34). The intervention group had significantly lower EPDS scores than controls in certain subgroups: women with few depressive symptoms at inclusion (EPDS <8): difference = 1.66 (95%CI: 0.17; 3.15), p = 0.05, adjusted for baseline EPDS score), women who were planning to raise the child with the child's father: difference = 1.45 (95%CI: 0.27; 2.62), p = 0.04 (adjusted); women with a higher educational level: difference = 1.59 (95%CI: 0.50; 2.68) p = 0.05 (adjusted). CONCLUSION: CAPEDP failed to demonstrate an overall impact on PND. However, post-hoc analysis reveals the intervention was effective in terms of primary prevention and in subgroups of women without certain risk factors. Effective overall reduction of PND symptomatology for young, first-time mothers presenting additional psychosocial risk factors may require more tailored interventions. TRIAL REGISTRATION: ClinicalTrials.gov NCT00392847 Promoting Parental Skills and Enhancing Attachment in Early Childhood (CAPEDP).

Supporting families in challenging contexts: the CAPEDP project.

Although France has one of the most generous health and social care systems for infant and maternal well-being in the Western world, professionals have been increasingly concerned by the rising number of children being referred for mental health problems. The present article describes the first home-visiting program in France to specifically target mental health questions in families living in vulnerable contexts. The CAPEDP project, involving 440 women and their families, took place in Paris and its inner suburbs from 2006 to 2011. To be eligible for inclusion, women had to be (i) under 26 years old, (ii) less that 27 weeks pregnant, (iii) sufficiently fluent in French to give truly informed consent to participate in the study and benefit from the intervention and (iv) presenting with one or more of the following social vulnerability factors: low income, low educational level, and/or intending to bring up the child without the child's father. The intervention consisted of 44 home visits from the third trimester of pregnancy through to the child's second birthday. The aim of the intervention was to promote infant mental health and reduce the incidence of infant mental health problems at the age of two years. The intervention paid particular attention to postnatal maternal depression and promoting parenting skills and attachment security, particularly through the use of video during home-visits. A major issue was that of adapting international best practice recommendations with regard to home-visiting programs to the particularities of the existing French social and health care system. An original aspect of the intervention was to use trained clinical psychologists to conduct all home visits.

Implementation and assessment of an early home-based intervention on infant attachment organisation: the CAPEDP attachment study in France.

Attachment is a long-term emotional link between infants and their mothers. Attachment quality influences subsequent psychosocial relationships, the ability to manage stress and, consequently, later mental health. Home intervention programmes targeting infant attachment have been implemented in several contexts with varying degrees of efficacy. Within the CAPEDP study (Parental Skills and Attachment in Early Childhood: reduction of risks linked to mental health problems and promotion of resilience), a subsample of 120 families were recruited with the objective of assessing the impact of this home-visiting programme on infant attachment organisation using the Strange Situation Procedure. The present paper describes the methodology used in this ancillary study.

Social participation, social environment and death ideations in later life.

OBJECTIVE: Few studies on elders' suicide and depression have integrated social and community factors in their explicative models. Most of the studied variables used are focused on individual and based on psychopathological models. The purpose of this study is to investigate the impact of socio-environmental factors on death ideations, using data from the European SHARE cohort. METHOD: Social support components and death ideations have been studied, together with known individual risk factors, within a sample of 11,425 European participants in the SHARE study, aged over 64. The item evaluating death ideations was extracted from the EURO-D12 questionnaire. RESULTS: The high prevalence of death ideations (6.9% for men and 13.0% for women) confirmed that elders' death ideations, as it is known to be linked to suicidal behaviors, is a major public health issue. Bivariate analyses revealed a strong association between community participation and death ideations. This association was no longer significant while adjusting for depressive symptomatology. The logistic model identified that factors significantly associated with death ideations, when adjusted for the other factors were: having multiple depressive symptoms (OR = 1.64 per symptom) being aged, especially over 84 (OR = 1.58), being retired for fewer than five years (OR = 1.46), being widowed (OR = 1.35) and having a long-term illness (OR = 1.28). CONCLUSIONS: Although social and community participation is associated to death ideations, this link becomes non-significant in a regression model taking into account other factors. It is important to notice that depressive symptoms, which are obviously closely related to death ideations, take the greatest part in the association among all associated factors. Our results suggest that, consistently with the literature, while addressing death ideation or suicide prevention, professionals have to consider first the secondary prevention of depressive symptomatology. Strategies targeting social isolation and community participation should be considered as part of primary prevention policies.

A home-visiting intervention targeting determinants of infant mental health: the study protocol for the CAPEDP randomized controlled trial in France.

BACKGROUND: Several studies suggest that the number of risk factors rather than their nature is key to mental health disorders in childhood. METHOD AND DESIGN: The objective of this multicentre randomized controlled parallel trial (PROBE methodology) is to assess the impact in a multi-risk French urban sample of a home-visiting program targeting child mental health and its major determinants. This paper describes the protocol of this study. In the study, pregnant women were eligible if they were: living in the intervention area; able to speak French, less than 26 years old; having their first child; less than 27 weeks of amenorrhea; and if at least one of the following criteria were true: less than twelve years of education, intending to bring up their child without the presence of the child's father, and 3) low income. Participants were randomized into either the intervention or the control group. All had access to usual care in mother-child centres and community mental health services free of charge in every neighbourhood. Psychologists conducted all home visits, which were planned on a weekly basis from the 7th month of pregnancy and progressively decreasing in frequency until the child's second birthday. Principle outcome measures included child mental health at 24 months and two major mediating variables for infant mental health: postnatal maternal depression and the quality of the caring environment. A total of 440 families were recruited, of which a subsample of 120 families received specific attachment and caregiver behaviour assessment. Assessment was conducted by an independent assessment team during home visits and, for the attachment study, in a specifically created Attachment Assessment laboratory. DISCUSSION: The CAPEDP study is the first large-scale randomised, controlled infant mental health promotion programme to take place in France. A major specificity of the program was that all home visits were conducted by specifically trained, supervised psychologists rather than nurses. Significant challenges included designing a mental health promotion programme targeting vulnerable families within one of the most generous but little assessed health and social care systems in the Western World. TRIAL REGISTRATION: Current Clinical trial number is NCT00392847.

Evaluating fidelity in home-visiting programs a qualitative analysis of 1058 home visit case notes from 105 families.

OBJECTIVE: Implementation fidelity is a key issue in home-visiting programs as it determines a program's effectiveness in accomplishing its original goals. This paper seeks to evaluate fidelity in a 27-month program addressing maternal and child health which took place in France between 2006 and 2011. METHOD: To evaluate implementation fidelity, home visit case notes were analyzed using thematic qualitative and computer-assisted linguistic analyses. RESULTS: During the prenatal period, home visitors focused on the social components of the program. Visitors discussed the physical changes in pregnancy, and psychological and social environment issues. Discussing immigration, unstable employment and financial related issues, family relationships and dynamics and maternity services, while not expected, were found in case notes. Conversely, health during pregnancy, early child development and postpartum mood changes were not identified as topics within the prenatal case notes. During the postnatal period, most components of the intervention were addressed: home visitors observed the mother's adaptation to the baby; routine themes such as psychological needs and medical-social networks were evaluated; information on the importance of social support and on adapting the home environment was given; home visitors counseled on parental authority, and addressed mothers' self-esteem issues; finally, they helped to find child care, when necessary. Some themes were not addressed or partially addressed: health education, child development, home environment, mother's education plans and personal routine, partner support and play with the child. Other themes were not expected, but found in the case notes: social issues, mother-family relationship, relation with services, couple issues, quality of maternal behavior and child's language development. CONCLUSIONS: In this program, home visitors experienced difficulties addressing some of the objectives because they gave precedence to the families' urgent needs. This research stresses the importance of training home visitors to adapt the intervention to the social, psychological and health needs of families.

Infant rhythms versus parental time: promoting parent-infant synchrony.

Traditional psychoanalytic theories of early development have been put into question by developmental psychology, and particularly by attachment theory. Psychopathology appears to be more linked to interpersonal relationship problems rather than to intra-psychic conflict, as hypothesized in Freudian drive theory. Establishing synchrony between parent and infant is probably one of the major tasks of the first year of life. Attachment theory appears to be an effective paradigm to understand how caregiver responses to stressful infant situations give way to different regulatory strategies, which impact on the effectiveness of the stress buffer systems and its physiological impact on emotion and stress regulation. This paper underlines the importance of synchronization between infant and caregiver; it highlights the key concept of attachment disorganization and of its relationship with sustained social withdrawal as a defence mechanism and an alarm signal when synchronization fails, and underlines the importance of early interventions promoting parent-infant synchrony.

[Evidence-based interventions in youth mental health prevention and promotion]. / Interventions validées en prévention et promotion de la santé mentale auprès des jeunes.

The purpose of this paper is to review the current scientific knowledge on mental health promotion interventions aimed at children and adolescents. Definitions of mental health, mental health prevention and mental health promotion are provided. The current state of knowledge in this area was assessed based on a specific method involving selection, a literature review and a classification of mental health promotion interventions identified using scientific databases. Seventeen interventions were identified as having an effect on youth mental health. Half of these interventions are aimed at the general population, while the other half target vulnerable individuals. The majority of the interventions are aimed at children aged 5 and over. Half of the interventions are multimodal, while unimodal interventions include programs aimed at promoting psychosocial competencies in children. An increased understanding of internationally recognized programs should promote reflection on current professional practice in France.