Improving help-seeking for postnatal depression and anxiety: a cluster randomised controlled trial of motivational interviewing

2017 ◽  
Vol 20 (6) ◽  
pp. 791-801 ◽  
Author(s):  
Charlene Holt ◽  
Jeannette Milgrom ◽  
Alan W. Gemmill
Keyword(s):  
Randomised Controlled Trial ◽  
Motivational Interviewing ◽  
Postnatal Depression ◽  
Help Seeking ◽  
Controlled Trial ◽  
Cluster Randomised Controlled Trial ◽  
Depression And Anxiety ◽  
Cluster Randomised ◽  
Randomised Controlled

scholarly journals ‘Presumptively Initiating Vaccines and Optimizing Talk with Motivational Interviewing’ (PIVOT with MI) trial: a protocol for a cluster randomised controlled trial of a clinician vaccine communication intervention

BMJ Open ◽  
2020 ◽  
Vol 10 (8) ◽  
pp. e039299
Author(s):  
Douglas J Opel ◽  
Jeffrey D Robinson ◽  
Heather Spielvogle ◽  
Christine Spina ◽  
Kathleen Garrett ◽  
...  
Keyword(s):  
Randomised Controlled Trial ◽  
Motivational Interviewing ◽  
Controlled Trial ◽  
Cluster Randomised Controlled Trial ◽  
Communication Strategy ◽  
Institutional Review Board ◽  
Cluster Randomised ◽  
Institutional Review ◽  
Randomised Controlled ◽  
Immunisation Status

IntroductionA key contributor to underimmunisation is parental refusal or delay of vaccines due to vaccine concerns. Many clinicians lack confidence in communicating with vaccine-hesitant parents (VHP) and perceive that their discussions will do little to change parents’ minds. Improving clinician communication with VHPs is critical to increasing childhood vaccine uptake.Methods and analysisWe describe the protocol for a cluster randomised controlled trial to test the impact of a novel, multifaceted clinician vaccine communication strategy on child immunisation status. The trial will be conducted in 24 primary care practices in two US states (Washington and Colorado). The strategy is called Presumptively Initiating Vaccines and Optimizing Talk with Motivational Interviewing (PIVOT with MI), and involves clinicians initiating the vaccine conversation with all parents of young children using the presumptive format, and among those parents who resist vaccines, pivoting to using MI. Our primary outcome is the immunisation status of children of VHPs at 19 months, 0 day of age expressed as the percentage of days underimmunised from birth to 19 months for 22 doses of eight vaccines recommended during this interval. Secondary outcomes include clinician experience communicating with VHPs, parent visit experience and clinician adherence to the PIVOT with MI communication strategy.Ethics and disseminationThis study is approved by the following institutional review boards: Colorado Multiple Institutional Review Board, Washington State Institutional Review Board and Swedish Health Services Institutional Review Board. Results will be disseminated through peer-reviewed manuscripts and conference presentations.Trial registration numberNCT03885232.

scholarly journals Cost-effectiveness of PoNDER health visitor training for mothers at lower risk of depression: findings on prevention of postnatal depression from a cluster-randomised controlled trial

2018 ◽  
Vol 49 (08) ◽  
pp. 1324-1334 ◽  
Author(s):  
Catherine Henderson ◽  
Simon Dixon ◽  
Annette Bauer ◽  
Martin Knapp ◽  
C. Jane Morrell ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Randomised Controlled Trial ◽  
Postnatal Depression ◽  
Lower Risk ◽  
Controlled Trial ◽  
Cost Effective ◽  
Cluster Randomised Controlled Trial ◽  
Cluster Randomised ◽  
Randomised Controlled ◽  
The Cost

AbstractBackgroundThere is evidence for the cost-effectiveness of health visitor (HV) training to assess postnatal depression (PND) and deliver psychological approaches to women at risk of depression. Whether this approach is cost-effective for lower-risk women is unknown. There is a need to know the cost of HV-delivered universal provision, and how much it might cost to improve health-related quality of life for postnatal women. A sub-study of a cluster-randomised controlled trial in the former Trent region (England) previously investigated the effectiveness of PoNDER HV training in mothers at lower risk of PND. We conducted a parallel cost-effectiveness analysis at 6-months postnatal for all mothers with lower-risk status attributed to an Edinburgh Postnatal Depression Scale (EPDS) score <12 at 6-weeks postnatal.MethodsIntervention HVs were trained in assessment and cognitive behavioural or person-centred psychological support techniques to prevent depression. Outcomes examined: quality-adjusted life-year (QALY) gains over the period between 6 weeks and 6 months derived from SF-6D (from SF-36); risk-of-depression at 6 months (dichotomising 6-month EPDS scores into lower risk (<12) and at-risk (⩾12).ResultsIn lower-risk women, 1474 intervention (63 clusters) and 767 control participants (37 clusters) had valid 6-week and 6-month EPDS scores. Costs and outcomes data were available for 1459 participants. 6-month adjusted costs were £82 lower in intervention than control groups, with 0.002 additional QALY gained. The probability of cost-effectiveness at £20 000 was very high (99%).ConclusionsPoNDER HV training was highly cost-effective in preventing symptoms of PND in a population of lower-risk women and cost-reducing over 6 months.

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