Abstract
Perinatal mental healthcare is an emerging area of practice for OTs in the UK, however research to guide practice remains scarce. A qualitative grounded theory methodology elicited data from 12 OTs using semistructured interviews. The MOHO was found to enable participants to understand the complex needs of mothers with mental illness, measure outcomes, and articulate their unique and distinct role to multiple audiences.
Primary Author and Speaker: Mandy Graham
The transition to becoming a parent is commonly viewed as a major life event imbued with occupational changes to roles, routines and responsibilities. Pregnancy, giving birth and raising a family can test the resilience of most women but for some, the experience is even more challenging with 10% of pregnant women and 13% of postnatal women reported to experience a diagnosed mental disorder (WHO, 2019). The consequences of such can have serious implications on the occupation of motherhood. The ability to perform daily tasks associated with caring for a baby such as bathing, dressing and feeding is significantly impaired by the cognitive and psycho-social symptoms of mental illness. Bonding, attachment and subsequent development of the child is well known to be negatively affected when women become unwell in the perinatal period. Mothers may also find it difficult to look after their own self care needs as well as balancing other employment, economic and relationship demands.
A recent investment and transformation of specialist perinatal mental health services in the UK has drawn a focus on interventions from a wide range of multi-disciplinary team members, with occupational therapy forming part of this holistic care. The evidence base for an occupational therapy perspective within maternal health services is emerging (Slootjes et al., 2017). However, given the complex nature of motherhood there remains scarce research on specific occupational therapy frameworks used to guide practice. The results of this paper are derived from a larger doctoral study which aimed to explore the nature, meaning and purpose of occupational therapy in both inpatient and community perinatal mental health services within the UK.
A contemporary Charmazian grounded theory approach was adopted with multiple data collection points (Charmaz, 2014). Theoretical sampling was employed to recruit participants via a specialist interest group of perinatal mental health occupational therapists in the UK. Twelve participants engaged in semi-structured telephone interviews to generate rich data regarding their clinical practice. Data analysis was performed using initial and focused coding to construct themes in line with grounded theory. Ethical approval for this study was granted by Leeds Beckett University, UK, ethics committee.
The results highlighted that the favoured model of practice most commonly utilised by participants was Kielhofner’s Model of Human Occupation (MOHO) (Taylor, 2017). Participants articulated that the model enabled them to explain the motivation and complex patterns for occupation in relation to the performance capacity required to carry out maternal occupations. Consideration of environmental contexts was also key to understanding the multifaceted demands of motherhood. Associated outcome measures of the model were also described by participants as being particularly useful in understanding the occupational needs of the women. Occupational formulation was reported to assist participants in articulating their assessment results to the rest of the clinical team and in ensuring collaboration with service users.
This research adds to the growing body of knowledge regarding the practice of occupational therapists working with women in the perinatal period. The use of the MOHO assists in understanding the complex needs of mothers and in articulating the associated intervention plan.
Charmaz, K. (2014). Constructing Grounded Theory: A Practical Guide Through Qualitative Analysis. London: Sage.
Slootjes, H., McKinstry, C., & Kenny, A. (2016). Maternal role transition: Why new mothers need occupational therapists. Australian Occupational Therapy Journal, 63, 130–133. Doi: 10.1111/1440-1630.12225
Taylor, R. (2017). Kielhofner’s Model of Human Occupation: Theory and Application (fifth edition). Philadelphia: Wolters Kluwer.
World Health Organisation (WHO) (2019). Maternal mental health. Retrieved 12th November 2019 from http://www.who.int/mental_health/maternal-child/maternal_mental_health/en/