Post-partum mental health and exercise in ethnically diverse ‘priority’ groups

Abstract

Background: Ethnically diverse post-partum women living in deprived, urban, multi-ethnic neighbourhoods in developed countries are one of the most disadvantaged and vulnerable populations of the developed world. Even women not in receipt of a diagnosis of mental illness, the majority sub-set of this population, experience considerable biological, material and social challenges to mental wellness, which are not well understood or addressed in healthcare or research. Exercise could present a useful, relatively low resource, non-pharmacological option to strengthen such women’s mental health. However, as a population with intersecting life-stage, social, cultural and material challenges to exercise participation, there is little to guide what intervening with exercise in this context should look like. Specifically, not enough is known about the efficacy of exercise in non-illness orientated post-partum mental health contexts; not enough too about how efficacy could be meaningfully measured and delivered. This programme of research set out to design an effective place-based exercise intervention for the mental health of non-clinical, ethnically diverse (predominantly Black and Minority Ethnic) post-partum women from a deprived neighbourhood of the United Kingdom [UK] to understand whether exercise could be efficacious in this context. In course of this, understandings of intervention design and effectiveness would be gained, offering potential to meaningfully inform practice. Research design: An exploratory sequential mixed methods design was adopted. Reflective of the Medical Research Council’s complex intervention guidance, qualitative (Study 1) and quantitative (Study 2) studies were conducted in sequence so that Study 1 informed Study 2. Methods: For Study 1, the principles of grounded theory were employed. Data from focus groups and interviews with stakeholders (end-users and professionals) (n=25) were obtained and analysed to inform a model for intervention and intervention content.and enjoyment are key motives, and an indoors group a preferred format, for exercise. Findings led to a model with three tenets, ‘core activity’, ‘acceptability and appeal’ and ‘structural factors’, and pointed to the need for a multi-component intervention designed to agree with women’s motives for post-partum exercise. Social support emerged as holding potential to modify and enhance participation and mental health, and thus worthy of being tested in the context of a multi-component intervention. Study 2 results indicate that mental health (as SWB, statistically analysed via repeated measures AVOVA) can improve significantly, in favour of one intervention permutation. The combined exercise and social support multi-component group intervention was more effective in terms of participation and mental health than multi-component group interventions based around exercise and social support individually. Additional statistical analyses using delta values show significance for the combination of exercise and social support (interaction). Conclusion: This programme of research indicates that an appropriately designed multi-component intervention based around exercise and social support can improve the mental health of post-partum women without mental illness but facing considerable biological, social and material challenges to mental wellness, such as ethnically diverse (BAME) post-partum women living in deprived neighbourhoods in developed countries. It also points to an enhanced effect for the combination of exercise and social support, which had not been previously adequately quantified: as the basis of a design principle it represents new knowledge with wide applicability. Knowledge contributions are in an understudied domain. The results of the research could inform the re-shaping domain of post-partum mental healthcare. They offer a model for effective intervention with post-partum women in this, and other deprived neighbourhoods in the UK and other developed countries, and hold promise for intervention and mental health promotion with other special, ‘priority’, populations. The research also contributes to the domains of exercise for mental health and social prescribing, with particular focus on multi-component intervention design, evaluation, and social support. The model privileged multi-component intervention designed to support women’s multi-faceted needs, and engage with their motives for exercise in conducive social conditions. Social support was identified as having potential to modify outcomes. Thus, for Study 2, along with exercise, social support was varied and evaluated via different multi-component group intervention permutations. Study 2 was based on a cluster Randomised Controlled Trial design. Women 8-16 weeks post-partum at baseline (n=41) were allocated to one of four study groups: 1) Exercise [E] group, 2) Social support [SS] group, 3) Exercise + Social Support [Ess] group, and 4) a non-intervention Control group [C]. Mental health as subjective well-being [SWB] was measured using SF-36v2 (version2, Short-form 36-tem questionnaire) and MYMOP2 (Measure yourself medical outcomes profile) over 12 weeks. An attendance register measured participation. Results: Study 1 indicates that the focal women believe in the benefits of exercise and are keen to participate. Health benefits, social benefits