Continuing from this recent post celebrating the publishing of papers from doctorates I’ve had a hand in supervising, here now are links to Nicola Savory’s PhD and to a first article from this in the journal Midwifery. Nicola is a midwife, and in her thesis (funded by RCBC Wales) used quantitative and qualitative methods to investigate women’s mental health needs in the antenatal period.
Nicola’s whole-thesis summary is this:
Background: Existing research on poor perinatal mental health largely focuses on recognition and treatment of postnatal depression. Consequently, there is a need to explore antenatal mental health.
Aim: To assess poor mental health prevalence in pregnancy, its relationship to sociodemographic characteristics, self-efficacy and perceived support networks. To understand experiences and barriers preventing women with mental health problems from receiving help and explore midwives’ understanding of their role.
Method: Questionnaires were completed by women in early pregnancy. A subset identified to have mental health problems, were interviewed in late pregnancy to explore their experiences and barriers to receiving care. Midwives completed questionnaires exploring their experiences of supporting women with mental health problems and focus groups further discussed the issues raised.
Results: Amongst participants (n=302), the Edinburgh Postnatal Depression Scale (EPDS) identified 8.6%, and the Generalised Anxiety Disorder Assessment (GAD-7) 8.3%, with symptoms of depression or anxiety respectively. Low self-efficacy (p=0.01) and history of previous mental health problems (p<0.01) were most strongly associated with anxiety or depression. Thematic analysis of interviews with women (n=20) identified three themes: ‘past present and future’; ‘expectations and control’; and ‘knowledge and conversations’.
Questionnaires were completed by 145 midwives. The three themes identified from the focus groups with midwives were: ‘conversations’; ‘it’s immensely complex’; and ‘there’s another gap in their care’.
Conclusion: Prevalence rates of anxiety and depression amongst women in early pregnancy were found to be similar to those reported in the literature. Low self-efficacy and previous poor mental health were significant predictors of anxiety and depression. Continuity and more time at appointments were suggested by midwives and women to improve discussions regarding mental health. Midwives were keen to support women but lacked knowledge and confidence. Consistent reference was made to the need for training regarding the practical aspects of supporting women’s mental health.
Nicola has a series of journal papers lined up from her doctorate, with the one I’ve linked to above (‘Prevalence and predictors of poor mental health among pregnant women in Wales using a cross-sectional survey’) being just the first.
Here in the School of Healthcare Sciences at Cardiff University we’ve continued to think about how best to appeal to potential PhD students, and to simultaneously develop research capacity across nursing, midwifery and the allied health professions. A change which we’ve recently made is to invite applicants for postgraduate research study to make clear how their developing plans fit with the research already going on in at least one of the School’s research themes. To help in this process we’re now advertising areas for future PhD study, closely aligned to the substantive and methodological expertise already found in the School. This makes lots of sense, and will help us to grow research in programmatic fashion and ensure students are appropriately supervised.
The place to go for the current list of topics/areas is here, where under the Workforce, Innovation and Improvement theme you’ll find this:
The use of in-depth qualitative methods to examine mental health systems. Specifically, projects investigating aspects of policy; service organisation and delivery; work, roles and values and user and carer experiences.
That’s the kind of PhD I’m primarily interested in supervising. For an example of what a completed one looks like, then follow this link to the full text of Dr Mohammad Marie’s freshly minted thesis titled, Resilience of Nurses who work in Community Mental Health Workplaces in West Bank-Palestine.
University departments for the health professions, like Cardiff University’s School of Healthcare Sciences, have long academic years. We welcome intakes of new pre-registration undergraduate nurses every September, which is a time when students of many other disciplines are still enjoying the tail end of their summer holidays. In September we also welcome back existing students, and this afternoon – assuming I can navigate across Cardiff and its NATO summit-encircling ring of steel – I’m off to the School’s University Hospital of Wales (UHW) campus to meet a group of third year undergraduates to talk about the ethical aspects of nursing and healthcare research.
More generally, I start the 2014-15 academic year as incoming Co-Director of Postgraduate Research in the School, sharing this work with my esteemed colleague Dr Tina Gambling. Currently in the School of Healthcare Sciences we have almost 80 students studying for either the degree of PhD or the Professional Doctorate in Advanced Healthcare Practice (DAHP). The student group is a rich and varied one, and includes many who have made significant commitments to leave their homes (and often, their families) in other parts of the world to live and study in Cardiff. An example is Mohammad Marie, who I have written about on this site before.
In the case of new, or intending, postgraduate research students in the School some helpful advice is: keep an eye on the School’s website. We’re in the process of launching a new research strategy with distinct themes, and our aim is to recruit new PhD and Professional Doctorate students whose interests are clearly aligned with these. Research theme groups will, we’re all hoping, become communities of scholars drawing in researchers with all levels of experience: including those just starting out, and those who are internationally regarded.
On Friday I had reason to ponder the relationships between theory and data, and the boundaries between different types of qualitative research. This was day two of my Working and Leading in Complex Systems professional doctorate module. What I discovered is that I may, in fact, have become an accidental grounded theorist. Or possibly not…I’ll let the reader decide.
During a talk about critical junctures I said how, in our recent paper, Nicola Evans and I had elected to lay out our theoretical contribution (i.e., our idea of ‘critical junctures’ as pivotal, punctuating, moments initiating or taking place within longer individual trajectories of care) ahead of displaying our data. We had done this even though our ‘theory’ had in fact been fieldwork-driven, as we then demonstrated in our article with extended, illustrative, extracts. Quite reasonably, in the classroom I was asked if we had therefore used a grounded theory approach.
This question got me thinking. My immediate response was that Nicola and I had developed a concept from empirical data but had absolutely not claimed to be ‘doing grounded theory’. In fact, the thought had never occurred to us (or to me, at any rate).
And there’s the nub of it. What does it actually mean to ‘do grounded theory’? Follow a stepwise recipe from a methodological cookbook? Or range freely over one or more sets of data in the search for new insights? Without wanting to suggest that ‘anything goes’ in terms of methods, I wonder if we can sometimes get too hung up on techniques and ‘rules’ when it’s the principles which really matter? In our critical junctures paper these included a commitment to the inductive ‘drawing out’ of conceptual insights from an analysis of talk and action. They also included the idea of staying close to our data, and of offering fieldwork extracts in support of the theory. I personally have no wish to agonise over what flavour of ‘doing qualitative research’ we have done here, and I’m also not sure that all of the finer distinctions and sub-divisions necessarily matter or even make sense.
But perhaps I’m missing something.
Today has reminded me of the pleasures of university teaching. A day in a classroom with lively doctoral students is to be savoured. Most (but not all) of the group were nurses, and most (but again, not all) were completing the taught elements of their professional doctorate programme ahead of beginning their research.
The module is concerned with understanding health system complexity, and is liberally sprinkled with local research (my own included). Today we began with an overview of the territory, and then discussed policy and services at the large scale using the idea of wicked problems. Pauline Tang gave a fabulous talk based on her study of electronic health records, before we closed with a whistlestop tour of systems of work and divisions of labour.
We meet again tomorrow for sessions led by students, to think about trajectories and critical junctures, and to hear Nicola Evans being interviewed about change in organisations. I’m looking forward.