Improving population-level maternal health: a hard nut to crack? Long term findings and reflections on a 16-community randomised trial in Australia to improve maternal emotional and physical health after birth [ISRCTN03464021]

PLoS One. 2014 Feb 28;9(2):e88457. doi: 10.1371/journal.pone.0088457. eCollection 2014.

Abstract

Background: Community level interventions to improve maternal and child health have been supported and well evaluated in resource poor settings, but less so in developed countries. PRISM--Program of Resources, Information and Support for Mothers--was a primary care and community-based cluster-randomised trial in sixteen municipalities in Victoria, Australia, which aimed to reduce depression in mothers and improve their physical health. The aim of this paper is to report the longer term outcomes of PRISM and to reflect on lessons learned from this universal community intervention to improve maternal health.

Methods: Maternal health outcome data in PRISM were collected by postal questionnaire at six months and two years. At two years, the main outcome measures included the Edinburgh Postnatal Depression Scale (EPDS) and the SF-36. Secondary outcome measures included the Experience of Motherhood Scale (EOM) and the Parenting Stress Index (PSI). A primary intention to treat analysis was conducted, adjusting for the randomisation by cluster.

Results: 7,169/18,424 (39%) women responded to the postal questionnaire at two years -3,894 (40%) in the intervention arm and 3,275 (38%) in the comparison arm. Respondents were mostly representative on available population data comparisons. There were no differences in depression prevalence (EPDS≥13) between the intervention and comparison arms (13.4% vs 13.1%; ORadj = 1.06, 95%CI 0.91-1.24). Nor did women's mental health (MCS: 48.6 vs 49.1) or physical health scores (PCS: 49.1 vs 49.0) on the SF-36 differ between the trial arms.

Conclusion: Improvement in maternal mental and physical health outcomes at the population level in the early years after childbirth remains a largely unmet challenge. Despite the lack of effectiveness of PRISM intervention strategies, important lessons about systems change, sustained investment and contextual understanding of the workability of intervention strategies can be drawn from the experience of PRISM. Trial Registration. Controlled-Trials.com ISRCTN03464021.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Australia
  • Female
  • Health Status*
  • Humans
  • Maternal Welfare*
  • Mental Health
  • Postnatal Care
  • Pregnancy
  • Social Support
  • Surveys and Questionnaires

Associated data

  • ISRCTN/ISRCTN03464021

Grants and funding

PRISM was funded by the following agencies: La Trobe University and the Victorian Department of Human Services with a Collaborative Industry grant 1997, the National Health and Medical Research Council with project grants in 1997 (ID 974083), 1999 (ID 990978) and 2001 (ID 191215), the Victorian Department of Human Services program implementation and data collection grants 1998–2000, the Victorian Health Promotion Foundation grants for program resources and implementation 1998–2000. We also received funding from the Alfred Felton Bequest in 1998, the Sidney Myer Fund in 1999, Beyondblue in 2002 and throughout the project received in-kind contributions from participating municipalities. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Funding body websites: La Trobe University: http://www.latrobe.edu.au/ National Health and Medical Research Council (NHMRC): http://www.nhmrc.gov.au/ Victorian Health Promotion Foundation: http://www.vichealth.vic.gov.au/ Victorian Department of Human Services, now Victorian Department of Health: http://www.health.vic.gov.au/ Beyondblue: http://www.beyondblue.org.au/ Sidney Myer Fund: http://www.myerfoundation.org.au/ Alfred Felton Bequest, managed by ANZ Trustees: http://www.anz.com/personal/private-bank-trustees/trustees/