Figure 1
Conceptual Framework of Maternal Depression, Stress and Context [17].
Figure 2
Summary of Research Programme.
Figure 3
Research Map [31].
Figure 4
Theorised Contextual conditions.
Figure 5
Summary of Consultation Forum.
Table 1
Design Elements.
| Design Component | Business Case | Child and Family Health Planning Priorities |
|---|---|---|
| Sustained Home Visiting (SHV) |
|
|
| Family and Community Integrated Service Development (FCISD) |
|
|
| Infrastructure Support (IS) |
|
|
[i] Note: SHV – Sustained Home Visiting; FCISD – Family and Community Integrated Service Development; IS – Infrastructure Support.
Table 2
CIMO Propositions.
| Theorised Contextual Conditions (Figure 2)[C] | Present contextual mechanisms activated [CM] | Proposed Intervention Design Elements (Table 1)[I] | Postulated Intervention Programme Mechanisms(Table 1)[MP] | Postulated psychological, motivational and behavioural Outcomes [O] |
|---|---|---|---|---|
| Self – Self-identity and individuals experience | ||||
| Lack of partner and family support, Distrust of services, Limited treatment access | Stress mechanism activated causing anxiety and depression | Friendship and family support, Professional support, Medication, Treatment | Activate mediating mechanisms of family, peer and professional support to strengthen and build trusting relationships with peers, family and clinicians through SHV and FCISD Design Components. | Decreased depression and anxiety |
| Lifetime trauma, Loss, Being alone, Isolation | Stress mechanism activated arising from mismatched expectations, and loneliness | Family and peer support, Home visiting, Telephone support | Increased perceived support | |
| Situated Activity – Face to Face activity | ||||
| Services unavailable or poor access, Services not trusted, Services not skilled | Absence of trusted professional support mechanism | “wrap around” services, Family Conferences, Workforce training | Activate services mechanisms that are client, peer and neighbourhood focused, and trauma and evidence informed through FCISD and IS Design Components. | Improved perceived access to skilled and trusted services |
| Community distrust, Low social capital and cohesion, crime, unemployment | Absence of trusted neighbourhood and community support mechanism | “wrap around” services, Family Conferences, Public health, Social work services | Improved perceived support from neighbours and community | |
| Intermediate Level social and service organisation | ||||
| Unhelpful intake and referral practices, Lack of service, knowledge and trust | Absence of specialist service support mechanism for front-line professionals | Strengthened pathways and design Collocation of services | Activate mechanisms related to trust and confidence with service network, increased local social capital, community trust and community safety Activate mechanisms relating to improved coordination and access to services and information through FCISD and IS Design Components. | Improved perceived access to services that are “wrapped” around front-line workers |
| Weak social networks, community trust, community safety, available social services, access to information | Social level stress mechanisms relating to class, position, racism, segregation, crime and neighbourhood decay are activated tending to increase psychological stress | Population and community level interventions in neighbourhoods and communities | Decrease in psychological stress of individuals and families | |
| Macro Level social and service organisation | ||||
| Migration, Mega-malls pull service activity away from neighbourhoods, Urban development | Activation of social level stress mechanisms tend to hinder the activation of social level buffer mechanisms | Population and community level interventions in neighbourhoods and communities | Activate mechanisms related to increased social level activities in deprived neighbourhoods. Activate mechanisms related to increased migrant related social activities among ethnic populations through FCISD and IS Design Components. | Increase in perceived social level buffers |
| Immigration policy, Racism, Media policy, Global market, Settlement patterns, Ethnic bonding networks, Access to services | Migrant related social level mechanisms including acculturation, cultural practices and integration tend to decrease social level stress | Ethnic and cultural specific community and population level interventions | Increase in perceived migrant social level buffers | |
Figure 6
ToC Logic Model.