Implementing the Maternal Postnatal Attachment Scale (MPAS) in universal services: Qualitative interviews with health visitors

Wellcome Open Res. 2023 Jan 6:7:85. doi: 10.12688/wellcomeopenres.17551.2. eCollection 2022.

Abstract

Background: A secure parent-infant relationship lays the foundations for children's development, however there are currently no measurement tools recommended for clinical practice. We evaluated the clinical utility of a structured assessment of the parent-infant relationship (the Maternal Postnatal Attachment Scale, MPAS) in a deprived, multi-ethnic urban community in England. This paper answers the question: what are health visitors' views on the parent-infant relationship, and experiences of piloting the MPAS? It explores the barriers and facilitators to implementation, and complements the paper on psychometric properties and representativeness reported in Dunn et al (2022). Methods: Semi-structured interviews were conducted with 11 health visitors and data were analysed using thematic analysis. Results: Health visitors saw identification and support of the parent-infant relationship as an important part of their role, and reported benefits of the MPAS, including opening conversation and identifying and reporting concerns. Challenges included timing and workload, the appropriateness of language, perceived intrusiveness and understanding of the questions, and the length of the tool. Suggestions for improvements to the tool were put forward. Conclusions: The experiences, benefits and challenges identified help to explain results in Dunn et al, and the wide-ranging challenges identified would hinder assessment of the parent-infant relationship in routine practice. Further work with health professionals and parents has been undertaken to co-produce an acceptable, feasible and reliable tool for clinical practice.

Keywords: attachment; child development; infant mental health; mother-infant dyad; parent-infant relationship; qualitative.

Grants and funding

This work was supported by the Wellcome Trust through a Biomedical Resources Grant to the Born in Bradford Study [101597, https://doi.org/10.35802/101597]. This study has received funding through a peer review process from the National Lottery Community Fund as part of the A Better Start programme. Authors PKB, ZH, AD, JD and TB were also supported by the NIHR CLAHRC Yorkshire and Humber (www.clahrc-yh.nihr.ac.uk). JD and TB were supported by the NIHR ARC Yorkshire and Humber (https://www.arc-yh.nihr.ac.uk/).