BackgroundThe World Health Organization recently made a recommendation supporting ‘culturally-appropriate’ maternity care services to improve maternal and newborn health. This recommendation results, in part, from a systematic review we conducted, which showed that interventions to provide culturally-appropriate maternity care have largely improved women’s use of skilled maternity care. Factors relating to the implementation of these interventions can have implications for their success. This paper examines stakeholders’ perspectives and experiences of these interventions, and facilitators and barriers to implementation; and concludes with how they relate to the effects of the interventions on care-seeking outcomes.MethodsWe based our analysis on 15 papers included in the systematic review. To extract, collate and organise data on the context and conditions from each paper, we adapted the SURE (Supporting the Use of Research Evidence) framework that lists categories of factors that could influence implementation. We considered information from the background and discussion sections of papers included in the systematic review, as well as cost data and qualitative data when included.ResultsWomen’s and other stakeholders’ perspectives on the interventions were generally positive. Four key themes emerged in our analysis of facilitators and barriers to implementation. Firstly, interventions must consider broader economic, geographical and social factors that affect ethnic minority groups’ access to services, alongside providing culturally-appropriate care. Secondly, community participation is important in understanding problems with existing services and potential solutions from the community perspective, and in the development and implementation of interventions. Thirdly, respectful, person-centred care should be at the core of these interventions. Finally, cohesiveness is essential between the culturally-appropriate service and other health care providers encountered by women and their families along the continuum of care through pregnancy until after birth.ConclusionSeveral important factors should be considered and addressed when implementing interventions to provide culturally-appropriate care. These factors reflect more general goals on the international agenda of improving access to skilled maternity care; providing high-quality, respectful care; and community participation.

This study systematically maps, assesses and aggregates research relating to postnatal depression (PND) and poverty in low and lower middle income countries (LLMICs). Our search of 12 databases yielded 2,202 articles, of which 47 items from 17 countries were included in our mapping. We highlight mechanisms for the relationships between poverty and PND in LLMICs. The research base on the relationships between poverty and PND in LLMIC is limited, but has recently expanded. It is dominated by studies that consider whether poverty is a risk factor for PND. Income, socio-economic status and education are all inconsistent risk factors for PND. Clues to better ways of framing and capturing economic stress in PND research is found in the qualitative studies included in our mapping. Evidence focuses overwhelmingly on individual-level analyses. To understand the scale and implications of PND in LLMICs, research has to take account of neighbourhoods, communities, and localities.

BackgroundA vast body of global research shows that cultural factors affect the use of skilled maternity care services in diverse contexts. While interventions have sought to address this issue, the literature on these efforts has not been synthesised. This paper presents a systematic mapping of interventions that have been implemented to address cultural factors that affect women's use of skilled maternity care. It identifies and develops a map of the literature; describes the range of interventions, types of literature and study designs; and identifies knowledge gaps.Methods and FindingsSearches conducted systematically in ten electronic databases and two websites for literature published between 01/01/1990 and 28/02/2013 were combined with expert-recommended references. Potentially eligible literature included journal articles and grey literature published in English, French or Spanish. Items were screened against inclusion and exclusion criteria, yielding 96 items in the final map. Data extracted from the full text documents are presented in tables and a narrative synthesis. The results show that a diverse range of interventions has been implemented in 35 countries to address cultural factors that affect the use of skilled maternity care. Items are classified as follows: (1) service delivery models; (2) service provider interventions; (3) health education interventions; (4) participatory approaches; and (5) mental health interventions.ConclusionsThe map provides a rich source of information on interventions attempted in diverse settings that might have relevance elsewhere. A range of literature was identified, from narrative descriptions of interventions to studies using randomised controlled trials to evaluate impact. Only 23 items describe studies that aim to measure intervention impact through the use of experimental or observational-analytic designs. Based on the findings, we identify avenues for further research in order to better document and measure the impact of interventions to address cultural factors that affect use of skilled maternity care.

The role of social support in promoting recovery from chronic illness has been the focus of a debate within the nursing and social science research communities. This paper reviews the literature on this important issue and discusses the implications for patient management. In providing holistic patient care, health care professionals need to reflect on the impact of this research for their clinical practice.

LSE has developed LSE Research Online so that users may access research output of the School. Copyright © and Moral Rights for the papers on this site are retained by the individual authors and/or other copyright owners. Users may download and/or print one copy of any article(s) in LSE Research Online to facilitate their private study or for non-commercial research. You may not engage in further distribution of the material or use it for any profit-making activities or any commercial gain. You may freely distribute the URL (http://eprints.lse.ac.uk) of the LSE Research Online website.This document is the author's final accepted version of the journal article. There may be differences between this version and the published version. You are advised to consult the publisher's version if you wish to cite from it. IntroductionPostpartum depression is a mild mental and behavioural disorder associated with the puerperium commencing within 6 weeks of delivery (World Health Organization, 2010). It is a global public health concern because of its adverse effects on the mother, infant and close others (Almond, 2009;Fisher, Cabral de Mello, Izutsu, & Tran, 2011). Historically, it was hypothesised that postpartum depression was largely absent in 'nonwestern' contexts due to greater social support during the postpartum period (Stern & Kruckman, 1983). Postpartum depression prevalence of around 13% is estimated for North American and western European contexts (Affonso, De, Horowitz, & Mayberry, 2000;O'Hara & Swain, 1996), but recent estimates suggest a much higher prevalence in South Asia, up to 36% in Pakistan (Gausia, Fisher, Ali, & Oosthuizen, 2009;Husain et al., 2006;Savarimuthu et al., 2010) Evidence for the aetiological contribution of psyco-social factors to postpartum depression is greater than that for biological factors, with chronic social adversity in women playing a substantial role (Fisher, et al., 2011;Robertson, Celasun, & Stewart, 2003). Systematic reviews consistently highlight an association between postpartum depression and aspects of social relationships, such as low social support or low quality marital relationship (Beck, 2001;O'Hara & Swain, 1996;Robertson, et al., 2003). This is supported by a large body of literature linking social relationships with a range of physical and mental health outcomes more generally (Cohen, Gottlieb, & Underwood, 2000). Social relationships may affect cognitions, emotions, behaviours and biological responses in a manner which has implications for health, either directly ('main effects' hypothesis) or indirectly by influencing affective reactions to situations ('stress buffering' hypothesis) .'Social relationships' are a complex and multi-dimensional concept. The literature focuses on 'social support', defined as the exchange of social resources between persons (Cohen & Syme, 1985). Support has structural dimensions, such as the size and range of the support network, as well as functional dimensions, such as the type, source and quality of support (House & Khan, 1985). Su...