ArticleBMC health services research2025
Working toward a stepped-care model of postnatal mental healthcare to improve access: the Theory of Change approach.
Article in BMC health services research, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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5 authors.
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Abstract
backgroundWomen who are pregnant or have recently given birth constitute a distinct life-stage-specific population with elevated risks for mental health problems and well understood risk and protective factors. Perinatal mental health remains a worldwide public health problem that requires local health service reform to improve access and meet need. The aim of this paper was to create a framework for a proposed model of postnatal mental healthcare and understand its application in existing health services in a rural area in Australia.
methodsThe Theory of Change (ToC) method was used in a three-step procedure: 1) document reviews 2) stakeholder consultations and 3) ToC workshops. A proposed model of postnatal mental healthcare was developed and its application in a local setting was investigated. The model was documented using a ToC framework.
resultsDrawing on evidence from policy documents, clinical practice guidelines, existing health systems, and practice expertise, a ToC for a proposed ‘stepped model of postnatal mental healthcare’ was developed. Stepped care is a complex intervention intended to deliver tailored care pathways according to severity of individual need. It links four interrelated components: primary prevention, secondary prevention, early intervention and treatment. In the ToC, evidence-based Rationales support each Pathway, and Assumptions describe external conditions that must be satisfied for successful implementation of each Pathway and the overall model.
conclusionsThe proposed stepped-care model is a valuable investigation of an integrated model of postnatal mental health service reform in a local service environment. The Assumptions generate testable hypotheses for future research to understand the conditions for successful implementation in this or other settings.
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