Discussion
SECONDARY, RECRUITMENT, ROBINSON
This study explored whether it is feasible to conduct a randomised trial examining whether sling use and support impacts upon maternal mental health and wellbeing (including variables such as parental self-efficacy, perceived social support and rates of secure mother-infant attachment). This study aimed to support the design of a future RCT through the assessment of feasibility indicators (recruitment, attrition), acceptability of the intervention, and preliminary effectiveness data. Both eligibility and consent rates (96% and 77%, respectively) were found to meet this study’s feasibility objectives, indicating that mothers of newborns are able and willing to participate in a sling and sling support intervention trial. While this study’s consent rate is similar to rates seen in feasibility studies of other close body contact interventions, such Kangaroo Mother Care [The majority of participants completed measures at all three timepoints across 12 weeks, however, attrition was higher than 15%. This rate is comparable to that seen in Neu and Robinson’s study [By their nature, effectiveness testing is not the primary aim of a feasibility studies and is not recommended given small sample sizes; however preliminary effectiveness analyses are acceptable as a secondary aim [Preliminary effectiveness analyses found a significant effect of the sling and support intervention upon parental self-efficacy scores, such that participants in the intervention group showed significant improvement in these scores in comparison to control group participants. No other statistical analyses found a significant effect of intervention group. However, this small feasibility study was not designed to detect between-group differences, and effectiveness analyses are unlikely to be reliable [This contrast between the quantitative and qualitative results may simply reflect that the study was not powered to detect the effects of the sling and support intervention upon outcome measure scores [Moreover, generally participants’ scores on the EPDS were low, with average scores for T1, T2 and T3 all below the clinical cut-off for this measure. Given the sample for this study was a non-clinical population of mothers who elected to participate, it may be that the sampling method employed produced a floor effect, whereby it was not possible to evidence significant change in EPDS scores over time or according to condition, as they were already low to begin with. The limitations of the volunteer sampling method employed are discussed further in the “Limitations and Recommendations” section below, and recommendations are made for a future, larger-scale RCT to employ alternative methods.There were no difficulties found regarding engaging mothers in the intervention group with the sling and support intervention. This is in contrast to Bigelow and Power’s study of the impact of SSC upon mother-infant interaction, in which 33% of participants in a skin-to-skin contact intervention condition were excluded from the study due to poor treatment adherence [The majority of participants appear to have found the sling and support intervention, and the study as whole, acceptable. Participants appeared to value contributing to research in this area, and also the apparent benefits of the sling for their baby (e.g. being easier to soothe, sleeping more) or for themselves (increased autonomy, feeling closer to their baby and less anxious as a parent, meeting other parents). A number of participants wished for greater one-to-one sling library input as part of the intervention, with some describing the drop-in session as busy or rushed.In terms of the outcome measures, a number of participants appeared to view completing the measures as a valuable opportunity to reflect on their mental health and their relationship with their child. A small minority found completing the measures distressing, confusing or onerous. It seems likely that the process of gaining feedback regarding possible outcome measure batteries from a service user involvement group contributed to the acceptability of these measures within this study [Overall the majority of participants reported positive feelings regarding their participation in the study, using a sling, or accessing sling library services, with very few mothers describing participation as onerous or distressing. However it must be noted that this feedback is gained exclusively from participants who completed the study with minimal information collected from those that discontinued participation. Nevertheless, this study indicates that sling use with support may be viewed by mothers as an acceptable psychosocial intervention for mood or wellbeing following birth, should future studies establish a significant positive impact of sling use and support upon maternal mental health.