title: Randomised controlled trial of training health visitors to identify and help couples with relationship problems following a birth.
abstract: BACKGROUND
  Stresses imposed by parenthood can provoke or intensify relationship problems between parents. These problems, which are often associated with postnatal depression, can have serious consequences for family well-being but are often not revealed to primary health care personnel.
  
  
  OBJECTIVE
  To evaluate a means of extending the primary health care team's ability to identify and respond to relationship problems of mothers and their partners in the postnatal period.
  
  
  METHODS
  Cluster randomised controlled trial.
  
  
  METHODS
  Specially trained health visitors in nine 'intervention' clinics--each matched with a 'control' clinic' in an outer London borough.
  
  
  METHODS
  Health visitors in intervention clinics invited mothers attending for the six-to-eight-week developmental check to complete a screening scale for relationship problems, and offered help (supportive listening, advice, or referral) if needed. When visiting the clinic for the 12-week immunizations, mothers from all clinics were asked to complete a follow-up self-report questionnaire. After the completion of the trial, 25 women who had attended the intervention clinics and had been offered support with a relationship problem were interviewed to elicit their views on the acceptability and value of the intervention. All 25 of the health visitors engaged in the intervention were asked to complete a questionnaire on their experience.
  
  
  RESULTS
  Screening led to striking differences between intervention and control clinics in the percentage of women identified at the six-to-eight-week check as potentially in need of help with a relationship problem (21% versus 5%, P = 0.007) and in the percentage actually offered help (18% versus 3%, P = 0.014). About one-half of the mothers so identified were also identified as having postnatal depression. At the 12-week visit for immunizations, the intervention group was twice as likely (P = 0.006) as the control group to report having discussed relationship problems with the health visitor and 75% more likely (P = 0.046) to report having received help with a problem.
  
  
  CONCLUSIONS
  The intervention offers a useful way of extending the primary health care team's ability to respond to problems that often have serious consequences for family well-being.
authors.affiliation: One Plus One Marriage & Partnership Research, London. John.Simons@lshtm.ac.uk
authors.forename: J
authors.initials: J
authors.lastname: Simons
authors.forename: J
authors.initials: J
authors.lastname: Reynolds
authors.forename: L
authors.initials: L
authors.lastname: Morison
mesh_terms: D000293:Adolescent; D000328:Adult; D002983:Clinical Competence; D003152:Community Health Nursing / Q000193:education* / Q000592:standards; D003162:Competency-Based Education; D019052:Depression, Postpartum / Q000451:nursing* / Q000517:prevention & control; D005195:Family Relations; D005260:Female; D006801:Humans; D008131:London; D008393:Marriage / Q000523:psychology; D010348:Patient Care Team; D011181:Postnatal Care / Q000379:methods*; D011340:Problem Solving