title: Inequity in provision of and access to health visiting postnatal depression services.
abstract: OBJECTIVE
  This paper is a report of a study of equity in the provision of a public health nursing postnatal depression service.
  
  
  BACKGROUND
  Postnatal depression is a global public health concern. Health visitors are nurses involved in the early detection and treatment of postnatal depression. However, research has revealed that all women are not assessed for postnatal depression particularly women in minority ethnic groups.
  
  
  METHODS
  A case study was conducted involving 21 observations of health visitors visiting postnatal women, interviews with 20 health visitors, 6 managers, 12 English women, 9 Bangladeshi women and 3 other personnel. Data were collected between 2003 and 2005 and analysis was completed in 2008.
  
  
  RESULTS
  The organization had a policy to create equitable postnatal depression services, but practitioners were not clear whether it was to be implemented, and it did not address the needs of a diverse population. All health visitors received specialized training and were consequently expected to assess and treat all women. The training based on the policy had not equipped health visitors with knowledge and skills to assess and treat women in minority ethnic groups.
  
  
  CONCLUSIONS
  While a policy was in place, equity in care was not achieved. An analysis of women's needs is recommended prior to policy development and policy implementation should be planned. To achieve equity, training should include knowledge and skills for cultural competency. Research is needed to illuminate the characteristics of equitable nursing services.
authors.affiliation: Anglia Ruskin University, Cambridge, UK. Palo.almond@anglia.ac.uk
authors.forename: Palo
authors.initials: P
authors.lastname: Almond
authors.forename: Judith
authors.initials: J
authors.lastname: Lathlean
mesh_terms: D000328:Adult; D001459:Bangladesh / Q000208:ethnology; D003152:Community Health Nursing / Q000458:organization & administration*; D054521:Cultural Competency; D019052:Depression, Postpartum / Q000175:diagnosis* / Q000208:ethnology / Q000451:nursing; D004739:England / Q000453:epidemiology; D005006:Ethnicity; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility / Q000458:organization & administration*; D054625:Healthcare Disparities; D006801:Humans; D008403:Mass Screening / Q000451:nursing*; D008875:Middle Aged; D008913:Minority Groups; D009723:Nurse-Patient Relations; D015399:Nursing Research; D057766:Policy; D011569:Psychiatric Status Rating Scales; D036301:Qualitative Research; D014504:Urban Health; D055815:Young Adult