Protocol for the effectiveness evaluation of the antenatal parenting programme “Baby Steps” on maternal outcomes: A Born in Broadford’s Better Start (BiBBS) study

Poor mental health during pregnancy and shortly after birth can have severe consequences for parents and children, requiring public health interventions to prevent psychological distress and achieve optimal health outcomes. However, there is little evidence of the effectiveness of such interventions, including a recent remote programme called “Baby Steps”, which aims to improve parental mental health and parent-infant bonding. A new evaluation was developed to assess “Baby Steps” through a quasi-experimental study. Its future results hope to interest researchers, families and decision-makers, as well as improve the assessment of future interventions.

Mental health problems during the antenatal period (during pregnancy) and the postnatal period (12 months after childbirth) can negatively affect mother–child bonding and the child’s cognitive, behavioural, and psychomotor development. Therefore, improving parental mental health is crucial for improving health outcomes for the whole family. Additionally, early parenting programmes that reduce psychological distress could potentially lessen the economic burden on society that suboptimal mental health and poor child health represent. However, systematic reviews and meta-analyses, which have summarised evidence about these interventions, have shown mixed results. It also remains unknown which specific groups of parents would benefit most from what kind of intervention.

The “Baby Steps” programme is a parenting programme developed by the UK’s National Society for Prevention of Cruelty to Children (NSPCC), which consists of nine remote relationship-based antenatal and postnatal educational sessions for parents. The programme’s goal is to improve parental mental health and maternal sensitivity, and its target group are vulnerable and socially excluded parents, who often face challenges and “overload” during those periods. While preliminary evidence of the programme from a qualitative study is encouraging, there is a need for a better and independent evaluation of “Baby Steps” to state its effectiveness confidently. This need motivated the development of a recent quasi-experimental study that evaluates the “Baby Steps” programme as delivered by the Better Start Bradford area by Action for Children (BiBBS) platform, an interventional family cohort platform.

The new evaluation consists of a women’s intervention group and a matched control group, which will be recruited from May 2022 onwards and is anticipated to end around late 2023. This study aims to assess whether the universally and remotely delivered “Baby Steps” programme is effective in improving postnatal maternal sensitivity (primary outcome) and postnatal maternal mental health (secondary outcome) when compared to services as usual 6–10 weeks post-birth. It will also assess whether the effects of “Baby Steps” on postnatal maternal sensitivity are mediated by postnatal maternal mental health. Lastly, the methodology of collecting cost and health-related-resource-use data for a future economic evaluation will be explored. All BiBBS mothers will complete outcome measures at 6-10 weeks after birth through phone or at a physical home visit. The questionnaires that are going to be used for the evaluation include the Patient Health Questionnaire-8 (PHQ-8), the Generalised Anxiety Disorder assessment-7 (GAD-7), and the Mothers Object Relations Scale-Short Form (MORS-SF). Service delivery costs and health resource use will be gathered from routine data. A graphical representation of the characteristics that will help to estimate the effect of Babys Steps on outcome can be found in the figure bellow (see Figure 1.)

Figure 1: Associations between characteristics, treatment exprosure, and primary outcome. As retreated on 13.03.2023 from: Mooney, K. E., Bywater, T., Dickerson, J., Richardson, G., Hou, B., Wright, J., & Blower, S. (2023). Protocol for the effectiveness evaluation of an antenatal, universally offered, and remotely delivered parenting programme ‘Baby Steps’ on maternal outcomes: a Born in Bradford’s Better Start (BiBBS) study. BMC public health, 23(1), 190.

As mentioned, the current study is nested within the BiBBS interventional family cohort study, primarily designed to examine the impact of interventions and services rather than conduct observational studies. Since 2016, BiBBS has worked in partnership with Better Start Bradford to engage the community and stakeholders, clarify the design of the interventions and monitor their implementation, harness routinely collected data, and develop toolkits and operational guides. The work from this partnership uses innovative study designs and methods to assess process outcomes, clinical outcomes, and cost evaluations, thus improving future interventions. Researchers from this evaluation hope that the future findings will be relevant for the scientific community, parents, service commissioners, and service staff, all essential parties for achieving optimal maternal and child care.

Paper available at: BMC Public Health

Full list of authors: Kate E. Mooney, Tracey Bywater, Josie Dickerson, Gerry Richardson, Bo Hou, John Wright, and Sarah Blower.

DIO: 10.1186/s12889-023-15111-1