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Student Number
Unit Code NUR 237
Unit name Evidence-Based Nursing Practice
Semester and year
Assignment name Assignment 1 Literacy Search
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2
Table of Contents
Introduction ……………………………………………………………………………………………………………………………… 1
Purpose Statement …………………………………………………………………………………………………………….. 2
PICOT Question ……………………………………………………………………………………………………………….. 2
Method ……………………………………………………………………………………………………………………………………… 2
Search Strategy ………………………………………………………………………………………………………………… 2
Search Terms …………………………………………………………………………………………………………………… 2
Inclusion and Exclusion Criteria …………………………………………………………………………………………. 3
Search Results ………………………………………………………………………………………………………………….. 3
Selection of Final Articles …………………………………………………………………………………………………. 3
Critical Appraisal …………………………………………………………………………………………………………………….. 4
Discussion …………………………………………………………………………………………………………………………………. 6
References ………………………………………………………………………………………………………………………………… 7
Appendix 1 ……………………………………………………………………………………………………………………………….. 9
1
NUR237 Assignment 1 Part 2 (1617 words)
Postpartum Depression among Immigrant Women in Western Culture
Introduction
Pregnancy can be difficult for mothers, as there is an increased risk of re-experiencing
or developing a mental illness, most commonly depression (Patabendige et al., 2020). The
State Government of Victoria (2022) reported that approximately 80% of women get
experienced mood swings, such as feeling sad, empty, or anxious. These mood changes, often
described as baby blues, can start during pregnancy and between day three and day ten after
childbirth (2022). According to Perinatal Anxiety and Depression Australia PANDA,
if the depressive symptoms are prolonged for more than two weeks, it indicates a more severe
mental condition known as postpartum depression. Postpartum depression is considered a
severe mental illness that involves the brain and interferes with mood and behaviors to
function with regular daily activities or to keep up with daily routines with infant care (n.d.).
While the prevalence rates vary among countries, 6.9% to almost 20% of women experience
postpartum depression (Stewart & Vigod, 2019). Recent research has found that mental
disorders during pregnancy and the postpartum period can potentially affect the mother’s
health and the child’s development (Cook et al., 2018; Hoffman et al., 2017). Moreover, 20%
of women with postpartum depression experience symptoms of suicidal thoughts and a desire
to harm their children (Wisner et al., 2013).
World Migration Report 2022 states that immigrant populations gradually comprise
women, often of their motherhood age (McAuliffe & Triandafyllidou, 2021). This trend has
attracted the interest of health authorities and researchers in some Westernised countries such
as the U.S., Canada, Australia, and Europe to promote culturally safe maternity services and
to explore the imperative of understanding the mental health among immigrant women,
particularly in the perinatal period (Arshad et al., 2021; Moore et al., 2019; Urindwanayo,
2018; Yu et al., 2019). Despite an endeavor to enhance maternity services, it has been shown
that immigrant women in Western culture have poorer postnatal mental health compared to
those women who were born in their home countries (Navodani et al., 2019). A recent study
illustrates that immigrant women are at twice the higher risk of postpartum depression than
non-immigrant women, at a rate of 42% (Falah-Hassani et al., 2015; Fellmeth et al., 2017).
Factors such as lack of social support, minority ethnicity, low socioeconomic status, and
limited language proficiency expose immigrant women to a high risk of developing
postpartum depression (Anderson et al., 2017). With those factors and barriers, immigrant
women are less likely to receive care that meets their needs (Ganann et al., 2020). Moreover,
those with depression often do not access primary healthcare services or community supports
due to limited culturally safe and appropriate care (Ahmed et al., 2017).
Considering factors that are believed to be associated with Amy’s situation, it is
recognised that by understanding the unique experience of immigrant women with
postpartum depression, the appropriate care or support for Amy could be delivered; therefore,
her recovery would accelerate. Factors include immigrant women with different cultural
backgrounds, lack of language efficiency, and limited social support. Although the cause of
postpartum depression is currently unknown, it has been shown that social life stressors play
a role in the development of postpartum depression (O’Hara & McCabe, 2013). There are
various studies on the risk of postpartum depression in migrant women or the effect of
current treatment and maternity services (Dennis et al., 2017; Schytt et al., 2020). However,
only limited studies have explored the meaning of the experience of postpartum depression
2
for immigrant women in Western culture, which cannot be easily put into numbers.
Therefore, a better understanding of immigrant women’s opinions or feelings based on their
experience of postnatal depressive symptoms is highly suggested. It can extend knowledge
and understanding, eventually providing practical strategies to address barriers and promote
improved mental health among immigrant women (Cleland, 2017).
Purpose Statement
The clinical question aims to explore how migrant women describe their unique
experience with postpartum depressive symptoms during pregnancy or the postpartum period
to gain a deeper understanding and knowledge of their experience. Therefore, the following
clinical question is formed via the PI(C)O(T) method to elaborate a focused, answerable
question with relevant keywords.
PICOT Question
What is it like for immigrant women in Western culture (P) to experience (O)
postpartum depression (I)?
The type of PICOT question is a meaning question. It is best answered with evidence
from qualitative studies, which help understand the experiences and feelings of immigrant
women in Western culture (P) in all complexity and natural settings.
Method
Search Strategy
The initial search process was started by identifying keywords and search terms
through database searching, such as CINAHL and MEDLINE (Ovid). Search results were
exported to Endnote to remove all duplicates before scanning titles. The abstract of the
sources was skimmed, and then articles were assessed against pre-established inclusion and
exclusion criteria. Afterwards, those collected articles to be believed relevant were read in
full to identify if the source contents addressed the clinical question. In the meantime, any
sources that used irrelevant study designs to answer the clinical question were excluded.
CINAHL and MEDLINE (Ovid) were mainly used as they provided peer-reviewed
journals in high-level subject fields, particularly in health sciences, medicine, and nursing.
They feature an advanced search tool to enable search strategies to be applied. Article
searches conducted on CINAHL were limited to the language of English and peer-reviewed
sources published last ten years. Article searches on MEDLINE (Ovid) used modified
parameters, limited to the recent five years for more current data, and additional limiters,
including nursing and qualitative studies. International Organization for Migration and
Google Scholar were used to search grey literature to address the clinical question with
detailed current data.
Search Terms
Search terms were developed by identifying keywords in the PIO question, immigrant
women in Western culture, postpartum depression, and experience. A list of synonyms and
differences in spelling for each keyword were deliberated. Boolean operator AND was
applied during literacy searches to confine the search and operator OR to expand it.
Moreover, phrase searching, nest operator, truncation, and wildcard allowed more specific
research and excluded irrelevant sources. Search terms used and how these additional search
strategies were used are presented in Table 1.
3
Inclusion and Exclusion Criteria
For inclusion criteria, sources were required to demonstrate experiences of
postpartum depressive symptoms among immigrant women in Western culture. Therefore,
qualitative study design or qualitative research was included. Studies on immigrant women in
irrelevant countries, such as Jordan and Thailand, were excluded. Also, articles discussing the
effects of current perinatal mental health screening tools, such as the Edinburgh Postnatal
Depression Scale and the consequences of doula support, were eliminated, as they were not
relevant studies to answer the clinical questions. Qualitative studies focused on groups other
than immigrant women in Western cultures, such as healthcare workers and immigrant
fathers, were omitted.
Search Results
As a result of the search process, twenty articles that were specific to answer the
clinical question and those that met the criteria were added to the separate library group in
Endnote. Table 1 below illustrates the databases and search terms used and the number of
articles retrieved and included to address the clinical question.
Table 1
Results of Literature Search for PIO Question
Items Findings Findings
Databases CINAHL MEDLINE (Ovid)
Search terms Immigrant women OR
migrant women OR migrant
mother OR migrant female
OR immigrant female AND
Western culture OR
Westernised country OR
Westernized country OR US
OR America* OR Canada
OR Australia* OR UK AND
postpartum depression OR
postnatal depression OR ppd
OR pnd AND experience*
OR percept* OR attitude*
OR view* OR feel* OR
qualitative OR perspective
(Immigrant women OR
migrant women OR migrant
mother OR migrant female
OR immigrant female) AND
(Western culture OR
Westernised country OR
Westernized country OR US
OR America* OR Canada
OR Australia* OR UK)
AND (postpartum
depression OR postnatal
depression OR ppd OR pnd)
AND (experience* OR
percept* OR attitude* OR
view* OR feel* OR
qualitative OR perspective)
Number retrieved 11 9
Number included 1 1
Selection of Final Articles
The first source selected is a qualitative, interpretive descriptive study by Ganann et
al. (2020). This study was chosen because it is current and the most appropriate for
addressing the meaning PICOT question. Although its evidence level was less strong than
other study designs, such as RCT, it may give voice to mental health issues that could be
overlooked among immigrant women. Furthermore, it provided a deep understanding of the
issues and built relationships, causes, risks, and effects to provide rich data. The data was
collected through phenomenological interviews, which shows congruity between the
methodology and data collection. Having the finding thematically analysed based on a socio4
ecological framework, the results of this study provided in-depth information. An appropriate
body ethically approved this study.
The second source selected is a qualitative study by Yu and Bowers (2020). This
study was chosen because it is current and apposite to address the meaning PICOT question.
Moreover, the study aimed to identify experiences of postpartum depression for immigrant
women, which was highly related to the clinical question. Using grounded theory
methodology, it examined the topic effectively and accurately to answer the questions. In
addition, the study emphasised its systemic data analysis by coding, which provided patterns
and connections within and between categories. Research strategies such as using a research
team, writing notes, and member-checking were used to ensure the rigor and trustworthiness
of the results.
NUR237 Assignment 2 Equivalent to 1000 words +/- 10%
Critical Appraisal
The Critical Appraisal Skills Programme, CASP, was used as a critical appraisal tool
to make sense of scientific evidence. The CASP checklist for qualitative research was
selected to appraise two selected research articles. Three broad issues were considered during
the critical appraisal: Are the study results valid? What are the consequences? Will the result
help locally? According to the CASP qualitative research checklist, the first study (Ganann et
al., 2020) replied yes to ten questions; it received 100 per cent on the list, indicating a highquality
publication. The second research paper (Yu & Bowers, 2020) also acquired 100 per
cent on the checklist by replying yes to ten questions. Thus, it can be considered that the
second paper selected is a high-quality publication. Table 1 illustrates the critical appraisal
results of two articles with more detailed information such as data collection, analysis, and
key findings.
5
Table 1
CASP Critical Appraisal Evaluation Results
Author
(year)
Country
Study
Design
Purpose Sampling &
Sites
Data Collection/ Analysis Key Findings Quality
Appraisal
Ganann
et al.
(2020),
Canada
Qualitative /
An
interpretive
descriptive
study
To explore
contributing
factors to
PPD, health
service
accessibility,
and the role
of health
services that
immigrant
women
perceive
Eleven
immigrant
women aged
20-49 living in
Scarborough,
Canada,
participated.
The study was
conducted in
Scarborough,
Ontario,
Canada.
Individual in-depth face-to-face
interviews with open-ended
questions were conducted.
A semi-structured interview guide
was developed by using a socioecological
framework.
Demographic questionnaire before
the interviews.
Interviews were digitally recorded,
transcribed verbatim, and checked
for accuracy.
Inductive thematic content analysis
Immigrant women had mental,
physical, and social difficulties
while experiencing PPD.
Immigrant women found public
health services the most helpful
when providers acknowledge their
concerns, allow them to build
trust, provide culturally safe care,
and help with navigating services.
Immigrant women felt very
relieved when building a
relationship with mental
healthcare providers.
Included
(10/10)
Yu and
Bowers
(2020),
U.S.
Qualitative/
Grounded
theory
methodolog
y
To generate a
conceptual
model for
illustrating
how
immigrant
women
experience
and respond
to postpartum
distress
22 Chinese
immigrant
women who
were foreignborn
and
experienced
PPD
participated.
The study was
conducted in a
mid-Western
U.S. city.
The initial interview questions were
general and nondirective; the new
questions were focused in response
to the evolving conceptual model
and driven by theoretical sampling.
Apart from two interviews
conducted via phone and online
messaging, all others were recorded
and transcribed verbatim.
Demographic questionnaires were
collected after the interview.
In vivo coding in a line-by-line
analysis
Chinese immigrant women
encountered losses that
significantly impacted their
psychological selves.
Although some women remain
broken selves, Chinese immigrant
women were trying to rediscover
unbroken selves.
The conceptual model revealed
that making sense of losses and
enabling and blocking conditions
to reduce distress is essential.
Included
(10/10)
6
Discussion
The appraised articles illustrated how immigrant women in Western culture
experienced and perceived postpartum depression (PPD) by conducting a qualitative study,
which showed applicability to answer the PICOT question. The core findings can be
categorized into four themes: PPD challenges, relationships with family, lack of knowledge,
and health provider – patient’s relationships.
PPD challenges include mental and physical health issues associated with PPD, such
as emotional difficulty, low self-esteem, hopelessness, and lack of sleep. For example, a
Bengali woman said, “I’m crying again. I am frustrated” (Ganann et al., 2020, p. 89). It is
also seen that immigrant women experienced suicidal thoughts, “I felt that I was crumbled …
I was thinking about suicide every day” (Yu & Bowers, 2020, p.1451). Physical concern was
described as “I felt that I was not all presentable, felt that my body was not in a good shape,
not attractive at all” (Yu & Bowers, 2020, p. 1449).
Relationships with family included conflict in cultural beliefs and lack of support. For
example, one participant explained, “My children are completely westernized, parents are
completely Chinese. I am “half and half.” It is very difficult to satisfy both side in
communication” (Yu & Bowers, 2020, p. 1449). Moreover, those with extended family in
Canada felt that their family created pressure rather than help reduce distress. For example,
another Bengali woman said, “I have in-laws here but they’re not so helpful … they come to
visit me for sure but they don’t help … it makes me so frustrated” (Ganann et al., 2020, p.
91).
Lack of knowledge was highly related to the accessibility to health care systems. For
example, one Chinese mother explained that many immigrant women do not know where to
go for support, saying, “How to get information or help when they are sick. This is very
important” (Ganann et al., 2020, p.91). However, those who were aware of services felt able
to access care. For instance, one Colombian woman stated, “I asked for it at the hospital
because I know that you have to ask because with [daughter] I did not have a [PHN]”
(Ganann et al., 2020, p. 91).
Immigrant women felt much less stressed when they were able to build a relationship
with the healthcare provider and when they acknowledged their concerns. For example, One
Filipino woman said, “Since [PHN] came here I felt like oh there’s somebody I can lean on
and there’s somebody that can help me … So soon after [PHN] came here I felt relief”
(Ganann et al., 2020, p. 92). According to Ganann et al. (2020), one Bengali mother stated,
“Time and trust is most important. If you rush, I can’t tell like this” (p. 92).
Findings from appraised articles can be applied to guide clinical practice. For
example, they highlight the need for mental health practitioners to allow good quality time to
build a trustworthiness relationship to provide more effective care to immigrant women with
PPD. Moreover, providing culturally safe and effective patient education on PPD and
available healthcare services will make them feel heard and cared for. For example, they
include reassuring the patient understands the information given, involving family members
in the programme, and offering language support, such as interpreters or broachers written in
their languages. These findings can also implicate public health policy development to
address perinatal mental health issues among immigrant women.
7
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9
Appendix 1
