In the north-western corner of Australia, health professionals and Aboriginal pregnant women and new mums are forging stronger relationships and coming to a deeper understanding of each other. This very remote expanse of country is proving to be fertile ground for innovation, with a mental health screening tool having unexpected added benefits for Aboriginal communities.
The Kimberley Mum’s Mood Scale (KMMS) was developed to identify depression and anxiety during pregnancy and in the first year after mothers give birth. Kimberley health services had been using a different perinatal mental health screening process for more than five years, but research and experience revealed that uptake was limited among Aboriginal women.
Aboriginal and Torres Strait Islander peoples are more likely than the wider community to experience high levels of psychological distress, including feelings of depression and anxiety, according to the Australian Bureau of Statistics.
For health professionals working in the Kimberley, the early identification and management of perinatal mental health issues for Aboriginal women is absolutely critical. Their work helps address the burden of mental health issues among women having children, which should improve the wellbeing of the next generation of Aboriginal children.
The research team set the goal of developing a culturally appropriate tool that enabled a safe space for Aboriginal women to talk. The first part of the tool is modelled on the Edinburgh Postnatal Depression Scale, which Kimberley health services had used previously.
“There were problems with using the Edinburgh Postnatal Depression Scale with Aboriginal women,” Julia Marley, who is the Principal Research Fellow at the Rural Clinical School of Western Australia, says. “The language that was being used was not appropriate, so Kimberley health professionals went about designing and developing a new tool with more than 100 Kimberley Aboriginal women.”
The first part of the tool has 10 questions and features images, such as smiling faces and frowns, which women use to indicate their how they feel about the question. “This part of the tool is focused on feelings rather than numbers,” Julia says.
The second part of the KMMS is a psychosocial tool that incorporates key elements identified by Kimberley Aboriginal women. “The guided questions in Part Two allow clinicians to structure the discussion in a way that women feel safe and enables the score from Part One to be put into context,” Julia says. As well as being a valuable part of a mental health screening process, the KMMS has had the inadvertent effect of being useful as a social tool.
“We discovered women wanted a safe space where they are able to talk about things that were important to them,” she says. “They wanted to talk not just about the negative, but also about what is working. The nurses were commenting after using the KMMS that they didn’t realise what some of their patients were going through and the information they received would change their health management plans. The process of doing the KMMS with the women has opened up the eyes of clinicians and provided valuable insights into their patients’ lived experiences and social, emotional and cultural wellbeing.”
Health professionals and women work together to complete the KMMS. The process can take between 30 to 60 minutes, depending on how much each woman would like to talk. The safe environment the tool helps to create and the rapport built between the health professionals and the women lasts after the interview has finished.
“Women in the study felt they were still able to open up after the discussion,” Julia says. “Some women came back the next day and said, ‘there was something I forgot to tell you’. Another thing that happened across the Kimberley was that the women in each town would go back and tell their relatives and friends to participate because it was so useful.”
The next step will be to explore if the tool is valid to use in other regions. “For Far North Queensland, that might be looking at changing the words or prompts,” Julia says.
Being able to see how the community benefits from her research is what drives Julia to continue working in such a remote part of the world. Julia completed a Master of Public Health at James Cook University, where she was awarded the Sidney Sax medal for best overall performance in the course. The globetrotting academic undertook laboratory research in Cambridge and Edinburgh after completing a PhD through The University of Western Australia. She returned to Perth and completed a Postgraduate Diploma in Policy Studies, which is where she started working on research relating to Aboriginal communities. A job offer lured her to Broome, which she has called home for the past 10 years. Julia is involved in 12 other Aboriginal health research projects, meaning the remote oasis will be her base for a while yet.
“Trying to establish yourself is really difficult in Western Australia,” she says. “Up in Broome, I have had to work out a lot of things out for myself. There are more challenges with it being remote, but the benefits are definitely there, too. I get to see change happening here.”
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