The co-creation and feasibility of a Health Visitor-led intervention, combining group exercise and behavioural activation approaches, which can be tailored for mothers at risk of postnatal depression

Background: Post-natal depression is experienced by 12% of women, leading to a high risk of self-harm and suicide, adverse developmental outcomes for children and costing the NHS £8.1 billion a year. Currently women with more severe symptoms are prioritised for treatment due to under-resourcing of mental health services. A gap in service provision for mothers at risk of, or with early stage post-natal depression exists. Health Visitors are uniquely placed to deliver interventions to these women. Physical activity is known to prevent and treat postnatal depression. Emerging evidence suggests behavioural activation, which helps individuals to re-engage with meaningful activity and reduce avoidance behaviours that exacerbate depressive symptoms, improves post-natal depression symptoms and can be delivered in a group setting. Combining group exercise with behavioural activation in a tailored intervention which can be flexibly implemented by Health Visitors provides a potential solution to address this issue. Aims: This study aims to co-create a mental health intervention, combining group exercise and behavioural activation techniques, which health visitors can implement according to the needs of mothers with less severe post-natal depression. Design: The study includes three phases: 1) evidence synthesis; 2) combine intervention; and 3) feasibility. Methods: Phase 1 (evidence synthesis) will include stakeholder and public engagement; a realist synthesis of evidence relating to theory, intervention requirements, and potential delivery modes; a cross-sectional online survey with local and national stakeholders and professionals to determine real-world practices, capacity, resources, demand and acceptability of the proposed intervention; and interviews (n=18) with a diverse population with protected characteristics. Phase 2 (combine intervention) will establish a co-creation group consisting of women with experience of post-natal depression and professionals to define and adapt the intervention for Health Visitors and women, and to define the content for the digital training package for Health Visitors. Phase 3 (feasibility) will train 10 Health Visitors to implement the intervention. The training will be evaluated using the Kirkpatrick Model Framework. The trained Health Visitors will implement the intervention for up to 40 participants. Participants will complete a baseline and follow-up survey assessing depression, wellbeing and anxiety, acceptability, experience and perceived impact; demographics and socio-economic background will be collected at baseline. Interviews will be conducted with women (n=10-15) to assess participants' perceptions, enjoyment, challenges, and perceived impact. Focus groups (n=2) will be held with Health Visitors and service managers to assess acceptability of prescribed activities, challenges in intervention delivery, and overall experience. Timelines: The study will be conducted over 24 months. A steering group will be established to ensure deliverable targets and governance are met. Impact and dissemination: The impact will be to determine if it is feasible to co-create and deliver an intervention acceptable to Health Visitors and women at risk of, or with early post-natal depression, which can be tested in a full RCT. Our findings will be disseminated through peer-reviewed journals, conference presentations and workshops with stakeholders and engagement with the media. Participants will be notified of study findings via email, a website, attending a webinar, or requesting a printed report.