Development and feasibility testing of a group nature-based intervention for mothers with postnatal depression and their infants

Background Postnatal depression (PND) affects 10-20% of mothers. It can have detrimental effects on mothers, infants, families, and society. Uptake and adherence to current treatments are low, especially amongst under-served groups, for whom acceptability of medication and access to talking therapies may be limited. Innovative solutions that help to reduce maternal mental health inequalities are needed. Nature-based interventions, delivered through Green Social Prescribing, are attracting significant UK Government investment. These outdoor interventions connect people to nature to improve mental health. They aim to address health inequalities, support personalised care, and reduce pressure on clinical services. Alongside a Patient and Public Involvement (PPI) group, I recently led the co-design of a six-week group nature-based intervention for mothers with PND and their infants. I conducted a pre-post evaluation with four groups of socio-economically and ethnically diverse mothers in Bristol (n=28). The intervention was highly acceptable and feasible to deliver. In preparation for a full-scale evaluation, remaining delivery uncertainties need clarifying, for example how the intervention could be delivered at scale. Aims To: clarify remaining intervention uncertainties, and produce training and a manual for facilitators assess the feasibility of conducting a future RCT to determine the effectiveness and cost-effectiveness of the intervention in treating PND explore participants' and facilitators' views of the intervention and materials, usual care, and proposed trial methods. Methods Three workstreams, developed with PPI input, map onto these aims. Workstream 1 I will conduct: qualitative focus groups and interviews with postnatal mothers, practitioners working with mothers, nature-based practitioners, and third sector representatives, to determine: who is best placed to deliver the intervention and in which settings how women should be referred how the intervention fits within existing PND care pathways. workshops with mothers, practitioners best placed to deliver the intervention, and nature-based providers, to co-produce training and a facilitator manual. Workstream 2: feasibility RCT I aim to recruit 48 mothers (with an infant under one) with PND, aged over 18 years, from one urban and one rural site in England. Participants will be randomly allocated (1:1) either to the six-week group nature-based intervention plus usual care, or usual care alone. Feasibility outcomes will include the proportion of: eligible women consenting participants completing baseline measures and randomised, attending each session, and completing follow-up measures. I will collect self-report outcome measures, including of mood and anxiety, at baseline, 10- and 22-weeks post-randomisation. Workstream 3: integrated qualitative study I will observe the co-produced training session for facilitators and gain feedback. In-depth interviews with participants and facilitators will elucidate the acceptability of the intervention and study processes. I will use findings to describe usual care and refine the intervention and materials. Impact and dissemination This Fellowship has the potential to develop an inclusive intervention for PND. It will clarify the feasibility of a full-scale evaluation of the interventions' clinical and cost-effectiveness. My dissemination strategy, co-designed with PPI, includes journal publications, presentations, and media reports. If effective, reports and briefings for NHS England, local commissioning services, and policymakers will be essential to support future implementation.