Thirty one participants were interviewed for this study. In total, 18 community child health nurses and 13 registered hospital midwives gave their consent to take part in a co-constructed, one-on-one, face-to-face interview in which five broad questions and six focussed questions were discussed. There are three main regions that comprise Tasmania and all regions were represented within the study. The child health nurses were distributed widely throughout the three regions: nine in the North, four in the South and five in the North West, whereas the midwives were situated within the three public hospitals in Tasmania; with ten participants in the capital city in the South, two in a North West hospital and one in the North.
The majority of child health nurses interviewed held a midwifery qualification, whether currently registered or not – as this was a requirement in the past, in order for a person to be able to undertake studies in child health. Seven of the midwives interviewed held a child health nurse qualification, and had worked in the area of child health but had returned to midwifery.
The interview questions were designed to elicit the participants’ knowledge around early parenting mental health promotion and to answer my research question:
“What do midwives and child health nurses consider ‘creates mental health’ in the perinatal period?”
This question was based on Antonovsky’s (1979) question pertaining to a Salutogenic orientation, as opposed to a pathological one which might question “what creates mental illness in parenting?” My sub-question was borne out of the need to ascertain answers to this question by firstly going to the health providers who work most closely with parents in the perinatal period (conception to the end of the first 12 months):
“How do midwives and child health nurses understand mental health promotion and how do they implement it in their practice?”
3.6.1
Formation of interview questions
From my reading over many years of all things protective for mental wellbeing and staying well, coupled with my experiences as a child health nurse and midwife – and incorporating the literature review for this study – I knew that my questions would be constructed out of intuition and anecdotal experience that the area of mental health promotion was not receiving broad coverage by health professionals in the parenting area. I had some ideas why this might be: selective primary health care as opposed to comprehensive; the burden of mental illness and the need for early detection and treatment as opposed to prevention and funding that requires short term, quantifiable outcomes. So, given these assumptions and the need to remain congruent with my critical lens, I created nine questions for discussion that I considered invited the participants to look critically and reflexively at the foundations of their practice in mental health promotion.
I now outline these broad and focussed questions with the aim of explaining how and why they were created. I do this in order to be transparent about my assumptions but also to engage the reader in the journey about the importance of ‘why these
questions?’, and the order in which they were used.
Formation of broad questions
I wanted to start the interview with a conversation regarding child health nursing and midwifery understandings of the broader terms or constructs of mental health
promotion: mental health, health promotion and mental health promotion. Starting this way would give the participants time to warm to the area under exploration which would then support them when they made the application to their practice that the focussed questions demanded. The information letter (Appendix 3) that the participants had received prior to the interview contained a brief statement aim of the interview:
“This study aims to explore how midwives and child health nurses understand the term ‘mental health promotion…and to inform perinatal educational curricula regarding mental health promotion partially from data collected during the interviews with early parenting health professionals.”
My first question in the interview was ‘What is your definition of mental health?’
In asking this question I wanted to understand how the participants personally viewed this term – hence my asking for their definition – not a definition. I then asked them ‘What are your thoughts regarding the terms ‘mental health’ as opposed to just ‘health’? (prompt – do we divide the terms and if so why?). In this question I was seeking to observe if they perceived that the terms were divided, if so why they were, and if possible to explore any historical or cultural reasons for the dualism. In asking this question, it helped me to see how they perceived mental health in the light of health.
Next, I asked ‘What do you think ‘creates’ mental health?’ based on Antonovsky’s question. From this question I was aiming to explore factors or elements that the participants considered may help people to stay well. Initially I asked the question stated above, but after the first few interviews, I realised that the sentence was being interpreted as ‘what causes mental illness?’ which I considered may also be
influencing a mental illness inclination. I decided to ask Antonovsky’s question but also to explain further ‘what are the elements that you consider go to make up mental health or mental wellbeing?’ I also used at times the phrase ‘positive mental health’ (Jahoda 1958; Labonte 1990; Cook 2005) in order to ensure the participants knew the interview was not about mental illness.
The next two questions asked the participants about their understanding and description of health promotion and mental health promotion: ‘What is your
understanding of health promotion? Tell me how you would describe mental health promotion?’ Sometimes these two questions were one and the same for some participants who saw no division between health and mental health, that is, something that was indicated in their answers to the first two questions. In asking these questions, I wanted to explore their knowledge and ideas of health promotion and directed them to illustrate their understanding in the parenting field if that was