The protection of human subjects through the application of appropriate ethical principles is important in all research study. In a qualitative study, ethical considerations have a particular resonance due to the indepth nature of the study process. The existing ethical guidance for undertaking qualitative research often provide general guidelines rather than focusing on how to apply it in practice, particularly when interviewing vulnerable group of women. The aim of this paper is to present my own experience of conducting 33 individual face to face interviews on the women’s experience of postnatal depression across three different cultural backgrounds in Malaysia. This paper reflects on the strategies that can be adopted by a qualitative researcher to ensure that their participants’ identity is protected throughout recruitment and dissemination process, to deal with participants from different cultural backgrounds, and to handle and manage distress during interview. The consideration of ethical issues is crucial throughout all stages of qualitative study to keep the balance between the potential risks of research and the likely benefits of the research.
Sociocultural contexts of motherhood have been found to have a link with postnatal depression. Malaysia has a wide-range of cultural and ethnic backgrounds that offers a wonderful chance to understand the different role of cultures and postnatal practices in relation to postnatal depression. The purpose of this paper is to discuss the link between the Malaysian healthcare system, social and cultural context, the existing health policy and postnatal depression. This paper highlights that while there are different levels of nurses who work collaboratively to manage pregnant and postnatal mothers in the maternal and child health clinic, the focus of their care is more on physical health. The international guidelines for diagnosing PND were not commonly used within the clinics, although the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) has been widely used within psychiatric setting in Malaysia. There is no formal mechanism or assessment to detect PND in the clinics. There were no guidelines found that specifically focused on the management of PND. It is questionable whether the current approaches to promote and manage maternal mental health in Malaysia have a sense of cultural-based strategies. These significant gaps call for empirical evidence that explicitly focussed on the experiences and perceptions of PND in Malaysia.
The World Health Organisation recommends healthcare practitioners to equip themselves with appropriate skills to assess the psychological distress in women attending the antenatal and postnatal healthcare. Nevertheless, little is known about the healthcare practitioners’ perceptions of postnatal depression and its management. The aims of this review were: (1) to explore the experiences of healthcare practitioners in caring for women with postnatal depression in different countries and (2) to identify any qualitative study conducted in Malaysia regarding the healthcare practitioners’ perceptions of postnatal depression. To achieve these objectives, a qualitative synthesis of studies reporting the healthcare practitioners’ experience of managing women with postnatal depression was conducted. A search in CINAHL, PubMed, MEDLINE, PsycINFO and ASSIA databases was performed using specific keywords and published peer-reviewed articles from 2006 to 2016 were screened for inclusion criteria. A total of 15 relevant studies were identified and reviewed. The studies included were conducted in eight different countries: America, Australia, United Kingdom, Brazil, Canada, Greek, Mexico and Slovenia. No study conducted in Malaysia was found. This review suggestedthat the experiences of managing women with postnatal depression were relatively similar among the healthcare professionals in different countries. The main limitations reported by the healthcare practitioners were the lack of resources on maternal mental health and the absence of policy regarding the management of postnatal depression. Further research should investigate how Malaysian healthcare practitioners perceive postnatal depression and their roles in its management to provide more insights into the current clinical practice in Malaysia for postnatal depression.