The Mother Nature Programme: a single-arm mixed-methods feasibility study of a group nature-based intervention for mothers experiencing postnatal mental health difficulties and their infants
Background: Postnatal mental health difficulties are common and often under-treated. Nature-based interventions have potential mental health benefits, but little research has focussed on their applicability postnatally. This study examined the acceptability and feasibility of delivering a co-designed, 5-week group nature-based intervention, The Mother Nature Programme (MNP), for mothers experiencing postnatal mental health difficulties and their infants, in preparation for a future trial. Methods: A single-arm, mixed-methods feasibility study with a prospective pre/post design, delivered across six intervention groups. We recruited mothers self-reporting postnatal mental health difficulties, with infants under 12 months (extended to under 24 months in some groups), via community and third-sector organisations. The programme comprised weekly 2-h sessions of invitational activities guiding participants to notice and connect with the natural world. It was delivered in local urban outdoor settings, by a nature-based practitioner and peer support worker. Feasibility outcomes included recruitment, retention rates, attendance, and completeness of the following participant-reported outcome measures (collected at baseline and week 5): Edinburgh Postnatal Depression Scale (EPDS), Generalised Anxiety Disorder-7 Scale (GAD-7), Warwick-Edinburgh Mental Wellbeing Scale (WEMWBS), and Nature Relatedness Scale-6 (NR-6). We explored participants’ experiences of the intervention through a nested qualitative study. Analysis of feasibility outcomes was based on descriptive statistics. We analysed qualitative data thematically. Results: Forty-three mothers, from diverse ethnic backgrounds, were enrolled in the study. Forty-two started the programme, of whom 90.5% (38/42) attended ≥ 3/5 sessions, and 47.6% (20/42) attended all five sessions. Post-intervention questionnaires were completed by 90.5% (38/42) for EPDS and GAD-7, and 81% (34/42) for all measures. Mean pre-post changes were EPDS − 3.6 (SD 4.3, n = 38), GAD-7 − 3.9 (SD 3.3, n = 38), WEMWBS + 8.6 (SD 8.0, n = 37), and NR-6 + 0.3 (SD 0.4, n = 34). We held interviews with 26 participants, and 6 women provided written feedback. Participants’ accounts of their experiences indicated high acceptability, and suggested modest ways in which to refine the intervention. Conclusions: The MNP was feasible to deliver and highly acceptable amongst a diverse sample of postnatal mothers. Findings support the progression to a pilot randomised controlled trial, with integrated process and economic evaluations, before any assessment of effectiveness or cost-effectiveness is undertaken. Trial registration: Not applicable; this was a non-randomised, single-arm feasibility study.