Picot Question Assessment 2022

Running head: PICOT QUESTION 1
Assessment 1: Part B and C
Name
Institutional Affiliation

PICOT QUESTION 2
Part B: Database Search and Findings
PICO Question
In women following childbirth (P) does having emotional support from the partner (I) compared
to no emotional support of partner (C) reduce the risk of develop postpartum mental illness (O)
within the first year after giving birth (T)?
Databases and Search Methods (Add extra rows for each data base used: see example in
Assessment Guide)
I began my search by signing into the Murdoch University Electronic Nursing Database, which
contains a collection of healthcare articles and resources. The nursing database provided by the
university also provided a wide range of articles that are relevant to the healthcare research, To
obtain relevant articles, I searched two databases namely Cumulative Index of Nursing and Allied
Health Literature (CINAHL) and PubMed.
I used the articles because I viewed them as the most resourceful to provide literature, particularly
in the field of maternal care and healthcare at large. The databases contain articles that are
reliable, and credible for use in evidence-based research.
Database
CINAHL with full text
Reason for Use
The database provides full texts that are relevant and credible healthcare and nursing resources.
Creating the Search Search Techniques Search Results
I was able to conduct an
advanced search by use of
the suggested search
terms. The search terms
included post-partum,
mental illness, childbirth,
partner support.
I entered the keywords
into the side bar. And
selected the subheadings
from the drop down menu.
The searches included
inputting the search
I used Boolean operators
including ‘and’ and ‘or’ to
combine the search terms.
I selected the limiters, which
included:
full text,
peer reviewed,
Published in the last 7
years
Mothers that have recently
given birth
Search 1: 109
Search 2: 87
Search 3: 127
I then combined search 1 to three
using Boolean operators ‘and’ and
‘or’ with no limiters yielded 5
articles, and with limiters yielded 1
article.

PICOT QUESTION 3
subheadings and clicking
the “search database”
button
A combination of the
search terms was essential
in narrowing down to the
specific and most relevant
articles.
Database
PubMed
Reason for Use
PubMed has more than 18 million citations from life science journals such ad MEDLINE. The
articles in the PubMed are related to Medicine and other related disciplines. They are also
available in full text within the database.
Creating the Search Search Techniques Search Results
The database has
provisions for the
advanced search. I used
search terms including
post-partum, mental
illness, childbirth, partner
support. And search
phrases resulting from
combining the search
terms.
I used Boolean operators:
‘and’ and ‘or’
The selected limiters
included:
full text,
peer reviewed,
Published in the last 7
years
Mothers that have recently
given birth
The advanced search yielded with
no limiters 21 articles
The advanced search with limiters
yielded 1 article.
Subject Headings/Key Words
The literature search headings were developed from the key words present in the PICO question.
The key words include: post-partum; mental illness; childbirth; partner support. I combined the
key words to develop search phrases such as: childbirth and postpartum mental illness; partner
support and post-partum mental illness; partner support and child birth; and postpartum stress
after childbirth. I also used synonyms and alternative words to diversify and broaden search and
to ensure that the search captured all relevant articles in the study.

PICOT QUESTION 4
Limiters
I used Boolean operators to perform an advanced search of the articles from the databases. The
Boolean operators were effective in creating a narrow search, and identifying the most credible
and relevant articles. I was able to improve the accuracy of the results from the search and to use
less time in identifying the search.
Date Range
The search from the database yielded data that was relevant to the issue of postpartum depression
and partner support after child birth. I was able to identify relevant data. The date range was in
the last seven years 2013 to 2020. The data range helped to ensure that I identifies new evidence
on the research topic and minimised the search process. The articles considered following the
data range were more specific and detailed about the research topic.
Sources
Source of
Literature
Description
Primary sources eg.
Original research
results in journals,
dissertations,
conference
proceedings,
correspondence
They refer to original studies that result from direct observation, statistical
records, experimental methods, interviews and actual impacts or practices
and policies (Georgia state Unioversity Library 2020).
Secondary Sources
eg. review articles,
systematic reviews,
meta-analysis,
practice guidelines,
monographs on a
specific subject
They refer to evaluations and interpretations that are derived or developed
from the primary data sources. They include systematic reviews, meta-
analysis and reference articles (Georgia state Unioversity Library 2020).
Tertiary sources
Eg
Textbooks,
encyclopaedias,
They refer to a distillation of the primary and secondary sources (Georgia
state Unioversity Library 2020).

PICOT QUESTION 5
handbooks,
newspapers
Grey Sources Data that is not formally published such as spoken information
Selection of Articles for Appraisal
I carefully examined all the articles to ascertain their suitability for the research and to address the
PICO question. I ensures that the selected articles had the highest level of evidence in that they
were peer-reviewed journals. I also ensures that they were recent as they had been published in
the last 10 years. I chose quantitative studies for the critical appraisal. I also conducted a critical
assessment to determine the relevance and quality of the articles for use in the study. Critically
assessing and a comprehensive search of the articles ensures academic integrity.
References
Georgia State University Library (2020). Literature Reviews: Types of Literature. Retrieved
from https://research.library.gsu.edu/c.php?g=115595&p=1940435

PICOT QUESTION 6
ARTICLE REVIEW
Article 1:
Pilkington, P. D., Whelan, T. A., Milne, L. C. (2016). Maternal crying and postpartum
distress: the moderating role of partner support. Journal of Reproductive and Infant
Psychology, 34(1), 64-76.
QUANTITATIVE QUESTIONS
Nine questions to ask when performing a preliminary appraisal (Box 10.1 p228)
1. Why was the study undertaken?
To investigate crying, mood and partner support in the postpartum period. Crying and moof are
indicators of stress.
2. What is the underlying question? Is it relevant to my PICO question?
The underlying question is: Emotional support from partners is expected to moderate the
associations between crying frequency and depression, anxiety and stress symptoms.
The question is relevant to the current study that explores the role of partner support in reducing
postpaternm mental illness.
3. What type of evidence is provided?
A survey was conducted using 21-item Depression Anxiety Stress Scales (DASS-21)
4. Is there a clear statement of aims? What are they?
The aims of the study were clearly stated. They are: to investigate maternal crying as a signal of
distress and request for support in the postpartum period.
5. What was the study design?
A cross-sectional survey
6. Is this design appropriate for the research question/study objectives?
The design is appropriate as it involves a large sample of 137 primiparous mothers.
7. Is the study population relevant to my question or clinical situation?
The study population was relevant to the clinical situation as both studies involves mother with
children between 1 and 12 months of age.
8. What were the outcomes of the study?
The study outcomes incdicated that women who reported more frequent crying and low partner
support reported higher levels of depression, while women who reported frequent crying and
high partner support reported lower levels of depression symptoms
9. Are the results and conclusions relevant?
The results are relevant to the current study. They provide evidence that partner support can
reduce the effects of postpartum mental illness.
Questions to ask when appraising methodology (Box 10.2 p232)
1. Quantitative studies: is the sample size adequate? What was the response rate?
A sample of 504 participants was adequate for this study. The response rate was 33%
(n=167) and it was adequate for the study. 24 did not complete the minimum requirement
for the student and the sample of 137 respondents was achieved.
2. Qualitative studies: are the participants the most appropriate to provide access to
the type of information sought?

PICOT QUESTION 7
3. Are details of ethical considerations provided and was ethics approval gained from
a relevant Research Ethics Committee?
The ethical considerations were achieved by gaining approval from the relevant
committees.
4. What was the source of the sample/participants and are they representative of the
broader population to whom the research might apply?
The study participants were obtained from Maternal and Child Health and Early Parenting
centres across nine councils in metropolitan Melbourne, Australia. The sample represents a
representatives of a broader population.
5. Is sufficient detail provided on inclusion/exclusion criteria?
There are details of inclusion and exclusion of participants. Excluding women with severe
mental disorders, and infants were born full-term (38–42 weeks), of normal birth weight
(2500 g or greater) and without any known medical or neurological conditions.
The study included first-time mothers of infants aged between 1 and 12 months.
6. Quantitative studies: What was the sampling method? How were participants
selected? Could the sampling method have introduced bias?
There was evidence of experience sampling methods through referrals from nursing staff at
the centres. The sampling method could have introduces research bias as the nurses could
have made erroneous referrals.
7. Quantitative studies: are the groups identical except for difference in exposure to
the treatment/variable under investigation?
The groups are identical as they include mothers with children of ages below 12 months.
8. For experimental designs: are participants and investigators blinded to treatment
allocation
The study was not experimental
9. Is there a clear description of how data were collected?
Yes
10. Quantitative studies: are the data collection methods and tools valid and reliable?
Was the instrument used previously validated?
The use of 21-item Depression Anxiety Stress Scales ensured reliability and validity as the
study has been used in previous researchers for years.
11. Qualitative studies: how does the researcher/s account for their own presence in
the data collection and analysis? Have the authors provided detail as to how
trustworthiness was achieved?
12. Were there any distorting, extraneous or contaminating factors that might have
influenced the data collected? If methods changed during the study, how are these
adequately accounted for?
There was no change in methods in the course of the study and there were no factors that
could affect data collection.
Questions to ask when appraising data analysis and findings (Box 10.3 p234)
1. Is the type of analysis appropriate for the type of data collected?
Yes regression analysis was appropriate to identify the relationship between variables
2. Qualitative studies: is there sufficient in-depth description of the analysis method?

PICOT QUESTION 8
3. Are the data clearly represented?
The data was clearly presented using tables and narrative presentation
4. Are dropout or missing data adequately accounted for?
Yes. The dropouts from the sample resulted in 167 articles and 24 incomplete responses
resulted in 137 respondents.
5. Qualitative studies: are the results credible and trustworthy?
6. Is clinical significance discussed? Do you feel the results are clinically significant?
Yes. Apart from the mention of statistical significance, the findings are essential in
management of postpartum mental illness among new mothers.
7. Are conclusions drawn relevant to the findings?
Yes.
Article 2:
Sampson, M., Villarreal, Y., & Padilla, Y. (2015). Association between Support and
Maternal Stress at One Year Postpartum: Does Type Matter? Social Work Research, 39(1),
49–60. doi:10.1093/swr/svu031
QUANTITATIVE QUESTIONS
Nine questions to ask when performing a preliminary appraisal (Box 10.1 p228)
10. Why was the study undertaken?
To examine the association between four types of social support and maternal parenting stress
among mothers of infants.
11. What is the underlying question? Is it relevant to my PICO question?
The underlying question is: What are the influences of different types of support on maternal
stress in the first year postpartum. The study is relevant to the PICO question, which focuses on
partner support and maternal stress in the first year postpartum.
12. What type of evidence is provided?
There was secondary data that only included mothers who had some form of romantic
involvement with the biological father at one year follow-up
13. Is there a clear statement of aims? What are they?
Yes. The aim of the study was to examine the association between four types of social support
and maternal parenting stress among mothers of infants. It also investigates whether maternal
education level moderates this association
14. What was the study design?
a longitudinal birth cohort study
15. Is this design appropriate for the research question/study objectives?
The design was appropriate for the study as it involved a large sample that is suitable fpor
generalization
16. Is the study population relevant to my question or clinical situation?
The study population is relevant to the study as it focuses on parenting stress for mothers and
partner support

PICOT QUESTION 9
17. What were the outcomes of the study?
The outcomes of the study indicated that emotional support from fathers was most ameliorative
for a mother’s stress regardless of education, race, or marital status.
18. Are the results and conclusions relevant?
Yes. The results lead to conclusions that partners are vital in supporting the child’s mother in
the first year after child birth.
Questions to ask when appraising methodology (Box 10.2 p232)
13. Quantitative studies: is the sample size adequate? What was the response rate?
A sample size of 2,412 mothers was adequate for the study and there is no evidence of drop
out from the study; hence a 100% response rate
14. Qualitative studies: are the participants the most appropriate t provide access to
the type of information sought?
15. Are details of ethical considerations provided and was ethics approval gained from
a relevant Research Ethics Committee?
There was no need for approvals as the research was based on secondary data.
16. What was the source of the sample/participants and are they representative of the
broader population to whom the research might apply?
The sample was obtained from the Fragile Families and Child Wellbeing Study (FFCWS)
that were followed from 1998 to 2000. The population was a representative of a broader
population applicable to the study.
17. Is sufficient detail provided on inclusion/exclusion criteria?
There is clear evidence of inclusion and exclusion criteria. And the cases with no missing
data for the stress and support variables were includes. The mothers had infacts below 12
months of age and were sin good terms with the fathers of their children during the period.
18. Quantitative studies: What was the sampling method? How were participants
selected? Could the sampling method have introduced bias?
There was no evidence of sampling as secondary data was used. The use of secondary data
limited the possibility of bias.
19. Quantitative studies: are the groups identical except for difference in exposure to
the treatment/variable under investigation?
The study was not an RCT and there were no study groups
20. For experimental designs: are participants and investigators blinded to treatment
allocation
The study was not experimental
21. Is there a clear description of how data were collected?
The study used secondary data; hence no evidence of data collection
22. Quantitative studies: are the data collection methods and tools valid and reliable?
Was the instrument used previously validated?
The study used secondary data; hence no evidence of data collection
23. Qualitative studies: how does the researcher/s account for their own presence in
the data collection and analysis? Have the authors provided detail as to how
trustworthiness was achieved?
24. Were there any distorting, extraneous or contaminating factors that might have

PICOT QUESTION
10
influenced the data collected? If methods changed during the study, how are these
adequately accounted for?
There was no evidence of distorted data
Questions to ask when appraising data analysis and findings (Box 10.3 p234)
8. Is the type of analysis appropriate for the type of data collected?
The Multivariate analyses of variance and ordinary least squares regression was essential
for data analysis.
9. Qualitative studies: is there sufficient in-depth description of the analysis method?
10. Are the data clearly represented?
Yes, participant demographics and the results were clearly identified.
11. Are dropout or missing data adequately accounted for?
Missing data was appropriately accounted for.
12. Qualitative studies: are the results credible and trustworthy?
13. Is clinical significance discussed? Do you feel the results are clinically significant?
The results of the study are clinically significant in providing evidence of factors
moderating postpartum depression and anxiety.
14. Are conclusions drawn relevant to the findings?
The conclusions are that Early interventions to help mothers build supportive relationships
may deter more severe psychological distress. and are relevant to the findings that partner
support is important in alleviating maternal stress,
Summary Discussion
The aim of the PICO question is to investigate the importance of emotional support from
the partner in reducing the risk of develop postpartum mental illness within the first year
after giving birth. Post-partum depression is a serious public health concern that has a
negative impact on maternal confidence, social, emotional and cognitive development.
Postpartum depression is particularly common for single and young mothers (Almutairi et
al. 2017).
To address the PICO question, I chose to conduct a critical appraisal of two articles. The
first articles was a quantitative cross-sectional survey using primary data and the other was
a longitudinal cohort study using secondary data. The articles were identified following a
comprehensive search from Pubmed and CINAHL databases. The critical review of the
articles revealed that they had appropriate quality to justify the importance of social
support for postpartum mothers within 12 months after childbirth. The findings revealed

PICOT QUESTION
11
that mothers who experiences partner support from their spouse reduce their risk of
postpartum mental illness.
The appraisal of the two articles is is essential for my studies and future career. The
appraisal has raised my experience on evidence-based practice. I have also gained a
broader understanding of the importance of social support particularly from partners in
alleviating post-partum distress in the first year after child birth. New mothers need support
from friends and families, but partner support plays a greater role in alleviating distress.
Based on the evidence from both articles, I will be keener to identify the availability of
support for new mothers within my area of practice.
The studies provide important knowledge that imply the importance of social support and
the important role that partners play in the lives of their spouses and children. In particular,
they contribute significantly to the mental health of mothers after child birth. Therefore,
programs to foster support for new mothers need consideration
Sources of Evidence (Two Articles Reviewed)
Pilkington, P. D., Whelan, T. A., Milne, L. C. (2016). Maternal crying and postpartum
distress: the moderating role of partner support. Journal of Reproductive and Infant
Psychology, 34(1), 64-76.
Sampson, M., Villarreal, Y., & Padilla, Y. (2015). Association between Support and
Maternal Stress at One Year Postpartum: Does Type Matter? Social Work Research,
39(1), 49–60. doi:10.1093/swr/svu031
Extra References (APA)
Almutairi, A. F., Salam, M., Alanazi, S., Alweldawi, M., Alsomali, N., & Alotaibi, N.
(2017). Impact of help-seeking behavior and partner support on postpartum depression
among Saudi women. Neuropsychiatric disease and treatment, 13, 1929–1936.
doi:10.2147/NDT.S135680
Kazmi, S. F., Khan, M., Tahir, R., Dil, S., & Khan, A. M. (2013). Relationship between
social support and postpartum depression. Ann Pak Inst Med Sci, 9(4), 191-194.