The Mother-Generated Index MGI

1. The Mother-Generated Index (MGI) Dr. Andrew Symon University of Dundee Jacqui McGreavey & Carol Picken Monifieth Health Centre

2. Background The Mother-Generated Index (MGI): A subjective postnatal quality of life assessment tool developed from Ruta et al’s Patient-Generated Index Pilot study in Perth - results published in Birth 2002 (29: 40-46) and JAN 2003 (42: 21-29) Minor modifications to form - study repeated. Results published in BJOG 2003 (110: 865-868)

3. Why measure postnatal quality of life? Despite concerns about the 6-week postnatal check, postnatal morbidity is by and large well recognised (e.g. anaemia, infections, haemorrhage, depression) More recent appreciation of other areas such as sexual function, backache, painful perineum, and constipation Health is "physical, mental and social well-being, and not merely the absence of disease or infirmity” (WHO 1948) An essentially pathological approach may not reflect the “social reality of the situation… Measures of health status lack focus.” (Hopkins 1992)

4. Quality of Life (QOL) “The extent to which hopes and ambitions are matched by experience.” The aim of medical care is to “narrow the gap between a patient’s hopes and aspirations and what actually happens.” (Calman 1984) Despite growing QOL research, little specific attention has been paid to maternity care Because of the diverse nature of QOL, a QOL assessment should aim to be as holistic and subjective (non-directive) as possible

5. The MGI MGI form - single-sheet three-step questionnaire Pilot study: used in conjunction with the EPDS, the SF-12, and Glazener et al’s postnatal morbidity index (PNMI) Main study: EPDS, MAMA, and Glazener et al’s PNMI Probably best to use the MGI together with an existing measure of physical / psychological morbidity

9. Results (1) Many aspects of life were cited, reflecting issues such as: Physical health, emotional well-being, family relationships, personal time, social life, and thoughts about returning to work Most mothers made a positive comment about their baby or partner, or about being in a family, or about feelings of fulfilment Very few cited a physical problem

10. Results (2) MGI scores were significantly correlated with the validators at both 6-8 weeks and 6-8 months Scores of 5 or less had a significantly higher incidence of physical problems, significantly higher EPDS scores, and significantly lower MAMA scores Mothers with MGI scores of 5 or less at 6-8 months also had babies with a higher incidence of physical problems, and were less likely to view their babies in a positive light

11. Results (3) MGI scores not affected by age, parity, or whether the mother lived alone or with one or more others At 6-8 months, mothers who were unemployed had significantly lower scores than those who were working (4.8 compared with 6.3; p=0.012, F=4.16, calculation by Anova) Other than that, socio-economic status (as measured by her postcode or occupation for herself and/or her partner) was not significantly associated with scores

12. Limitations We did not assess the degree of support experienced by the mothers, and so we cannot say how this may affect quality of life The population in which this tool was assessed is not ethnically diverse The MGI does require the mother to be able to articulate her feelings, although she can ask the health visitor to write these down for her Lack of familiarity with this type of approach meant that around 30-40 minutes was needed on average (most of this for the MGI)

13. Is it useful? Our tentative ‘cut-off point’ (an MGI score of five or less) identified mothers whose validator scores were, with two exceptions, significantly different in statistical terms from mothers who scored above five. In conjunction with other standard tools it may be useful as a screening tool. In putting the mother at the centre of the assessment, we believe this reinforces the ‘normal’ model and restricts the ‘medical / pathological’ model

14. Dr. Andrew SymonSchool of Nursing & MidwiferyUniversity of DundeeDD1 9SY+44 (0) 1382 632304a.g.symon@dundee.ac.uk