The feasibility of an objective measure of the parent-child relationship in health visiting practice: assessment of the Maternal Postnatal Attachment Scale
Authors: Dunn Abigail , Bird Philippa K. , Endacott Charlotte , Bywater Tracey , Howes Joanna , Dickerson Josie 
Published: December 2021

Positive parent infant relationships are key to achieving long term child outcomes. Identifying parents who may need support is difficult because of a lack of robust assessment tools. Working in partnership with health services we piloted the Maternal Postnatal Attachment Scale (MPAS) in a deprived, multi-ethnic urban community in Bradford, UK.

The pilot aimed to assess the clinical utility of MPAS to identify need for support: Was it administered to a representative group of women? Is MPAS valid for this population?

Data were linked to a cohort study in the pilot area (Born in Bradford’s Better Start - BiBBS). Chi Square tests assessed sample representativeness (age, ethnicity, parity, English language, education, deprivation). Exploratory factor analysis explored MPAS’ validity.

563 women in BiBBS were eligible, 210 (37%) completed MPAS. No differences were found between completers and non-completers, suggestive of a representative sample. In total, 336 women completed MPAS in the pilot. MPAS had ceiling effects and a satisfactory factor structure could not be identified, indicating poor psychometric properties

Health visitors were successful in administering MPAS to a representative sample, but poor psychometric robustness indicates that MPAS is unsuitable for routine use in this setting. A gap for such a measure remains.

Statement of relevance to practitioners

This research shows that:

Health practitioners working in universal early years services were willing and able to integrate structured assessments of parent-infant relationship into their routine practice

There is no evidence that health professionals were less likely to offer traditionally considered ‘hard to reach’ families an assessment of their parent-infant relationship

The Maternal Postnatal Attachment Scale did not demonstrate psychometric robustness when delivered in routine, universal, health visiting services in Bradford as part of an initial assessment of parent-infant relationship, and therefore cannot be recommended for continued routine use.

Statement of relevance to the field

This pilot study explores a significant gap in the field, namely how universal services can assess parent-infant relationship to facilitate timely signposting to appropriate services, in a preventative model, to those families that may benefit. This study contributes to the evidence base by assessing if health professionals working in a universal service can offer an assessment to a representative group of families, including families who may be considered hard to reach as well as providing psychometric evidence on the Maternal Postnatal Attachment Scale. We did not find good evidence for the psychometric properties of the Maternal Postnatal Attachment Scale when used in this way in Bradford. We found that health professionals offered the assessment to a representative sample of families, including those who may be at an enhanced risk of health inequalities because of their ethnicity, age, education, and wider socioeconomic circumstances.

This evidence is important for measure/tool selection for community studies. The findings also emphasise that practitioners can integrate tools for assessment in their practice, including with families who are at an increased risk of experiencing inequalities.

Diversity and anti-racist scholarship

This study was designed and executed in a very diverse community with approximately 60% of the population identifying as Asian/Asian British: Pakistani, and 10% of the population identifying as White: British and the remaining population identifying with a wide range of ethnicities. The health visiting service deliberately engages with the whole population in a culturally sensitive way, including ensuring staff speak key community languages and using translators as required. We included specific tests of representativeness as part of the study design and found that participants in the study were representative of the wider community in terms of ethnicity and English language comprehension.