Mental health experiences of mothers in Jos, Nigeria: An interpretative phenomenological analysis

Objectives: There is an increasing mental health disease burden in mothers with infants and young children, especially in low- and middle-income countries such as Nigeria. Children of distressed mothers suffer early-life exposure from the effects of maternal distress which contributes to the risk of physical and mental health problems in their childhood and beyond. This study explored mental health lived experiences of mothers in Jos, Nigeria. Methods: Purposive and Snowball sampling techniques were adopted, and a total of 40 mothers participated with 8 to 11 participants in one of the four focus group discussions. Participants were between the ages of 18 and 43 years, self-identified as mothers with each having a child between the ages of 3 and 48 months. Each focus group lasted approximately 60 minutes and was audio-recorded. Interviews were transcribed verbatim and analysed using interpretative phenomenological analysis. Results: Three overarching themes emerged from the data set such as (1) experience of persisting psychological distress from the time of labour/birth; (2) cultural practices that influence feelings; and (3) anxiety due to limited knowledge about childcare, access to support and healthy food. Conclusion: Maternal mental health in Nigeria is under-researched and distressed mothers have limited knowledge about evidence-based early child development. The study recommends developing and testing culturally appropriate parenting interventions in Jos, Nigeria. This is likely to be beneficial for the mother and may also improve child health outcomes. An interpretative phenomenological analysis (IPA) was adopted to explore the lived experience of mothers in Jos, Nigeria. Data analysis and interpretations were underpinned by IPA theoretical features such as phenomenology, hermeneutic and idiographic.25 The study employed the IPA method of coding, analysis and interpretation of data to help capture the essential and experiential quality of the account of participants in the data sets.26 To identify nuance and participants’ interpretative narratives, inductive and interactive processes were carried out by three researchers who listened and re-listened to the interview audio files, familiarised with the transcripts and made notes of initial exploratory comments; these included linguistic, descriptive and conceptual comments.26 Codes were harnessed and processed to identify preliminary themes in each focus group transcript, and the same process was adopted for all transcripts to generate themes. Re-occurring themes were collapsed and refined into the master themes. Master themes were reviewed across entire data sets; the best themes that encapsulate the participants’ experiences were chosen as final themes. Previous studies have consistently shown that IPA provides valuable insight into participants’ perceptions of their subjective lived experiences.25,26 Purposive and snowball sampling techniques were adopted for participants’ recruitment in four primary health care (PHC) facilities situated in four local government areas of Plateau State Nigeria. Four face-to-face focus groups were conducted with a total of 40 participants with no dropout or withdrawal of participation. The demographic breakdown of the participants by sites of data collection were Barkin Ladi (n = 11), Jos-South (n = 11), Jos-North (n = 10) and Riyom (n = 8). The four PHC facilities were purposively selected to plan for a future randomised controlled trial. The women were recruited when they brought their newborn for health checks such as immunisation against childhood communicable diseases at the PHC facilities. The sites of data collection were predominantly Berom ethnic people which might have provided data homogeneity based on similar cultural values and traditions. The focus group interviews were conducted between November 2019 and January 2020. The participants’ inclusion criteria included women who had children (0–48 months); aged 18 years and above; residents of Jos and environs; able to speak and understand English language; and able to provide consent for their participation. Exclusion criteria include women who are non-residents of Jos and environs; less than 18 years; unable to consent; patients currently undergoing treatment for severe mental illness such as psychosis; and unable to speak the English language fluently. Participants recruited for this study were between the ages of 21 and 43 years (mean age = 32.60 years; standard deviation = 14.79) and each participant’s youngest child was between the ages of 3 and 48 months (mean age = 23.93 months; standard deviation = 6.78). Each focus group interview lasted approximately 60 minutes and were all recorded with a digital audio recording device and transcribed verbatim. Data saturation was reached at the end of the fourth focus group discussion when no more new themes were being generated, and the interviews were stopped. A pilot focus group was initially conducted with seven volunteers who constituted about 17.5% of total participants. The pilot study helped to examine the face validity and compatibility of interview schedule items with the sample population. The pilot discussions provided a general impression on how the groups felt and thought about the topic items concerning their experiences. The valuable feedback helped to modify questions in the interview schedule. Interview questions were iteratively developed and refined by the research team (see the supplementary material for sample interview questions). The focus group interviews were planned and conducted by a PhD holder and supported by two research assistants (RAs) with MSc and BSc psychology levels of education. The two RAs were both trained in qualitative research methods before the commencement of the focus group interviews. Interviewers made concerted efforts to explore participants’ deeper meanings with regards to mental health distress such as anxiety and depressive experiences in the postpartum and maternal early childhood periods. However, participants were more keen to discuss the role of family members and sociocultural practices that influenced their overall mental health and wellbeing. Ethical approvals for the study were received from Nottingham Trent University, UK and the Jos University Teaching Hospital, Nigeria. Participants were initially contacted during their visits on routine clinic appointments in the participating primary health care facilities. Before participation, all participants read the participants’ information sheet and signed the written informed consent forms. All identifiable information in the data sets were deleted or anonymised with pseudonyms.