This thesis describes the development of a parent-to-infant attachment based questionnaire for use by health visitors as a discussion tool. An interpretive methodology was followed incorporating a sequential multi-method design. The original purpose of the study, to develop an attachment screening tool, changed due to reflexive decision making and the impact of changes in service delivery. This presented an opportunity to develop a tool that supported focused conversation between health visitors and parents about early relationships. Parallels between parent infant relationships and health visitor parent relationships were identified in four parent focus groups and four health visitor interviews. The resulting data were used to inform the development of the pilot questionnaire. Five parent-to-infant attachment relationship constructs were developed from attachment theory and current practice in infant mental health. These were combined with parent terminology preferences, and formed into a twenty-five item questionnaire. The twenty-five item questionnaire was used to collect data from twelve parents. Statistical testing on twenty-four test-retest completions of the tool resulted in a ten-item discussion tool that showed face and construct validity. Evidence of acceptability to practitioners and parents was gathered using a health visitor survey.

The important implications of the attachment relationship have led researchers to consider what the precursors to a secure attachment relationship are. Ainsworth, Bell, and Stayton (1971) proposed that maternal sensitivity was the fundamental trait in developing a secure attachment relationship. However, recent research has identified that mind-mindedness; the tendency of a parent to treat their infant as an individual with a mind (Meins, Fernyhough, Fradley & Tuckey, 2001), is a better predictor of parent infant attachment than maternal sensitivity. This study explored the impact of a new antenatal intervention called Baby World on the subsequent mind-mindedness of participants as well as its impact on the parent infant relationship. Participants who had attended the Baby World class and standard NHS antenatal classes (intervention group, N=21) were compared to those who had only attended standard NHS antenatal classes (control group, N=19). The study also explored whether planned pregnancies led to more mind-mindedness than unplanned pregnancies; whether emotional and physical wellbeing in pregnancy predicted mindmindedness and if there was any concordance between couples mind-mindedness. Results showed that participants in the intervention group used significantly more appropriate mind-minded comments than those in the control group. The intervention group also scored significantly higher than the control group on the Absence of Hostility subscale of the Maternal Postnatal Attachment Scale (MPAS, Condon & Corkindale, 1998). There was a non-significant trend of the intervention group scoring higher than the control group on the overall MPAS score as well as the Pleasure in Interaction subscale of the MPAS. The results also illustrated that emotional and physical wellbeing in pregnancy did not predict mind-mindedness and no concordance between couples mind-mindedness was found. Theoretical explanations of these findings are presented and the clinical implications and future research are discussed.