Abstract
BackgroundTask sharing has been used worldwide to improve access to mental health care, where nonspecialist providers—individuals with no formal training in mental health—have been trained to effectively treat perinatal depressive and anxiety symptoms. Little formative research has been conducted to examine relevant barriers and facilitators of nonspecialist providers and the use of telemedicine in treatment service delivery.ObjectiveThe primary objective of this study was to examine the main barriers and facilitators of nonspecialist provider–delivered psychological treatments for perinatal populations with common mental health disorders, such as depression and anxiety, from a multistakeholder perspective.MethodsThis study took place in Toronto, Canada. In total, 33 in-depth interviews were conducted with multiple stakeholder groups (women with lived experience and their significant others, as well as health and mental health professionals). Qualitative data were quantified to estimate commonly endorsed themes within and across stakeholder groups.ResultsPsychological treatments delivered by nonspecialist providers were considered acceptable by the vast majority of participants (30/33, 90%). Across all stakeholder groups, nurses (20/33, 61%) and midwives (14/33, 42%) were the most commonly endorsed cadre of nonspecialist providers. The majority of stakeholders (32/33, 97%) were amenable to nonspecialist providers delivering psychological treatment via telemedicine (27/33, 82%), although concerns were raised about the ability to establish a therapeutic alliance via telemedicine (16/33, 48%). Empathy was the most desired characteristic of a nonspecialist provider (61%). Patient and patient advocate stakeholders were more likely to emphasize stigma as an important barrier to accessing psychological treatments (7/12, 58%), compared to clinicians (2/9, 22%) and spouses (1/5, 20%). Clinician stakeholders were more likely to emphasize the importance of ensuring nonspecialist providers were trained to deliver psychological treatments (3/9, 33%), compared to other stakeholder groups.ConclusionsThese results can inform the design, implementation, and integration of nonspecialist-delivered interventions via telemedicine for women with perinatal depressive and anxiety symptoms in high-income country contexts.
Highlights
Depression is the leading cause of disability worldwide [1], with an estimated 10% to 15% of women experiencing depression and anxiety during pregnancy or in the year following childbirth [2,3,4]
45 participants were contacted, of which 33 agreed and consented to participate in the study. This included a wide range of stakeholders
We asked a range of stakeholders—including women with lived experiences, their significant others, patient advocates, health care providers, mental health specialists, and health administrators—to comment on accessing psychological treatments, nonspecialist-delivered psychological treatments, the role of experts, the use of telemedicine, and the best way to integrate nonspecialist providers within the broader health care system
Summary
Depression is the leading cause of disability worldwide [1], with an estimated 10% to 15% of women experiencing depression and anxiety during pregnancy or in the year following childbirth [2,3,4]. The term “task sharing” is appropriate in high-income countries (HICs) when few physicians are available and tasks may be shared with other providers with some supervision or referral to physicians [13] This concept was derived from the paraprofessional model in the United States and United Kingdom, where substantive evidence demonstrated the comparative effectiveness of paraprofessional and professional specialists, highlighting paraprofessionals as potential effective additions to mental health fields [14,15]. Task sharing has been used worldwide to improve access to mental health care, where nonspecialist providers—individuals with no formal training in mental health—have been trained to effectively treat perinatal depressive and anxiety symptoms. Little formative research has been conducted to examine relevant barriers and facilitators of nonspecialist providers and the use of telemedicine in treatment service delivery
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