Abstract
BackgroundPerinatal depression is highly prevalent in South Asia. Although effective and culturally feasible interventions exist, a key bottleneck for scaled-up delivery is lack of trained human resource. The aim of this study was to adapt an evidence-based intervention so that local women from the community (peers) could be trained to deliver it, and to test the adapted intervention for feasibility in India and Pakistan.MethodsThe study was conducted in Rawalpindi, Pakistan and Goa, India. To inform the adaptation process, qualitative data was collected through 7 focus groups (four in Pakistan and three in India) and 61 in-depth interviews (India only). Following adaptation, the intervention was delivered to depressed mothers (20 in Pakistan and 24 in India) for six months through 8 peers in Pakistan and nine in India. Post intervention data was collected from depressed mothers and peers through 41 in-depth interviews (29 in Pakistan and 12 in India) and eight focus groups (one in Pakistan and seven in India). Data was analysed using Framework Analysis approach.ResultsMost mothers perceived the intervention to be acceptable, useful, and viewed the peers as effective delivery-agents. The simple format using vignettes, pictures and everyday terms to describe distress made the intervention easy to understand and deliver. The peers were able to use techniques for behavioural activation with relative ease. Both the mothers and peers found that shared life-experiences and personal characteristics greatly facilitated the intervention-delivery. A minority of mothers had concerns about confidentiality and stigma related to their condition, and some peers felt the role was emotionally challenging.ConclusionsThe study demonstrates the feasibility of using peers to provide interventions for perinatal depression in two South Asian settings. Peers can be a potential resource to deliver evidence-based psychosocial interventions.Trial registrationPakistan Trial: ClinicalTrials.gov Identifier: NCT02111915 (9 April 2014), India Trial: ClinicalTrials.gov Identifier: NCT02104232 (1 April 2014).
Highlights
Perinatal depression is highly prevalent in South Asia
In a meta-analysis of 47 studies from low and middle-income countries (LMICs), the average point prevalence of depressive episode was reported to be 15.6% during pregnancy and 19.8% in the postpartum, with substantially higher rates found in South Asia [1]
Psychosocial interventions are the first-line treatment of perinatal depression [11] but, in LMIC, a key barrier to the delivery of such interventions is the lack of specialist workforce [12, 13]
Summary
Perinatal depression is highly prevalent in South Asia. effective and culturally feasible interventions exist, a key bottleneck for scaled-up delivery is lack of trained human resource. Psychosocial interventions are the first-line treatment of perinatal depression [11] but, in LMIC, a key barrier to the delivery of such interventions is the lack of specialist workforce [12, 13]. In such settings, “TaskShifting” has been recommended as an implementation strategy [12, 14, 15], and several studies have shown that psychosocial interventions can be successfully delivered to mothers by community or other front-line health workers [11, 16]. It becomes imperative to explore alternative human resources for the implementation of such interventions at scale
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