Process evaluations of task sharing interventions for perinatal depression in low and middle income countries (LMIC): a systematic review and qualitative meta-synthesis

Memory Munodawafa,Sumaya Mall,Marguerite Schneider,Crick Lund

doi:10.1186/s12913-018-3030-0

Abstract

BackgroundPerinatal depression is common in low and middle income countries (LAMICs). Task sharing interventions have been implemented to treat perinatal depression in these settings, as a way of dealing with staff shortages. Task sharing allows lay health workers to provide services for less complex cases while being trained and supervised by specialists. Randomized controlled trials suggest that these interventions can be effective but there is limited qualitative information exploring barriers and facilitators to their implementation. This systematic review aims to systematically review current qualitative evidence of process evaluations of task sharing interventions for perinatal depression in LAMICs in relation to the United Kingdom (UK) Medical Research Council (MRC) framework for conducting process evaluations.MethodsWe searched Medline/ PubMed, PsycINFO, Scopus, Cochrane Library and Web of science for studies from LAMICS using search terms under the broad categories of: (a) “maternal depression’” (b) “intervention” (c) “lay counsellor” OR “community health worker” OR “non-specialist” and (d) “LAMICs”. s were independently reviewed for inclusion by two authors. Full text articles were screened and data for included articles were extracted using a standard data extraction sheet. Qualitative synthesis of qualitative evidence was conducted.Results8420 articles were identified from initial searches. Of these, 26 full text articles were screened for eligibility with only three studies meeting the inclusion criteria. Main findings revealed that participants identified the following crucial factors: contextual factors included physical location, accessibility and cultural norms. Implementation factors included acceptability of the intervention and characteristics of the personnel. Mechanisms included counsellor factors such as motivating and facilitating trust; intervention factors such as use of stories and visual aids, and understandability of the content; and participant factors such as shared experience, meeting learning needs, and meeting expectations.ConclusionsWhile task sharing has been suggested as an effective way of filling the treatment gap for perinatal depression, there is a paucity of qualitative research exploring barriers and facilitators to implementing these interventions. Qualitative process evaluations are crucial for the development of culturally relevant interventions.

Highlights

Perinatal depression is common in low and middle income countries (LAMICs)
Perinatal depression which refers to the experience of depression during pregnancy and up to one year post-partum can be associated with adverse consequences for both mother and baby [3]
The line between efficacy and effectiveness [15] in relation to task sharing for mental health in LAMICS has been somewhat blurred, many trials have proceeded to effectiveness evaluations without necessarily demonstrating efficacy

Summary

Introduction

Perinatal depression is common in low and middle income countries (LAMICs). Task sharing interventions have been implemented to treat perinatal depression in these settings, as a way of dealing with staff shortages. Task sharing allows lay health workers to provide services for less complex cases while being trained and supervised by specialists. Task sharing is an approach to mental health service provision whereby non-specialist health workers provide care for less complex cases under the training and supervision of a specialist. This shares the burden of care [4] while providing locally relevant interventions to people from the same community and cultural background who speak the same language [13, 14]. Providing qualitative evidence on interventions is crucial for gaining insight into the participants’ and service providers’ views on the development of acceptable interventions [19]

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Results

Discussion

Conclusion