Abstract
BackgroundIndigenous Maya women in Guatemala show some of the worst maternal health indicators worldwide. Our objective was to test acceptability, feasibility and impact of a co-designed group psychosocial intervention (Women’s Circles) in a population with significant need but no access to mental health services.MethodsA parallel group pilot randomised study was undertaken in five rural Mam and three periurban K’iche’ communities. Participants included 84 women (12 per community, in seven of the communities) randomly allocated to intervention and 71 to control groups; all were pregnant and/or within 2 years postpartum. The intervention consisted of 10 sessions co-designed with and facilitated by 16 circle leaders. Main outcome measures were: maternal psychosocial distress (HSCL-25), wellbeing (MHC-SF), self-efficacy and engagement in early infant stimulation activities. In-depth interviews also assessed acceptability and feasibility.ResultsThe intervention proved feasible and well accepted by circle leaders and participating women. 1-month post-intervention, wellbeing scores (p-value 0.008) and self-care self-efficacy (0.049) scores were higher among intervention compared to control women. Those women who attended more sessions had higher wellbeing (0.007), self-care and infant-care self-efficacy (0.014 and 0.043, respectively), and early infant stimulation (0.019) scores.ConclusionsThe pilot demonstrated acceptability, feasibility and potential efficacy to justify a future definitive randomised controlled trial. Co-designed women’s groups provide a safe space where indigenous women can collectively improve their functioning and wellbeing.Trial registrationISRCTN13964819. Registered 26 June 2018, retrospectively registered.
Highlights
Indigenous Maya women in Guatemala show some of the worst maternal health indicators worldwide
A systematic review reported perinatal mental disorders were common in low- and lower-middle-income countries (LMIC), affecting 16% of pregnant women and 20% of women in the postpartum period [10]
Recent research has demonstrated the feasibility of psychosocial interventions for perinatal mental health in non-specialized health-care settings using psychoeducation [5, 22,23,24] cognitive restructuring [25, 26], problem-solving [25, 27, 28], behaviour activation [27], activating social networks [28, 29], and skilled parenting practices [30,31,32]. Few of these interventions have been tested in Latin America [27, 29] and none in indigenous populations. We addressed this knowledge gap for a population at special disadvantage of maternal mental health disorders through the co-design of a culturally safe perinatal group psychosocial intervention compatible with indigenous traditions – Women’s Circles
Summary
Indigenous Maya women in Guatemala show some of the worst maternal health indicators worldwide. Our objective was to test acceptability, feasibility and impact of a co-designed group psychosocial intervention (Women’s Circles) in a population with significant need but no access to mental health services. Guatemala’s indigenous women manifest some of the worst health indicators worldwide [14]; three in four live below the poverty line [15]. In rural indigenous Mam communities in the Western Highlands, lower household wealth, psychological distress, ineffective social support, inequality in decision-making, and experience of violence were consistent determinants of maternal stress, assessed via salivary cortisol, and infant stunting in the first 6 months of life [17]. The Guatemalan civil war and long history of racial discrimination places indigenous populations at an additional disadvantage in terms of access to health services [20, 21]
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