Filling the treatment gap: developing a task sharing counselling intervention for perinatal depression in Khayelitsha, South Africa.
Filling the treatment gap: developing a task sharing counselling intervention for perinatal depression in Khayelitsha, South Africa.
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DOI：
10.1186/s12888-016-0873-y
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发表时间：
2016-05-26
期刊：
影响因子：
4.4
通讯作者：
Lund C
中科院分区：
文献类型：
--
作者：
Nyatsanza M;Schneider M;Davies T;Lund C
围产期抑郁症是一个主要的公共卫生问题，特别是在南非的低收入环境中，那里缺乏心理健康专业人员。需要由非专科医生提供新的心理干预来填补治疗缺口。本文描述了在开普敦Khayelitsa开发基于手册的任务分担咨询干预围产期抑郁症的过程。为了探讨任务分担辅导干预的可行性、可接受性和内容，对26名参与者进行了定性的半结构化访谈，其中包括在Khayelitsa的一家诊所的服务提供者和服务使用者。采访被录音、翻译和转录。使用框架分析方法确定了主题，并使用NVivo V10进行了编码和分析。在半结构化访谈之后，与精神健康专家一起举办了一次关于抑郁症的循证心理干预的讲习班，并对南非社区卫生工作者的咨询手册进行了文件审查。研究结果表明，在以下条件下，任务分担辅导干预对Khayelitsa的抑郁症妇女是可以接受和可行的：(1)受访者更喜欢女性咨询师，并认为基于诊所的个别咨询至少应该由来自社区的有经验的科萨语咨询师提供一次；(2)咨询干预的内容应该包括关于抑郁的认知和行为影响、如何应对人际问题和经济压力的心理教育。根据这些情况、审查手册和专家咨询，咨询干预的关键组成部分被确定为：心理教育、解决问题、健康思维和行为激活。这些都包括在最后的咨询手册中。在制定针对围产期抑郁症的任务分担咨询干预措施时，应了解当地服务使用者和服务提供者的意见和需求。该研究说明了在低收入和中等收入国家的任务分担框架内，如何将这些观点纳入以证据为基础的心理干预措施的发展。本文的在线版本(doi：10.1186/s12888-0160873-y)包含补充材料，授权用户可以使用。
Perinatal depression is a major public health issue especially in low income settings in South Africa, where there is a shortage of mental health professionals. New psychological interventions delivered by non-specialists are needed to fill the treatment gap. This paper describes the process of developing a manual based task sharing counselling intervention for perinatal depression in Khayelitsha, Cape Town. Qualitative semi-structured interviews were conducted with 26 participants, including service providers and service users at a clinic in Khayelitsha in order to explore the feasibility, acceptability and content of a task sharing counselling intervention. The interviews were recorded, translated and transcribed. Themes were identified using the framework analysis approach and were coded and analysed using NVivo v10. After the semi-structured interviews, a workshop was conducted with mental health experts on evidence-based psychological interventions for depression, together with a document review of counselling manuals for community health workers in South Africa. The findings indicate that a task sharing counselling intervention was acceptable and feasible for depressed women in Khayelitsha, under the following conditions: (1) respondents preferred a female counsellor and felt that clinic based individual sessions should be provided at least once a month by an experienced Xhosa speaking counsellor from the community; and (2) the content of a counselling intervention should include psycho-education on cognitive and behavioural effects of depression, how to cope with interpersonal problems, and financial stressors. Based on these conditions, the review of manuals and expert consultation, key components of the counselling intervention were identified as: psycho-education, problem solving, healthy thinking and behaviour activation. These were included in the final counselling manual. The development of task sharing counselling interventions for perinatal depression should be informed by the views and needs of local service users and service providers. The study illustrates the manner in which these views can be incorporated for the development of evidence-based psychological interventions, within a task sharing framework in low and middle-income countries. The online version of this article (doi:10.1186/s12888-016-0873-y) contains supplementary material, which is available to authorized users.