Stigma and utilization of treatment for adolescent perinatal depression in Ibadan Nigeria
Stigma and utilization of treatment for adolescent perinatal depression in Ibadan Nigeria
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DOI：
10.1186/s12884-020-02970-4
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发表时间：
2020-05-14
影响因子：
3.1
通讯作者：
Gureje, Oye
中科院分区：
文献类型：
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作者：
Kola, Lola;Bennett, Ian M.;Gureje, Oye
背景抑郁症是低收入和中等收入国家低收入少女母亲中常见的严重疾病，治疗资源有限。我们希望确定的因素，影响卫生服务利用青少年围产期抑郁症，在尼日利亚通知新的战略，护理delivery.MethodsFocus小组讨论（FGD）之间进行了有目的地选择低收入的年轻母亲（青少年围产期抑郁症的病史），并分别与初级保健临床医生治疗这种情况下，在伊巴丹，尼日利亚。这项以社区为基础的研究的参与者来自参与2014年至2016年在伊巴丹11个地方政府地区的28个初级卫生保健设施进行的先前随机对照试验（RCT）的受访者数据库。根据弱势群体行为模式的主题，制定了半结构化访谈指南，以了解参与者对促进或阻碍寻求帮助和参与的因素的看法（见补充文件1和2）。在与六个小组讨论后，进行了FGD，并实现了主题饱和。成绩单进行了分析，使用内容analysis.ResultsA共42名参与者，17名母亲（谁是青少年在RCT的时间），和25名护理人员参加了6 FGD。在初级保健水平的护理围产期抑郁症的可用性是一个重要的有利因素，在青少年的医疗保健利用。接受围产期抑郁症治疗的健康益处是服务使用的强烈动机。护理提供者对少女怀孕和围产期抑郁症的严重污名化和负面陈规定型观念是护理的障碍。然而，个别病人的弹性是一个主要的有利因素，促进服务的参与。在围产期抑郁症的管理培训提供者被认为提供更多的宽容和支持性的护理，青少年mothersvalues.ConclusionsParticipants确定不支持和污名化的诊所环境对怀孕和育儿青少年的显着障碍，以获得可用的护理。减少医疗保健提供者之间的耻辱感的干预措施可能会改善对这一弱势群体的服务。
BackgroundDepression is a common and severe disorder among low-income adolescent mothers in low-and middle-income countries where resources for treatment are limited. We wished to identify factors influencing health service utilization for adolescent perinatal depression, in Nigeria to inform new strategies of care delivery.MethodsFocus Group Discussions (FGDs) were conducted among purposively selected low-income young mothers (with medical histories of adolescent perinatal depression), and separately with primary care clinicians treating this condition in Ibadan, Nigeria. Participants from this community-based study were from the database of respondents who participated in a previous randomized control trial (RCT) conducted between 2014 and 2016 in 28 primary health care facilities in the 11 Local government areas in Ibadan. Semi-structured interview guides, framed by themes of the Behavioral Model for Vulnerable Populations, was developed to obtain views of participants on the factors that promote or hinder help-seeking and engagement (see additional files 1 & 2). FGDs were conducted, and saturation of themes was achieved after discussions with six groups. Transcripts were analyzed using content analysis.ResultsA total of 42 participants, 17 mothers (who were adolescents at the time of the RCT), and 25 care providers participated in 6 FGDs. The availability of care for perinatal depression at the primary care level was an important enabling factor in healthcare utilization for the adolescents. Perceived health benefits of treatment received for perinatal depression were strong motivation for service use. Significant stigma and negative stereotypes expressed by care providers towards adolescent pregnancy and perinatal depression were obstacles to care. However, individual patient resilience was a major enabling factor, facilitating service engagement. Providers trained in the management of perinatal depression were perceived to deliver more tolerant and supportive care that adolescent mothers valued.ConclusionsParticipants identified unsupportive and stigmatizing clinic environments towards pregnant and parenting adolescents as significant barriers to accessing available care. Interventions to reduce stigma among healthcare providers may improve services for this vulnerable population.