Barefoot therapists: barriers and facilitators to delivering maternal mental health care through peer volunteers in Pakistan: a qualitative study.
Barefoot therapists: barriers and facilitators to delivering maternal mental health care through peer volunteers in Pakistan: a qualitative study.
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DOI：
10.1186/s13033-016-0055-9
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发表时间：
2016
影响因子：
3.6
通讯作者：
Rahman A
中科院分区：
文献类型：
--
作者：
Atif N;Lovell K;Husain N;Sikander S;Patel V;Rahman A
围产期抑郁症是低收入和中等收入国家的一个公共卫生问题。虽然存在有效的心理社会干预措施，但其推广的一个主要限制因素是缺乏心理健康专业人员。本研究的目的是探讨促进者和障碍的接受同伴志愿者（PV）-志愿者奠定妇女从社区共享的社会人口和生活经验的目标人群-作为交付代理人的心理社会干预围产期抑郁症在巴基斯坦农村地区。这项定性研究是嵌入在一个更大的同行提供的心理健康计划的试点阶段。49名参与者包括：抑郁的母亲（n = 21），PV（n = 8），初级卫生保健人员（n = 5），丈夫（n = 5）和岳母（n = 10）。通过深入访谈和焦点小组收集数据，并使用框架分析方法进行分析。所有主要利益攸关方都接受自愿捐助者作为执行机构。促进者包括PV的个人属性，如当地，值得信赖，同情，并有类似的母亲经历。人们认为干预措施的有用性和文化上的适当性以及与初级保健系统的联系对其合法性和可信性至关重要。志愿人员的动机很重要，影响这一动机的因素有：适当的选择;有效的培训和监督;社区对其作用的认可，以及适当的激励措施。障碍包括妇女缺乏自主权、某些文化信仰、与抑郁症有关的耻辱感、一些母亲缺乏参与以及一些家庭的抵制。PV是一个潜在的人力资源，提供心理社会干预围产期抑郁症在这个农村地区的巴基斯坦。可以考虑在全球其他资源不足的环境中使用这种交付媒介。
Perinatal depression is a public health problem in low and middle income countries. Although effective psychosocial interventions exist, a major limitation to their scale up is the scarcity of mental health professionals. The aim of this study was to explore the facilitators and barriers to the acceptability of peer volunteers (PVs)—volunteer lay women from the community with shared socio-demographic and life experiences with the target population—as delivery agents of a psychosocial intervention for perinatal depression in a rural area of Pakistan. This qualitative study was embedded in the pilot phase of a larger peer-delivered mental health programme. Forty nine participants were included: depressed mothers (n = 21), PVs (n = 8), primary health care staff (n = 5), husbands (n = 5) and mothers-in-law (n = 10). Data were collected through in-depth interviews and focus groups and analysed using the Framework Analysis approach. The PVs were accepted as delivery agents by all key stakeholders. Facilitators included the PVs’ personal attributes such as being local, trustworthy, empathetic, and having similar experiences of motherhood. The perceived usefulness and cultural appropriateness of the intervention and linkages with the primary health care (PHC) system was vital to their legitimacy and credibility. The PVs’ motivation was important, and factors influencing this were: appropriate selection; effective training and supervision; community endorsement of their role, and appropriate incentivisation. Barriers included women’s lack of autonomy, certain cultural beliefs, stigma associated with depression, lack of some mothers’ engagement and resistance from some families. PVs are a potential human resource for the delivery of a psychosocial intervention for perinatal depression in this rural area of Pakistan. The use of such delivery agents could be considered for other under-resourced settings globally.