Health care providers' perceptions of barriers to perinatal mental healthcare in South Africa.
Health care providers' perceptions of barriers to perinatal mental healthcare in South Africa.
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DOI：
10.1186/s12889-021-11954-8
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发表时间：
2021-10-21
影响因子：
4.5
通讯作者：
Sprague C
中科院分区：
文献类型：
--
作者：
Brown S;Sprague C
围产期精神障碍是导致妊娠和产后发病率和死亡率的一个主要因素，如果及早发现，治疗效果很好。然而，许多妇女，特别是低收入和中等收入国家的妇女，无法在公共卫生机构获得精神疾病的常规诊断和治疗。与高收入国家的妇女相比，南非妇女的围产期抑郁症和焦虑症（常见的精神障碍）患病率高出三倍。公共卫生系统已开始将心理健康纳入孕产妇保健，使南非成为围产期心理保健的相关案例研究。然而研究很少。我们试图调查卫生保健提供者对南非公共卫生机构早期识别和筛查常见围产期精神障碍的障碍的看法。采用定性方法，我们采用目的性抽样来确定研究参与者，辅以滚雪球抽样。从2019年9月至2020年6月，我们对南非的24名关键线人进行了深入采访。所有的采访都被逐字记录下来。我们使用主题方法来生成最初的分析主题，然后进行迭代编码来完善它们。我们采用了一个交付系统框架来组织研究结果，并在概念图中进行了描述。报告的围产期精神疾病早期识别和治疗障碍包括四个层面：(1)与政策、制度和资源相关的结构性因素；(2)社会文化因素，包括语言和文化障碍；(3)组织因素，如缺乏医护人员的准备和培训，以及诊所负担过重；(4)个体患者和医疗保健提供者因素。障碍跨越多个层面，降低了高质量的精神卫生促进和护理，从而创造了一种环境，在这种环境中，不公平地获得精神障碍鉴定和高质量的精神卫生服务已融入系统和日常实践。跨多个层面的综合干预措施对于改善南非围产期妇女精神疾病的早期识别和治疗至关重要。我们根据我们的研究结果提出建议，以克服四个确定水平上的障碍。在线版本包含补充材料，可在10.1186/s12889-021-11954-8获得。
Perinatal mental disorders are a leading contributor to morbidity and mortality during pregnancy and postpartum, and are highly treatable when identified early. However, many women, especially in low and middle-income countries, lack access to routine identification and treatment of mental illness in public health settings. The prevalence of perinatal depression and anxiety disorders, common mental disorders, is three times higher for South African women relative to women in high-income countries. The public health system has begun to integrate mental health into maternal care, making South Africa a relevant case study of perinatal mental healthcare. Yet studies are few. We sought to investigate healthcare providers’ perceptions of the barriers to early identification and screening of common perinatal mental disorders in public health facilities in South Africa. Employing qualitative methods, we used purposive sampling to identify study participants, supplemented by snowball sampling. From September 2019–June 2020, we conducted in-depth interviews with 24 key informants in South Africa. All interviews were recorded and transcribed verbatim. We used a thematic approach to generate initial analytical themes and then conducted iterative coding to refine them. We adapted a delivery systems’ framework to organise the findings, depicted in a conceptual map. Reported barriers to early identification and treatment of mental illness in the perinatal period encompassed four levels: (1) structural factors related to policies, systems and resources; (2) socio-cultural factors, including language and cultural barriers; (3) organisational factors, such as lack of provider preparation and training and overburdened clinics; and (4) individual patient and healthcare provider factors. Barriers act across multiple levels to reduce quality mental health promotion and care, thereby creating an environment where inequitable access to identification of mental disorders and quality mental health services was embedded into systems and everyday practice. Integrated interventions across multiple levels are essential to improve the early identification and treatment of mental illness in perinatal women in South Africa. We provide recommendations derived from our findings to overcome barriers at each of the four identified levels. The online version contains supplementary material available at 10.1186/s12889-021-11954-8.
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DOI：
10.3389/fgwh.2020.00001
发表时间：
2020
期刊：
Frontiers in global women's health
影响因子：
--
作者：
Davenport MH;Meyer S;Meah VL;Strynadka MC;Khurana R
通讯作者：
Khurana R
影响因子：
5
作者：
Fischer, Alex Emilio;Sebidi, Jane;Lalla-Edward, Samanta Tresha
通讯作者：
Lalla-Edward, Samanta Tresha
影响因子：
2.5
作者：
Honikman, Simone;Field, Sally;Cooper, Sara
通讯作者：
Cooper, Sara
影响因子：
3.7
作者：
Marais, Debra Leigh;Quayle, Michael;Petersen, Inge
通讯作者：
Petersen, Inge
影响因子：
3.4
作者：
Hartley, Mary;Tomlinson, Mark;Rotheram-Borus, Mary Jane
通讯作者：
Rotheram-Borus, Mary Jane