Implementation of a task-shared psychosocial intervention for perinatal depression in South Africa: A grounded theory process evaluation.
Implementation of a task-shared psychosocial intervention for perinatal depression in South Africa: A grounded theory process evaluation.
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DOI：
10.1016/j.ssmmh.2021.100056
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发表时间：
2022-12-01
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影响因子：
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通讯作者：
Schneider, Marguerite
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文献类型：
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作者：
Davies, Thandi;Lund, Crick;Schneider, Marguerite
围产期抑郁症对妇女及其婴儿的残疾程度很高，但在低收入和中等收入国家（LMIC），这种情况的治疗差距很大。为了解决这一差距，任务共享使用社区卫生工作者（CHW）提供心理社会干预围产期抑郁症越来越普遍。这些干预措施中有许多对产妇情绪产生了显著的积极影响，但并非所有干预措施都能做到这一点。本研究使用了来自南非开普敦的围产期抑郁症任务共享心理社会干预的数据，即“非洲关注心理健康干预研究”（AFFIRM-SA）随机对照试验（RCT）。它的目的是检查过程中发生的咨询干预的交付，并利用这些结果提供建议，在中低收入国家的心理社会任务分担。扎根理论分析进行了234咨询会议成绩单从随机选择的39名参与者的随机对照试验。这表明，干预措施的有效性受到参与者社会经济背景的负面影响以及与咨询手册意图不一致的咨询战略的影响。尽管如此，参与者提供了情绪和认知改善的自发说明，以及这些改善的原因，解释为对他们有效的治疗元素。这些元素中的大多数与先前确定的治疗“共同元素”一致。对未来研究和实践的建议包括进行参与性形成性研究，使用迭代和响应式研究设计，通过实施科学，将背景适当的策略纳入干预措施，如解决心理健康的社会决定因素，进行强化培训和监督，采用分阶段的方法来管理抑郁症，并使用治疗的共同要素作为心理社会干预的基础。
Perinatal depression carries significant levels of disability for both women and their infants, but there is a large treatment gap for this condition in low and middle-income countries (LMICs). To address this gap, task-sharing using community health workers (CHWs) to provide psychosocial interventions for perinatal depression is increasingly common. Many of these interventions have shown significant positive effects on maternal mood, however not all have done so. This study used data from a task-shared psychosocial intervention for perinatal depression in Cape Town, South Africa, the 'Africa Focus on Intervention Research for Mental Health' (AFFIRM-SA) randomised controlled trial (RCT). It aimed to examine the processes that occurred within the delivery of the counselling intervention, and to use these findings to provide recommendations for psychosocial task sharing in LMICs. A grounded theory analysis was conducted of 234 counselling session transcripts from 39 randomly selected participants from the RCT. This revealed that the effectiveness of the intervention was compromised by the negative influence of participants' socio-economic context, and by counselling strategies that did not align with what was intended in the counselling manual. Despite this, participants provided spontaneous accounts of improvement in mood and cognition, and reasons for these improvements, interpreted as elements that were therapeutically effective for them. Most of these elements aligned with previously identified 'common elements' of therapy. Recommendations for future research and practice include conducting participatory formative research, using an iterative and responsive research design informed by implementation science, incorporating contextually appropriate strategies in interventions such as addressing social determinants of mental health, conducting intensive training and supervision, adopting a staged approach to managing depression, and using common elements of therapy as the basis for psychosocial interventions.