Innovative approaches to developing scalable and sustainable adolescent maternal mental health interventions in Kenya and Mozambique

低收入和中等收入国家青春期母亲所生的20000名婴儿中的大多数生活在撒哈拉以南非洲。实现联合国可持续发展目标的努力主要集中在预防少女怀孕上，这使得青少年母亲在克服她们面临的具体挑战方面获得的支持有限。青春期女孩特别容易受到伤害，每2个女孩中就有1人在怀孕期间或出生后第二年经历精神障碍。这对他们的身体健康、社会网络、教育成就和就业机会以及其子女的发展、情感、行为和身体健康结果产生了严重的不利影响。尽管存在这种不平等，但在这些资源匮乏的环境中，没有对侧重于青少年产妇心理健康的干预措施进行评估。为了支持青春期母亲和她们的孩子生存和成长，有必要让利益相关者参与制定心理健康干预措施，并确定如何利用周围的结构和力量，通过以人为中心的设计和系统思维方法的结合，优化干预措施，用于一线使用和地方和国家实施。通过这一奖学金，我将使用以人为中心的、系统的设计，与青春期女孩、她们的家人和卫生保健提供者合作，设计、实施和评估干预措施，以改善莫桑比克和肯尼亚青少年在怀孕期间和出生后第二年的心理健康。将使用七年、三阶段、混合方法设计，为居住在莫桑比克和肯尼亚的15-19岁孕妇和新妈妈开发和评估心理健康预防干预措施。在第一阶段(第2-18个月)，将采用以人为中心、有系统意识的设计方法，与青少年、他们的家庭、当地服务提供者和政策制定者合作，以确定、调整和制定一项干预措施，以改善每个国家青少年产妇的心理健康结果。在第二阶段(14-48个月)，干预措施将在每个国家试行，以评估可行性、适当性和可接受性，并收集心理健康、过程和资源数据，为试验做准备。最后，在第三阶段(49-84个月)，将进行一项随机对照试验，评估临床效果和交付结果，并与常规护理/基本心理健康知识干预进行比较。这项研究将开发一种干预措施(S)，支持青少年母亲的福祉，并通过以一种对年轻母亲、她们的家人和服务提供者有吸引力的方式包装我们知道的母亲精神障碍的风险和保护因素，为青少年母亲和她们的孩子创造更好的生活的希望和技能。通过使用以人为中心、有系统意识的设计来了解年轻母亲的需求和优先事项以及她们所生活的健康和社区系统，由此产生的干预措施(S)和背景适应方法具有巨大的国际可转移性和影响，其影响超出莫桑比克和肯尼亚，甚至超出非洲。此外，开展的工作将为制定适应和实施心理健康干预措施的方法奠定基础，心理健康干预措施的提供者可以在整个生命周期内使用这些方法。

The majority of the 20,000 babies born to adolescent mothers in low and middle-income countries live in sub-Saharan Africa. Efforts to achieve the UN Sustainable Development Goals have focused on preventing teenage pregnancy, leaving adolescent mothers with limited support to overcome the specific challenges they face. Adolescent girls are particularly vulnerable with 1 in 2 experiencing a mental disorder during pregnancy or the year after birth. The adverse effects on their physical health, social networks, educational achievements and employment opportunities and well as the developmental, emotional, behavioural and physical health outcomes of their children are significant. Despite this inequity, no interventions focused on adolescent maternal mental health have been evaluated in these low-resource settings. This is the challenge this Fellowship will address.To support adolescent mothers and their children to survive and thrive, it is necessary to engage stakeholders in the development of mental health interventions and identify how to leverage the surrounding structures and forces to optimise interventions for both front-line use and local and national implementation through the combination of human-centred design and systems thinking approaches. Through this fellowship I will use human-centred, systems-minded design to partner with adolescent girls, their families, and health providers to design, implement, and evaluate interventions to improve the mental health of adolescents during pregnancy and the year after birth in Mozambique and Kenya.A seven-year, three-phase, mixed-method design will be used to develop and evaluate a mental health prevention intervention for pregnant and new mothers aged 15-19 living in Mozambique and Kenya. In Phase 1 (months 2-18) a human-centred, system-minded design approach will be used to partner with adolescents, their families, local service providers and policymakers to identify, adapt and prototype an intervention to improve adolescent maternal mental health outcomes in each country. In Phase 2 (months 14-48), the intervention will be piloted within each country to assess feasibility, appropriateness, and acceptability and collect mental health, process and resource data to prepare for a trial. Lastly, in Phase 3 (months 49-84), a randomised controlled trial evaluating clinical effectiveness and delivery outcomes compared to usual care/basic mental health literacy intervention will be conducted. The research will result in the development of an intervention(s) that supports adolescent maternal wellbeing and gives adolescent mothers the hope and skills to build a better life for them and their children by packaging what we know are the risk and protective factors for maternal mental disorders in a way that is attractive to young mothers, their families and service providers. By using human-centred, systems-minded design to understand the needs and priorities of young mothers and the health and community systems in which they live, the resulting intervention(s) and approach to contextual adaptation has significant potential for international transferability and impact beyond Mozambique and Kenya, and beyond Africa. In addition, the work undertaken will provide a foundation for the development of approaches to adaptation and implementation of mental health interventions which can be used by providers of mental health interventions across the lifespan.