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的青少年母亲所生的2万名婴儿中，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侧重于预防少女怀孕，这使得少女母亲在克服她们面临的具体挑战方面获得的支持有限。青春期女孩尤其容易受到伤害，每两个女孩中就有一个在怀孕期间或出生后一年出现精神障碍。这对她们的身体健康、社会关系、教育成就和就业机会以及她们子女的发展、情感、行为和身体健康结果产生了重大的不利影响。尽管存在这种不平等，但在这些资源匮乏的环境中，没有评估过以青少年孕产妇心理健康为重点的干预措施。这是本奖学金将要解决的挑战。为了支持青少年母亲及其子女生存和发展，有必要让利益攸关方参与制定精神卫生干预措施，并确定如何利用周围的结构和力量，通过结合以人为本的设计和系统思维方法，优化一线使用和地方和国家实施的干预措施。通过这项奖学金，我将采用以人为本、以系统为导向的设计，与莫桑比克和肯尼亚的青春期女孩、她们的家庭和卫生服务提供者合作，设计、实施和评估干预措施，以改善怀孕期间和出生后一年的青少年心理健康。将采用一项为期7年的三期混合方法设计，为生活在莫桑比克和肯尼亚的15-19岁孕妇和新妈妈制定和评估一项精神卫生预防干预措施。在第一阶段（2-18个月），将采用以人为本、注重系统的设计方法，与青少年、其家庭、当地服务提供者和政策制定者合作，确定、调整和设计一种干预措施，以改善各国的青少年孕产妇心理健康结果。在第二阶段（14-48个月），干预措施将在每个国家进行试点，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（第49-84个月），将进行一项随机对照试验，评估与常规护理/基本心理健康素养干预相比的临床有效性和交付结果。这项研究将导致制定一项干预措施，支持青少年孕产妇的福祉，并通过以一种对年轻母亲、她们的家庭和服务提供者有吸引力的方式，将我们所知道的孕产妇精神障碍的风险和保护因素包装起来，为青少年母亲提供希望和技能，为她们和她们的孩子创造更好的生活。通过采用以人为中心、注重系统的设计来了解年轻母亲的需求和优先事项以及她们生活的卫生和社区系统，由此产生的干预措施和适应环境的方法具有在莫桑比克和肯尼亚以外以及非洲以外的国际可转移性和影响的巨大潜力。此外，所开展的工作将为制定适应和实施精神卫生干预措施的方法奠定基础，供精神卫生干预措施提供者在整个生命周期中使用。

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.