Developing a tailored implementation plan for collaborative care of perinatal depression care in community health centers in Vietnam

项目总结/摘要 围产期抑郁症是一种常见而严重的疾病，自杀是孕产妇死亡的主要原因。 死亡率，但很少有来自低收入和中等收入国家（LMIC）的妇女得到有效的治疗。有效 改善围产期抑郁症和支持自杀预防的护理模式已经存在，但还没有 在中低收入国家的常规妇幼保健服务中广泛实施。这些模式包括创新， 允许稀缺的专业护理支持社区环境中的高质量护理，因此可能非常适合 低资源国家。实现这些模式效益的一个主要障碍是缺乏适当的 适应提供这些服务的环境中的文化和保健服务。而 基于证据的模型可能在它们被开发的背景下工作， 忠于保真度而不允许适应可能会导致新系统的有效性降低或"电压下降"。 设置.相比之下，注重灵活调整护理方法有可能实现甚至 通过支持干预"再造"， 一个学习健康系统。实施战略，以及保健服务的要素 提供服务本身也必须适合于护理创新的文化和卫生服务背景， 将被引入。我们计划采用参与式方法，系统地确定和调整关键要素 的循证模式的围产期抑郁症护理提供的文化和卫生服务的背景下， 越南坎托。这座联邦-省级城市为湄公河的大片地区提供卫生服务 三角洲有1900多万人口，大部分是农村居民。在为期两年的研究期间，我们将首先制定一个 根据循证方法改编的模式，用于接受围产期护理的妇女的筛查和治疗 社区卫生中心和产科医院的护理。同时探索潜力 沿着创建，将确定支持和维持该模型的实施战略 为这一背景提供培训和实施工具包。使用这些策略和工具，我们将开展一项 在公共卫生中心进行的围产期协作护理试点研究和坎托的产前护理实践 妇产科医院。这项试验的结果将用于修订和加强治疗 模型和相关的实施工具。这些将用于随后的有效性和/或 在坎托的保健系统中广泛实施。

Project Summary/Abstract Perinatal depression is a common and serious disorder, with suicide representing a major cause of maternal mortality, but few women from low and middle income countries (LMICs) receive effective treatment. Effective models of care that improve perinatal depression and support suicide prevention exist but have not yet been widely implemented in routine maternal-child care services in LMICs. These models include innovations to allow scarce specialty care to support high quality care in community settings and so are potentially well suited to low resourced countries. A major obstacle to achieving the benefits of these models is a lack of appropriate adaptation to the cultural and health services context of the settings in which they will be delivered. While evidence based models may work in the context in which they were developed maintaining too great an allegiance to fidelity without allowing adaptation can result in reduced effectiveness or “voltage drop” in new settings. In contrast, a focus on flexible adaptation of care approaches has the potential to achieve or even exceed the outcomes seen in controlled efficacy trials by supporting intervention “reinvention” within the context of a learning health system. Implementation strategies, in addition to the elements of the health service delivery itself, must also be appropriate to the cultural and health services context in which care innovations are to be introduced. We plan to use a participatory approach to systematically identify and adapt key elements of evidence based models of perinatal depression care delivery to the cultural and health services context of Can Tho, Vietnam. This federal-provincial city provides health services to a large region of the Mekong River Delta with over 19 million, mostly rural inhabitants. Over the two-year study period we will first develop a model, adapted from evidence based approaches, for screening and treatment for women receiving perinatal care in community health centers as well as obstetric hospitals. Simultaneous exploration of potential implementation strategies to support and sustain this model in context will be identified along with the creation of a training and implementation toolkit for this setting. Using these strategies and tools we will then carry out a pilot perinatal collaborative care study in a public health center and the prenatal care practice of the Can Tho Obstetric and Gynecologic Hospital. The results of this pilot will be used to revise and enhance the treatment model and related implementation tools. These will be used in subsequent trials of effectiveness and/or implementation broadly in the health care system of Can Tho.