Cultural Adaptation of Community Informant Tool for Detection of Maternal Depression in Rural Pakistan

Abstract

Background: Evidence indicates that mental health issues like depression, epilepsy, and substance misuse can be detected with reasonable accuracy in resource-poor settings. The Community Informant Detection Tool (CIDT) is one such approach used for detecting mental health problems, including depression. We adapted this community informant approach for detecting maternal depression in Pakistan.Methods: Adaptation of Community Informant Detection Tool for Maternal Depression (CIDT-MD) involved five steps. First, a scoping review of the literature was conducted to select an appropriate tool for adaptation. Second, in-depth interviews were conducted to explore the idioms of depression and distress, perceived causes, and the effects of maternal depression among currently depressed and recovered mothers (n = 11), mothers in law (n = 6), and Primary Care Providers (Primary Care Physicians and Lady Health Supervisors) (n = 6). Third, case vignettes and illustrations were created with input from a panel of mental health experts, incorporating the idioms of depression and distress used, causes, and effects for each symptom described. Fourth, to assess the comprehensibility of the illustrations and level of understanding, Focus Group Discussions (n = 4) were done with purposely selected community health workers (Lady Health Workers and Lay Peers, n = 28) trained in delivering maternal depression intervention. The final step was reflection and inputs by a panel of mental health experts on all steps to finalize the content of the tool.Results: Context-specific cultural adaptation in the presentation and format of CIDT-MD was conducted successfully. Lady Health Workers (LHW) and Lay Peers (LP) were found to be the most appropriate persons to use the tool and function as the informants. The adapted tool with all its vignettes and illustrations was found to be easily understandable, comprehensible, and culturally appropriate, meaningful, and contextually relevant by the community health workers and peers working in the relevant settings. They easily relate to and identify potentially depressed such women lining up with the tool. Lastly, the coding of the tool was found easy to follow as well.Conclusion: The Community Informant Detection Tool for Maternal Depression (CIDT-MD) is a culturally acceptable, easy to use, and comprehensible tool for detecting maternal depression in community settings of Pakistan. The community informants found the content and approach highly relevant to the local needs.

Accuracy of Community Informant Led Detection of Maternal Depression in Rural Pakistan

“…Keeping in line with the approach used in Nepal, a community informant based detection tool for maternal depression was adapted in Pakistan. Details of the adaptation process can be found elsewhere [19].…”

“…Psychometric properties such as sensitivity and specificity are common measures used to measure the accuracy of detection tools [21].The community informant detection tool developed in Nepal when compared with a diagnostic gold standard that is, the Composite International Diagnostic Interview (CIDI) was able to accurately assign case-ness for the majority of persons (64%) that matched with pictorial vignettes [12,22]. The goal of this active detection approach that was adapted in Pakistan [19], is not to make a specific diagnosis when used by Lady Health Workers of lay Peers but rather to identify mothers with maternal depression symptoms, with high degree of accuracy, so that they can seek timely advice and confirmation of diagnosis by the primary care physicians. Keeping in line with same strategy as used in Nepal we adapted the tool for active case detection for maternal depression in Pakistan [19].The CIDT-MD adaptation procedure has several steps.…”

“…The goal of this active detection approach that was adapted in Pakistan [19], is not to make a specific diagnosis when used by Lady Health Workers of lay Peers but rather to identify mothers with maternal depression symptoms, with high degree of accuracy, so that they can seek timely advice and confirmation of diagnosis by the primary care physicians. Keeping in line with same strategy as used in Nepal we adapted the tool for active case detection for maternal depression in Pakistan [19].The CIDT-MD adaptation procedure has several steps. First, perceived causes and idioms of symptoms of depression, as well as physical and psychological effects were found out by in-depth interviews with depressed and recovered mothers, mothers-in-laws and community health workers (lady health workers and lay peers).…”

“…Based on the analysis; vignettes for symptoms of depression and perceived causes was made and to facilitate the process of prompt recognition of people that potentially match the vignette, pictorial illustrations were developed for individual symptoms of maternal depression. In order to assess the comprehensibility of the tool focus group discussions was done with the end users community health workers (lady health workers and lay Peers) subsequently the tool was finalized by an expert panel of Pakistani mental health professionals [19]. The current paper focuses on reporting the accuracy of the Community Informant Maternal Depression Detection Tool (CIDT-MD) used by community-based informants that is Lady Health Workers and lay Peers in in the community settings of Pakistan.…”

Scalable Screening and Treatment Response Monitoring for Perinatal Depression in Low- and Middle-Income Countries

“…For the validation of these psychometric tools, secondary analyses were conducted on three datasets. These datasets were curated from three studies conducted in Kallar Syedan, a rural subdistrict in the Punjab province in Pakistan [ 10 , 21 , 22 ]. This subdistrict comprises a rural, demographically stable and socioeconomically homogenous area.…”