Developing a task-sharing psychological intervention to treat mild to moderate symptoms of perinatal depression and anxiety in South Africa: a mixed-method formative study

Boisits, Sonet; Abrahams, Zulfa; Schneider, Marguerite; Honikman, Simone; Kaminer, Debra; Lund, Crick

doi:10.1186/s13033-021-00443-5

Cited by 14 publications

(11 citation statements)

References 56 publications

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“…Standardised referral pathways and processes, speci c to each facility, need to be developed and disseminated widely to ensure that both healthcare workers and patients are aware of the services available and how to access them. To lessen the burden of specialised mental healthcare providers such as social workers and mental health nurses, a cadre of lay healthcare workers could be identi ed and trained to provide basic evidence-based problem-solving counselling (Boisits, et al, 2021) to women with mild symptoms of depression or anxiety. The limitations of the MCR will need to be addressed at a policy level to encourage healthcare providers to detect symptoms of depression, anxiety and experiences of domestic violence in all pregnant women, at all clinic visits.…”

Section: Discussionmentioning

confidence: 99%

Facilitators and barriers to detection and treatment of depression, anxiety and experiences of domestic violence in pregnant women attending Midwife Obstetric Units (MOUs) in Cape Town, South Africa: A qualitative study

Abrahams¹,

Boisits²,

Schneider³

et al. 2021

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Background In South Africa, symptoms of common mental disorders (CMDs) such as depression and anxiety are highly prevalent during the perinatal period and linked to experiences of domestic violence. However, limited routine detection and treatment is available to pregnant women with these problems. We investigated facilitators and barriers of service-providers and -users in detecting and treating pregnant women with symptoms of CMDs and experiences of domestic violence. Methods Service-provider perspectives were informed by qualitative interviews with 37 healthcare workers providing care to pregnant women attending four midwife obstetric units (MOUs) in Cape Town. Qualitative interviews with 38 pregnant women attending the same MOUs for their first antenatal care visit provided service-user perspectives. Results Facilitators identified included the availability of a mental health screening questionnaire and the perceived importance of detection and treatment. Barriers included service providers’ heavy workload and discomfort with discussing mental health issues; lack of standardised referral pathways and poor uptake of referrals; lack of confidentiality and feelings of shame related to experiences of domestic violence. Limitations: Difficulty in linking perceptions of care with specific healthcare providers; social desirability bias - pregnant women’s responses to questions on domestic violence, and service providers’ responses to their role in providing care. Conclusion The facilitators and barriers identified indicate the need to strengthen health systems by training antenatal care nurses to detect symptoms of CMDs and experiences of domestic violence in pregnant women, developing standardised referral pathways and training lay healthcare workers to provide treatment for mild symptoms of depression and anxiety.

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Section: Discussionmentioning

confidence: 99%

Facilitators and barriers to detection and treatment of depression, anxiety and experiences of domestic violence in pregnant women attending Midwife Obstetric Units (MOUs) in Cape Town, South Africa: A qualitative study

Abrahams¹,

Boisits²,

Schneider³

et al. 2021

Preprint

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“…The intervention involves the screening by facility-based nursing staff of all pregnant women for CMD and experiences of domestic violence during their antenatal visits. Those who screen positive are offered three sessions of problem-solving therapy delivered by community health workers (CHWs) in the pregnant women’s homes [ 40 ].…”

Section: Methodsmentioning

confidence: 99%

Exploring effort–reward imbalance and professional quality of life among health workers in Cape Town, South Africa: a mixed-methods study

Jensen

Lund

Abrahams

2022

glob health res policy

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Background In the context of a growing appreciation for the wellbeing of the health workforce as the foundation of high-quality, sustainable health systems, this paper presents findings from two complementary studies to explore occupational stress and professional quality of life among health workers that were conducted in preparation for a task-shifting intervention to improve antenatal mental health services in Cape Town. Methods This mixed-methods, cross-sectional study was conducted in public sector Midwife Obstetric Units and associated Non-Profit Organisations in Cape Town. Semi-structured interviews and a quantitative survey were conducted among facility-and community-based professional and lay health workers. The survey included demographic as well as effort–reward imbalance (ERI) and professional quality of life (PROQOL) questionnaires to examine overall levels of work-related psychosocial stress and professional quality of life, as well as differences between lay and professional health workers. Qualitative data was analysed using a thematic content analysis approach. Quantitative data was analysed using STATA 12. Results Findings from 37 qualitative interviews highlighted the difficult working conditions and often limited reward and support structures experienced by health workers. Corroborating these findings, our quantitative survey of 165 professional and lay health workers revealed that most health workers experienced a mismatch between efforts spent and rewards gained at work (61.1% of professional and 70.2% of lay health workers; p = 0.302). There were few statistically significant differences in ERI and PROQOL scores between professional and lay health workers. Although Compassion Satisfaction was high for all health worker groups, lay health workers also showed elevated levels of burnout and compassion fatigue, with community-based health workers particularly affected. Conclusions Findings of this study add to the existing evidence base on adverse working conditions faced by South African public-sector health workers that should be taken into consideration as national and local governments seek to ‘re-engineer’ South Africa’s Primary Health Care system. Furthermore, they also highlight the importance of taking into consideration the wellbeing of health workers themselves to develop interventions that can sustainably foster resilient and high-quality health systems.

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“…Standardised referral pathways and processes, speci c to each facility, need to be developed and disseminated widely to ensure that both healthcare workers and patients are aware of the services available and how to access them. To lessen the burden of specialised mental healthcare providers such as social workers and mental health nurses, a cadre of lay healthcare workers could be identi ed and trained to provide basic evidence-based problem-solving counselling [51] to women with mild symptoms of depression or anxiety. The limitations of the MCR will need to be addressed at a policy level to encourage healthcare providers to detect symptoms of depression, anxiety and experiences of domestic violence in all pregnant women, at all clinic visits.…”

Section: Discussionmentioning

confidence: 99%

Facilitators and Barriers to Detection and Treatment of Depression, Anxiety and Experiences of Domestic Violence in Pregnant Women Attending Midwife Obstetric Units (MOUs) in Cape Town, South Africa: A Qualitative Study

Abrahams

Boisits

Schneider

et al. 2021

Preprint

Self Cite

View full text Add to dashboard Cite

Background In South Africa, symptoms of common mental disorders (CMDs) such as depression and anxiety are highly prevalent during the perinatal period and linked to experiences of domestic violence. However, limited routine detection and treatment is available to pregnant women with these problems, even though evidence suggests that screening and treating CMDs during pregnancy improves the health and economic outcomes of mothers and their children, and has been suggested as a key approach to improving the health of perinatal women and children. We investigated facilitators and barriers of service-providers and service-users in detecting and treating pregnant women with symptoms of CMDs and experiences of domestic violence. Methods This study was conducted in four midwife obstetric units (MOUs) in Cape Town, South Africa, and in the NPOs providing community-based support in the communities surrounding the MOUs. Service-provider perspectives were informed by qualitative interviews with 37 healthcare workers providing care to pregnant women. Qualitative interviews with 38 pregnant women attending the same MOUs for their first antenatal care visit provided service-user perspectives. Results Facilitators identified included the availability of a mental health screening questionnaire and the perceived importance of detection and treatment by both service-providers and -users. Barriers contributing to the low detection rates included service-users concerns about the lack of confidentiality and feelings of shame related to experiences of domestic violence as well as service providers discomfort in dealing with mental health issues, their limited time available and heavy patient load. In addition, service-providers highlighted the lack of standardised referral pathways and the poor uptake of referrals by women with symptoms of depression and anxiety, or experiences of domestic violence Conclusions While the system-level barriers need to be addressed at a policy level, the patient- and provider-level barriers identified indicate the need to strengthen health systems by training antenatal care nurses to detect symptoms of CMDs and experiences of domestic violence in pregnant women, developing standardised referral pathways and training lay healthcare workers to provide treatment for mild symptoms of depression and anxiety.

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Developing a task-sharing psychological intervention to treat mild to moderate symptoms of perinatal depression and anxiety in South Africa: a mixed-method formative study

Cited by 14 publications

References 56 publications

Facilitators and barriers to detection and treatment of depression, anxiety and experiences of domestic violence in pregnant women attending Midwife Obstetric Units (MOUs) in Cape Town, South Africa: A qualitative study

Facilitators and barriers to detection and treatment of depression, anxiety and experiences of domestic violence in pregnant women attending Midwife Obstetric Units (MOUs) in Cape Town, South Africa: A qualitative study

Exploring effort–reward imbalance and professional quality of life among health workers in Cape Town, South Africa: a mixed-methods study

Facilitators and Barriers to Detection and Treatment of Depression, Anxiety and Experiences of Domestic Violence in Pregnant Women Attending Midwife Obstetric Units (MOUs) in Cape Town, South Africa: A Qualitative Study

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