Filling the treatment gap: developing a task sharing counselling intervention for perinatal depression in Khayelitsha, South Africa

Abstract

BackgroundPerinatal depression is a major public health issue especially in low income settings in South Africa, where there is a shortage of mental health professionals. New psychological interventions delivered by non-specialists are needed to fill the treatment gap. This paper describes the process of developing a manual based task sharing counselling intervention for perinatal depression in Khayelitsha, Cape Town.MethodsQualitative semi-structured interviews were conducted with 26 participants, including service providers and service users at a clinic in Khayelitsha in order to explore the feasibility, acceptability and content of a task sharing counselling intervention. The interviews were recorded, translated and transcribed. Themes were identified using the framework analysis approach and were coded and analysed using NVivo v10. After the semi-structured interviews, a workshop was conducted with mental health experts on evidence-based psychological interventions for depression, together with a document review of counselling manuals for community health workers in South Africa.ResultsThe findings indicate that a task sharing counselling intervention was acceptable and feasible for depressed women in Khayelitsha, under the following conditions: (1) respondents preferred a female counsellor and felt that clinic based individual sessions should be provided at least once a month by an experienced Xhosa speaking counsellor from the community; and (2) the content of a counselling intervention should include psycho-education on cognitive and behavioural effects of depression, how to cope with interpersonal problems, and financial stressors. Based on these conditions, the review of manuals and expert consultation, key components of the counselling intervention were identified as: psycho-education, problem solving, healthy thinking and behaviour activation. These were included in the final counselling manual.ConclusionThe development of task sharing counselling interventions for perinatal depression should be informed by the views and needs of local service users and service providers. The study illustrates the manner in which these views can be incorporated for the development of evidence-based psychological interventions, within a task sharing framework in low and middle-income countries.Electronic supplementary materialThe online version of this article (doi:10.1186/s12888-016-0873-y) contains supplementary material, which is available to authorized users.

The role and competence of midwives in supporting women with mental health concerns during the perinatal period: A scoping review

“…While most of the evidence of the effectiveness of midwife‐led counselling comes from interventions for women with childbirth fear or those who experienced emotional distress at birth (rather than a diagnosed mental health problems), this literature indicates that midwives can deliver counselling interventions with positive outcomes. This is consistent with a growing body of literature that highlights that perinatal mental health interventions can be delivered by non‐specialists with positive outcomes, with evidence from low‐ and middle‐income countries (Nyatsanza, Schneider, Davies, & Lund, ; Rahman et al., ), the volunteer sector (Coe & Barlow, ) and peer support (Jones, Jomeen, & Hayter, ).…”

Implementation outcomes of cognitive behavioural therapy delivered by non-specialists for common mental disorders and substance-use disorders in low- and middle-income countries: a systematic review

“…Feasibility The use of CBT components was shown to be feasible for NSHW delivery by seven studies [2,3,7,10,12,24,27,30,33,40]. The selection of feasible strategies and components was based on piloting/ feasibility studies (n = 4) or qualitative studies (n = 3) involving stakeholders.…”

“…While Chibanda et al [11] and Dawson et al [16] expressed concern about the complexity of the cognitive component of standard CBT, Papas et al [34,35] suggested that its "highly structured format" made Acceptability Five studies reported that acceptable interventions contained beneficial information and skills for the service user and the community [2,3,11,12,24,31]. Some barriers to acceptability were women's lack of autonomy (both as service users and providers), cultural barriers, stigma, lack of engagement and resistance to changes in sociocultural hierarchies [3,33]. Some service users reported concerns about whether their confidentiality would be ensured, especially in group interventions or if there were family members present [2,24].…”

“…Adoption Engaging families and financial remuneration were motivating factors for the peer volunteers to promote adoption of CBT [2,3,40]. A barrier to adoption was lack of perceived usefulness of counselling by the communities [3,11,33]. A facilitator to adoption was the perceived usefulness of the intervention to service users, providers and the community [2,24].…”

Old age and depression in Ghana: assessing and addressing diagnosis and treatment gaps

“…National estimates range from 75 per cent in South Africa [33] to over 90 per cent in Ethiopia [34]. There are a number of studies on depression treatment gap in different sub-Saharan African settings, but these focus on younger age groups and conditions such as postpartum and perinatal depression [35,36].…”