Health Systems Strengthening Interventions for Perinatal Common Mental Disorders and Experiences of Domestic Violence in Cape Town, South Africa: Protocol for a Pilot Implementation Study

Abstract

Background: During the perinatal period, common mental disorders (CMDs) such as depression and anxiety are highly prevalent, especially in low resource settings, and are associated with domestic violence, poverty and food insecurity. Perinatal CMDs have been associated with several adverse maternal and child outcomes. While the Department of Health in South Africa provides healthcare workers with the tools to detect psychological distress and experiences of domestic violence, few healthcare workers routinely screen pregnant women at clinic visits, citing discomfort with mental health issues and the lack of standardised referral pathways as the key barriers. The aim of this study is to select and evaluate a set of health systems strengthening (HSS) interventions aimed at improving the care and outcomes for perinatal women with CMDs and experiences of domestic violence, attending public healthcare facilities in Cape Town.Methods: This study consists of a pre-implementation, development, and implementation phase. Contextual barriers identified during the pre-implementation phase included poor patient knowledge and health-seeking behaviour, high levels of stigma, and poor detection, referral and treatment rates. Implementation science determinant frameworks were applied to findings from the pre-implementation phase to identify determinants and gaps in delivering high-quality evidence-informed care. A participatory Theory of Change workshop was used to design a HSS programme, consisting of awareness raising, detection, referral, and treatment. HSS interventions selected to support the delivery of the HSS programme includes training, health promotion, change to the healthcare environment, task-sharing, audit and feedback and performance monitoring. The implementation phase will be used to assess several implementation and clinical outcomes associated with delivery of the HSS programme, which will be piloted at three healthcare facilities. Qualitative and quantitative methods will be used to evaluate the implementation and clinical outcomes. Discussion: This pilot implementation study will inform us about a range of implementation and clinical outcome measures that are relevant for assessing health systems strengthening interventions for perinatal women with depression, anxiety or experiences of domestic violence in low resource settings. Lessons learnt from the pilot study will be incorporated into the design of a cluster randomised control trial for which further funding will be sought.

Implementation outcomes of a health systems strengthening intervention for perinatal women with common mental disorders and experiences of domestic violence in South Africa: Pilot feasibility and acceptability study

“…the Western Cape Department of Health to design a health systems strengthening (HSS) programme aimed at improving the quality of care for perinatal women with CMDs and experiences of domestic violence [11].…”

“…The ASSET study consisted of three phases: pre-implementation, intervention development, and pilot evaluation [11].…”

“…Several cadres of healthcare workers were trained as Master Trainers and tasked with cascading the training to facility-and community-based healthcare workers to deliver the HSS programme components. Further details are described in the pilot study protocol paper [11].…”

“…All healthcare workers involved in the study provided written, informed consent. Further details are described in the pilot study protocol paper [11].…”