Preparing to launch the ‘Thinking Healthy Programme’ perinatal depression intervention in Urban Lima, Peru: experiences from the field

Abstract

Background.An estimated 19–25% of perinatal women in low- and middle-income countries are affected by depression which, untreated, is associated with multiple health problems for mothers and children. Nonetheless, few perinatal women have access to depression care. The Thinking Healthy Programme (THP), promoted by the World Health Organization (WHO), is an evidence-based, non-specialist delivered depression intervention that addresses this care gap. However, the WHO THP manual explains intervention delivery but not the antecedents to implementation. Here, we describe a principled, planned approach leading to the implementation of THP in Lima, Peru by the non-profit organization Socios En Salud with community health workers (CHW) to inform its implementation in other settings.Methods.The Replicating Effective Programs (REP) framework guided THP implementation, following four phases: (I) pre-conditions; (II) pre-implementation; (III) implementation; and (IV) maintenance and evolution. This paper centers on REP phases I and II, including (1) documented high perinatal depression rates in Peru; (2) designation of perinatal depression as a government priority; (3) THP Implementation Team orientation and training; (4) data collection plan development; (5) public health system coordination; (6) CHW selection and training; and (7) THP launch.Results.Between December 2016 and March 2017, a THP training program was developed and seven CHW were trained to deliver the intervention to 10 perinatal women, the first of whom was enrolled on 17 April 2017.Conclusions.THP was rapidly implemented by a community-based organization with no prior experience in delivering non-specialist perinatal depression care. The steps followed may inform the implementation of THP in other settings.

Making therapies culturally relevant: translation, cultural adaptation and field-testing of the Thinking Healthy Programme for perinatal depression in China

“…THP-Vietnam findings were similar to our study, i.e., THP core structure, processes and techniques were transferrable across cultures but required some linguistic and cultural adaptations. The results of our study, and studies conducted in other settings indicate that the key constructs of the Thinking Healthy Programme are culturally transferable [22,24,25].…”

“…This method, recommended by the WHO has been used successfully to rapidly adapt a self-help intervention for psychological distress among refugees in an African context [29]. In Peru, the Replicating Effective Programmes (REP) framework was used to guide the implementation process of THP, but the authors relied on a pretranslated Spanish version of the manual conducted by a community-based organisation for their local programmes [24,35]. It is therefore difficult to evaluate the process of adaptation and the key changes made to the original THP and their rationale.…”

“…Thus, it is ideally suited to regions where there are not enough mental health specialists. THP is part of the WHO's flagship mental health gap action programme (mhGAP) and has been translated into a number of languages and is being implemented in many countries [20,[23][24][25].…”

A non-specialist depression care pathway for adolescents living with HIV and transitioning into adult care in Peru: a nested, proof of concept pilot study

“…In Peru, non-mental health specialists delivering mental health services are part of a larger national strategy to increase access to care for all people (Toyama et al, 2017), and nonspecialist depression interventions have been successfully implemented outside of the HIV-service setting (Eappen et al, 2018;Scorza et al, 2018). In the future, basic depression care pathways like ours could be expanded beyond screening and brief supportive care to include existing, evidence-based depression interventions, such as the WHO's Mental Health Gap Programme Jerome T. Galea et al (WHO, 2010) delivered by non-specialists.…”

Outcomes associated with scale-up of the Stepping On falls prevention program: A case study in redesigning for dissemination

“…Without the application of implementation science principles, we would not have been able to systematically identify key elements and identify and correct lapses in fidelity with broad dissemination. The REP framework has been used previously to guide adaptations of interventions for new settings or target groups, and/or develop strategies to overcome implementation barriers with spread [22][23][24][25][26][27][28][29]. However, there are little data on the utility of the REP framework to maintain fidelity and effectiveness with scale-up.…”