“Someone like us”: Delivering maternal mental health through peers in two South Asian contexts

Abstract

BACKGROUND Peer-led psychosocial interventions are one solution to address the great paucity of skilled mental health human resources in South Asia. The aim of this study was to explore peer-delivered care for maternal depression in two diverse contexts in South Asia. METHODS The study was carried out in the urban setting of Goa, India and a rural setting in Rawalpindi, Pakistan. In total, 61 in-depth interviews (IDIs) and 3 focus group discussions (FGDs), and 38 IDIs and 10 FGDs, were conducted with multiple stakeholders in urban Goa and rural Rawalpindi respectively. We used the framework approach to analyze data. RESULTS Peers, from the same community were the most preferred delivery agents of a community-based psychosocial intervention in both sites. There were contextual similarities and differences between the two sites. Preferred characteristics among peers included local, middle-aged, educated mothers with similar experiences, good communication skills and a good character. Key differences between the two contexts included a greater emphasis on the peer's family social standing in rural Rawalpindi and financial incentives as motivators for individual peers in urban Goa. LIMITATIONS Generalizability of our findings is limited to two specific contexts in a vast and diverse region. DISCUSSION Our study demonstrates that peers have the potential to deliver maternal psychosocial interventions in low-income settings. There are contextual differences in the preferred characteristics and motivators between the sites, and these should be carefully considered in program implementation.

Psychological Treatments for the World: Lessons from Low- and Middle-Income Countries

“…The selection of this type of NSP reflects attempts to utilize local, affordable, and sustainable resources (Fairburn & Patel 2014); the pragmatic considerations inherent to the goal of integrating mental health care into primary care (Patel et al 2010); and community attitudes regarding preferred and accepted providers (Singla et al 2014a). Mental health specialists had diverse roles related to building competency, maintaining quality, assuring safety, and (as researchers) evaluating psychological treatments.…”

Delivering the Thinking Healthy Programme for perinatal depression through peers: an individually randomised controlled trial in India

“…Incentives for women living in urban Goa were financial rewards compared to rural Rawalpindi where altruistic motives were of greater importance. 15 Evidence shows that the type of remuneration is indeed context-specific and has implications for the acceptability and sustainability of the intervention, and its scaling up. 28 Second, we observed that the reduction in symptom severity was greatest within the first 3 months post-childbirth.…”

“…THPP was developed during a two-year formative research phase. 11,15 Two major adaptations, related to the content and delivery mechanism, were made to the original THP intervention to make it deliverable by peers. Firstly, we shifted the focus from CBT (the active ingredient of the original THP intervention) to behavioural activation, because formative research indicated that CBT is more difficult for lay providers such as peers to learn.…”

“…Additional criteria of Sakhis are published elsewhere. 15 Sakhis were recruited from the local community through word-of-mouth, particularly through key informants in women's self-help groups and CHWs responsible for the well-being and nutrition of mothers and their new-borns. In total, 26 Sakhis entered the trial and each received 25-40 hours of classroom-based training focusing on intervention content and relationship-building skills.…”

“…Public healthcare is provided through a network of healthcare providers working in urban primary health centres, sub-centres, community health centres and a district hospital. 15 Antenatal care coverage is high in India with 89% of women attending at least four antenatal care visits (urban areas 91%; rural areas 86%). 16…”