Atif Najia, Bibi Amina, Nisar Anum, Zulfiqar Shaffaq, Ahmed Ikhlaq, LeMasters Katherine, Hagaman Ashley, Sikander Siham, Maselko Joanna, Rahman Atif
1Human Development Research Foundation, Mandra, Gujar Khan, Pakistan.
2University of North Carolina at Chapel Hill, Chapel Hill, NC USA.
Int J Ment Health Syst. 2019 Sep 17;13:62. doi: 10.1186/s13033-019-0318-3. eCollection 2019.
Maternal depression affects one in five women in low-and middle income countries (LMIC) and has significant economic and social impacts. Evidence-based psychosocial interventions delivered by non-specialist health workers are recommended as first-line management of the condition, and recent studies on such interventions from LMIC show promising results. However, lack of human resource to deliver the interventions is a major bottle-neck to scale-up, and much research attention has been devoted to 'task-sharing' initiatives. A - version of the World Health Organization's Thinking Healthy Programme for perinatal depression in Pakistan and India showed clinical, functional and social benefits to women at 3 months postpartum. The programme has been iteratively adapted and continually delivered for 5 years in Pakistan. In this report, we describe the extended intervention and factors contributing to the peers' continued motivation and retention, and suggest future directions to address scale-up challenges.
The study was conducted in rural Rawalpindi. We used mixed methods to evaluate the programme 5 years since its initiation. The competency of the peers in delivering the intervention was evaluated using a specially developed Quality and Competency Checklist, an observational tool used by trainers to rate a group session on key areas of competencies. In-depth interviews explored factors contributing to the peer volunteers' continued motivation and retention, as well as the key challenges faced.
Our key findings are that about 70% of the peer volunteers inducted 5 years ago continued to be part of the programme, retaining their competency in delivering the intervention, with only token financial incentives. Factors contributing to sustained motivation included altruistic aspirations, enhanced social standing in the community, personal benefits to their own mental health, and the possibility for other avenues of employment. Long-term challenges included demotivation due to lack of certainty about the programme's future, increased requirement for financial incentivisation, the logistics of organising groups in the community, and resistance from some families to the need for ongoing care.
The programme, given the sustained motivation and competence of peer volunteers in delivering the intervention, has the potential for long-term sustainability in under-resourced settings and a candidate for scale-up.
在低收入和中等收入国家（LMIC），五分之一的女性受产后抑郁症影响，且产后抑郁症具有重大经济和社会影响。非专科卫生工作者提供的循证心理社会干预措施被推荐为该病的一线管理方法，近期来自低收入和中等收入国家关于此类干预措施的研究显示出了有前景的结果。然而，缺乏实施干预措施的人力资源是扩大规模的主要瓶颈，并且许多研究关注都投入到了“任务分担”倡议上。巴基斯坦和印度针对围产期抑郁症的世界卫生组织“健康思考”计划的一个版本，在产后3个月时对女性显示出了临床、功能和社会方面的益处。该计划在巴基斯坦经过反复调整并持续实施了5年。在本报告中，我们描述了扩展干预措施以及促使同伴持续保持积极性和留存率的因素，并提出应对扩大规模挑战的未来方向。
该研究在拉瓦尔品第农村地区开展。我们采用混合方法对该计划启动5年后的情况进行评估。使用专门制定的质量和能力检查表评估同伴实施干预措施的能力，这是培训人员用于对小组会议在关键能力领域进行评分的一种观察工具。深入访谈探究了促使同伴志愿者持续保持积极性和留存率的因素，以及所面临的关键挑战。
我们的主要发现是，5年前招募的同伴志愿者中约70%仍继续参与该计划，保持了实施干预措施的能力，且仅有少量经济激励。促使持续保持积极性的因素包括利他愿望、在社区中社会地位提高、对自身心理健康有益，以及其他就业途径的可能性。长期挑战包括因对该计划未来缺乏确定性而导致的积极性下降、对经济激励需求增加、在社区组织小组活动的后勤问题，以及一些家庭对持续护理需求的抵触。
鉴于同伴志愿者在实施干预措施方面持续保持的积极性和能力，该计划在资源匮乏地区具有长期可持续性的潜力，是一个可供扩大规模的候选方案。
