Center for Community Health, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, 750 N Lake Shore Drive, Suite 643, Chicago, IL, 60611, USA.
Center for Community Health, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, 750 N Lake Shore Drive, Suite 680, Chicago, IL, 60611, USA.
BMC Health Serv Res. 2020 Mar 7;20(1):189. doi: 10.1186/s12913-020-5031-z.
Perinatal depression is a prevalent public health concern. Although preventive interventions exist, there is limited literature on the acceptability and appropriateness of these interventions, especially those delivered by paraprofessionals. The Mothers and Babies Program (MB) is a group-based perinatal depression preventive intervention delivered prenatally. A cluster-randomized controlled trial examined the acceptability, appropriateness, and effectiveness of MB delivered by mental health professionals compared to paraprofessional staff from home visiting programs.
The full study enrolled 874 pregnant women. Fifty-three facilitators were trained and delivered the MB intervention to women in one of seven states in the United States. Semi-structured interviews were attempted with a randomly-selected subset of the full sample of pregnant women who received the MB intervention and with all facilitators. Specifically, interviews were conducted with 88 women who received the MB group intervention (45 in the paraprofessional-led arm and 43 in the mental health professional-led arm) and 46 women who facilitated the groups (27 home visiting staff and 19 mental health professionals). Interviews were conducted over the phone in English or Spanish and audio recorded. The recordings were translated into English, as needed, and transcribed. Thematic analysis was conducted using NVIVO to identify key themes related to intervention acceptability and appropriateness. Similarities and differences between study arms were explored.
Clients and facilitators found the MB content and group format acceptable. Challenges included maintaining group attendance, transportation issues, and managing group discussion. Overall, facilitators found the intervention appropriate for pregnant clients with some challenges presented for clients in crisis situations, experiencing housing instability, and with literacy and learning challenges. Participants provided suggestions for improvement, both for the course content and implementation. There were no significant differences found between study arms.
Overall, clients and facilitators enjoyed MB irrespective of study arm, and facilitators found the intervention appropriate for the population. These findings add to the qualitative literature on perinatal depression preventive interventions, specifically those delivered by paraprofessionals.
This trial is registered on ClinicalTrials.gov (Initial post: December 1, 2016; identifier: NCT02979444).
围产期抑郁是一个普遍存在的公共卫生问题。虽然有预防干预措施，但关于这些干预措施的可接受性和适宜性的文献有限，特别是那些由非专业人员提供的干预措施。母亲和婴儿计划（MB）是一种基于小组的围产期抑郁预防干预措施，在产前提供。一项整群随机对照试验研究了由心理健康专业人员与家庭访视项目的非专业人员提供的 MB 的可接受性、适宜性和有效性。
这项完整的研究纳入了 874 名孕妇。53 名培训师在七个州向孕妇提供 MB 干预。对接受 MB 干预的孕妇全样本的随机子样本和所有培训师进行了半结构式访谈。具体来说，对接受 MB 小组干预的 88 名妇女（45 名在非专业人员领导的小组中，43 名在心理健康专业人员领导的小组中）和 46 名促进小组的妇女（27 名家庭访视工作人员和 19 名心理健康专业人员）进行了访谈。访谈以英语或西班牙语进行，并录音。需要时，将录音翻译成英文并转录。使用 NVIVO 进行主题分析，以确定与干预可接受性和适宜性相关的关键主题。探讨了研究臂之间的相似点和不同点。
客户和培训师发现 MB 的内容和小组形式是可以接受的。挑战包括维持小组出勤率、交通问题和管理小组讨论。总的来说，培训师发现该干预措施适合有一定挑战的孕妇，如处于危机情况、住房不稳定和读写困难的孕妇。参与者提出了改进课程内容和实施的建议。在研究臂之间没有发现显著差异。
总的来说，客户和培训师无论在哪个研究臂都喜欢 MB，培训师认为该干预措施适合该人群。这些发现增加了围产期抑郁预防干预措施的定性文献，特别是由非专业人员提供的干预措施。
这项试验在 ClinicalTrials.gov 注册（初始发布：2016 年 12 月 1 日；标识符：NCT02979444）。
