Department of Psychiatry, College of Medicine, University of Ibadan, Ibadan, Nigeria.
Department of Sociology and Psychology, Faculty of Social Sciences, Lead City University, Ibadan, Nigeria.
BMC Pregnancy Childbirth. 2020 May 14;20(1):294. doi: 10.1186/s12884-020-02970-4.
Depression is a common and severe disorder among low-income adolescent mothers in low-and middle-income countries where resources for treatment are limited. We wished to identify factors influencing health service utilization for adolescent perinatal depression, in Nigeria to inform new strategies of care delivery.
Focus Group Discussions (FGDs) were conducted among purposively selected low-income young mothers (with medical histories of adolescent perinatal depression), and separately with primary care clinicians treating this condition in Ibadan, Nigeria. Participants from this community-based study were from the database of respondents who participated in a previous randomized control trial (RCT) conducted between 2014 and 2016 in 28 primary health care facilities in the 11 Local government areas in Ibadan. Semi-structured interview guides, framed by themes of the Behavioral Model for Vulnerable Populations, was developed to obtain views of participants on the factors that promote or hinder help-seeking and engagement (see additional files 1 & 2). FGDs were conducted, and saturation of themes was achieved after discussions with six groups. Transcripts were analyzed using content analysis.
A total of 42 participants, 17 mothers (who were adolescents at the time of the RCT), and 25 care providers participated in 6 FGDs. The availability of care for perinatal depression at the primary care level was an important enabling factor in healthcare utilization for the adolescents. Perceived health benefits of treatment received for perinatal depression were strong motivation for service use. Significant stigma and negative stereotypes expressed by care providers towards adolescent pregnancy and perinatal depression were obstacles to care. However, individual patient resilience was a major enabling factor, facilitating service engagement. Providers trained in the management of perinatal depression were perceived to deliver more tolerant and supportive care that adolescent mothers valued.
Participants identified unsupportive and stigmatizing clinic environments towards pregnant and parenting adolescents as significant barriers to accessing available care. Interventions to reduce stigma among healthcare providers may improve services for this vulnerable population.
在资源有限的中低收入国家，抑郁是低收入青少年母亲中常见且严重的障碍。我们希望确定影响青少年围产期抑郁患者寻求卫生服务的因素，以便为提供新的护理策略提供信息。
在伊巴丹，我们对有青少年围产期抑郁病史的低收入年轻母亲（有医疗记录）进行了焦点小组讨论（FGD），并分别与治疗这种疾病的初级保健临床医生进行了讨论。这项基于社区的研究的参与者来自于之前在伊巴丹 11 个地方政府区的 28 个初级保健机构中进行的一项随机对照试验（RCT）的受访者数据库。根据脆弱人群行为模型的主题框架制定了半结构化访谈指南，以获取参与者对促进或阻碍寻求帮助和参与的因素的看法（请参见附加文件 1 和 2）。进行了 FGD，并在与六个小组讨论后达到了主题的饱和度。使用内容分析法分析了转录本。
共有 42 名参与者参加了 6 次 FGD，其中 17 名母亲（在 RCT 时为青少年）和 25 名护理提供者。初级保健一级提供围产期抑郁护理是促进青少年获得保健服务的一个重要有利因素。接受围产期抑郁治疗的感知健康益处是使用服务的强大动力。护理提供者对青少年怀孕和围产期抑郁表达的强烈污名化和负面刻板印象是护理的障碍。但是，个体患者的适应能力是主要的有利因素，有助于服务的参与。接受过围产期抑郁管理培训的提供者被认为提供了更宽容和支持性的护理，这是青少年母亲所重视的。
参与者确定了对怀孕和育儿青少年不支持和污名化的诊所环境是获得现有护理的重大障碍。减少医疗保健提供者中污名化的干预措施可能会改善对这一弱势群体的服务。
