School of Nursing, Faculty of Health, York University, HNES 313, 4700 Keele Street, Toronto, Ontario, M3J 1P3, Canada.
Department of Psychology, University of Calgary, Administration 235A, 2500 University Drive NW, Calgary, Alberta, T2N 1N4, Canada.
BMC Pregnancy Childbirth. 2021 Jan 6;21(1):15. doi: 10.1186/s12884-020-03473-y.
Mental health in China is a significant issue, and perinatal depression has been recognized as a concern, as it may affect pregnancy outcomes. There are growing calls to address China's mental health system capacity issues, especially among vulnerable groups such as pregnant women due to gaps in healthcare services and inadequate access to resources and support. In response to these demands, a perinatal depression screening and management (PDSM) program was proposed. This exploratory case study identified strategies for successful implementation of the proposed PDSM intervention, informed by the Consolidated Framework for Implementation Research (CFIR) framework, in Ma'anshan city, Anhui province.
This qualitative study included four focus group discussions and two in-depth individual interviews with participants using a semi-structured interview guide. Topics examined included acceptance, utility, and readiness for a PDSM program. Participants included perinatal women and their families, policymakers, and healthcare providers. Interviews were transcribed verbatim, coded, and analyzed for emergent themes.
The analysis revealed several promising factors for the implementation of the PDSM program including: utilization of an internet-based platform, generation of perceived value among health leadership and decision-makers, and the simplification of the screening and intervention components. Acceptance of the pre-implementation plan was dependent on issues such as the timing and frequency of screening, ensuring high standards of quality of care, and consideration of cultural values in the intervention design. Potential challenges included perceived barriers to the implementation plan among stakeholders, a lack of trained human health resources, and poor integration between maternal and mental health services. In addition, participants expressed concern that perinatal women might not value the PDSM program due to stigma and limited understanding of maternal mental health issues.
Our analysis suggests several factors to support the successful implementation of a perinatal depression screening program, guidelines for successful uptake, and the potential use of internet-based cognitive behavioral therapy. PDSM is a complex process; however, it can be successfully navigated with evidence-informed approaches to the issues presented to ensure that the PDSM is feasible, effective, successful, and sustainable, and that it also improves maternal health and wellbeing, and that of their families.
心理健康是中国面临的一个重大问题，围产期抑郁已被认为是一个值得关注的问题，因为它可能会影响妊娠结局。人们越来越呼吁解决中国精神卫生系统能力问题，特别是在孕妇等弱势群体中，因为医疗服务存在差距，资源和支持不足。针对这些需求，提出了围产期抑郁筛查和管理（PDSM）计划。这项探索性案例研究根据实施研究综合框架（CFIR）框架，确定了在安徽省马鞍山市成功实施拟议 PDSM 干预措施的策略。
本定性研究包括对参与者进行四次焦点小组讨论和两次深度个人访谈，使用半结构化访谈指南。探讨的主题包括对 PDSM 计划的接受程度、实用性和准备情况。参与者包括围产期妇女及其家属、政策制定者和医疗保健提供者。采访内容逐字记录、编码，并对出现的主题进行分析。
分析显示，实施 PDSM 计划有几个有希望的因素，包括：利用基于互联网的平台、在卫生领导层和决策者中产生感知价值，以及简化筛查和干预措施。对预实施计划的接受程度取决于筛查的时间和频率、确保高质量的护理标准以及干预设计中考虑文化价值观等问题。潜在挑战包括利益相关者对实施计划的看法存在障碍、缺乏受过培训的人力资源以及母婴健康服务之间的整合不善。此外，参与者表示担心围产期妇女可能不会重视 PDSM 计划，因为存在耻辱感和对孕产妇心理健康问题的认识有限。
我们的分析表明，有几个因素可以支持成功实施围产期抑郁筛查计划，为成功采用提供了指导方针，并为基于互联网的认知行为疗法的潜在应用提供了指导。PDSM 是一个复杂的过程；但是，可以通过针对提出的问题采用循证方法来成功应对，以确保 PDSM 是可行、有效、成功和可持续的，并且还可以改善孕产妇的健康和福祉，以及她们的家庭。
