Boisits Sonet, Abrahams Zulfa, Schneider Marguerite, Honikman Simone, Kaminer Debra, Lund Crick
Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, 46 Sawkins Road, Rondebosch, Cape Town, 7700, South Africa.
Perinatal Mental Health Project, Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, 46 Sawkins Road, Rondebosch, Cape Town, 7700, South Africa.
Int J Ment Health Syst. 2021 Mar 15;15(1):23. doi: 10.1186/s13033-021-00443-5.
Symptoms of depression and anxiety are highly prevalent amongst perinatal women in low-resource settings of South Africa, but there is no access to standardised counselling support for these conditions in public health facilities. The aim of this study is to develop a task-sharing psychological counselling intervention for routine treatment of mild to moderate symptoms of perinatal depression and anxiety in South Africa, as part of the Health Systems Strengthening in sub-Saharan Africa (ASSET) study.
We conducted a review of manuals from seven counselling interventions for depression and anxiety in low- and middle-income countries and two local health system training programmes to gather information on delivery format and common counselling components used across task-sharing interventions. Semi-structured interviews were conducted with 20 health workers and 37 pregnant women from four Midwife Obstetric Units in Cape Town to explore perceptions and needs relating to mental health. Stakeholder engagements further informed the intervention design and appropriate service provider. A four-day pilot training with community-based health workers refined the counselling content and training material.
The manual review identified problem-solving, psychoeducation, basic counselling skills and behavioural activation as common counselling components across interventions using a variety of delivery formats. The interviews found that participants mostly identified symptoms of depression and anxiety in behavioural terms, and lay health workers and pregnant women demonstrated their understanding through a range of local idioms. Perceived causes of symptoms related to interpersonal conflict and challenging social circumstances. Stakeholder engagements identified a three-session counselling model as most feasible for delivery as part of existing health care practices and community health workers in ward-based outreach teams as the best placed delivery agents. Pilot training of a three-session intervention with community-based health workers resulted in minor adaptations of the counselling assessment method.
Input from health workers and pregnant women is a critical component of adapting existing maternal mental health protocols to the context of routine care in South Africa, providing valuable data to align therapeutic content with contextual needs. Multisector stakeholder engagements is vital to align the intervention design to health system requirements and guidelines.
在南非资源匮乏地区的围产期妇女中，抑郁和焦虑症状极为普遍，但在公共卫生机构无法获得针对这些病症的标准化咨询支持。本研究的目的是开发一种任务分担式心理咨询干预措施，用于南非围产期抑郁和焦虑轻度至中度症状的常规治疗，作为撒哈拉以南非洲卫生系统强化（ASSET）研究的一部分。
我们查阅了七个针对低收入和中等收入国家抑郁和焦虑的咨询干预手册以及两个当地卫生系统培训项目，以收集有关任务分担干预措施的实施形式和常见咨询组成部分的信息。对开普敦四个助产士产科病房的20名卫生工作者和37名孕妇进行了半结构化访谈，以探讨与心理健康相关的看法和需求。利益相关者的参与进一步为干预设计和合适的服务提供者提供了信息。对社区卫生工作者进行的为期四天的试点培训完善了咨询内容和培训材料。
手册审查确定，使用各种实施形式的干预措施中，解决问题、心理教育、基本咨询技巧和行为激活是常见的咨询组成部分。访谈发现，参与者大多从行为角度识别抑郁和焦虑症状，非专业卫生工作者和孕妇通过一系列当地习语表达了他们的理解。症状的感知原因与人际冲突和具有挑战性的社会环境有关。利益相关者的参与确定，作为现有医疗保健实践的一部分，三阶段咨询模式最可行，而病房外展团队中的社区卫生工作者是最合适的实施人员。对社区卫生工作者进行的三阶段干预试点培训导致对咨询评估方法进行了轻微调整。
卫生工作者和孕妇的意见是使现有孕产妇心理健康方案适应南非常规护理背景的关键组成部分，提供了宝贵数据，使治疗内容与实际需求相匹配。多部门利益相关者的参与对于使干预设计符合卫生系统要求和指导方针至关重要。
