Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Building B, 46 Sawkins Road, Rondebosch, Cape Town, 7700, South Africa.
Alcohol, tobacco and other drug research unit, South African Medical Research Council, Cape Town, South Africa.
BMC Health Serv Res. 2022 May 13;22(1):641. doi: 10.1186/s12913-022-08050-x.
South Africa has a high burden of perinatal common mental disorders (CMD), such as depression and anxiety, as well as high levels of poverty, food insecurity and domestic violence, which increases the risk of CMD. Yet public healthcare does not include routine detection and treatment for these disorders. This pilot study aims to evaluate the implementation outcomes of a health systems strengthening (HSS) intervention for improving the quality of care of perinatal women with CMD and experiences of domestic violence, attending public healthcare facilities in Cape Town.
Three antenatal care facilities were purposively selected for delivery of a HSS programme consisting of four components: (1) health promotion and awareness raising talks delivered by lay healthcare workers; (2) detection of CMD and domestic violence by nurses as part of routine care; (3) referral of women with CMD and domestic violence; and (4) delivery of structured counselling by lay healthcare workers in patients' homes. Participants included healthcare workers tasked with delivery of the HSS components, and perinatal women attending the healthcare facilities for routine antenatal care. This mixed methods study used qualitative interviews with healthcare workers and pregnant women, a patient survey, observation of health promotion and awareness raising talks, and a review of several documents, to evaluate the acceptability, appropriateness, feasibility, adoption, fidelity of delivery, and fidelity of receipt of the HSS components. Thematic analysis was used to analyse the qualitative interviews, while the quantitative findings for adoption and fidelity of receipt were reported using numbers and proportions.
Healthcare workers found the delivery and content of the HSS components to be both acceptable and appropriate, while the feasibility, adoption and fidelity of delivery was poor. We demonstrated that the health promotion and awareness raising component improved women's attitudes towards seeking help for mental health conditions. The detection, referral and treatment components were found to improve fidelity of receipt, evidenced by an increase in the proportion of women undergoing routine detection and referral, and decreased feelings of distress in women who received counselling. However, using a task-sharing approach did not prove to be feasible, as adding additional responsibilities to already overburdened healthcare workers roles resulted in poor fidelity of delivery and adoption of all the HSS components.
The acceptability, appropriateness and fidelity of receipt of the HSS programme components, and poor feasibility, fidelity of delivery and adoption suggest the need to appoint dedicated, lay healthcare workers to deliver key programme components, at healthcare facilities, on the same day.
南非围产期常见精神障碍（CMD）负担沉重，如抑郁和焦虑，以及贫困、粮食不安全和家庭暴力水平高，这些都会增加 CMD 的风险。然而，公共医疗保健并不包括对这些疾病的常规检测和治疗。这项试点研究旨在评估一项卫生系统强化（HSS）干预措施的实施结果，该措施旨在改善开普敦公立医疗保健机构中患有围产期 CMD 和家庭暴力的妇女的护理质量。
有针对性地选择了三个产前保健设施来提供 HSS 方案，该方案包括四个组成部分：（1）由非专业医疗保健工作者进行健康促进和提高认识的讲座；（2）护士在常规护理中检测 CMD 和家庭暴力；（3）转诊患有 CMD 和家庭暴力的妇女；（4）由非专业医疗保健工作者在患者家中提供结构化咨询。参与者包括负责实施 HSS 组成部分的医疗保健工作者和接受常规产前保健的围产期妇女。这项混合方法研究使用了对医疗保健工作者和孕妇的定性访谈、患者调查、健康促进和提高认识讲座的观察以及对几份文件的审查，以评估 HSS 组成部分的可接受性、适当性、可行性、采用、交付的保真度和接收的保真度。使用主题分析对定性访谈进行分析，而采用和接收保真度的定量结果则使用数字和比例报告。
医疗保健工作者认为 HSS 组成部分的交付和内容既可以接受又合适，而可行性、采用和交付保真度较差。我们证明，健康促进和提高认识部分改善了妇女对寻求心理健康问题帮助的态度。检测、转诊和治疗部分被发现提高了接收的保真度，这表现在接受常规检测和转诊的妇女比例增加，以及接受咨询的妇女的痛苦感减轻。然而，采用任务分担方法并不可行，因为向已经负担过重的医疗保健工作者角色增加额外责任会导致 HSS 所有组成部分的交付保真度和采用率下降。
HSS 方案组成部分的可接受性、适当性和接收保真度，以及可行性差、交付保真度和采用率低表明需要在医疗保健设施中指定专门的、非专业的医疗保健工作者在同一天来提供关键的方案组成部分。
