探讨心理社会干预——由同伴实施的思考健康计划（THPP）——在马拉维利隆圭用于围产期抑郁的文化适宜性。
Exploring the cultural appropriateness of a psychosocial intervention, the Thinking Healthy Programme-Peer delivered (THPP), for perinatal depression in Lilongwe, Malawi.
机构信息
Department of Mental Health, Kamuzu University of Health Sciences, Blantyre, Malawi.
St John of God Hospitaller Services, Lilongwe, Malawi.
出版信息
Malawi Med J. 2022 Jun;34(2):87-94. doi: 10.4314/mmj.v34i2.3.
BACKGROUND
Perinatal depression is a common and disabling mental health problem in Malawi and other Low- and middle-income countries. There is evidence for effective psychosocial interventions for perinatal depression, but no such intervention has been developed for use in Malawi. The broad aim of this study was to explore the cultural appropriateness of a psychosocial intervention for perinatal depression called the Thinking Healthy Programme-Peer delivered for adaptation and use in Lilongwe, Malawi.
METHODS
A qualitative exploratory design was used. Data were collected through conducting five Focus Group Discussions, involving thirty-eight purposefully selected participants including pregnant women, community volunteers and their supervisors, the Health Surveillance Assistants and maternal health care workers at implementation and policy level following observations of video recorded role plays of the Thinking Healthy Programme-Peer delivered sessions in theatre testing. A content analysis approach was used to analyse data.
RESULTS
Six main themes were generated regarding the appropriateness of the content and delivery of the Thinking Healthy Programme-Peer delivered intervention, including: 1) Focus of the intervention; 2) Cultural appropriateness of the content; 3) Language used; 4) Context; 5) Provider of the intervention; and 6) Flexibility in the delivery of the intervention. The Thinking Healthy Programme-Peer delivered intervention was deemed appropriate for the target population, though with recommendations to: review illustrations to enhance clarity, use culturally appropriate stories and idioms, use daily spoken language, and adapt the number and duration of sessions to meet the needs of individual clients.
CONCLUSIONS
These findings highlight important areas to inform adaptation of the Thinking Healthy Programme-Peer delivered and add to the growing evidence of cultural adaptation of psychosocial interventions for perinatal depression.
背景
围产期抑郁是马拉维和其他中低收入国家常见且致残的心理健康问题。有证据表明，针对围产期抑郁的心理社会干预措施是有效的，但在马拉维还没有开发出这种干预措施。本研究的总体目标是探讨一种名为“思维健康计划-同伴提供”的围产期抑郁心理社会干预措施在马拉维的文化适宜性，该干预措施旨在适应和使用。
方法
采用定性探索性设计。通过开展五次焦点小组讨论，收集数据，参与者包括孕妇、社区志愿者及其主管、健康监督助理和产妇保健工作者，在实施和政策层面观察到“思维健康计划-同伴提供”角色扮演的视频记录后，参与者包括孕妇、社区志愿者及其主管、健康监督助理和产妇保健工作者。采用内容分析法对数据进行分析。
结果
围绕“思维健康计划-同伴提供”干预措施的内容和交付的适宜性，生成了六个主要主题，包括：1）干预的重点；2）内容的文化适宜性；3）使用的语言；4）背景；5）干预的提供者；6）干预交付的灵活性。“思维健康计划-同伴提供”干预措施被认为适合目标人群，但也提出了一些建议，如：审查插图以提高清晰度、使用文化上合适的故事和习语、使用日常口语、并调整课程的数量和时长以满足个别客户的需求。
结论
这些发现突出了告知“思维健康计划-同伴提供”改编的重要领域，并为围产期抑郁心理社会干预措施的文化改编增加了越来越多的证据。
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