Human Development Research Foundation, Islamabad, Pakistan
Human Development Research Foundation, Islamabad, Pakistan.
BMJ Open. 2023 Feb 23;13(2):e069988. doi: 10.1136/bmjopen-2022-069988.
A manualised cognitive-behavioural therapy-based psychosocial intervention for prenatal anxiety called Happy Mother Healthy Baby is being tested for its effectiveness through a randomised control trial in Pakistan. The aim of this study was to evaluate the intervention delivery process and the research process.
Qualitative methods were used to explore in depth the intervention delivery and research process.
This process evaluation was embedded within a randomised control trial conducted in a tertiary care facility in Rawalpindi, Pakistan.
Data were collected through in-depth interviews (n=35) with the trial participants and focus group discussions (n=3) with the research staff. Transcripts were analysed using a Framework Analysis.
The evaluation of the intervention delivery process indicated that it can be effectively delivered by non-specialist providers trained and supervised by a specialist. The intervention was perceived to be culturally acceptable and appropriately addressing problems related to prenatal anxiety. Lack of awareness of 'talking' therapies and poor family support were potential barriers to participant engagement. The evaluation of the research process highlighted that culturally appropriate consent procedures facilitated recruitment of participants, while incentivisation and family involvement facilitated sustained engagement and retention. Lack of women's empowerment and mental health stigma were potential barriers to implementation of the programme.
We conclude that non-specialists can feasibly deliver an evidence-based intervention integrated into routine antenatal care in a tertiary hospital. Non-specialist providers are likely to be more cost effective and less stigmatising. Inclusion of family is key for participant recruitment, retention and engagement with the intervention.
NCT03880032.
一项名为“快乐妈妈健康宝宝”的基于认知行为疗法的心理社会干预措施，旨在针对产前焦虑，目前正在巴基斯坦通过随机对照试验来测试其有效性。本研究旨在评估干预措施的实施过程和研究过程。
采用定性方法深入探讨干预措施的实施过程和研究过程。
该过程评估嵌入在巴基斯坦拉瓦尔品第一家三级保健机构开展的随机对照试验中。
通过对试验参与者进行深入访谈（n=35）和对研究人员进行焦点小组讨论（n=3）收集数据。使用框架分析法分析转录本。
干预措施实施过程的评估表明，经过专门培训和监督的非专业人员可以有效地提供该干预措施。该干预措施被认为具有文化适宜性，并能适当解决与产前焦虑相关的问题。对“谈话”疗法缺乏认识和家庭支持不足是参与者参与的潜在障碍。研究过程的评估强调，文化适宜的知情同意程序有助于参与者的招募，而激励措施和家庭参与有助于持续参与和保留。妇女赋权不足和精神卫生污名化是方案实施的潜在障碍。
我们得出结论，非专业人员可以在三级医院的常规产前护理中切实提供基于证据的干预措施。非专业人员可能更具成本效益，且污名化程度更低。纳入家庭是招募、保留和参与干预措施的关键。
NCT03880032。
