Saint John of God Hospitaller services, Mzuzu, Malawi.
School of Population Health, Faculty of Health Sciences, Curtin University, Perth, Australia.
BMC Health Serv Res. 2024 Aug 26;24(1):983. doi: 10.1186/s12913-024-11469-z.
Integration of maternal mental health into primary health care is considered a strategy to improve access to mental health support in low- and middle-income countries (LMICs). Health care workers' (HCWs) and traditional practitioners' (traditional healers, herbalists, traditional birth attendants, spiritual healers, prophets, and community health volunteers) perceptions of the availability and management of adolescent mothers' maternal mental health care were explored in rural Malawi. Recognizing and identifying the barriers associated with access to maternal mental health support is essential to improving the mental health of adolescent mothers.
A descriptive qualitative design (DQ) was used to explore HCWs' and traditional practitioners' perceptions of maternal mental health services for adolescent mothers. In-depth interviews were conducted with HCWs (n = 6), and three focus group discussions were conducted with 30 community-based traditional practitioners. Participants were purposefully recruited because they provide formal or informal health services to adolescent mothers during the postnatal period at Mitundu Rural Hospital and its catchment area in Lilongwe District, in Malawi. Interviews were analyzed using reflective thematic analysis and inductive thinking.
Thematic analysis found four themes to describe access to maternal mental health care for adolescent mothers. Participant perceptions were themed around health system challenges and how cultural background and beliefs influence access to mental health care and support. The themes were: (1) Inadequate staff development; (2) Limited resources (medication and infrastructure); (3) Limited policy and guidelines implementation; and (4) Cultural background and belief influence on help-seeking. HCWs suggested improving pre-service and in-service training to improve mental health assessment of mothers, while traditional practitioners wanted to increase their awareness of mental health issues.
Participants emphasized that multifaceted factors influenced access to mental health support. These factors affect the assessment, treatment, and support of adolescent mothers and help-seeking by mothers. Therefore, strengthening the healthcare system and empowering providers with the knowledge and skills to recognize at-risk mothers and provide timely support is essential.
将孕产妇心理健康纳入初级卫生保健被认为是改善中低收入国家（LMICs）获得心理健康支持的一种策略。在马拉维农村，探索了卫生保健工作者（HCWs）和传统从业者（传统治疗师、草药师、传统助产士、灵媒、先知和社区卫生志愿者）对青少年母亲孕产妇心理健康护理的可用性和管理的看法。认识和确定与获得孕产妇心理健康支持相关的障碍对于改善青少年母亲的心理健康至关重要。
采用描述性定性设计（DQ）探讨 HCWs 和传统从业者对青少年母亲孕产妇心理健康服务的看法。对 HCWs（n=6）进行深入访谈，并对 30 名社区传统从业者进行了三次焦点小组讨论。参与者是有目的招募的，因为他们在马拉维利隆圭区米通杜农村医院及其集水区，在产后期间为青少年母亲提供正式或非正式的卫生服务。使用反思性主题分析和归纳思维对访谈进行分析。
主题分析发现了四个主题，以描述青少年母亲获得孕产妇心理健康护理的情况。参与者的看法围绕卫生系统挑战以及文化背景和信仰如何影响获得心理健康护理和支持展开。这些主题包括：（1）工作人员发展不足；（2）资源有限（药物和基础设施）；（3）政策和指南实施有限；（4）文化背景和信仰对寻求帮助的影响。HCWs 建议改善职前和在职培训，以提高对母亲的心理健康评估，而传统从业者希望提高他们对心理健康问题的认识。
参与者强调，多方面的因素影响着获得心理健康支持的机会。这些因素影响对青少年母亲的评估、治疗和支持以及母亲的求助意愿。因此，加强医疗保健系统并赋予提供者识别高危母亲和及时提供支持的知识和技能至关重要。
