Subba Prasansa, Shrestha Pragya, Rahman Atif, Luitel Nagendra, Waqas Ahmed, Sikander Siham
Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK.
Research Department, Transcultural Psychosocial Organization Nepal, Kathmandu, Nepal.
Glob Ment Health (Camb). 2025 May 26;12:e54. doi: 10.1017/gmh.2025.10010. eCollection 2025.
Task sharing is endorsed as one of the strategies to address the treatment gap in common perinatal mental health conditions. There is a well-established body of evidence on the effectiveness of psychological interventions delivered by nonspecialist health workers (NSHWs); however, there is a dearth of evidence documenting factors determining the feasibility, acceptability and sustainability of integrating and implementing these interventions. This systematic review aims to synthesize the implementation outcomes and implementation process of NSHWs-delivered psychological interventions for the management of perinatal depression and anxiety using Proctor's implementation science framework outlining eight constructs: feasibility, acceptability, appropriateness, adoption, cost, fidelity, penetration and sustainability. We searched PubMed, Web of Science and Cochrane Center Register of Controlled Trials for studies published in English and between 2000 and 2022 using search terms under five broad categories: (a) "perinatal"; (b) "common mental disorders"; (c) "psychological interventions"; (d) "nonspecialist" and (e) "implementation outcomes." Secondary publications were also hand-searched for data extraction. Two authors independently reviewed abstracts and full-text articles. Data for included articles were extracted using a standard data extraction sheet. A narrative synthesis of qualitative evidence was conducted. Initial searches identified 885 articles of which full text of 128 articles were screened for eligibility, with 56 studies meeting the inclusion criteria. Out of the eight constructs of Proctor's framework, "feasibility," "acceptability," "appropriateness" and "fidelity" were the most evaluated outcomes. None of the studies reported "penetration" and very few reported "sustainability," "adoption" or "cost." None of the studies used any implementation science framework for the study evaluation. Despite the well-established evidence on the effectiveness of psychosocial interventions for perinatal depression and anxiety by NSHWs, these interventions are rarely adopted into the health system. More studies applying systems thinking are needed to explore facilitators, barriers and mechanisms for integrating interventions in the health system. Using implementation science frameworks to design, plan, execute and evaluate psychosocial interventions by NSHWs can address this gap in evidence.
任务分担被认为是解决常见围产期心理健康问题治疗差距的策略之一。关于非专科卫生工作者（NSHWs）提供心理干预措施的有效性，已有大量确凿的证据；然而，缺乏记录决定整合与实施这些干预措施的可行性、可接受性和可持续性因素的证据。本系统评价旨在使用普罗克特的实施科学框架（该框架概述了八个构建要素：可行性、可接受性、适宜性、采用、成本、保真度、渗透率和可持续性），综合NSHWs提供的用于管理围产期抑郁和焦虑的心理干预措施的实施结果和实施过程。我们在PubMed、科学网和考科蓝对照试验中心注册库中检索了2000年至2022年期间以英文发表的研究，使用了五大类搜索词：（a）“围产期”；（b）“常见精神障碍”；（c）“心理干预措施”；（d）“非专科”；（e）“实施结果”。还对手稿进行了手工检索以提取数据。两位作者独立审阅摘要和全文文章。使用标准数据提取表提取纳入文章的数据。对定性证据进行了叙述性综合分析。初步检索识别出885篇文章，其中筛选了128篇文章的全文以确定其是否符合纳入标准，56项研究符合纳入标准。在普罗克特框架的八个构建要素中，“可行性”“可接受性”“适宜性”和“保真度”是评估最多的结果。没有研究报告“渗透率”情况，很少有研究报告“可持续性”“采用情况”或“成本”情况。没有研究使用任何实施科学框架进行研究评估。尽管已有充分证据表明NSHWs提供的心理社会干预措施对围产期抑郁和焦虑有效，但这些干预措施很少被纳入卫生系统。需要更多运用系统思维的研究来探索将干预措施纳入卫生系统的促进因素、障碍和机制。使用实施科学框架来设计、规划、执行和评估NSHWs提供的心理社会干预措施可以填补这一证据空白。
