Adaptation and integration of the Thinking Healthy Programme into pregnancy schools in Istanbul, Turkey

Abstract

Background Perinatal mental health is a major public health concern. In Turkey, the public hospitals operate pregnancy schools which provides an opportunity to integrate an evidence-based Thinking Healthy Programme (THP) for perinatal depression. The aim of this study is to adapt the THP for universal use in the group setting, and to understand its acceptability and feasibility for integration into the existing antenatal care programme for both face-to-face and online delivery. Methods Following an expert-led adaptation process using the Bernal Framework, field-testing was conducted on a group of women and facilitators (n=21) followed by in-depth interviews and group discussions. Data were analysed using Thematic Framework Analysis. Results Minor but significant adaptations were made to the individually delivered THP for use in the universal group pregnancy schools. Initial findings indicate that the THP-group version was relatable and acceptable to its target population and could be integrated into the antenatal care plan for delivery during face-to-face and on-line group classes. Conclusion THP is transferable to the Turkish cultural and healthcare context. The THP – group version has the potential to add value to Turkey's existing perinatal healthcare programme.

Delivering the Thinking Healthy Programme as a universal group intervention integrated into routine antenatal care: a randomized-controlled pilot study

“…As the study was conducted during the COVID pandemic, routine antenatal pregnancy schools were run online and arrangements were made to deliver the THP-BGV classes online incorporated into routine classes. Before online adaptation, focus group discussions were performed to explore women's views and needs about online classes [24]. Main adaptations to account for online delivery included user experience and accessibility such as providing data credits to participants and instructions on how to attend the sessions.…”

“…The intervention is based on the Thinking Healthy Programme [20,21,26], an evidence-based intervention that employs cognitive behaviour therapy strategies to achieve three main goals: a) To identify and modify maladaptive styles of thinking and behaving -in particular those leading to poor self-esteem, inability to care for their infants, and disengagement from social networks; b) behavioural activation -adopting behaviours, such as self-care, attention to diet, and positive interactions with the infant, and practicing these between sessions; c) problem-solving to overcome barriers to practicing such strategies. The adapted THP-BGV employs similar strategies adapted for prevention rather than treatment of perinatal depression [24]. An additional element is support from the facilitator and other group members.…”

“…The nurses have no formal mental health care training. A training manual was developed with the aim of standardizing the training and delivery procedures [24]. The Bernal Framework for adaptation was used to adapt THP for universal use in the group settings [27].…”

“…The Bernal Framework for adaptation was used to adapt THP for universal use in the group settings [27]. The original THP manual was previously translated into Turkish by PB and adapted for the five sessions of antenatal pregnancy school [24]. Original pictures were replaced with culturally appropriate illustrations.…”

“…Integrating THP into this existing service for perinatal health has the potential to fill the important gap of mental health care in Turkey. In view of this, we have developed an on-line brief group version of the THP (THP-BGV) designed to be integrated into the routine on-line antenatal pregnancy classes as a preventative intervention [24]. The Medical Research Council (MRC) guidelines suggest pilot studies resembling the intended trial having a control group and randomization on a smaller scale to be used prior to any large-scale definitive trial designed to evaluate the effect of complex interventions [25].…”