Barefoot therapists: barriers and facilitators to delivering maternal mental health care through peer volunteers in Pakistan: a qualitative study

Abstract

BackgroundPerinatal depression is a public health problem in low and middle income countries. Although effective psychosocial interventions exist, a major limitation to their scale up is the scarcity of mental health professionals. The aim of this study was to explore the facilitators and barriers to the acceptability of peer volunteers (PVs)—volunteer lay women from the community with shared socio-demographic and life experiences with the target population—as delivery agents of a psychosocial intervention for perinatal depression in a rural area of Pakistan.MethodsThis qualitative study was embedded in the pilot phase of a larger peer-delivered mental health programme. Forty nine participants were included: depressed mothers (n = 21), PVs (n = 8), primary health care staff (n = 5), husbands (n = 5) and mothers-in-law (n = 10). Data were collected through in-depth interviews and focus groups and analysed using the Framework Analysis approach.ResultsThe PVs were accepted as delivery agents by all key stakeholders. Facilitators included the PVs’ personal attributes such as being local, trustworthy, empathetic, and having similar experiences of motherhood. The perceived usefulness and cultural appropriateness of the intervention and linkages with the primary health care (PHC) system was vital to their legitimacy and credibility. The PVs’ motivation was important, and factors influencing this were: appropriate selection; effective training and supervision; community endorsement of their role, and appropriate incentivisation. Barriers included women’s lack of autonomy, certain cultural beliefs, stigma associated with depression, lack of some mothers’ engagement and resistance from some families.ConclusionPVs are a potential human resource for the delivery of a psychosocial intervention for perinatal depression in this rural area of Pakistan. The use of such delivery agents could be considered for other under-resourced settings globally.

Development of a Psychological Intervention to Address Anxiety During Pregnancy in a Low-Income Country

“…Perinatal anxiety is a critical public health priority, given the high prevalence, its tendency to predispose women to subsequent postpartum depression, and the negative impacts on child development and health outcomes. Lack of trained mental health specialists to deliver psychosocial interventions is a major barrier to addressing this problem (45). This simple intervention can be delivered by non-specialists under supervision and thus, if shown to be effective in subsequent large scale evaluations, could address the treatment gap for common mental disorders in LMICs (46).…”

“Pain in my heart”: Understanding perinatal depression among women living with HIV in Malawi

“…This guide began by presenting PND symptoms and asking if they had seen someone with these symptoms and how they would describe them, then presented vignettes, or short stories with hypothetical characters, and closed by asking women about their personal experiences with depression. Vignettes were used due to the sensitivity of the study topic (18). The vignette in the interview guide centered around a woman with a new child experiencing signs of PND and receiving an HIV diagnosis.…”

Acceptability of a role for community health workers in integrated mental health care for perinatal depression: a qualitative study from Surabaya, Indonesia

“…Padmanathan and De Silva [15] found that health service needs of the community and satisfaction with services contribute to acceptability of task-sharing in mental health care. Studies carried out in several countries have found that acceptability of task-sharing in mental health care is supported by perceptions of benefits such as accessibility, saving of time and money, and less stigma [16,17].…”

“…Personal attributes of CHWs, such as gender, educational background, experience and knowledge, together with personal qualities (personality, being polite and friendly) also contribute to acceptability [15,17]. Proximity of non-specialist health workers to service users, and community endorsement of their role, support community acceptability [17], whereas level of training, support and supervision are significant factors affecting acceptability among professionals [16]. From a health system perspective, acceptability is influenced by the availability of appropriate infrastructure, workload, and issues such as assurance of confidentiality [15].…”

“…From a health system perspective, acceptability is influenced by the availability of appropriate infrastructure, workload, and issues such as assurance of confidentiality [15]. Others reported that perception of CHWs as being trustworthy and as respected members of the community, and their links with the local health system, support acceptability of task-sharing in maternal mental health [17].…”