Making assessment locally relevant: measuring functioning for maternal depression in Khayelitsha, Cape Town

Abstract

Purpose We developed a locally relevant functioning assessment instrument (FAI) for pregnant women and mothers of young babies to complement a widely validated instrument—the World Health Organization’s Disability Assessment Schedule (WHODAS) 12-item version. The FAI is an outcome measure in a randomised controlled trial on the effectiveness of a lay counsellor administered intervention for distressed pregnant women in Khayelitsha, Cape Town. Methods Nine items most commonly reported by 40 pregnant women or mothers with young babies in qualitative interviews were selected for the instrument, with a 10th item ‘Other’. The FAI was validated with 142 pregnant women and mothers in Khayelitsha. Analysis was conducted to assess internal reliability, exploratory factor analysis and convergent validity. Results The FAI had good internal reliability (Cronbach’s alpha = 0.77) and the explanatory factor analysis showed a clear 3-factor solution, relating to domestic, childcare and social activities. The FAI scores showed floor effects, but were positively correlated with the two measures of functioning (WHODAS 2.0 and Washington Group Short Set). The FAI scores also correlated with the measure of depression (Edinburgh Postnatal Depression Scale—EPDS), reflecting increased functional limitations associated with increased depressive symptoms. Conclusion The results show that the FAI has good internal reliability, and good convergent and construct validity as a measure of functioning for this context. This paper reports on the process of developing an instrument and highlights the importance of using instruments that are locally relevant to ensure accurate measurement of functional status.

Social Support, Stigma and Antenatal Depression Among HIV-Infected Pregnant Women in South Africa

“…Although slightly lower than other recently reported estimates among pregnant women in the region [29–31], the proportion of participants with elevated depression scores observed here is concerning, given documented adverse effects on maternal and child health and on HIV-related treatment outcomes. Although much progress has been made in improving maternal physical health, this persistently high prevalence of depressive symptoms suggests that more focus is needed on mental health in this population.…”

Validation of the World Health Organization Disability Assessment Schedule in people with severe mental disorders in rural Ethiopia

“…This study highlights the importance of also using a functioning measure that is developed based on locally relevant tasks in rural African setting, such as the Butajira Functioning Scale (BFS) [23]. Recent attempts to develop local, health condition specific functioning instruments [38, 44] have demonstrated that it is possible to develop measures that are easy and quick to administer and psychometrically sound with items that are contextually relevant and acceptable.…”

Patterns of intimate partner violence among perinatal women with depression symptoms in Khayelitsha, South Africa: a longitudinal analysis

“…The measures collected at all assessment time points are described in the AFFIRM-SA RCT protocol (Lund et al 2014 ). Briefly, these included the AFFIRM Functional Assessment Instrument (AFFIRM-FAI) (Schneider et al 2015 ), the WHO Disability Assessment Schedule 2.0 (12 items) (WHODAS 2.0) (Üstün et al 2010 ), the Multidimensional Scale of Perceived Social Support (MSPSS) (Zimet et al 1988 ), the WHO Alcohol Use Disorder Identification Test (AUDIT) (Saunders et al 1993 ) and the Household Food Insecurity Access Scale (HFIAS) (Coates et al 2006 ). The Hamilton Depression Rating Scale (HDRS; Hamilton, 1960 ) was used to provide a more robust measure of depressive symptoms as compared with the EPDS.…”