Mother-to-mother therapy in India and Pakistan: adaptation and feasibility evaluation of the peer-delivered Thinking Healthy Programme

Abstract

BackgroundPerinatal depression is highly prevalent in South Asia. Although effective and culturally feasible interventions exist, a key bottleneck for scaled-up delivery is lack of trained human resource. The aim of this study was to adapt an evidence-based intervention so that local women from the community (peers) could be trained to deliver it, and to test the adapted intervention for feasibility in India and Pakistan.MethodsThe study was conducted in Rawalpindi, Pakistan and Goa, India. To inform the adaptation process, qualitative data was collected through 7 focus groups (four in Pakistan and three in India) and 61 in-depth interviews (India only). Following adaptation, the intervention was delivered to depressed mothers (20 in Pakistan and 24 in India) for six months through 8 peers in Pakistan and nine in India. Post intervention data was collected from depressed mothers and peers through 41 in-depth interviews (29 in Pakistan and 12 in India) and eight focus groups (one in Pakistan and seven in India). Data was analysed using Framework Analysis approach.ResultsMost mothers perceived the intervention to be acceptable, useful, and viewed the peers as effective delivery-agents. The simple format using vignettes, pictures and everyday terms to describe distress made the intervention easy to understand and deliver. The peers were able to use techniques for behavioural activation with relative ease. Both the mothers and peers found that shared life-experiences and personal characteristics greatly facilitated the intervention-delivery. A minority of mothers had concerns about confidentiality and stigma related to their condition, and some peers felt the role was emotionally challenging.ConclusionsThe study demonstrates the feasibility of using peers to provide interventions for perinatal depression in two South Asian settings. Peers can be a potential resource to deliver evidence-based psychosocial interventions.Trial registrationPakistan Trial: ClinicalTrials.gov Identifier: NCT02111915 (9 April 2014), India Trial: ClinicalTrials.gov Identifier: NCT02104232 (1 April 2014).

Delivering the Thinking Healthy Programme for perinatal depression through peers: an individually randomised controlled trial in India

“…THPP was developed during a two-year formative research phase. 11,15 Two major adaptations, related to the content and delivery mechanism, were made to the original THP intervention to make it deliverable by peers. Firstly, we shifted the focus from CBT (the active ingredient of the original THP intervention) to behavioural activation, because formative research indicated that CBT is more difficult for lay providers such as peers to learn.…”

“…Firstly, we shifted the focus from CBT (the active ingredient of the original THP intervention) to behavioural activation, because formative research indicated that CBT is more difficult for lay providers such as peers to learn. 11 Secondly, we reduced the number of sessions. THPP was delivered over 6-14 individual sessions in four phases over 7-12 months depending on the eligible trimester of recruitment, with sessions lasting between 30 and 45 minutes each.…”

“…We adapted the intervention for implementation in two diverse rural and peri-urban contexts in South Asia (India and Pakistan). 11 In this paper, we describe the findings of the trial in India where THPP was delivered through individual sessions. The results of the Pakistan trial, which delivered THPP through both individual and group sessions, are reported in the companion paper.…”

Lay counselors: Thoughts on the crossing of ecological frameworks and the use of lay counselors in the scale up of early infant mental health interventions

“…, Olin et al., ). Shared life experiences and similar demographic and personal characteristics have been found to significantly facilitate intervention delivery (Atif et al., ).…”

“…A number of studies have identified that lay mental health workers find the work emotionally challenging and that burnout rates are high (Atif et al., ). Within the South African setting, the only studies that have investigated burnout among lay counselors are those conducted with HIV counselors.…”