Health systems strengthening interventions for perinatal common mental disorders and experiences of domestic violence in Cape Town, South Africa: protocol for a pilot implementation study

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dc.contributor.authorAbrahams, Zulfa
dc.contributor.authorSchneider, Marguerite
dc.contributor.authorHonikman, Simone
dc.contributor.authorOlckers, Patti
dc.contributor.authorBoisits, Sonet
dc.contributor.authorSeward, Nadine
dc.contributor.authorLund, Crick
dc.date.accessioned2022-07-08T08:40:44Z
dc.date.available2022-07-08T08:40:44Z
dc.date.issued2022-05-07
dc.date.updated2022-05-08T03:25:14Z
dc.description.abstractBackground During the perinatal period, common mental disorders (CMDs) such as depression and anxiety are highly prevalent, especially in low-resource settings, and are associated with domestic violence, poverty, and food insecurity. Perinatal CMDs have been associated with several adverse maternal and child outcomes. While the Department of Health in South Africa provides healthcare workers with the tools to detect psychological distress and experiences of domestic violence, few healthcare workers routinely screen pregnant women at clinic visits, citing discomfort with mental health issues and the lack of standardised referral pathways as the key barriers. The aim of this study is to select and evaluate a set of health systems strengthening (HSS) interventions aimed at improving the care and outcomes for perinatal women with CMDs and experiences of domestic violence, attending public healthcare facilities in Cape Town. Methods This study consists of a pre-implementation, development, and implementation phase. Contextual barriers identified during the pre-implementation phase included poor patient knowledge and health-seeking behaviour, high levels of stigma, and poor detection, referral, and treatment rates. Implementation science determinant frameworks were applied to findings from the pre-implementation phase to identify determinants and gaps in delivering high-quality evidence-informed care. A participatory Theory of Change workshop was used to design a HSS programme, consisting of awareness raising, detection, referral, and treatment. HSS interventions selected to support the delivery of the HSS programme includes training, health promotion, change to the healthcare environment, task-sharing, audit and feedback, and performance monitoring. The implementation phase will be used to assess several implementation and clinical outcomes associated with the delivery of the HSS programme, which will be piloted at three healthcare facilities. Qualitative and quantitative methods will be used to evaluate the implementation and clinical outcomes. Discussion This pilot implementation study will inform us about a range of implementation and clinical outcome measures that are relevant for assessing HSS interventions for perinatal women with depression, anxiety, or experiences of domestic violence in low-resource settings. Lessons learnt from the pilot study will be incorporated into the design of a cluster randomised control trial for which further funding will be sought.en_US
dc.identifier.apacitationAbrahams, Z., Schneider, M., Honikman, S., Olckers, P., Boisits, S., Seward, N., & Lund, C. (2022). Health systems strengthening interventions for perinatal common mental disorders and experiences of domestic violence in Cape Town, South Africa: protocol for a pilot implementation study. <i>Pilot and Feasibility Studies</i>, 8(1), 100. http://hdl.handle.net/11427/36637en_ZA
dc.identifier.chicagocitationAbrahams, Zulfa, Marguerite Schneider, Simone Honikman, Patti Olckers, Sonet Boisits, Nadine Seward, and Crick Lund "Health systems strengthening interventions for perinatal common mental disorders and experiences of domestic violence in Cape Town, South Africa: protocol for a pilot implementation study." <i>Pilot and Feasibility Studies</i> 8, 1. (2022): 100. http://hdl.handle.net/11427/36637en_ZA
dc.identifier.citationAbrahams, Z., Schneider, M., Honikman, S., Olckers, P., Boisits, S., Seward, N. & Lund, C. 2022. Health systems strengthening interventions for perinatal common mental disorders and experiences of domestic violence in Cape Town, South Africa: protocol for a pilot implementation study. <i>Pilot and Feasibility Studies.</i> 8(1):100. http://hdl.handle.net/11427/36637en_ZA
dc.identifier.ris TY - Journal Article AU - Abrahams, Zulfa AU - Schneider, Marguerite AU - Honikman, Simone AU - Olckers, Patti AU - Boisits, Sonet AU - Seward, Nadine AU - Lund, Crick AB - Background During the perinatal period, common mental disorders (CMDs) such as depression and anxiety are highly prevalent, especially in low-resource settings, and are associated with domestic violence, poverty, and food insecurity. Perinatal CMDs have been associated with several adverse maternal and child outcomes. While the Department of Health in South Africa provides healthcare workers with the tools to detect psychological distress and experiences of domestic violence, few healthcare workers routinely screen pregnant women at clinic visits, citing discomfort with mental health issues and the lack of standardised referral pathways as the key barriers. The aim of this study is to select and evaluate a set of health systems strengthening (HSS) interventions aimed at improving the care and outcomes for perinatal women with CMDs and experiences of domestic violence, attending public healthcare facilities in Cape Town. Methods This study consists of a pre-implementation, development, and implementation phase. Contextual barriers identified during the pre-implementation phase included poor patient knowledge and health-seeking behaviour, high levels of stigma, and poor detection, referral, and treatment rates. Implementation science determinant frameworks were applied to findings from the pre-implementation phase to identify determinants and gaps in delivering high-quality evidence-informed care. A participatory Theory of Change workshop was used to design a HSS programme, consisting of awareness raising, detection, referral, and treatment. HSS interventions selected to support the delivery of the HSS programme includes training, health promotion, change to the healthcare environment, task-sharing, audit and feedback, and performance monitoring. The implementation phase will be used to assess several implementation and clinical outcomes associated with the delivery of the HSS programme, which will be piloted at three healthcare facilities. Qualitative and quantitative methods will be used to evaluate the implementation and clinical outcomes. Discussion This pilot implementation study will inform us about a range of implementation and clinical outcome measures that are relevant for assessing HSS interventions for perinatal women with depression, anxiety, or experiences of domestic violence in low-resource settings. Lessons learnt from the pilot study will be incorporated into the design of a cluster randomised control trial for which further funding will be sought. DA - 2022-05-07 DB - OpenUCT DP - University of Cape Town IS - 1 J1 - Pilot and Feasibility Studies KW - Common mental disorders KW - Domestic violence KW - Detection KW - Counselling KW - Implementation science KW - Health system strengthening LK - https://open.uct.ac.za PY - 2022 T1 - Health systems strengthening interventions for perinatal common mental disorders and experiences of domestic violence in Cape Town, South Africa: protocol for a pilot implementation study TI - Health systems strengthening interventions for perinatal common mental disorders and experiences of domestic violence in Cape Town, South Africa: protocol for a pilot implementation study UR - http://hdl.handle.net/11427/36637 ER - en_ZA
dc.identifier.urihttps://doi.org/10.1186/s40814-022-01053-9
dc.identifier.urihttp://hdl.handle.net/11427/36637
dc.identifier.vancouvercitationAbrahams Z, Schneider M, Honikman S, Olckers P, Boisits S, Seward N, et al. Health systems strengthening interventions for perinatal common mental disorders and experiences of domestic violence in Cape Town, South Africa: protocol for a pilot implementation study. Pilot and Feasibility Studies. 2022;8(1):100. http://hdl.handle.net/11427/36637.en_ZA
dc.language.isoenen_US
dc.language.rfc3066en
dc.publisher.departmentCentre for Public Mental Healthen_US
dc.publisher.facultyFaculty of Health Sciencesen_US
dc.rights.holderThe Author(s)
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/en_US
dc.sourcePilot and Feasibility Studiesen_US
dc.source.journalissue1en_US
dc.source.journalvolume8en_US
dc.source.pagination100en_US
dc.source.urihttps://pilotfeasibilitystudies.biomedcentral.com/
dc.subjectCommon mental disordersen_US
dc.subjectDomestic violenceen_US
dc.subjectDetectionen_US
dc.subjectCounsellingen_US
dc.subjectImplementation scienceen_US
dc.subjectHealth system strengtheningen_US
dc.titleHealth systems strengthening interventions for perinatal common mental disorders and experiences of domestic violence in Cape Town, South Africa: protocol for a pilot implementation studyen_US
dc.typeJournal Articleen_US
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