1,721,046 research outputs found
Feasibility, acceptability, and appropriateness of the “Thinking Healthy Programme” for perinatal depression delivered by the Female Community Health Volunteers in Nepal: a pilot cluster randomized controlled trial
Get PDFPerinatal depression in Nepal poses an urgent public health challenge however, the current health system in Nepal is focused on physical health without any services dedicated to address maternal mental health. The Thinking Healthy Program (THP) is an evidence-based community psychological intervention designed for perinatal depression which has promising results of being effective even when delivered by non-specialists without prior training and experience in mental health. The positioning of the FCHVs in the community for the promotion of maternal and child health programmes provide unique opportunity to train and mobilize them for the delivery of THP in Nepali context. Therefore, this study employed pilot cluster randomized controlled trial design to pilot test the THP as well as assess the feasibility and acceptability of training and mobilizing FCHVs to deliver THP. The lessons gathered from this study will inform the design of future definitive trial. Health facility was the unit of randomization. Altogether 37 FCHVs (control arm=20; treatment arm=17) were trained on identification, psychoeducation, and referral of perinatal depression. FCHVs in the treatment arm received additional training in THP. Altogether 39 pregnant women were recruited (control arm=11; treatment arm=28) in the study. Quantitative data with trial participants was collected at three timepoints- before intervention (t0), 3 months post intervention (t1), and 3 months postnatal (t2) using validated questionnaires. Qualitative study was conducted at the end of the study with trial participants (n=20), their family members (n=11), FCHVs (FGD with 32 FCHVs; KII=5), field clinical supervisor (n=1), and health system representatives (n=2). Process notes were maintained throughout the study and competency assessment of the FCHVs were also conducted.
Quantitative data revealed improvements in depression, anxiety, and disability symptoms for both arms but higher mean difference among THP participants. The intervention showed no effect on social support or internalized stigma. Qualitative findings highlighted the appropriateness of the THP in the Nepali context and acceptability of FCHVs as local, resourceful community members. FCHVs reported personal growth and satisfaction from their involvement, though they also experienced an emotional burden and desired more training and supervision. Competency assessments demonstrated improvements in FCHVs' skills over time but there are some caveats that must be addressed in the future trial.
The study indicates that with proper training, practice, and close supervision, FCHVs can effectively deliver THP in Nepal. However, challenges remain, particularly regarding the status of FCHVs in Nepal's federal health system. The lessons and findings from this pilot study provide valuable insights for future definitive trial
Acceptability of a technology-assisted peer-delivered psychological intervention: A qualitative study
Get PDFBackground: Perinatal depression is a global health priority. The WHO-endorsed Thinking Healthy Programme (WHO-THP), based on principles of cognitive behaviour therapy, is an evidence-based intervention used widely in low-and middle-income countries. To make this intervention more scalable, a technology-assisted peer-delivered version of the Thinking Healthy Programme (THP-TAP) was developed in Pakistan. The innovation involved a peer-operated App with a therapist avatar and a narrative cognitive behavioural therapy-based approach towards intervention delivery. In this context, my PhD study had two key aims: First, to explore the challenges, primarily from an implementation perspective, of technology-assisted interventions for perinatal depression globally. Secondly, to investigate the acceptability of the technology-assisted peer-delivered innovation amongst end-users in lower socioeconomic rural settings in Pakistan.
Methods: For the first aim, I conducted a systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, using four academic databases: PubMed, Web of Science, PsycINFO and Cochrane Central Register of Controlled Trials from May 2002 to June 2022. For the second aim, I employed the Theoretical Framework of Acceptability (TFA) consisting of seven key domains, including affective attitude, burden, ethicality, intervention coherence, opportunity costs, perceived effectiveness, and self-efficacy. A qualitative study, embedded within a randomised controlled trial of THP-TAP, was conducted. Data collection included 46 in-depth interviews (IDIs) and 4 focus group discussions (FGDs) with purposively selected end-users. Participants comprised THP-TAP recipients (n=29), their significant family members (n=10), their peers who delivered the intervention (n=25), peer trainers (n=4), and specialist trainers (n=2). Data were analysed using the framework analysis approach.
Results: The systematic review showed a significant gap in the literature regarding the acceptability of digital interventions in their target populations, as none of the reviewed studies conducted comprehensive acceptability assessments. My qualitative study showed that the technology-assisted peer-delivered intervention was acceptable across all TFA domains with high levels of satisfaction and no major challenges reported by end-users in using the technology. The narrative approach and ‘avatars’ resonated with the end-users and motivated behaviour change and improved well-being. The automated delivery helped peers facilitate training as well as delivery, ensuring relevance and improving retention, and freeing up the peers for empathy and support. The role of peers as co-therapists was identified as crucial, with their empathy and support enhancing the intervention’s effectiveness. The flexibility and choice for home-based sessions were perceived to be facilitators, but suggestions for shorter or more adaptable sessions emerged, especially for those in late pregnancy or with multiple children. Challenges included time and other burdens on peers such as travel costs and responsibility for the equipment. Some peers faced resistance from families, especially due to the semi-voluntary nature of the work.
Conclusions: This study supports the acceptability of the technology-assisted peer-delivered innovation amongst end-users. If found to be effective, the approach can potentially assist in bridging the large treatment gap for this condition in low- and middle-income countries
Father involvement in the first year of life: Associations with maternal mental health and child development outcomes in rural Pakistan
No full textThe contribution of fathers to child development and maternal mental health is increasingly acknowledged, although research on this topic outside of high income countries is limited. Using longitudinal data, we characterized father involvement in a rural setting in Pakistan and investigated the link between father involvement in the first year of life and child development and maternal depression. Data come from the Bachpan study, a birth cohort established in the context of a perinatal depression intervention. Father involvement was mother reported at 3 and 12 months postpartum and covered domains such as playing with or soothing the infant. Child outcomes included growth at 3, 6 and 12 months postpartum, socioemotional development at 6 months (Ages and Stages Questionnaire-socioemotional), and developmental milestones at 12 months (Bayley Scales of Infant and Toddler Development, BSID)). Maternal depression was assessed at 3, 6, and 12 months postpartum. Roughly 20% of the fathers were temporarily non-resident. Among the rest, most mothers reported that fathers were involved: for example, approximately 40% reported that the father plays with the baby on a typical day. We observed no clear pattern of association between 3-month father involvement and child growth at any time point; however, 12-month father involvement was cross-sectionally inversely associated with child growth. We observed a protective pattern of association between 3-month father involvement and 6-month child socioemotional development. For the BSID domains, while almost all effect estimates suggested a protective association with higher levels of father involvement/father being temporarily non-resident, the magnitude of the estimates was smaller and most 95% confidence intervals crossed the null. Finally, there was a trend toward greater father involvement/being temporary non-resident predicting lower levels of maternal depression. Using longitudinal data, these results provide new evidence about the association between father involvement, and both child development and maternal mental health
Going Beyond Counting First Authors in Author Co-citation Analysis
Get PDFThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Get PDF“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Appropriate Similarity Measures for Author Cocitation Analysis
Get PDFWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
Dispelling the Myths Behind First-author Citation Counts
Get PDFWe conducted a full-scale evaluative citation analysis study of scholars in the XML research field to explore just how different from each other author rankings resulting from different citation counting methods actually are, and to demonstrate the capability of emerging data and tools on the Web in supporting more realistic citation counting methods. Our results contest some common arguments for the continued
use of first-author citation counts in the evaluation of scholars, such as high correlations between author rankings by first-author citation counts and other citation
counting methods, and high costs of using more realistic citation counting methods that are not well-supported by the ISI databases. It is argued that increasingly available digital full text research papers make it possible for citation analysis studies to go beyond what the ISI databases have directly supported and to employ more
sophisticated methods
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