1,720,975 research outputs found
Effectiveness of mental health services in primary care in Nepal: Results from PRIME studies
No full textFeasibility, 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
Full text linkPerinatal 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
Narrative approaches for community detection of mental health problems in Chitwan, Nepal
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Exploring feasibility and acceptability of mobilizing non-specialists for the delivery of psychological intervention for perinatal depression in Nepal
No full textUnderstanding barriers to help-seeking and developing innovative strategies for perinatal depression in Chitwan
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A formative study on the adaptation of mental health promotion programmes for perinatal depression in West Chitwan
Full text linkIntroduction: Depression in mothers can have debilitating consequences on the women themselves, their infants and their family. Thus, it is imperative to detect and treat perinatal depression early. Due to lack of awareness and stigma, help seeking, detection and treatment for perinatal depression in Nepal remains low. To counter barriers on lack of awareness, stigma and non-detection of mental health problems including depression, alcohol use disorder, psychosis and epilepsy, the PRogramme for Improving Mental Health carE (PRIME) developed and implemented a community sensitization programme and a Community Informant Detection Tool (CIDT). Neither of these programmes has focused on perinatal depression. This study aims to adapt the depression CIDT and the community sensitization programme to include perinatal depression. Methods: The CIDT and community sensitization programme were adapted using the following four steps. Firstly, a qualitative study was conducted with perinatal women with depressive symptoms visiting Meghauli and Dibyanagar health facilities or "gau-ghar clinic" (n=26) and service providers (n=34) to develop a culturally relevant content. Secondly, a draft CIDT and community sensitization manual were prepared based on the qualitative findings. Thirdly, a one-day workshop and several consultation meetings were held with mental health professionals (n=16) to ensure that the content was understandable and applicable to the context. Lastly, based on the workshop findings and consultation meetings, the manual and tools were modified and adapted for perinatal depression. Results: Due to poor awareness and stigma, none of our respondents had ever sought help for depression from the antenatal or postnatal service providers. Using local expressions for common depressive symptoms such as loss of interest, rumination, pessimistic views, extreme worries, restlessness, two separate CIDTs were developed each for antenatal and postnatal depression. Lack of support from the husband and family followed by poverty were the major contributing factors for depression. In addition, cultural factors such as the low position of women in patriarchal society and preference for son exacerbated problems in some women. The community sensitization manual was adapted to include local myths and facts about perinatal depression; causes with examples related to local beliefs; symptoms explained in local idioms; and role of the family. The heads of the families and key community members were recommended as key targets for the community sensitization programmes. Conclusion: It is important for any intervention to be responsive to local understanding and needs. The adapted CIDT and community sensitization manual has integrated the local issues and expressions of symptoms of perinatal depression for women in the Chitwan district
Adapting Thinking Healthy in Nepal: A Transdisciplinary, Community-Engaged Approach to Perinatal Mental Health Equity
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