Journal article

Developing a task-sharing psychological intervention to treat mild to moderate symptoms of perinatal depession and anxiety in South Africa: a mixed- method formative study

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Publication Details

Author list: Boisits S; Abrahams Z; Schneider M; Honikman S; Kaminer D; Lund C

Publisher: BMC (part of Springer Nature)

Publication year: 2021

Journal: International Journal of Mental Health Systems

Volume number: 2021

Start page: 15

End page: 23

Total number of pages: 9

ISSN: 1752-4458

eISSN: 1752-4458


Background: Symptoms of depression and anxiety are highly prevalent amongst perinatal women in low-resource
settings of South Africa, but there is no access to standardised counselling support for these conditions in public
health facilities. The aim of this study is to develop a task-sharing psychological counselling intervention for routine
treatment of mild to moderate symptoms of perinatal depression and anxiety in South Africa, as part of the Health
Systems Strengthening in sub-Saharan Africa (ASSET) study.
Methods: We conducted a review of manuals from seven counselling interventions for depression and anxiety in
low- and middle-income countries and two local health system training programmes to gather information on delivery
format and common counselling components used across task-sharing interventions. Semi-structured interviews
were conducted with 20 health workers and 37 pregnant women from four Midwife Obstetric Units in Cape Town to
explore perceptions and needs relating to mental health. Stakeholder engagements further informed the intervention
design and appropriate service provider. A four-day pilot training with community-based health workers refined
the counselling content and training material.
Results: The manual review identified problem-solving, psychoeducation, basic counselling skills and behavioural
activation as common counselling components across interventions using a variety of delivery formats. The interviews
found that participants mostly identified symptoms of depression and anxiety in behavioural terms, and lay health
workers and pregnant women demonstrated their understanding through a range of local idioms. Perceived causes of
symptoms related to interpersonal conflict and challenging social circumstances. Stakeholder engagements identified
a three-session counselling model as most feasible for delivery as part of existing health care practices and community
health workers in ward-based outreach teams as the best placed delivery agents. Pilot training of a three-session intervention
with community-based health workers resulted in minor adaptations of the counselling assessment method.


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Last updated on 2021-25-06 at 10:35