Acceptability and appropriateness of a perinatal depression preventive group intervention: a qualitative analysis

Alicia Diebold, Melissa Segovia, Jessica K Johnson, Aria Degillio, Dana Zakieh, Hee Jin Park, Kenneth Lim, S Darius Tandon, Alicia Diebold, Melissa Segovia, Jessica K Johnson, Aria Degillio, Dana Zakieh, Hee Jin Park, Kenneth Lim, S Darius Tandon

Abstract

Background: Perinatal depression is a prevalent public health concern. Although preventive interventions exist, there is limited literature on the acceptability and appropriateness of these interventions, especially those delivered by paraprofessionals. The Mothers and Babies Program (MB) is a group-based perinatal depression preventive intervention delivered prenatally. A cluster-randomized controlled trial examined the acceptability, appropriateness, and effectiveness of MB delivered by mental health professionals compared to paraprofessional staff from home visiting programs.

Methods: The full study enrolled 874 pregnant women. Fifty-three facilitators were trained and delivered the MB intervention to women in one of seven states in the United States. Semi-structured interviews were attempted with a randomly-selected subset of the full sample of pregnant women who received the MB intervention and with all facilitators. Specifically, interviews were conducted with 88 women who received the MB group intervention (45 in the paraprofessional-led arm and 43 in the mental health professional-led arm) and 46 women who facilitated the groups (27 home visiting staff and 19 mental health professionals). Interviews were conducted over the phone in English or Spanish and audio recorded. The recordings were translated into English, as needed, and transcribed. Thematic analysis was conducted using NVIVO to identify key themes related to intervention acceptability and appropriateness. Similarities and differences between study arms were explored.

Results: Clients and facilitators found the MB content and group format acceptable. Challenges included maintaining group attendance, transportation issues, and managing group discussion. Overall, facilitators found the intervention appropriate for pregnant clients with some challenges presented for clients in crisis situations, experiencing housing instability, and with literacy and learning challenges. Participants provided suggestions for improvement, both for the course content and implementation. There were no significant differences found between study arms.

Conclusions: Overall, clients and facilitators enjoyed MB irrespective of study arm, and facilitators found the intervention appropriate for the population. These findings add to the qualitative literature on perinatal depression preventive interventions, specifically those delivered by paraprofessionals.

Trial registration: This trial is registered on ClinicalTrials.gov (Initial post: December 1, 2016; identifier: NCT02979444).

Keywords: Home visiting; Implementation; Perinatal depression; Qualitative analysis.

Conflict of interest statement

The authors declare that they have no competing interests.

References

    1. Gavin NI, Gaynes BN, Lohr KN, Meltzer-Brody S, Gartlehner G, Swinson T. Perinatal depression: a systematic review of prevalence and incidence. Obstet Gynecol. 2005;106(5 Pt 1):1071–1083. doi: 10.1097/01.AOG.0000183597.31630.db.
    1. Kim S, Soeken TA, Cromer SJ, Martinez SR, Hardy LR, Strathearn L. Oxytocin and postpartum depression: delivering on what's known and what's not. Brain Res. 2014;1580:219–232. doi: 10.1016/j.brainres.2013.11.009.
    1. O'Hara MW, McCabe JE. Postpartum depression: current status and future directions. Annu Rev Clin Psychol. 2013;9:379–407. doi: 10.1146/annurev-clinpsy-050212-185612.
    1. American College of Obstetricians and Gynecologists Screening for Perinatal Depression. ACOG Committee Opinion No. 757. Obstet Gynecol. 2018;132(5):e208–ee12. doi: 10.1097/AOG.0000000000002927.
    1. Hagan JF, Shaw JS, Duncan PM. Promoting mental health. In: Hagan JF, Shaw JS, Duncan PM, eds. Bright Futures Guidelines for Health Supervision of Infants, Children, and Adolescents. 4th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2017. p. 115–50.
    1. Earls MF, Yogman MW, Mattson G, Rafferty J. Incorporating recognition and Management of Perinatal Depression into Pediatric Practice. Pediatrics. 2019;143(1):1–29. doi: 10.1542/peds.2018-3259.
    1. Preventive Services Task Force US. Interventions to prevent perinatal depression. JAMA. 2019;321(6):580–587. doi: 10.1001/jama.2019.0007.
    1. Morrell CJ, Sutcliffe P, Booth A, Stevens J, Scope A, Stevenson M, et al. A systematic review, evidence synthesis and meta-analysis of quantitative and qualitative studies evaluating the clinical effectiveness, the cost-effectiveness, safety and acceptability of interventions to prevent postnatal depression. Health Technol Assess. 2016;20(37):1–414. doi: 10.3310/hta20370.
    1. Muñoz RF, Le H-N, Ippen CG, Diaz MA, Urizar GG, Soto J, et al. Prevention of postpartum depression in low-income women: development of the Mamás y Bebés/mothers and babies course. Cogn Behav Pract. 2007;14(1):70–83. doi: 10.1016/j.cbpra.2006.04.021.
    1. McFarlane E, Burrell L, Duggan A, Tandon D. Outcomes of a randomized trial of a cognitive behavioral enhancement to address maternal distress in home visited mothers. Matern Child Health J. 2017;21(3):475–484. doi: 10.1007/s10995-016-2125-7.
    1. Le HN, Perry DF, Stuart EA. Randomized controlled trial of a preventive intervention for perinatal depression in high-risk Latinas. J Consult Clin Psychol. 2011;79(2):135–141. doi: 10.1037/a0022492.
    1. Tandon SD, Leis JA, Mendelson T, Perry DF, Kemp K. Six-month outcomes from a randomized controlled trial to prevent perinatal depression in low-income home visiting clients. Matern Child Health J. 2014;18(4):873–881. doi: 10.1007/s10995-013-1313-y.
    1. Scope A, Booth A, Morrell CJ, Sutcliffe P, Cantrell A. Perceptions and experiences of interventions to prevent postnatal depression. A systematic review and qualitative evidence synthesis. J Affect Disord. 2017;210:100–110. doi: 10.1016/j.jad.2016.12.017.
    1. Glenton C, Lewin S, Scheel IB. Still too little qualitative research to shed light on results from reviews of effectiveness trials: a case study of a Cochrane review on the use of lay health workers. Implement Sci. 2011;6:53. doi: 10.1186/1748-5908-6-53.
    1. Glenton C, Colvin CJ, Carlsen B, Swartz A, Lewin S, Noyes J, Rashidian A. Barriers and facilitators to the implementation of lay health worker programmes to improve access to maternal and child health: a qualitative evidence synthesis. Cochrane Database Syst Rev. 2013;10.
    1. Proctor E, Silmere H, Raghavan R, Hovmand P, Aarons G, Bunger A, et al. Outcomes for implementation research: conceptual distinctions, measurement challenges, and research agenda. Admin Pol Ment Health. 2011;38(2):65–76. doi: 10.1007/s10488-010-0319-7.
    1. Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)--a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009;42(2):377–381. doi: 10.1016/j.jbi.2008.08.010.
    1. Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3(2):77–101. doi: 10.1191/1478088706qp063oa.
    1. Kennedy HP, Farrell T, Paden R, Hill S, Jolivet R, Willetts J, et al. “I wasn't alone”—a study of group prenatal care in the military. J Midwifery Womens Health. 2009;54(3):176–183. doi: 10.1016/j.jmwh.2008.11.004.
    1. Tanner-Smith EE, Steinka-Fry KT, Lipsey MW. A multi-site evaluation of the CenteringPregnancy® programs in Tennessee. Nashville, TN: Vanderbilt University; 2012.
    1. Evans M, Donelle L, Hume-Loveland L. Social support and online postpartum depression discussion groups: a content analysis. Patient Educ Couns. 2012;87(3):405–410. doi: 10.1016/j.pec.2011.09.011.
    1. Doran F, Hornibrook J. Women's experiences of participation in a pregnancy and postnatal group incorporating yoga and facilitated group discussion: a qualitative evaluation. Women Birth. 2013;26(1):82–86. doi: 10.1016/j.wombi.2012.06.001.
    1. Andersson E, Christensson K, Hildingsson I. Parents' experiences and perceptions of group-based antenatal care in four clinics in Sweden. Midwifery. 2012;28(4):502–508. doi: 10.1016/j.midw.2011.07.006.
    1. Tandon S, Johnson JK, Diebold A, Segovia M, Gollan J, Degillio A, et al. Comparing effectiveness of paraprofessional home visitors and mental health professionals delivering a postpartum depression preventive intervention: a cluster-randomized non-inferiority clinical trial. 2019.
    1. Barnett ML, Lau AS, Miranda J. Lay health worker involvement in evidence-based treatment delivery: a conceptual model to address disparities in care. Annu Rev Clin Psychol. 2018;14:185–208. doi: 10.1146/annurev-clinpsy-050817-084825.

Source: PubMed

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