Piloting a psychosocial intervention for perinatal depression, the Thinking Healthy Programme-Peer delivered (THPP), in a primary care setting in Lilongwe District, Malawi

Mwawi Ng'oma; Najia Atif; Samantha Meltzer-Brody; Ellen Chirwa; Robert C Stewart

doi:10.1371/journal.pgph.0002128

Piloting a psychosocial intervention for perinatal depression, the Thinking Healthy Programme-Peer delivered (THPP), in a primary care setting in Lilongwe District, Malawi

PLOS Glob Public Health. 2024 May 1;4(5):e0002128. doi: 10.1371/journal.pgph.0002128. eCollection 2024.

Authors

Mwawi Ng'oma^{1

2}, Najia Atif³, Samantha Meltzer-Brody⁴, Ellen Chirwa⁵, Robert C Stewart⁶

Affiliations

¹ Department of Psychiatry and Mental Health, Kamuzu University of Health Sciences, Blantyre, Malawi.
² Programs Department, St John of God Hospitaller Services, Lilongwe, Malawi.
³ Human Development Research Foundation, Islamabad, Pakistan.
⁴ Department of Psychiatry, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, United States of America.
⁵ Department of Reproductive Health, Kamuzu University of Health Sciences, Blantyre, Malawi.
⁶ Division of Psychiatry, University of Edinburgh, Edinburgh, United Kingdom.

Abstract

Despite the evidence for the effectiveness of psychosocial interventions for perinatal depression, their uptake is low in Low- and Middle-Income Countries. Reasons for this include the lack of contextually adapted interventions and mental health specialists to deliver them. This study aimed to test the acceptability and feasibility of a psychosocial intervention for perinatal depression, the Thinking Healthy Programme-Peer Delivered, adapted for use in rural Malawi. A multi-method evaluation of feasibility and acceptability of the intervention was conducted using a one-group pretest-posttest quasi-experimental design and an exploratory qualitative study. Pre-post intervention change in depression scores (paired t-test) and recruitment, retention and session adherence rates were calculated. Qualitative data were collected through 29 in-depth interviews (22 mothers and 7 peer volunteers) and 1 Focus Group Discussion (18 mothers). Thematic analysis approach was used to analyse qualitative data. Seven (7) out of 8 peer volunteers were successfully trained to deliver the intervention. A total of 31 pregnant women with Edinburgh Postnatal Depression Scale (EPDS) score ≥12 were offered intervention, of whom 24 were enrolled (recruitment rate 77.4%). Out of these 24 women, 22 completed the intervention (retention rate 91.6%). Mean difference between pre- and post-test EPDS scores one week after 8th session was 7.59 (95% CI 4.98 to 10.19), p<0.001. Qualitative evaluation showed that the intervention was acceptable despite some challenges including stigma and issues around incentivization of peer volunteers. The Thinking Healthy Programme-Peer Delivered, adapted for use in Malawi, was feasible to deliver and acceptable to its target population. The intervention may be useful in management of perinatal depression in primary care settings in Malawi. However, definitive trials are needed to evaluate its effectiveness.

Copyright: © 2024 Ng’oma et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Grants and funding

This work was independently carried out by the authors and was supported through the DELTAS Africa Initiative [DEL-15-01]. The DELTAS Africa Initiative is an independent funding scheme of the African Academy of Sciences (AAS)’s Alliance for Accelerating Excellence in Science in Africa (AESA) and supported by the New Partnership for Africa’s Development Planning and Coordinating Agency (NEPAD Agency) with funding from Welcome Trust [DEL-15-01] and the UK Government. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. The views expressed in this publication are those of the author(s) and not necessarily those of AAS, NEPAD Agency, Welcome Trust or the UK Government. RCS, one of the authors is also supported by MRC GCRF grant MR/S035818/1.