Abstract
Purpose
This paper describes the design of a theory-informed pragmatic intervention for adolescent perinatal depression in primary care in Nigeria.
Methods
We conducted Focus Group Discussions (FGDs) among 17 adolescent mothers and 25 maternal health care providers with experience in the receipt and provision of care for perinatal depression. The Consolidated Framework for Implementation Research (CFIR) was used to systematically examine the barriers and facilitators affecting adolescent mothers' use of an existing intervention package for depression. The Theoretical Domain Framework (TDF) and the Capability, Opportunity, Motivation, Behaviour (COM-B) model were used to analyze the results of the data across the five CFIR domains.
Results
FGD analysis revealed that care providers lacked knowledge on approaches to engage young mothers in treatment. Young mothers had poor treatment engagement, low social support, and little interest in parenting. A main characteristic of the newly designed intervention is the inclusion of age-appropriate psychoeducation supported with weekly mobile phone calls, to address treatment engagement and parenting behaviours of young mothers. Also in the outer setting, low social support from relatives was addressed with education, “as need arises” phone calls, and the involvement of "neighborhood mothers”. In the inner settings, care providers’ behaviour is addressed with training to increase their capacity to engage young mothers in treatment.
Conclusion
A theory-based approach helped develop an age-appropriate intervention package targeting depression and parenting skills deficit among perinatal adolescents in primary maternal care and in which a pragmatic use of mobile phone was key.
Similar content being viewed by others
References
Ekefre EN, Ekanem SA, Esien OEE (2014) Teenage pregnancy and education in Nigeria: a philo-sociological management strategy. J Educ Soc Res 4(3):41
Wardlaw T et al (2014) UNICEF report: enormous progress in child survival but greater focus on newborns urgently needed. Reprod Health 11(1):1–4
Gureje O et al (2019) High- versus low-intensity interventions for perinatal depression delivered by non-specialist primary maternal care providers in Nigeria: cluster randomised controlled trial (the EXPONATE trial). Br J Psychiatry 215(3):528–535
Dinwiddie KJ, Schillerstrom TL, Schillerstrom JE (2018) Postpartum depression in adolescent mothers. J Psychosom Obstet Gynaecol 39(3):168–175
Siegel RS, Brandon AR (2014) Adolescents, pregnancy, and mental health. J Pediatr Adolesc Gynecol 27(3):138–150
World Health Organization (2010) Mental Health Gap Action Programme: MhGAP intervention guide for mental, neurological and substance use disorders in non-specialized health settings: version 1.0. World Health Organization, pp 86–94
Keynejad RC et al (2018) WHO mental health gap action programme (mhGAP) intervention guide: a systematic review of evidence from low and middle-income countries. Evid Based Ment Health 21(1):30–34
Rahman A (2007) Challenges and opportunities in developing a psychological intervention for perinatal depression in rural Pakistan—A multi-method study. Arch Womens Ment Health 10(5):211–219
Hatzenbuehler ML, Phelan JC, Link BG (2013) Stigma as a fundamental cause of population health inequalities. Am J Public Health 103(5):813–821
Kola L et al (2020) Stigma and utilization of treatment for adolescent perinatal depression in Ibadan Nigeria. BMC Pregnancy Childbirth 20:1–8
Naslund JA et al (2017) Digital technology for treating and preventing mental disorders in low-income and middle-income countries: a narrative review of the literature. Lancet Psychiatry 4(6):486–500
Kola L (2019) Making a case for use of digital interventions to manage adolescent perinatal depression in Nigeria. Biomed Sci Res 6(4)
Kruse C et al (2019) Barriers to the use of mobile health in improving health outcomes in developing countries: systematic review. J Med Internet Res 21(10):e13263
Yang Q, Van Stee SK (2019) The comparative effectiveness of mobile phone interventions in improving health outcomes: meta-analytic review. JMIR mHealth uHealth 7(4):e11244
Akinfaderin-Agarau F et al (2012) Opportunities and limitations for using new media and mobile phones to expand access to sexual and reproductive health information and services for adolescent girls and young women in six Nigerian states. Afr J Reprod Health 16(2):219–230
Oyeyemi SO, Wynn R (2014) Giving cell phones to pregnant women and improving services may increase primary health facility utilization: a case–control study of a Nigerian project. Reprod Health 11(1):8
Colaci D, Chaudhri S, Vasan A (2016) mHealth interventions in low-income countries to address maternal health: a systematic review. Ann Glob Health 82(5):922–935
Kola L et al (2021) Mobile phone use and acceptability for the delivery of mental health information among perinatal adolescents in Nigeria: survey study. JMIR Mental Health 8(1):e20314
Fedele DA et al (2017) Mobile health interventions for improving health outcomes in youth: a meta-analysis. JAMA Pediatr 171(5):461–469
Nilsen P (2020) Making sense of implementation theories, models, and frameworks. In: Implementation Science 3.0. Springer, New York, pp 53–79
Cane J, O’Connor D, Michie S (2012) Validation of the theoretical domains framework for use in behaviour change and implementation research. Implement Sci 7(1):37
Michie S, Van Stralen MM, West R (2011) The behaviour change wheel: a new method for characterising and designing behaviour change interventions. Implement Sci 6(1):42
Means AR et al (2020) Evaluating and optimizing the consolidated framework for implementation research (CFIR) for use in low-and middle-income countries: a systematic review. Implement Sci 15(1):1–19
Gureje O et al (2015) Expanding care for perinatal women with depression (EXPONATE): study protocol for a randomized controlled trial of an intervention package for perinatal depression in primary care. BMC Psychiatry 15:136
Krueger RA, Casey MA (2002) Designing and conducting focus group interviews. St Paul, Minnesota, USA
Srivastava P, Hopwood N (2009) A practical iterative framework for qualitative data analysis. Int J Qual Methods 8(1):76–84
Mayring P (2000) Pensionierung als Krise oder Glücksgewinn?—Ergebnisse aus einer quantitativ-qualitativen Längsschnittuntersuchung. Z Gerontol Geriatr 33(2):124–133
Kondracki NL, Wellman NS, Amundson DR (2002) Content analysis: Review of methods and their applications in nutrition education. J Nutr Educ Behav 34(4):224–230
Griffiths KM et al (2011) Seeking help for depression from family and friends: a qualitative analysis of perceived advantages and disadvantages. BMC Psychiatry 11(1):196
Elayyan M, Rankin J, Chaarani M (2018) Factors affecting empathetic patient care behaviour among medical doctors and nurses: an integrative literature review. East Mediterr Health J 24(3):311–318
Hagen P et al (2012) Participatory Design of evidence-based online youth mental health promotion, intervention and treatment. http://pandora.nla.gov.au/pan/141862/20160405-1343/www.youngandwellcrc.org.au/wp-content/uploads/2014/03/Young_and_Well_CRC_IM_PD_Guide.pdf.
Damschroder LJ et al (2009) Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Implement Sci 4:50
Riley WT et al (2011) Health behavior models in the age of mobile interventions: are our theories up to the task? Transl Behav Med 1(1):53–71
Greenspun H, Coughlin S (2012) mHealth in an mWorld: how mobile technology is transforming health care. Deloitte Center for Health Solutions, London, pp 1–21
Comulada WS et al (2019) Using mHealth to deliver a home-based testing and counseling program to improve linkage to care and ART adherence in rural South Africa. Prev Sci 20(1):126–136
Braun R et al (2013) Community health workers and mobile technology: a systematic review of the literature. PLoS ONE 8(6):e65772
Tursi MFS et al (2013) Effectiveness of psychoeducation for depression: a systematic review. Austr N Z J Psychiatry 47(11):1019–1031
Hoeft TJ et al (2018) Task-sharing approaches to improve mental health care in rural and other low-resource settings: a systematic review. J Rural Health 34(1):48–62
Weinstein J (2010) Mental health, service user involvement and recovery. Jessica Kingsley Publishers, London
Brand G, Morrison P, Down B (2014) How do health professionals support pregnant and young mothers in the community? A selective review of the research literature. Women Birth 27(3):174–178
Lukens EP, McFarlane WR (2004) Psychoeducation as evidence-based practice: considerations for practice, research, and policy. Brief Treatment Crisis Interv 4(3):205–225
Howard M et al (2019) Primary care clinicians’ confidence, willingness participation and perceptions of roles in advance care planning discussions with patients: a multi-site survey. Fam Pract 37(2):219–226
Shorey S et al (2015) A randomized controlled trial of the effectiveness of a postnatal psychoeducation programme on self-efficacy, social support and postnatal depression among primiparas. J Adv Nurs 71(6):1260–1273
Mildon A, Sellen D (2019) Use of mobile phones for behavior change communication to improve maternal, newborn and child health: a scoping review. J Glob Health 9(2):020425
Kak N, Burkhalter B, Cooper M-A (2001) Measuring the competence of healthcare providers. Oper Res Issue Pap 2(1):1–28
Van Straten A et al (2010) Stepped care for depression in primary care: what should be offered and how? Med J Aust 192:S36–S39
Forman DR et al (2007) Effective treatment for postpartum depression is not sufficient to improve the developing mother–child relationship. Dev Psychopathol 19(2):585–602
Funding
This work was supported by a research grant from Innovating for Maternal and Child Health in Africa/International Development Research Centre Canada (Grant number: 108040-001).
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
All authors have no conflict of interest.
Rights and permissions
About this article
Cite this article
Kola, L., Abiona, D., Oladeji, B.D. et al. Theory-driven development of a mobile phone supported intervention for adolescents with perinatal depression. Soc Psychiatry Psychiatr Epidemiol 57, 1201–1210 (2022). https://doi.org/10.1007/s00127-021-02198-3
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00127-021-02198-3