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Integrating Care for Perinatal Depression in Primary Care: An Implementation Study
Thesis (PhD)--Stellenbosch University, 2025.
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| Format: | Thesis |
| Language: | English |
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Stellenbosch : Stellenbosch University
2025
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| _version_ | 1867614033443553280 |
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| access_status_str | Open Access |
| author | Oladeji, Bibilola Damilola |
| author2 | Seedat, Soraya |
| author_browse | Oladeji, Bibilola Damilola Seedat, Soraya |
| author_facet | Seedat, Soraya Oladeji, Bibilola Damilola |
| author_sort | Oladeji, Bibilola Damilola |
| collection | Thesis |
| dc_rights_str_mv | Stellenbosch University |
| description | Thesis (PhD)--Stellenbosch University, 2025. |
| format | Thesis |
| id | oai:scholar.sun.ac.za:10019.1/134337 |
| institution | Stellenbosch University (South Africa) |
| language | English |
| last_indexed | 2026-06-10T12:45:36.533Z |
| license_str | Other — see source repository |
| provenance_str_mv | Harvested via OAI-PMH from SUNScholar — Stellenbosch University Repository |
| publishDate | 2025 |
| publishDateRange | 2025 |
| publishDateSort | 2025 |
| publisher | Stellenbosch : Stellenbosch University |
| publisherStr | Stellenbosch : Stellenbosch University |
| record_format | dspace |
| source_str | SUNScholar — Stellenbosch University Repository |
| spelling | oai:scholar.sun.ac.za:10019.1/134337 Integrating Care for Perinatal Depression in Primary Care: An Implementation Study Oladeji, Bibilola Damilola Seedat, Soraya Gureje, Oye Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Psychiatry. Thesis (PhD)--Stellenbosch University, 2025. Oladeji, B. D. 2025. Integrating Care for Perinatal Depression in Primary Care: An Implementation Study. Unpublished doctoral thesis. Stellenbosch: Stellenbosch University [online]. Available: https://scholar.sun.ac.za/items/beb61a8c-9416-4dfd-9786-5460d795f827 Perinatal depression (PND) is associated with adverse consequences for both the mother and infant. The utility and effectiveness of task sharing for interventions for PND in primary healthcare in low-and-middle-income countries have been demonstrated in clinical trials. However, gap remains on how best to scale up an integrated PND care. This study was designed to study the factors that can facilitate or impede the use of WHO Mental Health Gap Action Programme-Intervention Guide (mhGAP-IG) by non-physician primary healthcare workers (PHCW) for integrating care for PND within routine perinatal services. This hybrid type 2 implementation-effectiveness study was implemented using the Replicating Effectiveness Programmes (REP) framework. The study adopted a pre-post design and data was collected using a mix of qualitative and quantitative methods. In line with REP framework, the project was conducted in four overlapping phases. In the first phase, consultative engagement meetings were held with representatives of relevant groups along with a planning workshop and key informant interviews (KII) with clinic heads. The next phase assessed the organization of services in the clinics and the current available care for PND. During during this phase, a cohort of women registering for antenatal care who met diagnostic criteria for depression were recruited and followed up till 6 months postpartum. In the third (implementation) phase, using a train-the-trainer approach, all the PHCWs in the selected clinics were trained to use the mhGAP-IG to assess and treat PND. The last phase followed the training of the PHCW during which a second cohort of women were recruited, and the selected clinics randomly assigned to either routinely screen for PND or not. Implementation and effectiveness outcomes were compared between the two cohorts of women while the barriers and facilitators of scale-up were explored in KII on purposively selected PHCWs and participants. The recovery rates and median time to remission was not significantly different between the two cohorts- 20.9 weeks for cohort 1 and 18 weeks for cohort 2. Spontaneous remission occurred in 50% of untreated cases, 19.6% had persistent symptoms and 30.3% had intermittent symptoms. The trained trainers were able to deliver the training with high fidelity which produced significant increase in the knowledge of PHCWs and improvements in their attitudes. The rate of detection of PND before training was 1.4%. Each additional input resulted in incremental changes in detection: 4.3% following only the training of the PHCWs, 7.6% when structured supervision was implemented, 11% when detection by PHCWs was aided with the use of a brief screening tool, and 40% following an additional top-up training six months after the initial training. Facilitating factors for scale up identified include- enabling policies and PHCW willingness to provide services while the key barriers were staff shortages and the low rates of detection of PND. The study demonstrated the effectiveness of a train-the-trainer approach to rapidly provide training and upskilling PHCWs. Findings suggests that, for optimal efficiency of task-shifting to improve the care of PND, a combination of training, routine screening, structured supervision and regular re-fresher training is required. Doctoral 2025-11-11T12:20:29Z 2025-11-11T12:20:29Z 2025-03 Thesis https://scholar.sun.ac.za/handle/10019.1/134337 en Stellenbosch University 180 pages : ill. application/pdf Stellenbosch : Stellenbosch University |
| spellingShingle | Oladeji, Bibilola Damilola Integrating Care for Perinatal Depression in Primary Care: An Implementation Study |
| title | Integrating Care for Perinatal Depression in Primary Care: An Implementation Study |
| title_full | Integrating Care for Perinatal Depression in Primary Care: An Implementation Study |
| title_fullStr | Integrating Care for Perinatal Depression in Primary Care: An Implementation Study |
| title_full_unstemmed | Integrating Care for Perinatal Depression in Primary Care: An Implementation Study |
| title_short | Integrating Care for Perinatal Depression in Primary Care: An Implementation Study |
| title_sort | integrating care for perinatal depression in primary care an implementation study |
| url | https://scholar.sun.ac.za/handle/10019.1/134337 |
| work_keys_str_mv | AT oladejibibiloladamilola integratingcareforperinataldepressioninprimarycareanimplementationstudy |