Feasibility and acceptability of a community health worker administered behavioral activation intervention for postpartum depression: a single arm pilot study from India.

Introduction: Women in India experience high rates of postpartum depression (PPD), with minimal availability of screening or treatment. India has an extensive network of community health workers, known as accredited social health activists (ASHAs). While they are knowledgeable about most maternal-child health problems, they have minimal knowledge about PPD. We trained ASHAs to deliver a simple home-based intervention, behavioral activation (BA), which involves individuals in activities that are sources of positive reinforcement to counter depression. The research questions guiding this study were as follows: 1) What are the feasibility and acceptability of ASHAs screening for and delivering a brief behavioral activation intervention addressing PPD among women in Belagavi, South India? 2) What impact did the brief behavioral activation intervention have on PPD? Methods: The mixed methods evaluation used interviews with participants and interventionists, and depression scores were assessed before and after the evaluation. After a 2-day training with 17 ASHAs that focused on understanding PPD, screening using the Edinburgh Postnatal Depression Scale (EPDS), and implementing the BA protocol, ASHAs and researcher supervisors screened the mothers 6-12 weeks postpartum presenting at pediatric immunization clinics. Mothers who screened positive were invited to participate in an ASHA-led 5-week BA intervention, with ASHAs visiting the mothers' homes. We assessed post-intervention EPDS scores and conducted satisfaction assessments and individual interviews. Results: All 26 women who screened positive on the EPDS agreed to be enrolled in the study. All participants had a significant reduction (p < 0.001) in PPD scores. Both ASHAs and mothers had high enthusiasm for the intervention methods and activities. Discussion: This ASHA-delivered BA intervention was found to be feasible, acceptable, and effective in treating PPD in rural Indian mothers. This corroborates literature that demonstrates the efficacy of a BA intervention among individuals with generalized depression in South Asia. In communities with minimal mental health resources, interventions led by trained community workers have the potential to address PPD.

Postpartum Depression in India: Perceptions by Key Stakeholders.

While postpartum depression (PPD) rates in India are among the highest in the world, screening and treatment is minimal. Socio-cultural issues including perceptions of stakeholders play role in this treatment gap. Efficient identification and treatment of women experiencing PPD has great importance for not only maternal, but infant outcomes. Infants born to mothers with PPD have a higher likelihood of lower birth weight, breastfeeding, maternal-infant bonding, and even cognitive delays throughout childhood. With the goal of improving maternal mental health outcomes, researchers conducted group and individual interviews with 26 stakeholders working with peripartum women in India to explore social perceptions of PPD. Analysis followed the social ecological model (SEM). Three themes were found: low awareness, minimal resources, and traditions and customs. Conclusion: Findings of this research can be used to develop interventions based on the three themes and their relation to the facets of the SEM framework.

Exploring the convergence of knowledge, attitudes, and practice towards mental illness among nurses in South India: A cross-sectional analysis.

Mental illness is a leading cause of global morbidity. Over 10% of the Indian population experience a mental health disorder yet deficits in knowledge and negative attitudes towards metal illness limit early identification and treatment. We explored the relationship among knowledge, attitudes and practice among generalist nurses working at a large tertiary care hospital in South India. Participants demonstrated positive attitudes and sufficient knowledge about mental illness, yet these variables did not predict practice when presented with a patient case scenario of postpartum depression-related mental distress in a non-psychiatric inpatient setting. Findings warrant application-based pedagogies to facilitate nurses' enhanced recognition and treatment of patients experiencing mental distress in non-psychiatric settings.

Public health champions in the making: An innovative undergraduate nursing pedagogy.

BACKGROUND: This manuscript describes an innovative approach to public health nursing education. Health care delivery is radically shifting to non-acute, community-based settings, warranting a new-thinking graduate who is comfortable responding to societal trends in health and wellness. Graduates must confidently work to address social determinants of health to improve health outcomes and advance health equity. AIMS: We propose a unique pedagogy designed to prepare baccalaureate nursing students to work effectively in the community setting by developing seminars that address pressing, relevant public health initiatives. MATERIALS & METHODS: We describe our experience integrating community-based Naloxone, Stop the Bleed, and Mental Health First Aid training to the curriculum. We outline a session designed to inform future health care providers about provision of care to suspected victims of human trafficking. RESULTS: As a novice program, we have not formally evaluated the described pedagogy for specific outcome measures. DISCUSSION: We include guidance for implementing a similar program and plans for future evaluation of this unique public health nursing pedagogy. CONCLUSIONS: We are confident that future iterations of this pedagogy will continue to foster robust public health nursing skills among BSN students.

Access to health care by refugees: a dimensional analysis.

PURPOSE: A dimensional analysis of access to healthcare services by the refugee population was conducted. BACKGROUND: Refugees resettled to the United States are categorized as a vulnerable population and have limited economic and social resources. METHODS: Dimensional analysis was employed to identify the concept by varying perspectives and dimensions. The perspectives from the healthcare provider and the refugee, as the healthcare consumer, were explored. RESULTS: The following dimensions were identified: culture, language discrimination and stigmatization, and logistical concerns. Findings support that specific refugee groups have not been well-represented in the literature. CONCLUSION: Knowledge of this unique population is integral to healthcare professionals who encounter refugees in clinical practice. Regardless of the specific group, access to healthcare services must be determined for better health outcomes.