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.

Socio-Cultural Discourses of Children Engaged in Child Labor in India: A Macro-Ethnographic Study.

Background: Child labor is considered one of the main social problems that affect the community and has a physical and psychosocial impact on a child's health, growth, and development. The study aimed to describe the sociocultural discourses of children involved in child labor. A macroethnographic approach was used to collect the data from the selected community areas of Punjab, India. Materials and Methods: A community-based qualitative study using purposive sampling was carried out among children engaged in child labor (n = 8). The data were gathered through in-depth or semi-structured interviews and non-participant observation under four phases: community context assessment, egocentric network analysis, validation, and dissemination of study findings. The guide for consolidated criteria for reporting qualitative research (COREQ) was followed. Ongoing analysis was conducted using Spradley's analysis approach to identify the themes. Results: Thematic analysis resulted in the emergence of various themes related to child labor, namely, adaptability, money-centric attitude, sense of being underserved, social deprivation, work burden, reduced emotional expression, workaholism, abuse, family shoulder, family cohesion, and sense of industry. Apart from that, inhuman living and working conditions, as well as school deprivation among study subjects, were observed. Poverty emerged as the single most compelling factor for child labor in India. Conclusion: The study concluded that child labor had a negative impact on children's overall development. An effective intervention to stop child labor is if vulnerable children are identified through primary healthcare, and a relationship of trust is built that allows for the provision of health care, education, support, and referral to additional services outside the health sector.

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.

Maternal Anemia and BMI as Determinants of Pregnancy Outcomes: A Hospital-Based Study.

BACKGROUND: Malnutrition is a serious underlying cause of child and maternal deaths around the world. The objective of this study evaluates maternal anemia and body mass index as determinants of pregnancy outcomes. Undernourishment during pregnancy can occurs Intra Uterine Growth Retardation. Contributing to about 80,0000 new-borns, 40,0000 infant deaths and 20% under 2 years children have stunted, 20% of maternal deaths during labor and early postpartum. METHODS: This study Hospital-based cross-sectional study. The study comprised laboring women admitted for delivery in selected tertiary care hospital in South India from 10th November 2021 to 20th January 2022. Structured interview schedule for demographic information, patient's case sheet for information about the 'Body Mass Index as a determinants of pregnancy outcomes' and anthropometric measurement for body mass index (weight and height). All registered deliveries in the study period have been included, comprising of 101 sample size Bivariate logistic regressions were used to determine the factors associated with outcome variables. A significant level of 5% was used to decide the significance of statistical tests. RESULTS: Body Mass Index in the 1st antenatal visit of the women who came for delivery in tertiary care hospital, underweight 36.6%, normal body mass index 52.5%, and overweight 10.9%. During 1st antenatal visit 58.4% had anemia, while 53.5% had mild anemia during the last antenatal visit. Respectively 39.6% of antenatal women had normal Hb% during 1st antenatal care visit, whereas 46.5% had normal Hb%, during their last antenatal visit. The mode of delivery; spontaneous vaginal delivery 45.5%, vacuum delivery 3.0%, emergency caesarean section delivery 50.5%. Preterm delivery was statistically significant among whose first antenatal care visit was after 11th weeks of gestation. Whereas, emergency caesarean section delivery was statistically significant among underweight. Increasing maternal weight body mass index was associated with maternal and neonatal health outcomes. Which was risk of pregnancy induced hypertension, preeclampsia, eclampsia, gestational diabetes mellitus and caesarean section delivery. CONCLUSIONS: Every 2nd women was anemic, every 3rd pregnant women was underweight (BMI >18.5), every 2nd baby was born with caesarean section delivery. Preterm delivery was statically significant of weeks of gestation during first antenatal care visit with more than 11th weeks of gestation. Whereas, emergency cesarean section was significant with low body mass index.

Evaluation of a digital application to support internationally qualified nurses' communication and leadership skills.

BACKGROUND: Internationally qualified nurses enrolled in Australian bridging programs to support professional registration lack confidence, and require support and time to develop communication and leadership skills in the clinical setting. Strategies that strengthen professional self-concept have been demonstrated to improve the nursing performance of internationally qualified nurses. OBJECTIVE: To evaluate an interactive mobile application called mPreceptor, specifically designed to support internationally qualified nurses' communication and leadership skills during a 6 week clinical placement. The application facilitated weekly learning content and activities in the areas of clinical communication and leadership, including self-assessment, goal-setting, case studies, and weekly detailed reflections while on placement. DESIGN: A quasi-experimental pre and post-test design with a non-equivalent comparison group was used to explore the effectiveness of mPreceptor on internationally qualified nurses' self-appraisal of professional self-concept, including leadership and communication skills, compared with standard clinical placement. The psychometrically tested Nurse Self-Concept Questionnaire, measured changes to perceived professional self-concept. RESULTS: Overall, there was a significant increase in Nurse Self-Concept following the clinical placement, confirming that the bridging program for internationally qualified nurses in Australia improves leadership and communication skills. Leadership skills were significantly greater for those internationally qualified nurses who engaged with mPreceptor. CONCLUSION: Further research is required to investigate the application of interactive mobile applications, as effective education resources to facilitate internationally qualified nurses' transition of skills and knowledge to the Australian healthcare context.

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.