Acceptability and feasibility of a screening protocol for antenatal depression (SPADe) in Blantyre District, Malawi.

BACKGROUND: Depression is one of the most common perinatal mental health problems that affect pregnant women. Antenatal depression can adversely affect the well-being of the pregnant woman and her foetus. Depression is rarely detected by midwives due to the unavailability of relevant screening instruments in Malawi. A Screening Protocol for Antenatal Depression (SPADe) was developed and recommended for possible use to screen for depression in antenatal clinics in the country. The acceptability and feasibility of using the SPADe protocol to screen for depression has not been established. The aim of this study was to assess the acceptability and feasibility of screening for depression by midwives using SPADe in antenatal clinics in Blantyre district. METHODS: This study used a quantitative survey design to collect data among 60 midwives in three antenatal clinics in primary care settings. All inclusive sampling of all 60 midwives were used. The Structured Assessment of FEasibility and Ottawa Acceptability of Decision Rules Instruments were used to collect the data. Descriptive statistics and Chi square tests were used to analyse the data. RESULTS: This study found that it was feasible to implement SPADe and the following enablers for screening depression had the highest ratings: the SPADe is applicable to pregnant women (M = 3.9, sd = 0.4); the intended goal of the SPADe matches the prioritised goals of Malawi Ministry of Health (M = 3.9, sd = 0.5); and the SPADe is likely to be effective (M = 3.8, sd = 0.6). On the other hand, barriers for implementing the SPADe were: the need for specific training to deliver the SPADe (M = 3.7, sd = 0.7); ongoing support and supervision (M = 3.5, sd = 0.8); and additional resources (M = 3.0, sd = 0.9). This study also found that the implementation of the SPADe was acceptable to respondents. The overall mean score for respondents on acceptability of screening antenatal depression using SPADe was found to be high (M = 4.6, sd = 0.6). However the differences in the respondents' mean scores on acceptability of screening for depression in antenatal clinics using SPADe in relation to their demographic characteristics were not significant (p > .05). CONCLUSION: This study suggests that midwives feel that it is feasible and acceptable for them to implement the SPADe in antenatal clinics with ongoing training, support and clinical supervision.

Professional quality of life amongst nurses in psychiatric observation units.

BACKGROUND: Professional quality of life amongst nurses in psychiatric observations units may be affected by working conditions such as an overflow of mental health care users (MHCUs), a shortage of nurses, lack of specialised staff and inadequate infrastructure to accommodate MHCUs amongst others. AIM: The aim of the study was to investigate the professional quality of life amongst nurses in psychiatric observation units. SETTING: The study was conducted in psychiatric observation units in eight hospitals in the Metropole District Health Services in the Western Cape. METHOD: A quantitative descriptive survey design using the Professional Quality of Life (ProQoL version 5) questionnaire was conducted with an all-inclusive sample of 175 nurses. The ProQoL has two scales, namely, the compassion satisfaction and the compassion fatigue. Compassion fatigue includes two subscales, burnout and secondary traumatic stress. Ethics to conduct the study was obtained from the Research Ethics Committee at the university and the Department of Health in the Western Cape. RESULTS: A response rate of 93% (n = 163) was obtained. Respondents reported moderate compassion satisfaction. Psychiatric nurse specialists and registered nurses reported lower compassion satisfaction than enrolled nurses and nursing assistants. This came with moderate levels of burnout and high levels of secondary traumatic stress, with enrolled nurses and enrolled nursing assistants reporting lower levels than the other professional groups. CONCLUSION: Psychiatric nurse specialists and registered nurses experienced higher burnout and secondary traumatic stress and lower compassion satisfaction than the lower categories of nurses.

A cross-sectional study of depression among women attending antenatal clinics in Blantyre district, Malawi.

BACKGROUND: Pregnancy is a period associated with major psychological and social changes in the life of a woman and can be associated with anxiety and depression. AIM: To describe demographic, clinical and risk profile of antenatal depression among pregnant women attending antenatal clinics in Blantyre district, Malawi. SETTING: The study was conducted in eight antenatal clinics in Blantyre district, Malawi. METHODS: A cross-sectional study of 480 randomly selected pregnant women attending antenatal clinics was conducted. Prevalence was determined using the Edinburgh Postnatal Depression Scale (EPDS) which was validated against a sub-sample using the Mini International Neuropsychiatric Interview. The risk factors of depression were assessed using the Pregnancy Risk Questionnaire. Data were analysed using descriptive statistics, Pearson chi-square test and binary logistic regression. RESULTS: Prevalence of antenatal depression using the EPDS was 19% (95% CI 15.5% - 22.5%, n = 91) and was comparable to the Mini International Neuropsychiatric Interview (25.8% [95% CI = 17.5-34], n = 25). The key risk factors that predicted antenatal depression were: 'being distressed by anxiety or depression for more than 2 weeks during this pregnancy' (OR = 4.1 [2.1-7.9], p ≤ 0.001); 'feeling that a relationship with partner is not an emotionally supportive one' (OR = 3.5 [1.4-8.4], p = 0.01); 'having major stresses, changes or losses in the course of this pregnancy' (OR = 3.2 [1.7-6.2], p = 0.01); 'feeling that father was critical of her when growing up' (OR = 3.2 [1.4-7.6], p = 0.01); and 'having history of feeling miserable or depressed for ≥2 weeks before this pregnancy' (OR = 2.4 [1.3-4.4], p = 0.01). CONCLUSION: This study confirmed the high-prevalence rate of depression in this group and illustrated that antenatal depression was associated with being distressed by anxiety or depression; support from partner; major stresses during pregnancy; and history of feeling miserable or depressed before pregnancy. This study also found a history of poor relationship between pregnant women and their fathers during childhood.

A systematic review of screening instruments for depression for use in antenatal services in low resource settings.

BACKGROUND: In low resource settings, short, valid and reliable instruments with good high sensitivity and specificity are essential for the screening of depression in antenatal care. A review of published evidence on screening instruments for depression for use in antenatal services in low resource settings was conducted. The aim of this review was to appraise the best available evidence on screening instruments suitable for detecting depression in antenatal care in low resource settings. METHODS: Searching, selection, quality assessment, and data abstraction was done by two reviewers. ScienceDirect, CINAHL, MEDLINE, PubMed, SABINET and PsychARTICLES databases were searched using relevant search terms. Retrieved studies were evaluated for relevancy (whether psychometric data were reported) and quality. Data were synthesised and sensitivity and specificity of instruments were pooled using forest plots. RESULTS: Eleven articles were included in the review. The methodological quality ranged from adequate to excellent. The review found 7 tools with varying levels of accuracy, sensitivity and specificity, including the Edinburgh Postnatal Depression Scale, Beck Depression Index, Centre for Epidemiologic Studies Depression Scale 20, Hamilton Rating Scale for Depression, Hopkins Symptoms Checklist-25, Kessler Psychological Distress Scale and Self-Reporting Questionnaire. The Edinburgh Postnatal Depression Scale was most common and had the highest level of accuracy (AUC = .965) and sensitivity. CONCLUSION: This review suggests that the Edinburgh Postnatal Depression Scale can be a suitable instrument of preference for screening antenatal depression in low resource settings because of the reported level of accuracy, sensitivity and specificity. PROSPERO REGISTRATION: CRD42015020316 .

Social capital and mental well-being of older people residing in a residential care facility in Durban, South Africa.

INTRODUCTION: Global increases in life expectancy are expected to continue, with accompanying physical and mental well-being challenges specifically for older people living in residential care settings. OBJECTIVE: The aim of the study was to investigate the association between mental well-being and social capital of older residents (60+ years) in an urban residential care facility in South Africa. METHOD: A descriptive survey was conducted with 103 residents living in a residential care facility in an urban environment in South Africa. The social capital framework from the Canadian Policy Research Initiative, the WHO-5 well-being index, the Kessler-6 measure of psychosocial distress, the OSLO-3 Social Support Scale and the Australian Bureau of Statistics Indigenous Health Questionnaire were used to develop the questionnaire. RESULTS: The WHO-5 showed moderate ratings of mental well-being for the standard scoring (>13) (62, 82.7%), but lower levels when using 'no negative ratings' (36; 50.6%). Significant differences in the primary network size, average closeness, self-efficacy and social support as well as the ability to confide in primary network was shown between residents with mentally well and unwell ratings. Logistic regression showed that the strongest predictor for mental well-being was participation in activities outside of the residence and having a primary network. CONCLUSION: The study confirms the association between social capital and mental well-being.

A survey of university students' perceptions of learning management systems in a low-resource setting using a technology acceptance model.

Learning management systems have been widely advocated for the support of distance learning. In low-resource settings, the uptake of these systems by students has been mixed. This study aimed to identify, through the use of the Technology Acceptance Model, the individual, organizational, and technological factors that could be influencing the use of learning management systems. A simple quantitative descriptive survey was conducted of nursing and health science students at a university in South Africa as part of their first exposure to a learning management system. A total of 274 respondents (56.7%) completed the survey questionnaire, made up of 213 nursing respondents (87.7%) and 61 health sciences respondents (25%). Overall, the respondents found the learning management system easy to use and useful for learning. There were significant differences between the two groups of respondents, with the respondents from health sciences being both younger and more computer literate. The nursing respondents, who received more support and orientations, reported finding the learning management system more useful. Recommendations are made for training and support to ensure uptake.

Cardiovascular risk among community members in three communities in the Cape Metropole of the Western Cape.

BACKGROUND:  Cardiovascular diseases pose a risk to population health in South Africa and are responsible for almost one in six deaths (17.3%). AIM:  To determine the cardiovascular risk among community members who attended a community outreach programme. SETTING:  Three communities in the Cape Metropole of the Western Cape. METHODS:  A health survey was conducted with 783 participants, 18 years and older, conveniently sampled. The survey included questions about cardiovascular risk factors, and biometric measurements of blood pressure (BP), height and weight were conducted. RESULTS:  A total of 777 participants were included in the study. Most participants were female (529, 68.1%), with an average age of 42.3 years (s.d. 14.2). Risk behaviours reported included smoking (216, 27.8%), consuming more than two drinks of alcohol daily (78, 10%), low physical activity (384, 49.4%), being stressed on most days (436, 56.1%) and unhealthy eating habits (253, 32.6%). More than half of the participants (402, 51.7%) had a body mass index (BMI) ≥ 30, 26.0% (202) had a systolic BP of ≥ 140 mm Hg and 22.4% (174) had a diastolic BP of ≥ 90 mm Hg; 16.6% (130) had a cardiovascular disease (CVD) risk of 10-20 and 19.3% (150) had a CVD risk of 20%. CONCLUSION:  Nearly a fifth of the participants had a significant probability of developing heart disease or experiencing a stroke over the next 10 years.Contribution: There is an urgent need for comprehensive health promotion and behaviour change interventions focused on reducing CVD risk factors at the community level.

Role analysis of the nurse/midwives in the health services in Sub-Saharan Africa.

AIM: To describe the tasks and the roles of nurses and midwives in Sub-Saharan African health services. BACKGROUND: The current roles of nurses and midwives in the African region of the World Health Organization have not been empirically established, with only studies from two countries found (South Africa and Mozambique). This makes it difficult to establish whether current nursing/midwifery education programmes and regulations adequately address the needs in the health services. DESIGN: A descriptive quantitative study. METHODS: A survey questionnaire was administered to ambulatory and hospital services. Data were collected between June-December 2010, with completed responses from 734 nurses from nine African countries (five Anglophone and four Francophone). RESULTS: The highest reported role functioning in both settings was for 'General Care and Treatment'. The lowest role functioning reported in both settings was in the role 'Maternal and Child Health' and in 'The Provision of Mental Health Care'. The reported role performance in Anglophone countries was significantly greater than in Francophone countries. CONCLUSION: The development of competency in nursing/midwifery roles other than medical surgical roles (general assessment and care) should receive more attention in curricula. Special attention needs to be given to Francophone countries, where the professions of nursing and midwifery are poorly developed.

Out of Chaos Leaders Emerged.

COVID-19 had a major influence on nursing with the pandemic resulting in changes in the work environment while experiencing physical and emotional challenges such as moral distress, fear for self and family and dealing with the unknown. However, during this period, nurses demonstrated extraordinary resilience, crafted innovations in clinical practice, communication and support, providing leadership in the health service and in the nursing profession.

COVID-19 fear among junior undergraduate nursing students during the pandemic in South Africa.

Background: During the COVID-19 pandemic, nursing students continued to work in facilities to complete clinical hours. Little was known about the impact of COVID-19 on nursing students during this time. Aim: To investigate fear of COVID-19 among junior undergraduate nursing students during the pandemic. Setting: A student nursing school at a university in the Western Cape, South Africa. Methods: A cross-sectional survey was conducted with 559 nursing students. A self-administered questionnaire with the validated COVID-19 fear scale (α= 0.84) was distributed. Scale reliability, factor analysis, means and 95% confidence intervals were calculated for items, overall scale and associations with demographic variables were tested using Kruskal-Wallis Independent Samples and Mann-Whitney U tests. Results: There were 370 respondents (68.51% response rate), predominantly female (294, 79.5%) and exhibited a mean age of 21.9 years (± 3.9). More than half, 192 respondents (51.9%) reported mild fear of COVID-19, 103 (27.8%) moderate fear and 57 (15.4%) severe fear. Apart from gender, no significant demographic associations with overall COVID-19 fear were found. Factor analysis identified two distinct factors, physiological and emotional expressions of fear (moderate significant positive correlation between factors [r = 0.541]). Conclusion: The study's findings reveal that junior undergraduate nursing students, during the pandemic, generally reported experiencing mild fear related to COVID-19. Contribution: This study contributes to the field of COVID-19 fear studies, provides insight into factors influencing fear levels and validates the scale's factor structure.

Training needs of professional nurses in primary health care in the Cape Metropole, South Africa.

BACKGROUND: In the fast-changing healthcare environment, it is important to ensure that primary health care (PHC) nurses are suitably qualified and have access to appropriate and relevant ongoing education. AIM: The aim of this study was to determine the training needs of professional nurses working in PHC facilities. SETTING: The research was conducted in PHC facilities in the Cape Metropole, Western Cape, South Africa. METHODS: A quantitative descriptive survey with all-inclusive sampling was used. All professional nurses (N = 303), employed for at least a minimum of 6 months in PHC facilities were included in the study. The Hennessy-Hicks Training Needs Analysis (TNA) questionnaire was used to collect the data on professional tasks training needs and open-ended questions for specific PHC contextual training needs. Importance and performance means for each of the TNA subsections and training needs were calculated. Open-ended questions were analysed using content analysis, identifying training domains and topics in terms of frequency and ranking. RESULTS: The TNA identified 'Research' as the highest training need. Research tasks were significantly rated as the least important and the lowest rated performance compared to other domains. Child mental health was rated as the most important specific training need. CONCLUSION: The results of this survey provide insight into the training needs of professional nurses employed in PHC facilities and highlight the need for child mental healthcare and research training in this setting.Contribution: The study contributes to the understanding of the training and education needs of professional nurses working in PHC facilities.

Professional Values of Undergraduate Students at a Nursing School in South Africa.

Background: Nursing schools play an important role in instilling nursing professional values in undergraduate nursing students and ensuring that they produce professional nurse graduates. Several studies in various countries have been conducted to describe the professional values held by nursing students, but this has not been explored in detail in South Africa. Aim: The purpose of this study was to describe the professional values held by undergraduate degree students at a nursing school in South Africa. Methods: A cross-sectional survey using a self-administered questionnaire was conducted. With a population of 1,233 undergraduate nursing students across four years in the degree programme at the nursing school, a sample of 294 was calculated as the representative (95% CI, 5% error, and 50% response distribution). The 26-item nurses professional values scale revision (NPVS-R) with five value dimensions was used to collect the data. Means, frequencies, and confidence intervals were used to describe the values and Mann-Whitney U tests and Kruskal-Wallis independent sample tests were used to compare the findings with the demographic characteristics. Results: A total number of 245 respondents completed the questionnaire (response rate of 83.3%). Overall, the nurse professional value score was high (113.1 ± 13.1). The values of trust (4.46 ± 0.61), justice (4.39 ± 0.57), and caring (4.38 ± 0.55) were rated significantly higher than those of professionalism (4.23 ± 0.64) and activism (4.22 ± 0.57). First- and final-year students had significantly higher professional value scores. Conclusion: The study results describe the professional values of undergraduate nursing students in the school and confirmed the importance of trust, justice, and caring as the key professional values in the South African setting. Clinical Relevance. Nursing education should embed and monitor nursing professional values in the curriculum. Instilling nursing professional values in undergraduate nurses during formal training programmes improves quality patient care and service delivery for clinical practice.

A systematic review of the effectiveness of videoconference-based tele-education for medical and nursing education.

BACKGROUND: Rural nurses and doctors typically have little opportunity to further their education and training. Studies have shown high participant satisfaction with the use of educational technology, such as videoconferencing, for education. A review of effectiveness of videoconference-based tele-education for medical and nursing education was conducted. AIMS: The aims of this study were to: (1) systematically review the literature and critique the research methods on studies addressing the review question: "How effective is videoconference-based education for the education of doctors and nurses?" (2) summarize the existing evidence on the effectiveness of videoconference education for medical and nursing staff; and (3) apply the findings to South Africa and other countries across the globe. METHODS: Research citations from 1990 to 2011 from cumulative index of nursing and allied health literature, Medline, Pubmed, PsycInfo, EBSCOhost, SABINET, Cochrane Database of Systematic Reviews, the Cochrane Controlled Trial Registry, Database of Abstracts of Reviews of Effectiveness, unpublished abstracts through NEXUS and Internet search engines (Google/Google scholar) were searched. Review methods included searching, sifting, abstraction, and quality assessment of relevant studies by two reviewers. Studies were evaluated for sample, design, intervention, threats to validity, and outcomes. No meta-analysis was conducted as the studies provided heterogeneous outcome data. RESULTS: Five studies were reviewed. Videoconference and face-to-face education is at least equivalent and one study reported an increase in knowledge and knowledge integration. RECOMMENDATIONS: Despite the methodological limitations and heterogeneity of the reviewed studies, there appears to be sufficient evidence of effectiveness to provide a rigorous Grade B evidence-based recommendation of moderate support. CONCLUSIONS: The use of videoconferencing for nursing and medical education should be encouraged along with guidelines for the use of videoconferencing. The paucity of studies and the lack of empirical precision in evaluating effectiveness of these interventions necessitate future rigorously designed experimental studies.

Perceived technology use, attitudes, and barriers among primary care nurses.

Background: In primary healthcare, health information technology has the potential to facilitate the delivery of healthcare services by improving quality of care, efficiency and patient safety. However, little is known about the uptake and technology acceptance among primary healthcare nurses. Aim: The aim of this study was to describe health information technology acceptance and use among primary healthcare nurses. Setting: Primary healthcare centres in the Western Cape. Methods: A quantitative descriptive survey was conducted with a sample of 160 nurses working in primary healthcare for more than 6 months, using a self-administered questionnaire based on the technology acceptance model constructs. Eighteen primary healthcare centres were randomly selected with a sample of 160 using nonprobability purposive sampling. Results: Ninety-three (58.1%) respondents completed the survey. Three-quarters of the respondents reported positive attitudes, positive perceptions of usefulness and ease of use towards the use of health information technology. Barriers of access and training were reported by 75%, with around half the respondents reporting poor computer and information accessing skills. Health information technology use was varied, with high ratings for seeking and using and low ratings of ability to use health information technology for patient administration and management. Health information technology use was predicted by perceptions of ease of use. Conclusion: This research presents a mixed picture of acceptance of technology among primary healthcare nurses and highlights the lack of access to computers and Internet in these settings. Contribution: This study contributes to the field of technology acceptance among primary healthcare nurses.

Public perceptions on Twitter of nurses during the COVID-19 pandemic.

BACKGROUND: The use of social media platforms to convey public opinions and attitudes has exponentially increased over the last decade on topics related to health. In all these social media postings related to the pandemic, specific attention has been focused on healthcare professionals, specifically nurses. OBJECTIVE: This study aimed to explore how the keyword 'nurse' is located in COVID-19 pandemic-related tweets during a selected period of the pandemic in order to assess public perception. METHODS: Tweets related to COVID-19 were downloaded from Twitter for the period January 1st, 2020, to November 11th, 2021. Sentiment analysis was used to identify opinions, emotions, and approaches expressed in tweet which included 'nurse', 'COVID-19', and 'pandemic' as either keyword or hashtags. RESULTS: A total of 2,440,696 most used unique words in the downloaded 582,399 tweets were included and the sentiment analysis indicated that 24.4% (n = 595,530) of the tweets demonstrated positive sentiment while 14.1% (n = 343,433) of the tweets demonstrated negative sentiment during COVID-19. Within these results, 17% (n = 416,366) of the tweets included positive basic emotion words of trust and 4.9% (n = 120,654) of joy. In terms of negative basic emotion words, 9.9% (n = 241,758) of the tweets included the word fear, 8.3% (n = 202,179) anticipation, 7.9% (n = 193,145) sadness, 5.7% (n = 139,791) anger, 4.2% (n = 103,936) disgust, and 3.6% (n = 88,338) of the tweets included the word surprised. CONCLUSIONS: It is encouraging to note that with the advent of major health crises, public perceptions on social media, appears to portray an image of nurses which reflects the professionalism and values of the profession.

Nursing informatics skills relevance and competence for final year nursing students.

BACKGROUND:  The increasing use of technology in nursing practice requires nursing students to be competent in nursing informatics with an attitude of acceptance of technology in the healthcare environment. OBJECTIVES:  The objectives of the study were to determine final year nursing students' perceptions and skills in nursing informatics and their attitudes towards computerisation in nursing practice. METHOD:  The study population were 198 final year nursing students from a selected university in the Western Cape, South Africa. All-inclusive sampling was used. A descriptive survey was conducted using a self-administered questionnaire which included two validated scales, namely the validated Nursing Informatics Competency Assessment Tool (NICAT) and the Nurses' Attitudes towards Computerisation scale. Means and 95% confidence intervals (CI) of the ratings of the perceived relevance of nursing informatics skills in nursing practice, perceived levels of competence in nursing informatics skills and attitudes towards computers were calculated. RESULTS:  A total of 91 undergraduate respondents completed the survey. Computer literacy skills were rated overall as most relevant (4.23, 95% confidence interval [95% CI]: 4.06-4.40) and the skills perceived most competent (4.16, 95% CI: 3.81-4.22). The respondents had an overall positive score for attitudes towards computerisation in healthcare (67.34, s.d. = 10.40, 95% CI: 65.18-69.51). CONCLUSION:  The study concluded that computer literacy skills, informatics literacy skills and information management skills were relevant to nursing practice, despite varying levels of competence in these skills among nurses.Contribution: What key insights into the research results and its future function are revealed? How do these insights link to the focus and scope of the journal? It should be a concise statement of the primary contribution of the manuscript; and how it fits within the scope of the journal.

Evaluation of a digital programme for final year nursing students during COVID-19.

Aim: The aim of this study was to evaluate a digital programme aimed to address COVID-19 related anxiety of final year undergraduate nursing students on returning to the clinical practice during the pandemic in South Africa. Background: In South Africa, concern about the physical and psychological safety of nursing students resulted in the planning of a psychological first aid program to facilitate nursing students return to clinical practice. Design: A survey was conducted in September 2020 following the August 2020 return of final year nursing students to clinical facilities. Methods: All final year nursing students were invited to participate in the study (N = 196). An online survey was circulated via WhatsApp asking respondents to rate their anxiety and fear of COVID-19 before and after return to practice following an intervention (eCOVID). Related pair analysis was done on the main outcome measures of anxiety, COVID-19 fears and concerns using Related Samples Wilcoxon Signed Rank tests. Results: After the programme, the respondents reported a significant reduction in anxiety (W = 2.92, p =.004) and COVID fear (W=0.3.1, p =.001), specifically related to infecting family, being exposed to COVID-19 at work, propagating infection at work and lacking access to COVID-19 information and communication. Conclusion: The implementation of a dedicated digital programme, underpinned by a sound theory base of psychological first aid, may have decreased anxiety and fear in nursing students during clinical practice in the pandemic.Contribution: The study contributes to evidence on psychological first aid support of nursing students during the COVID-19 pandemic.

Protocol for assessing feasibility, acceptability and fidelity of screening for antenatal depression (FAFSAD) by midwives in Blantyre District, Malawi.

BACKGROUND: Depression is often underdiagnosed by treating health professionals. This is a situation in Malawi where there is no routine screening of depression at antenatal clinics. Recently, a Screening Protocol for Antenatal Depression (SPADe) that can be used by midwives to screen for antenatal depression was developed in Blantyre District. SPADe proposes multistage screening of antenatal depression by midwives which may enable early detection and treatment of pregnant women with depression. Proper treatment of antenatal depression can assist in achieving Sustainable Development Goals (SDGs). However, utilisation of SPADe in clinical practice to screening for depression in antenatal clinics has not been established yet. Therefore, the primary aim of this study is to assess feasibility of screening for depression by midwives using SPADe in antenatal clinics in Blantyre District. The secondary aim was to assess acceptability and fidelity of screening for depression by midwives using SPADe in antenatal clinics in Blantyre District. METHODS: This will be a feasibility study which will consist of scientific investigations that will support movement of evidence-based, effective health care approach, SPADe, from the clinical knowledge base into routine use. This study will consist three phases: phase 1 will introduce SPADe in antenatal clinics in Blantyre District where screening of depression is almost none existent; phase 2 will implement screening of depression using SPADe in antenatal clinics in Blantyre District; and phase 3 will evaluate the screening of antenatal depression using SPADe to establish its feasibility, acceptability and fidelity in antenatal clinics in Blantyre District. DISCUSSION: This study will establish and document feasibility, acceptability and fidelity of screening for depression by midwives using SPADe in antenatal clinics in Blantyre District. It is expected that midwives will develop more confidence in detecting and dealing with antenatal depression. Consequently, there will be increased numbers of pregnant women detected with depression by midwives and increased accessibility to mental health care by pregnant women in antenatal clinics.