Table 1 Contextual barriers identified, HSS interventions selected, and implementation outcomes to be assessed during the implementation phase
Contextual barriers | HSS interventions | Implementation outcomes |
|---|---|---|
Poor patient knowledge and health-seeking behaviour; high levels of stigma | Training — of health promotion (HP) officers to deliver health promotion talks Health promotion — delivery of daily health promotion talks to pregnant women | Acceptability, appropriateness, satisfaction, and feasibility of talks — qualitative interviews with pregnant women and HP officers Adoption and fidelity of talks — observation of talks and completion of a checklist Sustainability of daily talks — qualitative interviews with HP officers Effectiveness of talks — change in knowledge, attitudes, and health-seeking behaviour of pregnant women |
Low levels of detection | Training — of antenatal care (ANC) nurses to (i) detect pregnant women with symptoms of common mental disorders (CMDs) and experiences of abuse and (ii) assess the severity of symptoms Delivery of individual-level care — ANC nurses screen pregnant women for symptoms of CMDs and experiences of abuse Audit and feedback — screening rates assessed and performance summarised and discussed at bi-monthly meetings | Acceptability, appropriateness, satisfaction, and feasibility of detection process — qualitative interviews with pregnant women and ANC nurses Adoption and fidelity of detection process — review of patient files and documents used to record detection rates Sustainability of the detection process — qualitative interviews with ANC nurses |
Poor linkage to care | Referral systems — development of standardised referral pathways Training — of ANC nurses to refer pregnant women with symptoms of common mental disorders and experiences of abuse for treatment Audit and feedback — referral rates assessed and performance summarised and discussed at bi-monthly meetings | Acceptability, appropriateness, satisfaction, and feasibility of referral process — qualitative interviews with pregnant women and ANC nurses Adoption and fidelity of referral process — review of patient files and documents used for referral Sustainability of the referral process — qualitative interviews with ANC nurses |
Limited availability of treatment | Task-sharing — psychological counselling programme to be delivered by lay healthcare workers Training — of lay healthcare workers to deliver psychological counselling Delivery of individual-level care — lay healthcare workers deliver psychological counselling Change to healthcare environment — psychological counselling delivered in patients’ homes or at off-site venues Audit and feedback — counselling rates assessed and performance summarised and discussed at bi-monthly meetings Performance monitoring — supervisors monitor delivery of counselling | Acceptability, appropriateness, satisfaction, and feasibility of counselling programme — qualitative interviews with pregnant women and lay healthcare workers Fidelity of counselling delivery — counselling competence of lay healthcare workers Adoption, penetration, and sustainability of counselling programme — review documents used for referral; qualitative interviews with pregnant women and lay healthcare workers |