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Table 1 Contextual barriers identified, HSS interventions selected, and implementation outcomes to be assessed during the implementation phase

From: Health systems strengthening interventions for perinatal common mental disorders and experiences of domestic violence in Cape Town, South Africa: protocol for a pilot implementation study

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