Feasibility and acceptability of community-based psychosocial interventions delivered by nonspecialists for perinatal common mental disorders: A systematic review using an implementation science framework.

Abstract

Task sharing is endorsed as one of the strategies to address the treatment gap in common perinatal mental health conditions. There is a well-established body of evidence on the effectiveness of psychological interventions delivered by nonspecialist health workers (NSHWs); however, there is a dearth of evidence documenting factors determining the feasibility, acceptability and sustainability of integrating and implementing these interventions. This systematic review aims to synthesize the implementation outcomes and implementation process of NSHWs-delivered psychological interventions for the management of perinatal depression and anxiety using Proctor's implementation science framework outlining eight constructs: feasibility, acceptability, appropriateness, adoption, cost, fidelity, penetration and sustainability. We searched PubMed, Web of Science and Cochrane Center Register of Controlled Trials for studies published in English and between 2000 and 2022 using search terms under five broad categories: (a) "perinatal"; (b) "common mental disorders"; (c) "psychological interventions"; (d) "nonspecialist" and (e) "implementation outcomes." Secondary publications were also hand-searched for data extraction. Two authors independently reviewed abstracts and full-text articles. Data for included articles were extracted using a standard data extraction sheet. A narrative synthesis of qualitative evidence was conducted. Initial searches identified 885 articles of which full text of 128 articles were screened for eligibility, with 56 studies meeting the inclusion criteria. Out of the eight constructs of Proctor's framework, "feasibility," "acceptability," "appropriateness" and "fidelity" were the most evaluated outcomes. None of the studies reported "penetration" and very few reported "sustainability," "adoption" or "cost." None of the studies used any implementation science framework for the study evaluation. Despite the well-established evidence on the effectiveness of psychosocial interventions for perinatal depression and anxiety by NSHWs, these interventions are rarely adopted into the health system. More studies applying systems thinking are needed to explore facilitators, barriers and mechanisms for integrating interventions in the health system. Using implementation science frameworks to design, plan, execute and evaluate psychosocial interventions by NSHWs can address this gap in evidence.