Co-designing the FOotpaths foR Adolescent MAternal Mental HeAlth (FOR MAMA) intervention for pregnant teens in Malawi.

Background: This study aimed to gain insights into stakeholders' priorities and preferences for a scalable intervention for common mental problems among perinatal adolescents in Malawi.

Methods: Participatory stakeholder workshops (n=9) were conducted iteratively according to the principles of the Person-Based Approach. Three stakeholder groups were recruited from one urban and one rural primary health centre in Zomba district, Malawi: perinatal adolescents (n=10), their family members (n=8) and healthcare workers (n=10). Framework analysis was conducted using intervention descriptors from the Template for Intervention Description and Replication checklist.

Results: Participants emphasized the need for information on causes and symptoms of common mental problems and for developing coping strategies: a) those focused on external stressors-problem-solving, financial literacy and interpersonal skills-and b) emotion-focused approach behaviours-behavioural activation, relaxation and anger management. There was a strong preference for healthcare workers as intervention providers. Participants agreed on a brief antenatal intervention delivered weekly using both group and individual formats. There were positive views on both self-help and guided formats. All stakeholder groups felt there was a need for follow-up to ensure that adolescents correctly engaged with the intervention material.

Conclusions: Findings informed the design of a brief multicomponent guided intervention for adolescents in the antenatal period.