{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,17]],"date-time":"2026-05-17T06:44:32Z","timestamp":1779000272762,"version":"3.51.4"},"reference-count":35,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2022,5,13]],"date-time":"2022-05-13T00:00:00Z","timestamp":1652400000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2022,5,13]],"date-time":"2022-05-13T00:00:00Z","timestamp":1652400000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Health Serv Res"],"published-print":{"date-parts":[[2022,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>South Africa has a high burden of perinatal common mental disorders (CMD), such as depression and anxiety, as well as high levels of poverty, food insecurity and domestic violence, which increases the risk of CMD. Yet public healthcare does not include routine detection and treatment for these disorders. This pilot study aims to evaluate the implementation outcomes of a health systems strengthening (HSS) intervention for improving the quality of care of perinatal women with CMD and experiences of domestic violence, attending public healthcare facilities in Cape Town.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>Three antenatal care facilities were purposively selected for delivery of a HSS programme consisting of four components: (1) health promotion and awareness raising talks delivered by lay healthcare workers; (2) detection of CMD and domestic violence by nurses as part of routine care; (3) referral of women with CMD and domestic violence; and (4) delivery of structured counselling by lay healthcare workers in patients\u2019 homes. Participants included healthcare workers tasked with delivery of the HSS components, and perinatal women attending the healthcare facilities for routine antenatal care. This mixed methods study used qualitative interviews with healthcare workers and pregnant women, a patient survey, observation of health promotion and awareness raising talks, and a review of several documents, to evaluate the acceptability, appropriateness, feasibility, adoption, fidelity of delivery, and fidelity of receipt of the HSS components. Thematic analysis was used to analyse the qualitative interviews, while the quantitative findings for adoption and fidelity of receipt were reported using numbers and proportions.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>Healthcare workers found the delivery and content of the HSS components to be both acceptable and appropriate, while the feasibility, adoption and fidelity of delivery was poor. We demonstrated that the health promotion and awareness raising component improved women\u2019s attitudes towards seeking help for mental health conditions. The detection, referral and treatment components were found to improve fidelity of receipt, evidenced by an increase in the proportion of women undergoing routine detection and referral, and decreased feelings of distress in women who received counselling. However, using a task-sharing approach did not prove to be feasible, as adding additional responsibilities to already overburdened healthcare workers roles resulted in poor fidelity of delivery and adoption of all the HSS components.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>The acceptability, appropriateness and fidelity of receipt of the HSS programme components, and poor feasibility, fidelity of delivery and adoption suggest the need to appoint dedicated, lay healthcare workers to deliver key programme components, at healthcare facilities, on the same day.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12913-022-08050-x","type":"journal-article","created":{"date-parts":[[2022,5,13]],"date-time":"2022-05-13T10:04:30Z","timestamp":1652436270000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["Implementation outcomes of a health systems strengthening intervention for perinatal women with common mental disorders and experiences of domestic violence in South Africa: Pilot feasibility and acceptability study"],"prefix":"10.1186","volume":"22","author":[{"given":"Zulfa","family":"Abrahams","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yuche","family":"Jacobs","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mbali","family":"Mohlamonyane","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sonet","family":"Boisits","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marguerite","family":"Schneider","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Simone","family":"Honikman","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nadine","family":"Seward","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Crick","family":"Lund","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2022,5,13]]},"reference":[{"issue":"1","key":"8050_CR1","doi-asserted-by":"publisher","first-page":"30","DOI":"10.1017\/S204017441700071X","volume":"9","author":"S Redinger","year":"2018","unstructured":"Redinger S, Norris S, Pearson R, Richter L, Rochat T. First trimester antenatal depression and anxiety: prevalence and associated factors in an urban population in Soweto, South Africa. J Dev Orig Health Dis. 2018;9(1):30\u201340.","journal-title":"J Dev Orig Health Dis"},{"issue":"4","key":"8050_CR2","doi-asserted-by":"publisher","first-page":"363","DOI":"10.1007\/s00127-018-1497-y","volume":"53","author":"Z Abrahams","year":"2018","unstructured":"Abrahams Z, Lund C, Field S, Honikman S. Factors associated with household food insecurity and depression in pregnant South African women from a low socio-economic setting: a cross-sectional study. Soc Psychiatry Psychiatr Epidemiol. 2018;53(4):363\u201372.","journal-title":"Soc Psychiatry Psychiatr Epidemiol"},{"issue":"1","key":"8050_CR3","doi-asserted-by":"publisher","first-page":"9","DOI":"10.1186\/1742-4755-8-9","volume":"8","author":"M Hartley","year":"2011","unstructured":"Hartley M, Tomlinson M, Greco E, Comulada WS, Stewart J, Le Roux I, et al. Depressed mood in pregnancy: prevalence and correlates in two Cape Town peri-urban settlements. Reprod Health. 2011;8(1):9.","journal-title":"Reprod Health"},{"issue":"12","key":"8050_CR4","doi-asserted-by":"publisher","first-page":"940","DOI":"10.7196\/SAMJ.6009","volume":"102","author":"L Manikkam","year":"2012","unstructured":"Manikkam L, Burns JK. Antenatal depression and its risk factors: an urban prevalence study in KwaZulu-Natal. S Afr Med J. 2012;102(12):940\u20134.","journal-title":"S Afr Med J"},{"issue":"6","key":"8050_CR5","doi-asserted-by":"publisher","first-page":"765","DOI":"10.1007\/s00737-017-0768-z","volume":"20","author":"T van Heyningen","year":"2017","unstructured":"van Heyningen T, Honikman S, Myer L, Onah MN, Field S, Tomlinson M. Prevalence and predictors of anxiety disorders amongst low-income pregnant women in urban South Africa: a cross-sectional study. Arch Womens Ment Health. 2017;20(6):765\u201375.","journal-title":"Arch Womens Ment Health"},{"key":"8050_CR6","volume-title":"Food insecurity and common mental disorders in perinatal women living in low socio-economic settings in Cape Town, South Africa during the COVID-19 pandemic: a cohort study","author":"Z Abrahams","year":"2021","unstructured":"Abrahams Z, Lund C. Food insecurity and common mental disorders in perinatal women living in low socio-economic settings in Cape Town, South Africa during the COVID-19 pandemic: a cohort study; 2021."},{"key":"8050_CR7","doi-asserted-by":"crossref","unstructured":"Malan M, Spedding MF, Sorsdahl K. The prevalence and predictors of intimate partner violence among pregnant women attending a midwife and obstetrics unit in the Western Cape. Global Mental Health. 2018;e5:1\u201313.","DOI":"10.1017\/gmh.2018.9"},{"key":"8050_CR8","doi-asserted-by":"publisher","first-page":"593","DOI":"10.2471\/BLT.12.109819","volume":"91","author":"A Rahman","year":"2013","unstructured":"Rahman A, Fisher J, Bower P, Luchters S, Tran T, Yasamy MT, et al. Interventions for common perinatal mental disorders in women in low-and middle-income countries: a systematic review and meta-analysis. Bull World Health Organ. 2013;91:593\u2013601I.","journal-title":"Bull World Health Organ"},{"issue":"3","key":"8050_CR9","doi-asserted-by":"publisher","first-page":"277","DOI":"10.1007\/s11121-013-0376-8","volume":"15","author":"M Tomlinson","year":"2014","unstructured":"Tomlinson M, O\u2019Connor MJ, Le Roux IM, Stewart J, Mbewu N, Harwood J, et al. Multiple risk factors during pregnancy in South Africa: the need for a horizontal approach to perinatal care. Prev Sci. 2014;15(3):277\u201382.","journal-title":"Prev Sci"},{"key":"8050_CR10","volume-title":"Facilitators and barriers to detection and treatment of depression, anxiety and experiences of domestic violence in pregnant women attending Midwife Obstetric Units (MOUs) in Cape Town","author":"Z Abrahams","year":"2021","unstructured":"Abrahams Z, Boisits S, Schneider M, Honikman S, Lund C. Facilitators and barriers to detection and treatment of depression, anxiety and experiences of domestic violence in pregnant women attending Midwife Obstetric Units (MOUs) in Cape Town. South Africa: A qualitative study; 2021."},{"key":"8050_CR11","volume-title":"Health Systems Strengthening Interventions for Perinatal Common Mental Disorders and Experiences of Domestic Violence in Cape Town","author":"Z Abrahams","year":"2022","unstructured":"Abrahams Z, Schneider M, Honikman S, Olckers P, Boisits S, Seward N, et al. 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. Health Services Research; 2022."},{"issue":"2","key":"8050_CR12","doi-asserted-by":"publisher","first-page":"65","DOI":"10.1007\/s10488-010-0319-7","volume":"38","author":"E Proctor","year":"2011","unstructured":"Proctor E, Silmere H, Raghavan R, Hovmand P, Aarons G, Bunger A, et al. Outcomes for implementation research: conceptual distinctions, measurement challenges, and research agenda. Adm Policy Mental Health. 2011;38(2):65\u201376.","journal-title":"Adm Policy Mental Health"},{"key":"8050_CR13","volume-title":"Private vs. public healthcare in South Africa","author":"M Young","year":"2016","unstructured":"Young M. Private vs. public healthcare in South Africa; 2016."},{"issue":"4","key":"8050_CR14","doi-asserted-by":"publisher","first-page":"256","DOI":"10.7196\/SAMJ.9181","volume":"105","author":"RC Pattinson","year":"2015","unstructured":"Pattinson RC, Makin JD, Pillay Y, van den Broek N, Moodley J. Basic and comprehensive emergency obstetric and neonatal care in 12 South African health districts. S Afr Med J. 2015;105(4):256\u201360.","journal-title":"S Afr Med J"},{"key":"8050_CR15","volume-title":"Not white enough, not black enough: Racial identity in the South African coloured community","author":"M Adhikari","year":"2005","unstructured":"Adhikari M. Not white enough, not black enough: Racial identity in the South African coloured community: Ohio University Press; 2005."},{"key":"8050_CR16","unstructured":"Effective Practice and Organisation of Care (EPOC). EPOC Taxonomy. 2015; Available at: https:\/\/epoc.cochrane.org\/epoc-taxonomy. Accessed 23 Sept\u00a02021."},{"key":"8050_CR17","unstructured":"Department of Health. Maternity Case Record. 2018; Available at: https:\/\/pmhp.za.org\/wp-content\/uploads\/Western-Cape-Maternity-Case-Record-Version-19-June-2018.pdf. Accessed 23 March 2020."},{"issue":"Suppl 5","key":"8050_CR18","doi-asserted-by":"publisher","DOI":"10.1136\/bmjgh-2018-000962","volume":"3","author":"R Cornick","year":"2018","unstructured":"Cornick R, Picken S, Wattrus C, Awotiwon A, Carkeek E, Hannington J, et al. The Practical Approach to Care Kit (PACK) guide: developing a clinical decision support tool to simplify, standardise and strengthen primary healthcare delivery. BMJ Glob Health. 2018;3(Suppl 5):e000962.","journal-title":"BMJ Glob Health"},{"issue":"1","key":"8050_CR19","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s12913-016-1904-6","volume":"16","author":"L Rixon","year":"2016","unstructured":"Rixon L, Baron J, McGale N, Lorencatto F, Francis J, Davies A. Methods used to address fidelity of receipt in health intervention research: a citation analysis and systematic review. BMC Health Serv Res. 2016;16(1):1\u201324.","journal-title":"BMC Health Serv Res"},{"issue":"1","key":"8050_CR20","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/1471-2288-13-117","volume":"13","author":"NK Gale","year":"2013","unstructured":"Gale NK, Heath G, Cameron E, Rashid S, Redwood S. Using the framework method for the analysis of qualitative data in multi-disciplinary health research. BMC Med Res Methodol. 2013;13(1):1\u20138.","journal-title":"BMC Med Res Methodol"},{"issue":"1","key":"8050_CR21","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s13033-021-00443-5","volume":"15","author":"S Boisits","year":"2021","unstructured":"Boisits S, Abrahams Z, Schneider M, Honikman S, Kaminer D, Lund C. Developing a task-sharing psychological intervention to treat mild to moderate symptoms of perinatal depression and anxiety in South Africa: a mixed-method formative study. Int J Mental Health Syst. 2021;15(1):1\u201314.","journal-title":"Int J Mental Health Syst"},{"issue":"1","key":"8050_CR22","doi-asserted-by":"publisher","first-page":"5","DOI":"10.4103\/0970-0218.94009","volume":"37","author":"S Kumar","year":"2012","unstructured":"Kumar S, Preetha G. Health promotion: an effective tool for global health. Indian J Commun Med. 2012 Jan;37(1):5\u201312.","journal-title":"Indian J Commun Med"},{"key":"8050_CR23","unstructured":"Thutobophelo Training and Skills Academy. Health Promotion Officer. Available at: https:\/\/www.thutoskills.co.za\/our-courses\/health-promotional-officer\/#:~:text=Health%20Promotional%20Officer%20(HPO)%20is,of%20diseases%20and%20improving%20lifestyles. Accessed 8 Dec 2021."},{"key":"8050_CR24","volume-title":"Community health worker incentives and disincentives","author":"K Bhattacharyya","year":"2001","unstructured":"Bhattacharyya K, Winch P, LeBan K, Tien M. Community health worker incentives and disincentives. Virginia: USAID-BASICS II; 2001."},{"issue":"1","key":"8050_CR25","doi-asserted-by":"publisher","first-page":"24085","DOI":"10.3402\/gha.v7.24085","volume":"7","author":"Z Hill","year":"2014","unstructured":"Hill Z, Dumbaugh M, Benton L, K\u00e4llander K, Strachan D, Ten Asbroek A, et al. Supervising community health workers in low-income countries\u2013a review of impact and implementation issues. Glob Health Action. 2014;7(1):24085.","journal-title":"Glob Health Action"},{"issue":"1","key":"8050_CR26","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/1478-4491-7-15","volume":"7","author":"R Pillay","year":"2009","unstructured":"Pillay R. Work satisfaction of professional nurses in South Africa: a comparative analysis of the public and private sectors. Hum Resour Health. 2009;7(1):1\u201310.","journal-title":"Hum Resour Health"},{"issue":"1","key":"8050_CR27","doi-asserted-by":"publisher","first-page":"1","DOI":"10.4102\/curationis.v39i1.1545","volume":"39","author":"RC Shihundla","year":"2016","unstructured":"Shihundla RC, Lebese RT, Maputle MS. Effects of increased nurses' workload on quality documentation of patient information at selected Primary Health Care facilities in Vhembe District, Limpopo Province. Curationis. 2016;39(1):1\u20138.","journal-title":"Curationis"},{"issue":"1","key":"8050_CR28","first-page":"1","volume":"24","author":"J January","year":"2018","unstructured":"January J, Chimbari MJ. Opportunities and obstacles to screening for perinatal depression among women in Zimbabwe: A narrative review of literature. S Afr J Psychiatry. 2018;24(1):1\u20135.","journal-title":"S Afr J Psychiatry."},{"key":"8050_CR29","doi-asserted-by":"crossref","unstructured":"Drigo L, Luvhengo M, Lebese RT, Makhado L. Attitudes of Pregnant Women Towards Antenatal Care Services Provided in Primary Health Care Facilities of Mbombela Municipality, Mpumalanga Province, South Africa. Open Public Health J. 2020;13(1).","DOI":"10.2174\/1874944502013010569"},{"key":"8050_CR30","doi-asserted-by":"publisher","first-page":"47","DOI":"10.1016\/j.midw.2017.12.020","volume":"59","author":"H Bayrampour","year":"2018","unstructured":"Bayrampour H, Hapsari AP, Pavlovic J. Barriers to addressing perinatal mental health issues in midwifery settings. Midwifery. 2018;59:47\u201358.","journal-title":"Midwifery"},{"key":"8050_CR31","doi-asserted-by":"publisher","first-page":"149","DOI":"10.1146\/annurev-clinpsy-032816-045217","volume":"13","author":"DR Singla","year":"2017","unstructured":"Singla DR, Kohrt BA, Murray LK, Anand A, Chorpita BF, Patel V. Psychological treatments for the world: lessons from low-and middle-income countries. Annu Rev Clin Psychol. 2017;13:149\u201381.","journal-title":"Annu Rev Clin Psychol"},{"key":"8050_CR32","doi-asserted-by":"crossref","unstructured":"Davies T, Lund C, Schneider M. Implementation of a task-shared psychosocial intervention for perinatal depression in South Africa: A grounded theory process evaluation. SSM-Mental Health. 2021;100056.","DOI":"10.1016\/j.ssmmh.2021.100056"},{"key":"8050_CR33","doi-asserted-by":"publisher","first-page":"82","DOI":"10.1016\/j.socscimed.2013.08.004","volume":"97","author":"P Padmanathan","year":"2013","unstructured":"Padmanathan P, De Silva MJ. The acceptability and feasibility of task-sharing for mental healthcare in low and middle income countries: a systematic review. Soc Sci Med. 2013;97:82\u20136.","journal-title":"Soc Sci Med"},{"issue":"6","key":"8050_CR34","doi-asserted-by":"publisher","first-page":"1082","DOI":"10.1007\/s10597-020-00734-0","volume":"57","author":"Y Jacobs","year":"2021","unstructured":"Jacobs Y, Myers B, van der Westhuizen C, Brooke-Sumner C, Sorsdahl K. Task sharing or task dumping: counsellors experiences of delivering a psychosocial intervention for mental health problems in South Africa. Community Ment Health J. 2021;57(6):1082\u201393.","journal-title":"Community Ment Health J"},{"key":"8050_CR35","doi-asserted-by":"publisher","first-page":"33","DOI":"10.1016\/j.socscimed.2014.07.057","volume":"118","author":"E Mendenhall","year":"2014","unstructured":"Mendenhall E, De Silva MJ, Hanlon C, Petersen I, Shidhaye R, Jordans M, et al. Acceptability and feasibility of using non-specialist health workers to deliver mental health care: stakeholder perceptions from the PRIME district sites in Ethiopia, India, Nepal, South Africa, and Uganda. Soc Sci Med. 2014;118:33\u201342.","journal-title":"Soc Sci Med"}],"container-title":["BMC Health Services Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12913-022-08050-x.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12913-022-08050-x\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12913-022-08050-x.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,5,13]],"date-time":"2022-05-13T10:11:45Z","timestamp":1652436705000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmchealthservres.biomedcentral.com\/articles\/10.1186\/s12913-022-08050-x"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,5,13]]},"references-count":35,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2022,12]]}},"alternative-id":["8050"],"URL":"https:\/\/doi.org\/10.1186\/s12913-022-08050-x","relation":{},"ISSN":["1472-6963"],"issn-type":[{"value":"1472-6963","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,5,13]]},"assertion":[{"value":"27 January 2022","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"22 April 2022","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"13 May 2022","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Research was conducted according to the principles of the Declaration of Helsinki. Ethical approval for the study was obtained from the Human Research Ethics Committee at the University of Cape Town (Ref No: 139\/2018) and the Psychiatry, Nursing and Midwifery Research Ethics Subcommittee at King\u2019s College London (Ref No: 17\/18-7807). In addition, the WC DoH approved the use of the research sites (Ref No: WC_201807_008 & WC_201911_004). All participants provided written, informed consent after the procedure had been verbally explained to them and were informed that they were free to withdraw from the study at any time without consequences.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"641"}}