@phdthesis{01HB5VCN3S0NCP79G2DDMYRV77,
  abstract     = {{Background and objectives
Perinatal mental health is a significant public health concern with a rising global burden. Its detrimental effects and consequences can have lasting impacts on a mother, child, and subsequently the entire family. This situation is more serious in developing countries like Pakistan. Numerous factors, such as poverty, economic instability, illiteracy, gender discrimination, sociocultural beliefs, a lack of social support, awareness, and stigma, etc. are associated with poor mental health in women. Given that the majority of Pakistan's population lacks access to adequate resources, it is crucial to draw attention to the prevention and promotion of mental health during pregnancy. Positive interventions to build resilience have been shown to have a strong protective effect against anxiety and depression during pregnancy because of their capacity to mediate the relationship between stress and its effects on mental health. It is a construct that helps a person in developing internal strength, capability, flexibility, and the capacity to cope successfully with difficulties. In the context of Pakistan, this has not yet been tested therefore, the overall aim of this research is to help disadvantaged pregnant women of Pakistan in building resilience. Our study objectives were to explore resilience core characteristics, develop, validate, and evaluate a resilience-based intervention to improve pregnant women’s resilience and marital adjustment and reduce depressive and pregnancy-related anxiety.
Methods
Two-phased intervention research was used to achieve the objectives. The first phase was the formative/ pre-intervention phase, and the second was the intervention phase.
In phase I, we used an exploratory-descriptive design to better understand this resilience phenomenon and to develop the content of the intervention. We identified the core characteristics of resilience by interviewing 25 stakeholders: 17 pregnant women and 8 key informants. All of the women were married, aged 18 years and above, and at least 12 weeks of gestation. The key informants were professionals with more than five years of experience in the field of mental health. Participants were enrolled using purposive sampling techniques. For pregnant women and KIs, a separate semi-interview guide was developed. Data collection was stopped until saturation was obtained. Based on the input and responses from the pregnant women and KIs, the intervention content was considered and developed using a variety of teaching and learning techniques. The Gunning Fog Index (GFI) was used to assess each sentence, paragraph, and module to ensure that the language was clear, concise, and comprehensive. Then for content validation, eight expert members (two mental health nurses, two psychiatrists, two psychologists, and two maternal and child health experts) were approached. They evaluated our contextually developed Safe Motherhood- Accessible Resilience Training (SM-ART) intervention based on a self-developed 15-item checklist. The whole formative/pre-intervention phase was conducted over the course of a year and nine months (January 2019 to September 2020).
In the second intervention phase, a single-centered, single-blind, two-group Randomized Control Trial design (RCT) was adopted to test the effectiveness of the SM-ART intervention on improving resilience, marital adjustment, and decreasing depression and pregnancy-related anxiety in a sample of pregnant women presenting to midwifery-led, Koohi Goth Hospital of Karachi, Pakistan. Our total sample size was 200 with 100 in each group. Permuted block randomization with blocks of four was employed. To ensure equal representation in each block, pregnant women were randomly assigned in a 1:1 ratio to either the intervention or control group. The intervention group received six weeks of SM-ART intervention, one session lasting 60 to 90 minutes each week, on resilience-based skills. CMWs (Community Midwives) were trained to deliver this intervention. Both intervention and control groups had access to standard care, a self-developed pamphlet on positive mental health, and a comprehensive list of local mental health service providers. Validated scales were used to measure outcomes (resilience, depression, pregnancy-related anxiety, and marital adjustment) in both the intervention and control groups at baseline (pre-intervention) and post-intervention. This intervention phase was conducted over the course of six months.
Results
In phase I, our study identified six core components of resilience that may promote mental health during pregnancy. These include: 1) finding the purpose of life, 2) dealing with emotions, 3) believing in yourself, 4) adopting an optimistic approach, 5) strengthening support and relationship, and 6) internalizing spirituality and humanity. Six themes emerged from their in-depth interviews and became part of the SM-ART intervention. The intervention comprised six modules based on these six different themes. Every module has a unique purpose that sets it distinct from the others and allows it to stand on its own. The GFI varied between modules, ranging from an index of nine to an index of seven. As per the expert's evaluation, The SM-ART intervention consisting of six modules showed strong to perfect CVI scores for each of the modules. Their responses also supported the intervention's strengths as having innovative and engaging activities, contextual and cultural relevance, and a detailed comprehensive facilitator guide.
In Phase II, the intervention and control groups were found comparable regarding their socio-demographic, pregnancy, marriage, and family-related factors. Additionally, there is no statistically significant difference between their baseline mean scores for resilience, depression, marital adjustment, and pregnancy-related anxiety. Post-Intervention findings revealed that mean resilience scores in the intervention group (82.68 +14.54)) showed a significant difference (6.91) compared to the control group (75.77 +13.06), with p-value <0.001. Also, the mean depression scores of the intervention group were (8.86+6.67) significantly different (-2.12) compared to the control group mean (10.98+7.56), p-value <0.05. However, no significant change was observed in anxiety and marital adjustment scores between the intervention and control groups.
Conclusion and recommendations
The main findings of this study emphasize the use of these core competencies to define the resilience pathway, the availability of readily available SM-ART resource material, and the enhancement of women's resilience and reduction in depressive symptoms following a 6-week SM-ART intervention. The study also recognizes the potential for a non-medical, strength-based positive psychological intervention to improve resilience and reduce depression scores, which could ultimately lessen the burden of perinatal mental illness in Pakistan. We recommend that every woman seeking antenatal care be encouraged to take part in this intervention at least once while she is pregnant. Women will have the chance to express their emotions and worries in a secure environment. Moreover, this should be part of the core curriculum of midwives. Consequently, including such interventions in public health initiatives, especially in resource-limited countries like Pakistan, may help to improve the mental health of women and promote the development of healthy families.}},
  author       = {{Bhamani, Shireen}},
  language     = {{eng}},
  pages        = {{197}},
  publisher    = {{Ghent University. Faculty of Medicine and Health Sciences}},
  school       = {{Ghent University}},
  title        = {{Resilience and perinatal mental health : development and evaluation of an intervention}},
  year         = {{2023}},
}