Context, input, process and product model for evaluation of the Perinatal Wellness Program for common mental disorders in a primary care setting
Bhuvaneshwari Sethuraman, Swati Chandramouli, Samrat Gali, Systla Rukmini, Avita R. Johnson, Priya Sreedaran, Ramakrishna Goud B, Anupama N. Shetty, Shroff M. Manohari
A
BSTRACT
Background:
Common mental disorders (CMD) in perinatal women are underdiagnosed in India and lead to impaired obstetric and neonatal outcomes. There are no program evaluations of perinatal mental health services in India. Perinatal Wellness Program (PWP) through task shifting with screening of CMD and psycho-social counselling by community health workers (CHW) could assist primary care settings. We evaluated a PWP through a mixed-methods study design using the context, input, process, and product (CIPP) model.
Materials and Methods:
Sixty-six antenatal women were recruited. Of these, 15 postnatal women were further studied using qualitative methods to identify the barriers and needs for determining the “context” of PWP. “Input” was assessed by the fidelity of PWP implementation using checklists with quantitative metrics. “Process” was determined by the acceptability of PWP by the postnatal women. “Product” was assessed by the proportion of CMD screened by CHW and sample dropout.
Results:
Perceived barriers included the unavailability of mental health services in maternity hospitals. Women expressed a need for PWP in all perinatal settings. All participants received the PWP of the intended duration. Postnatal participants found PWP acceptable and relevant for their mental health during the perinatal period. The proportion of CMD was 22.7%, and loss to follow-up was 12%.
Conclusion:
The absence of perinatal mental health services in primary settings is a perceived barrier. PWPs using task shifting for perinatal mental health in primary settings is an acceptable option that should be considered due to the high prevalence of CMD in perinatal women in India.