| ObjectivesThe purposes of our study are to evaluate the operability of"screening and management of antenatal depression"within primary care through qualitative interviews before implementation and determine the implementation program of pilot study.The RE-AIM model is used to conduct a phased evaluation evaluating the coverage,effectiveness and implementation of the project,analyze the adoption and sustainability of future institutions,and complete implementation strategies for the scale up study.MethodsPreparation for implementation:researchers organized stakeholders which including health service providers(n=7),perinatal women(n=6),family members(n=7),health policy makers(n=1),and institutional managers(n=1)to conduct qualitative interviews using semi-structured interview outlines to determine pilot study strategies before implementation;Questionnaire was designed to collect the general demographic characteristics of antenatal women including age,education,living type,work status,history of mental illness,annual family income,subjective socioeconomic status,etc;the Edinburgh Postnatal Depression Scale(EPDS)was used to assess the degree of depression in antenatal women;Relevant implementation staffs were trained to provide outpatient screening review services and online psychological counseling or consultation;Internet system was developed for screening and management of antenatal depression.Implementation:pilot study was carryed out in Maternal and Child Health Hospital on May 24,2019.Universal screening of depression was performed in early pregnancy clinic.Hierarchical management was established for depressed women,including self-help video for mild depression,online counseling/defusing services for moderate and severe depression,referral service for severe suicide warning.Data collection and evaluation during the implementation:two qualitative interviews were conducted during the implementation to collect qualitative data.For the first time,an experienced interview host conducted a personal telephone interview with 9 pregnant women using a semi-structured interview outline;The second time,focus group interviews was organized with pregnant women(n=6),and women’s families(n=4);Quantitative data collection including maternal demographic characteristics and intervention status was completed through the Internet system and hospital management system.After the completion of the follow-up during pregnancy,the cross-sectional survey was completed to collect the distribution of depressive symptoms in the control group.Finally,we combined qualitative and quantitative data using RE-AIM to conduct interim implementation evaluation.ResultsAs of December 11,2019,a total of 1 157 pregnant women were screened for depression during the first trimester,of which 971(83.9%)were screened during the second trimester,810(70.0%)were screened during the third trimester.The results of the phased evaluation showed that the coverage of outpatient screening reached 96.0%,the coverage of intervention in mild depression was 45.5%and in moderate to severe depression was 82.4%.The important reasons that affected ICBT coverage including no time,uncertainty about the effectiveness of video animation,self-consideration that no treatment was needed.Based on the results of cross-sectional surveys that did not participate in the implementation,theχ~2test results showed that the detection rate of mild and moderate to severe depression in the first trimester of the implementation group was higher than that of the control group,and the difference between the groups was not statistically significant(χ~2=2.08,P>0.05);The detection rate of mild and moderate to severe depression in the second trimester of the implementation group was lower than that of the control group,and the difference between the groups was statistically significant(χ~2=13.76,P<0.01);The detection rate of mild and moderate to severe depression in the third trimester of the implementation group was lower than that of the control group,and the difference between the groups was statistically significant(χ~2=13.15,P<0.01).Implementation at the organizational and maternal levels,the interview results showed that outpatient doctors and psychological counselors can follow the work manual to complete the implementation.1 043(90.1%)pregnant women received screenings at least two times and 738(63.8%)pregnant women continued to receive screenings all 3 times.Among outpatients who were screened for depression,204(93.2%)of them followed the instructions of the doctor and downloaded the"Mom,s Good Mood"app.Among pregnant women with mild depression,the proportion of watching animated videos was 45.5%,but most(78.8%)women watched less than 3videos;The proportion of moderate to severe depression women made an appointment with counselors was 82.4%,but the vast majority(86.9%)of women received consultations less than 3 times.ConclusionIt is feasible to increase the screening and management of antenatal depression in maternal and child health care clinics.Maternal acceptance of antenatal depression screening is higher,antenatal women are able to complete the self-administered of the screening scale with high quality.In terms of overall effectiveness,the screening and management measures for depression during pregnancy in the primary health care system may effectively reduce the incidence of depression during the second and third trimesters.Further research is needed to study the effectiveness of the screening and intervention measures separately.At the implementation level,the proportion of pregnant women who continue to be screened according to the implementation plan is acceptable,However,the proportion of continuing to receive intervention is low and the number of qualitative interviews needs to be increased in the future for further analysis with the factors affecting implementation. |
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