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Table 1 Overview of the contextual barriers , HSS programme components, HSS interventions and data collection methods

From: 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

Contextual Barriers HSS programme components HSS interventions Collection methods
Poor patient knowledge and health seeking behaviour; high levels of stigma Health promotion and awareness raising - delivery of health promotion and awareness raising talks
• Provider – lay healthcare workers
• Recipient – perinatal women
• Place – waiting areas at MOU and BANC clinics
• Time – in the morning
• Frequency – daily
• Tools – ASSET provided flipchart
Training – to equip healthcare workers with the knowledge, skills and tools to deliver the talks
Health education – to provide pregnant women with health information
Delivery of group care – to deliver talks to groups of women
Role expansion – to task healthcare workers with delivering the talks in addition to their usual responsibilities
Audit and feedback – to assess and discuss the delivery of talks with healthcare workers involved
Qualitative interviews with healthcare workers
Observation of the health promotion and awareness talks and completion of a checklist used to capture healthcare worker competency, adherence to the structure, and environmental factors such as noise, lighting and size of area
Patient survey – a self-administered survey questionnaire, completed during baseline and after the talks
Low levels of detection Detection - of symptoms of CMDs and domestic violence in pregnant women as part of routine antenatal care
• Provider – antenatal care nurses
• Recipient – pregnant women
• Place – at MOU and BANC clinics
• Time – during routine consultations
• Frequency – at every antenatal visit
• Tools – Maternity Case Record (MCR) [17] and PACK guide [18]
Training – to equip healthcare workers with the knowledge and skills to detect women with CMDs and domestic violence
Delivery of individual-level care – to detect women with symptoms of CMDs and domestic violence during private consultations
Audit and feedback – to assess and discuss screening rates with healthcare workers involved
Qualitative interviews with pregnant women and ANC nurses Documentation review - review of patient files and documents used to record detection rates
Poor linkages to care Referral - of pregnant women with symptoms of CMDs and domestic violence
• Provider – antenatal care nurses
• Recipient – pregnant women with CMDs or domestic violence
• Place – at MOU and BANC clinics
• Time – during routine consultations
• Frequency – when a woman screens positive and consents to counselling
• Tools – Referral form – Section A
Training – to equip ANC nurses with the tools and processes to link pregnant women who screen positive to care
Referral systems – development of standardised referral pathways
Audit and feedback – to assess and discuss referral rates with healthcare workers involved
Qualitative interviews with pregnant women and ANC nurses
Documentation review - review of registers and referral forms used during the referral process
Limited availability of treatment Treatment - provision of counselling sessions to perinatal women with symptoms of CMDs and domestic violence
• Provider – community health workers
• Recipient – perinatal women with symptoms of CMDs or domestic violence
• Place – in patients’ homes
• Time – as agreed by CHW and patient
• Frequency – 3 sessions
• Tools – Referral feedback – Section B
Training – to equip CHWs and OTLs with the knowledge, skills and tools to deliver psychological counselling
Task-sharing – to task CHWs with delivering a psychological counselling program
Delivery of individual-level care – to provide women with symptoms of CMDs and domestic violence with private psychological counselling sessions
Change to healthcare environment – to provide psychological counselling in women’s homes or at off-site venues
Audit and feedback – to assess and discuss counselling rates with CHWs and OTLs Performance monitoring – for OTLs to monitor the delivery of counselling sessions by CHWs
Qualitative interviews with pregnant women, OTLs and CHWs
Documentation review – weekly reports on counselling progress