Adaptation and Integration of Psychosocial Stimulation, Maternal Mental Health and Nutritional Interventions for Pregnant and Lactating Women in Rural Bangladesh
Abstract
:Key Messages
- Extending the scope of early child development intervention by including pregnancy and the post-childbirth periods, as well as maternal mental health is feasible in a low-resource setting;
- Development of such an integrated intervention requires a systematic process for the adaptation and feasibility testing;
- The three adaptation phases: situation analysis, intervention pilot, and identification of facilitators and barriers through participant feedback allow for productive curriculum revision;
- Inclusion of a greater number of visual cues, interactive role-play activities, simplified mental health contents, motivational meetings with family members, and tailoring of intervention contents to the age groups present improved intervention acceptability and ease of delivery;
- A structured adaptation process may allow for rapid development of a feasible intervention in a new population.
1. Background
2. Methods
2.1. Study Site and Design
2.2. Adaptation Phases of Integrated Intervention
2.2.1. Phase 1—Identify Core Components and Structure of Intervention
2.2.2. Phase 2—Pilot Initial Revisions of Intervention
2.2.3. Phase 3—Identify Feedback from Participants and CHWs
2.3. Ethical Approval
2.4. Data Analysis
3. Results
3.1. Phase 1: Identified Intervention Components and Structure
3.2. Phase 2: Feasibility of Implementing the Initial Revision of Intervention (Pilot Trial)
3.3. Phase 3: Participants’ Feedback after Intervention and Final Revision
3.4. Intervention Content
Before attending the session, I used to give toys to my baby, and she played alone… Now I have learned from the session… I followed this, and I have observed the benefit. Now my 5 month old daughter can make noise, pay attention to my sounds, and look at me when I call her by name (IDI-5).
I cannot eat between the afternoon (Asar) and evening (Maghrib) prayers, as my 27-day-old child died last year during this time period. People say that my dead son won’t get food if I take food during that time. So I will maintain this until my death (IDI-3).
Mothers can’t understand the thinking healthy story appropriately by the pictures only. It is difficult for us also (KII-1).
More visual things will help us to understand more. Videos are very helpful to memorize. Drama will be interesting (IDI-4).
3.5. Intervention Delivery and Participation
Some pregnant women felt uneasy to sit on the bed or floor. So, they sat on the chair. They also cannot sit for long. Then I allowed them to move for a while (KII-1).
Sometimes they didn’t want to share some feminine problems like danger signs if someone else was present in the session (KII-1).
It was hard to make them understand about the thinking healthy component and to identify their unhealthy thoughts. Who want to reveal own unproductive behavior in front of others? (KII-2)
If I could not finish my work, and the session is about to begin, my mother-in-law does the remaining work and let me go for the session (IDI-6).
3.6. Final Adaptation of Integrated Intervention
4. Discussion
5. Conclusions and Recommendations
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
References
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Study Phases | Goldstein et al.’s Manual Adaptation Process | Adaptation Stages of the Integrated Intervention in Parallel with the Process Developed by Goldstein et al. |
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Phase 1: Identify core components and structure of intervention | Stage-1: Choose a base manual for adaptation | The Reach-up curriculum for psychosocial stimulation was revised: contents for pregnancy and 0–5-month-old children were added. |
Stage-2: Conduct a focus group with the new target population | Two small group discussions with nine pregnant women and nine lactating mothers were used to identify the core contents of the intervention. | |
Stage-3: Make initial manual revisions | The integrated components of the intervention curriculum were revised based on the results of two small group discussions. | |
Phase 2: Pilot initial revision of intervention | Stage-4: Pilot initial revisions of the manualized intervention | The adapted intervention package was piloted with 11 pregnant women and 29 mothers of children <24 months of age with two different delivery strategies. |
Phase 3: Identify feedback from participants’ and CHWs | Stage-5: Conduct facilitator focus group | Interviews were conducted with the two facilitators and eight participants to identify areas for modification. |
Stage-6: Acquire expert review of the revised manual | The qualitative data from the pilot were systematically analyzed and reviewed by child development specialists to identify the barriers and facilitators of intervention delivery and uptake. | |
Stage-7: Incorporate staff and expert feedback | The curriculum was revised incorporating feedback from the facilitators, participants, and child development specialists. |
Major Theme | Pregnant Women | Lactating Mothers |
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General perception of factors affecting early childhood development |
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Interaction with children |
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Maternal mental health |
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Pregnancy problems |
| NA |
Negative thinking/Alternative beliefs |
| NA |
Characteristics (n = 36) | n (%) |
---|---|
Types of participants | |
Pregnant women | 9 (25) |
Mothers of children <2 years old | 27 (75) |
Mother’s education | |
Below primary or no formal education | 6 (16.7) |
Primary education | 26 (72.2) |
Secondary education | 4 (11.1) |
Father’s education | |
Below primary or no formal education | 13 (36.1) |
Primary education | 17 (47.2) |
Secondary education | 6 (16.7) |
Participants’ occupation | |
Housewife | 36 (100) |
Husbands’ occupation | |
Irregular income (e.g., day labor, farming) | 18 (50) |
Salaried work (e.g., government or private job with fixed monthly salary) | 6 (16.7) |
Other (e.g., shopkeeper, retired, living abroad) | 12 (33.3) |
Monthly Income | |
<8000 BDT (<94 USD) | 4 (11.1) |
8000–20,000 BDT (94–235 USD) | 29 (80.6) |
>20,000 BDT (>235 USD) | 3 (8.3) |
Housing construction (Wall material) | |
Cement | 7 (19.4) |
Corrugated iron sheets | 28 (77.8) |
Mud | 1 (2.8) |
Study Activities | Challenges | Mitigation Strategies |
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Initial curriculum development |
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Selection and training of CHWs |
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Pilot intervention |
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Respondents Code | Type of Respondents | Age (Years) | Last Completed Grade in School | Occupation | Monthly Household Income (BDT) |
---|---|---|---|---|---|
IDI-1 | Pregnant woman (2nd trimester) | 20 | Grade 8 | Housewife | 6000/= |
IDI-2 | Lactating mother (8-month old child) | 30 | Grade 2 | Housewife | 5000/= |
IDI-3 | Pregnant woman (3rd trimester) | 22 | Grade 5 | Housewife | 6000/= |
IDI-4 | Lactating mother (6-month old child) | 20 | Grade-5 | Housewife | 20,000/= |
IDI-5 | Lactating mother (5-month old child) | 24 | Grade 6 | Housewife | 6500/= |
IDI-6 | Lactating mother (7-month old child) | 20 | Grade 7 | Housewife | 25,000/= |
IDI-7 | Pregnant woman (2nd trimester) | 26 | Grade 10 | Housewife | 6000/= |
IDI-8 | Pregnant woman (2nd trimester) | 30 | Grade 6 | Housewife | 15,000/= |
KII-1 | CHW | 25 | Higher secondary level | Bachelor’s degree student | ------- |
KII-2 | CHW | 18 | Secondary level | Higher secondary school student | -------- |
Theme | Sub-Theme | Core Findings |
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Intervention content | ||
Facilitators to intervention success |
| |
Obstacles to practice recommended behavior |
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Suggestions for revision |
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Intervention strategy and participation | ||
Facilitators to intervention success |
| |
Obstacles to session delivery and participation |
| |
Suggestion for revision |
|
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Share and Cite
Akter, F.; Rahman, M.; Pitchik, H.O.; Winch, P.J.; Fernald, L.C.H.; Nurul Huda, T.M.; Jahir, T.; Amin, R.; Das, J.B.; Hossain, K.; et al. Adaptation and Integration of Psychosocial Stimulation, Maternal Mental Health and Nutritional Interventions for Pregnant and Lactating Women in Rural Bangladesh. Int. J. Environ. Res. Public Health 2020, 17, 6233. https://doi.org/10.3390/ijerph17176233
Akter F, Rahman M, Pitchik HO, Winch PJ, Fernald LCH, Nurul Huda TM, Jahir T, Amin R, Das JB, Hossain K, et al. Adaptation and Integration of Psychosocial Stimulation, Maternal Mental Health and Nutritional Interventions for Pregnant and Lactating Women in Rural Bangladesh. International Journal of Environmental Research and Public Health. 2020; 17(17):6233. https://doi.org/10.3390/ijerph17176233
Chicago/Turabian StyleAkter, Fahmida, Mahbubur Rahman, Helen O. Pitchik, Peter J. Winch, Lia C. H. Fernald, Tarique Mohammad Nurul Huda, Tania Jahir, Ruhul Amin, Jyoti Bhushan Das, Khobair Hossain, and et al. 2020. "Adaptation and Integration of Psychosocial Stimulation, Maternal Mental Health and Nutritional Interventions for Pregnant and Lactating Women in Rural Bangladesh" International Journal of Environmental Research and Public Health 17, no. 17: 6233. https://doi.org/10.3390/ijerph17176233