Accepted for/Published in: JMIR Mental Health
Date Submitted: Apr 10, 2020
Date Accepted: Jul 26, 2020
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Scaling up psychological treatments through non-specialist providers and telemedicine: A multi-stakeholder perspective
ABSTRACT
Background:
Task-sharing has been used worldwide to improve access to health care, where non (mental health) specialist providers—individuals with no formal training in mental health—have been educated to effectively treat perinatal depressive and anxiety symptoms. Little formative research has been conducted to determine the acceptability and feasibility of non-specialist providers and the use of digital solutions like telemedicine in treatment service delivery.
Objective:
The primary objective of this study was to examine the acceptability and feasibility of non-specialist provider-delivered psychological treatments for the perinatal population with depression from a multi-stakeholder perspective.
Methods:
The study took place in Toronto, Canada. N=33 in-depth interviews were conducted with multiple stakeholder groups (women with lived experience, their significant others, as well as health and mental health clinicians). Qualitative data was quantified to estimate commonly endorsed themes within and across stakeholder groups.
Results:
Psychological treatments delivered by non-specialist providers was considered acceptable and feasible by the vast majority of participants (n=30 of 33; 90%). Nurses and midwives were the most commonly endorsed cadre of non-specialist providers. Most stakeholders were amenable to non-specialist providers delivering psychological treatment via telemedicine although concerns were raised about the ability to establish a therapeutic alliance. There was minimal different between stakeholder groups. However, patient stakeholders emphasized stigma as an important barrier to accessing psychological treatments and clinician stakeholders emphasized the importance of ensuring non-specialist providers were well-trained to deliver psychological treatments.
Conclusions:
These results can inform the scalability of non-specialist delivered interventions and the design of future studies involving psychological treatments delivered by NSPs and via telemedicine delivered for women with perinatal depressive and anxiety symptoms. In light of COVID-19, the implications of scaling up psychological treatments through telemedicine and non-specialist providers are particularly relevant to address the burden of perinatal mental health. Clinical Trial: Not applicable
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