Table 4 Key features of THP adaptation
Original THP | THPP–Pakistan | THPP–India |
|---|---|---|
Format of delivery | ||
LHW-delivered 16 home based individual sessions. | Peer-delivered 10 home based individual sessions & 4 group sessions. | Peer-delivered 6 to14 home based individual sessions. |
Rationale: Fewer individual sessions as period of delivery was shorter for THPP. Introduction of group sessions in Pakistan based on formative research findings and evidence from the literature indicating that groups could be helpful for maternal depression. | ||
Training | ||
Training of LHWs: Three days classroom training conducted by mental health specialist. | Training of peers: Five days classroom training and field training conducted by the THPP trainers. Training of THPP trainers: 20 h classroom training and six month internship period conducted and supervised by the master trainer. | Training of peers: Five days classroom training comprising of eight sessions, delivered in two phases (the antenatal phase and the postnatal phases) and the field training conducted by the master trainer. |
Rationale: In order to develop a more sustainable model, peers were trained by non-specialist THPP trainers in Pakistan. Field training was introduced in both settings to build peers’ competency and fidelity to the intervention. | ||
Intervention material | ||
Reference Manual & Health Calendar | Reference Manual, Job-Aids and Health Calendar–consisting of health charts aimed towards behavioural activation of the mothers. | Field Guides and Activity Workbook. |
Rationale: The Job-Aids/Field Guides were introduced containing step-by-step instructions to facilitate peers’ in delivering of sessions. In India, pictorial illustrations were adapted and narratives were introduced to make the intervention culturally relevant to the setting. | ||
Supervision | ||
LHWs were supervised through monthly group supervisions by the mental health specialist. | Peers were supervised by the THPP trainers through regular monthly group and field supervisions. THPP trainers were supervised fortnightly by the mental health specialist. | Peers were supervised by the THPP trainers through fortnightly group supervisions and two individual supervisions during their internship period. |
Rationale: Cascade model is a relatively sustainable model because it requires fewer specialist workers. In Pakistan, frequent field supervisions to ensure continuous experiential learning, quality to the intervention and to maintain peers’ motivation. In India sessions were audio recorded and discussed during supervisions in order to provide feedback to the peers and to ensure quality. | ||
Emphasis on behaviour activation | ||
More discussion during supervisions and sessions delivery on cognitions. | More emphasis during supervisions and sessions delivery on behaviour. | Emphasis on using behaviour activation strategies during delivery of sessions and as focal point of discussion during supervisions. |
Rational: Based on formative research findings emphasis was given to behaviour activation. This strategy enabled the intervention to be comprehensible and deliverable by peers with no prior experience of delivering health care. To facilitate peers’ supervisions through non-mental health specialist, requiring less specialist skills. | ||
Payment | ||
LHWs were paid a regular salary. | Peers were paid only the sustenance allowance for travel to trainings and supervision. | Peers were paid a fixed amount for every session they successfully delivered. |
Rational: In Pakistan, the rural context was conducive to volunteerism. In India in order to ensure peers’ continuous motivation and engagement with the programme. See Singla et al., 2014 [29]. | ||