Perinatal depression is a common and serious disorder, with suicide representing a major cause of maternal mortality, but few women from low and middle income countries (LMICs) receive effective treatment. Effective models of care that improve perinatal depression and support suicide prevention exist but have not yet been widely implemented in routine maternal-child care services in LMICs. These models include innovations to allow scarce specialty care to support high quality care in community settings and so are potentially well suited to low resourced countries. A major obstacle to achieving the benefits of these models is a lack of appropriate adaptation to the cultural and health services context of the settings in which they will be delivered. While evidence based models may work in the context in which they were developed maintaining too great an allegiance to fidelity without allowing adaptation can result in reduced effectiveness or ?voltage drop? in new settings. In contrast, a focus on flexible adaptation of care approaches has the potential to achieve or even exceed the outcomes seen in controlled efficacy trials by supporting intervention ?reinvention? within the context of a learning health system. Implementation strategies, in addition to the elements of the health service delivery itself, must also be appropriate to the cultural and health services context in which care innovations are to be introduced. We plan to use a participatory approach to systematically identify and adapt key elements of evidence based models of perinatal depression care delivery to the cultural and health services context of Can Tho, Vietnam. This federal-provincial city provides health services to a large region of the Mekong River Delta with over 19 million, mostly rural inhabitants. Over the two-year study period we will first develop a model, adapted from evidence based approaches, for screening and treatment for women receiving perinatal care in community health centers as well as obstetric hospitals. Simultaneous exploration of potential implementation strategies to support and sustain this model in context will be identified along with the creation of a training and implementation toolkit for this setting. Using these strategies and tools we will then carry out a pilot perinatal collaborative care study in a public health center and the prenatal care practice of the Can Tho Obstetric and Gynecologic Hospital. The results of this pilot will be used to revise and enhance the treatment model and related implementation tools. These will be used in subsequent trials of effectiveness and/or implementation broadly in the health care system of Can Tho.
Perinatal depression and associated risk of suicide are rarely identified or treated in low and middle income countries (LMICs). A major obstacle to achieving the benefits of evidence based models of care for perinatal depression is a focus on fidelity which may reduce adaptation and fit of models to local culture and context. We plan, over the two-year study period, to use a participatory approach to explore an intervention adaptation approach to develop a tailored treatment model and implementation strategy for perinatal depression in Can Tho Vietnam.
