Skip to main content
Top
Published in: BMC Pregnancy and Childbirth 1/2020

Open Access 01-12-2020 | Affective Disorder | Research article

Making therapies culturally relevant: translation, cultural adaptation and field-testing of the Thinking Healthy Programme for perinatal depression in China

Authors: Anum Nisar, Juan Yin, Nan Yiping, Huo Lanting, Jingjun Zhang, Duolao Wang, Atif Rahman, Xiaomei Li

Published in: BMC Pregnancy and Childbirth | Issue 1/2020

Login to get access

Abstract

Background

The prevalence of perinatal depression in China ranges from 15 to 20% and the vast majority of prenatally depressed women do not receive the intervention they require. Recent research evidence shows that evidence based, culturally–adapted psychosocial interventions are effective in reducing mental health problems. The World Health Organization (WHO) has endorsed the Thinking Healthy Programme (THP), which is an evidence based psychosocial intervention that can be delivered by non-mental health specialists. The aim of this study was to translate and adapt THP for the Chinese population and to establish its acceptability when delivered by non-specialists to a group of mothers with perinatal depression.

Methods

The study was conducted in two phases. The THP manual, handbook, and health calendar was translated and adapted based on 8 domains of the Bernal framework (language, metaphors, content, concepts, goals, context, people and methods). Pre-testing was done using cognitive interviewing in the first phase. In second phase of field-testing, THP sessions were delivered to the depressed women by local THP trained nurses. Post intervention, programme survey was used for evaluation.

Results

This study showed that the core structure, process and techniques of the THP were culturally compatible with the target Chinese population and did not require major changes. It was found that the adapted version of THP manual, handbook, and health calendar were acceptable, understandable, and culturally relevant to the Chinese women and their family members. Nurses were found as a suitable delivery agent by the mothers and their families.

Conclusion

The Thinking Healthy Programme is acceptable and transferable to the Chinese cultural and healthcare context and nurses are a suitable delivery agent. The translated and adapted version of THP can be used for further implementation and evaluation studies in the Chinese context. Further evaluation can help establish the effectiveness of the programme and barriers to scale-up in China.
Literature
1.
go back to reference Rahman A, Surkan PJ, Cayetano CE, Rwagatare P, Dickson KE. Grand challenges: integrating maternal mental health into maternal and child health programmes. PLoS Med. 2013;10(5):e1001442.CrossRef Rahman A, Surkan PJ, Cayetano CE, Rwagatare P, Dickson KE. Grand challenges: integrating maternal mental health into maternal and child health programmes. PLoS Med. 2013;10(5):e1001442.CrossRef
2.
go back to reference Gaynes BN, Gavin N, Meltzer-Brody S, Lohr KN, Swinson T, Gartlehner G, et al. Perinatal depression: prevalence, screening accuracy, and screening outcomes: summary report: Agency for Healthcare Research and Quality (US); 2005. Gaynes BN, Gavin N, Meltzer-Brody S, Lohr KN, Swinson T, Gartlehner G, et al. Perinatal depression: prevalence, screening accuracy, and screening outcomes: summary report: Agency for Healthcare Research and Quality (US); 2005.
3.
go back to reference Austin MP. Antenatal screening and early intervention for “perinatal” distress, depression and anxiety: where to from here? Arch Womens Ment Health. 2004;7(1):1–6.CrossRef Austin MP. Antenatal screening and early intervention for “perinatal” distress, depression and anxiety: where to from here? Arch Womens Ment Health. 2004;7(1):1–6.CrossRef
4.
go back to reference Fisher J, Mello MC, Patel V, Rahman A, Tran T, Holton S, et al. Prevalence and determinants of common perinatal mental disorders in women in low-and lower-middle-income countries: a systematic review. Bull World Health Organ. 2012;90:139–49.CrossRef Fisher J, Mello MC, Patel V, Rahman A, Tran T, Holton S, et al. Prevalence and determinants of common perinatal mental disorders in women in low-and lower-middle-income countries: a systematic review. Bull World Health Organ. 2012;90:139–49.CrossRef
5.
go back to reference Grote NK, Bridge JA, Gavin AR, Melville JL, Iyengar S, Katon WJ. A meta-analysis of depression during pregnancy and the risk of preterm birth, low birth weight, and intrauterine growth restriction. Arch Gen Psychiatry. 2010;67(10):1012–24.CrossRef Grote NK, Bridge JA, Gavin AR, Melville JL, Iyengar S, Katon WJ. A meta-analysis of depression during pregnancy and the risk of preterm birth, low birth weight, and intrauterine growth restriction. Arch Gen Psychiatry. 2010;67(10):1012–24.CrossRef
6.
go back to reference Evans J, Heron J, Francomb H, Oke S, Golding J. Cohort study of depressed mood during pregnancy and after childbirth. BMJ. 2001;323(7307):257–60.CrossRef Evans J, Heron J, Francomb H, Oke S, Golding J. Cohort study of depressed mood during pregnancy and after childbirth. BMJ. 2001;323(7307):257–60.CrossRef
7.
go back to reference Kurki T, Hiilesmaa V, Raitasalo R, Mattila H, Ylikorkala O. Depression and anxiety in early pregnancy and risk for preeclampsia. Obstet Gynecol. 2000;95(4):487–90.PubMed Kurki T, Hiilesmaa V, Raitasalo R, Mattila H, Ylikorkala O. Depression and anxiety in early pregnancy and risk for preeclampsia. Obstet Gynecol. 2000;95(4):487–90.PubMed
8.
go back to reference Lutsiv O, McKinney B, Foster G, Taylor VH, Pullenayegum E, McDonald SD. Pregnancy complications associated with the co-prevalence of excess maternal weight and depression. Int J Obes. 2015;39(12):1710.CrossRef Lutsiv O, McKinney B, Foster G, Taylor VH, Pullenayegum E, McDonald SD. Pregnancy complications associated with the co-prevalence of excess maternal weight and depression. Int J Obes. 2015;39(12):1710.CrossRef
9.
go back to reference Bitew T, Hanlon C, Kebede E, Honikman S, Fekadu A. Antenatal depressive symptoms and perinatal complications: a prospective study in rural Ethiopia. BMC Psychiatry. 2017;17(1):301.CrossRef Bitew T, Hanlon C, Kebede E, Honikman S, Fekadu A. Antenatal depressive symptoms and perinatal complications: a prospective study in rural Ethiopia. BMC Psychiatry. 2017;17(1):301.CrossRef
10.
go back to reference Bernard-Bonnin A-C, Canadian Paediatric S, Mental H, Developmental DC. Maternal depression and child development. Paediatr Child Health. 2004;9(8):575–83.CrossRef Bernard-Bonnin A-C, Canadian Paediatric S, Mental H, Developmental DC. Maternal depression and child development. Paediatr Child Health. 2004;9(8):575–83.CrossRef
11.
go back to reference Rahman A, Bunn J, Lovel H, Creed F. Association between antenatal depression and low birthweight in a developing country. Acta Psychiatr Scand. 2007;115(6):481–6.CrossRef Rahman A, Bunn J, Lovel H, Creed F. Association between antenatal depression and low birthweight in a developing country. Acta Psychiatr Scand. 2007;115(6):481–6.CrossRef
12.
go back to reference Bergman K, Sarkar P, O'Connor TG, Modi N, Glover V. Maternal stress during pregnancy predicts cognitive ability and fearfulness in infancy. J Am Acad Child Adolesc Psychiatry. 2007;46(11):1454–63.CrossRef Bergman K, Sarkar P, O'Connor TG, Modi N, Glover V. Maternal stress during pregnancy predicts cognitive ability and fearfulness in infancy. J Am Acad Child Adolesc Psychiatry. 2007;46(11):1454–63.CrossRef
13.
go back to reference Beijers R, Jansen J, Riksen-Walraven M, de Weerth C. Maternal prenatal anxiety and stress predict infant illnesses and health complaints. Pediatrics. 2010;126(2):e401–e9.CrossRef Beijers R, Jansen J, Riksen-Walraven M, de Weerth C. Maternal prenatal anxiety and stress predict infant illnesses and health complaints. Pediatrics. 2010;126(2):e401–e9.CrossRef
14.
go back to reference Mu T-Y, Li Y-H, Pan H-F, Zhang L, Zha D-H, Zhang C-L, et al. Postpartum depressive mood (PDM) among Chinese women: a meta-analysis. Archives of women's mental health. 2019;22(2):279–87.CrossRef Mu T-Y, Li Y-H, Pan H-F, Zhang L, Zha D-H, Zhang C-L, et al. Postpartum depressive mood (PDM) among Chinese women: a meta-analysis. Archives of women's mental health. 2019;22(2):279–87.CrossRef
16.
go back to reference Patel V, Xiao S, Chen H, Hanna F, Jotheeswaran AT, Luo D, et al. The magnitude of and health system responses to the mental health treatment gap in adults in India and China. Lancet. 2016;388(10063):3074–84.CrossRef Patel V, Xiao S, Chen H, Hanna F, Jotheeswaran AT, Luo D, et al. The magnitude of and health system responses to the mental health treatment gap in adults in India and China. Lancet. 2016;388(10063):3074–84.CrossRef
17.
go back to reference Guo Y, Huang Y. Realising equity in maternal health: China's successes and challenges. Lancet. 2019;393(10168):202–4.CrossRef Guo Y, Huang Y. Realising equity in maternal health: China's successes and challenges. Lancet. 2019;393(10168):202–4.CrossRef
18.
go back to reference Sockol LE, Epperson CN, Barber JP. A meta-analysis of treatments for perinatal depression. Clin Psychol Rev. 2011;31(5):839–49.CrossRef Sockol LE, Epperson CN, Barber JP. A meta-analysis of treatments for perinatal depression. Clin Psychol Rev. 2011;31(5):839–49.CrossRef
19.
go back to reference Rahman A, Fisher J, Bower P, Luchters S, Tran T, Yasamy MT, et al. Interventions for common perinatal mental disorders in women in low-and middle-income countries: a systematic review and meta-analysis. Bull World Health Organ. 2013;91:593–601I.CrossRef Rahman A, Fisher J, Bower P, Luchters S, Tran T, Yasamy MT, et al. Interventions for common perinatal mental disorders in women in low-and middle-income countries: a systematic review and meta-analysis. Bull World Health Organ. 2013;91:593–601I.CrossRef
21.
go back to reference Rahman A, Malik A, Sikander S, Roberts C, Creed F. Cognitive behaviour therapy-based intervention by community health workers for mothers with depression and their infants in rural Pakistan: a cluster-randomised controlled trial. Lancet. 2008;372(9642):902–9.CrossRef Rahman A, Malik A, Sikander S, Roberts C, Creed F. Cognitive behaviour therapy-based intervention by community health workers for mothers with depression and their infants in rural Pakistan: a cluster-randomised controlled trial. Lancet. 2008;372(9642):902–9.CrossRef
22.
go back to reference Fuhr DC, Weobong B, Lazarus A, Vanobberghen F, Weiss HA, Singla DR, et al. Delivering the thinking healthy Programme for perinatal depression through peers: an individually randomised controlled trial in India. Lancet Psychiatry. 2019;6(2):115–27.CrossRef Fuhr DC, Weobong B, Lazarus A, Vanobberghen F, Weiss HA, Singla DR, et al. Delivering the thinking healthy Programme for perinatal depression through peers: an individually randomised controlled trial in India. Lancet Psychiatry. 2019;6(2):115–27.CrossRef
23.
go back to reference Sikander S, Ahmad I, Atif N, Zaidi A, Vanobberghen F, Weiss HA, et al. Delivering the thinking healthy Programme for perinatal depression through volunteer peers: a cluster randomised controlled trial in Pakistan. Lancet Psychiatry. 2019;6(2):128–39.CrossRef Sikander S, Ahmad I, Atif N, Zaidi A, Vanobberghen F, Weiss HA, et al. Delivering the thinking healthy Programme for perinatal depression through volunteer peers: a cluster randomised controlled trial in Pakistan. Lancet Psychiatry. 2019;6(2):128–39.CrossRef
24.
go back to reference Eappen BS, Aguilar M, Ramos K, Contreras C, Prom MC, Scorza P, et al. Preparing to launch the ‘thinking healthy Programme’perinatal depression intervention in urban Lima, Peru: experiences from the field. Global Mental Health. 2018;5. Eappen BS, Aguilar M, Ramos K, Contreras C, Prom MC, Scorza P, et al. Preparing to launch the ‘thinking healthy Programme’perinatal depression intervention in urban Lima, Peru: experiences from the field. Global Mental Health. 2018;5.
25.
go back to reference Fisher J, Nguyen H, Mannava P, Tran H, Dam T, Tran H, et al. Translation, cultural adaptation and field-testing of the thinking healthy program for Vietnam. Glob Health. 2014;10(1):37.CrossRef Fisher J, Nguyen H, Mannava P, Tran H, Dam T, Tran H, et al. Translation, cultural adaptation and field-testing of the thinking healthy program for Vietnam. Glob Health. 2014;10(1):37.CrossRef
26.
go back to reference Bernal G, Jiménez-Chafey MI, Rodriguez MMD. Cultural adaptation of treatments: a resource for considering culture in evidence-based practice. Professional Psychology Research and Practice. 2009;40(4):361–8.CrossRef Bernal G, Jiménez-Chafey MI, Rodriguez MMD. Cultural adaptation of treatments: a resource for considering culture in evidence-based practice. Professional Psychology Research and Practice. 2009;40(4):361–8.CrossRef
27.
go back to reference Beatty PC, Willis GB. Research synthesis: the practice of cognitive interviewing. Public Opin Q. 2007;71(2):287–311.CrossRef Beatty PC, Willis GB. Research synthesis: the practice of cognitive interviewing. Public Opin Q. 2007;71(2):287–311.CrossRef
28.
go back to reference Carbone ET, Campbell MK, Honess-Morreale L. Use of cognitive interview techniques in the development of nutrition surveys and interactive nutrition messages for low-income populations. J Am Diet Assoc. 2002;102(5):690–6.CrossRef Carbone ET, Campbell MK, Honess-Morreale L. Use of cognitive interview techniques in the development of nutrition surveys and interactive nutrition messages for low-income populations. J Am Diet Assoc. 2002;102(5):690–6.CrossRef
29.
go back to reference Tol WA, Augustinavicius J, Carswell K, Leku MR, Adaku A, Brown FL, et al. Feasibility of a guided self-help intervention to reduce psychological distress in south Sudanese refugee women in Uganda. World Psychiatry. 2018;17(2):234.CrossRef Tol WA, Augustinavicius J, Carswell K, Leku MR, Adaku A, Brown FL, et al. Feasibility of a guided self-help intervention to reduce psychological distress in south Sudanese refugee women in Uganda. World Psychiatry. 2018;17(2):234.CrossRef
30.
go back to reference Carter PD. Building purposeful action: action methods and action research. Educational Action Research. 2002;10(2):207–32.CrossRef Carter PD. Building purposeful action: action methods and action research. Educational Action Research. 2002;10(2):207–32.CrossRef
31.
go back to reference Howie P, Bagnall R. A methodology for field-testing concepts through expert practitioner engagement. Int J Soc Res Methodol. 2017;20(4):401–10.CrossRef Howie P, Bagnall R. A methodology for field-testing concepts through expert practitioner engagement. Int J Soc Res Methodol. 2017;20(4):401–10.CrossRef
33.
go back to reference Xiang Y-T, Yu X, Sartorius N, Ungvari GS, Chiu HFK. Mental health in China: challenges and progress. Lancet. 2012;380(9855):1717–6.CrossRef Xiang Y-T, Yu X, Sartorius N, Ungvari GS, Chiu HFK. Mental health in China: challenges and progress. Lancet. 2012;380(9855):1717–6.CrossRef
34.
go back to reference Wang W, Bian Q, Zhao Y, Li X, Wang W, Du J, et al. Reliability and validity of the Chinese version of the patient health questionnaire (PHQ-9) in the general population. Gen Hosp Psychiatry. 2014;36(5):539–44.CrossRef Wang W, Bian Q, Zhao Y, Li X, Wang W, Du J, et al. Reliability and validity of the Chinese version of the patient health questionnaire (PHQ-9) in the general population. Gen Hosp Psychiatry. 2014;36(5):539–44.CrossRef
35.
go back to reference Kilbourne AM, Neumann MS, Pincus HA, Bauer MS, Stall R. Implementing evidence-based interventions in health care: application of the replicating effective programs framework. Implement Sci. 2007;2(1):42.CrossRef Kilbourne AM, Neumann MS, Pincus HA, Bauer MS, Stall R. Implementing evidence-based interventions in health care: application of the replicating effective programs framework. Implement Sci. 2007;2(1):42.CrossRef
37.
go back to reference Ngai F-W, Wong PW-C, Leung K-Y, Chau P-H, Chung K-F. The effect of telephone-based cognitive-behavioral therapy on postnatal depression: a randomized controlled trial. Psychother Psychosom. 2015;84(5):294–303.CrossRef Ngai F-W, Wong PW-C, Leung K-Y, Chau P-H, Chung K-F. The effect of telephone-based cognitive-behavioral therapy on postnatal depression: a randomized controlled trial. Psychother Psychosom. 2015;84(5):294–303.CrossRef
38.
go back to reference Huang J, Li H-J, Wang J, Mao H-J, Jiang W-Y, Zhou H, et al. Prenatal emotion management improves obstetric outcomes: a randomized control study. Int J Clin Exp Med. 2015;8(6):9667.PubMedPubMedCentral Huang J, Li H-J, Wang J, Mao H-J, Jiang W-Y, Zhou H, et al. Prenatal emotion management improves obstetric outcomes: a randomized control study. Int J Clin Exp Med. 2015;8(6):9667.PubMedPubMedCentral
39.
go back to reference Mao HJ, Li HJ, Chiu H, Chan WC, Chen SL. Effectiveness of antenatal emotional self-management training program in prevention of postnatal depression in Chinese women. Perspect Psychiatr Care. 2012;48(4):218–24.CrossRef Mao HJ, Li HJ, Chiu H, Chan WC, Chen SL. Effectiveness of antenatal emotional self-management training program in prevention of postnatal depression in Chinese women. Perspect Psychiatr Care. 2012;48(4):218–24.CrossRef
40.
go back to reference Yin J, Nisar A, Waqas A, Guo Y, Qi W, Wang D, et al. Psychosocial interventions for perinatal depression in China: a systematic review and meta-analysis. J Affect Disord. 2020; (In press). Yin J, Nisar A, Waqas A, Guo Y, Qi W, Wang D, et al. Psychosocial interventions for perinatal depression in China: a systematic review and meta-analysis. J Affect Disord. 2020; (In press).
41.
go back to reference Ma H. Integration of hospital and community services—the ‘686 project’—is a crucial component in the reform of China's mental health services. Shanghai Arch Psychiatry. 2012;24(3):172.PubMedPubMedCentral Ma H. Integration of hospital and community services—the ‘686 project’—is a crucial component in the reform of China's mental health services. Shanghai Arch Psychiatry. 2012;24(3):172.PubMedPubMedCentral
42.
go back to reference Pan X, Dib HH, Wang X, Zhang H. Service utilization in community health centers in China: a comparison analysis with local hospitals. BMC Health Serv Res. 2006;6(1):93.CrossRef Pan X, Dib HH, Wang X, Zhang H. Service utilization in community health centers in China: a comparison analysis with local hospitals. BMC Health Serv Res. 2006;6(1):93.CrossRef
43.
go back to reference Liu S, Page A. Reforming mental health in China and India. Lancet. 2016;388(10042):314–6.CrossRef Liu S, Page A. Reforming mental health in China and India. Lancet. 2016;388(10042):314–6.CrossRef
Metadata
Title
Making therapies culturally relevant: translation, cultural adaptation and field-testing of the Thinking Healthy Programme for perinatal depression in China
Authors
Anum Nisar
Juan Yin
Nan Yiping
Huo Lanting
Jingjun Zhang
Duolao Wang
Atif Rahman
Xiaomei Li
Publication date
01-12-2020
Publisher
BioMed Central
Published in
BMC Pregnancy and Childbirth / Issue 1/2020
Electronic ISSN: 1471-2393
DOI
https://doi.org/10.1186/s12884-020-03044-1

Other articles of this Issue 1/2020

BMC Pregnancy and Childbirth 1/2020 Go to the issue