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Background. Depression is a common and severe disorder among low-income adolescent mothers in low-and middle-income countries where resources for treatment are limited. We wished to identify factors influencing health service utilization for adolescent perinatal depression, in Nigeria to inform new strategies of care delivery.
Methods. Focus Group Discussions (FGDs) were conducted among purposively selected low-income young mothers (with medical histories of adolescent perinatal depression), and separately with primary care clinicians treating this condition in Ibadan, Nigeria. Participants from this community-based study were from the database of respondents who participated in a previous randomized control trial (RCT) conducted between 2014 and 2016 in 28 primary health care facilities in the 11 Local government areas in Ibadan. Semi-structured interview guides, framed by themes of the Behavioral Model for Vulnerable Populations, was developed to obtain views of participants on the factors that promote or hinder help-seeking and engagement (see additional files 1 & 2). FGDs were conducted, and saturation of themes was achieved after discussions with six groups. Transcripts were analyzed using content analysis.
Results. A total of 42 participants, 17 mothers (who were adolescents at the time of the RCT), and 25 care providers participated in 6 FGDs. The availability of care for perinatal depression at the primary care level was an important enabling factor in healthcare utilization for the adolescents. Perceived health benefits of treatment received for perinatal depression were strong motivation for service use. Significant stigma and negative stereotypes expressed by care providers towards adolescent pregnancy and perinatal depression were obstacles to care. However, individual patient resilience was a major enabling factor, facilitating service engagement. Providers trained in the management of perinatal depression were perceived to deliver more tolerant and supportive care that adolescent mothers valued.
Conclusions. Participants identified unsupportive and stigmatizing clinic environments towards pregnant and parenting adolescents as significant barriers to accessing available care. Interventions to reduce stigma among healthcare providers may improve services for this vulnerable population.
Keywords
Perinatal depression, adolescent, pregnancy, stigma, health care utilization, resilience, low- and middle-income country.
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CURRENT STATUS: Published
View the published article at BMC Pregnancy and Childbirth.
Version 4
Posted 04 May, 2020
No community comments so far
Submission checks complete
On 23 Apr, 2020
Editorial decision: Accept
On 23 Apr, 2020
No comments provided
Submission checks complete
On 15 Apr, 2020
Editorial decision: Minor revision
On 15 Apr, 2020
No comments provided
Editorial decision: Minor revision
On 01 Apr, 2020
Review #2 received
Received 31 Mar, 2020
Review #1 received
Received 17 Mar, 2020
Reviewer #2 agreed
On 03 Mar, 2020
Reviewer #1 agreed
On 27 Feb, 2020
Reviewers invited
Invitations sent on 26 Feb, 2020
Editor assigned
On 17 Feb, 2020
Submission checks complete
On 16 Feb, 2020
Editor invited
On 16 Feb, 2020
No comments provided
Editorial decision: Major revision
On 07 Jan, 2020
Review #2 received
Received 03 Jan, 2020
Review #1 received
Received 27 Dec, 2019
Reviewer #1 agreed
On 12 Dec, 2019
Reviewer #2 agreed
On 12 Dec, 2019
Reviewers invited
Invitations sent on 12 Dec, 2019
Editor assigned
On 09 Dec, 2019
Submission checks complete
On 05 Dec, 2019
Editor invited
On 05 Dec, 2019
Metrics
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PDF Downloads: ...
HTML Views: ...
Subject Areas
Maternal & Fetal Medicine
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A new preprint design is coming!
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See the published version of this preprint at BMC Pregnancy and Childbirth.
This is a preprint, a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research article
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Published
View the published article at BMC Pregnancy and Childbirth.
Version 4
Posted 04 May, 2020
No community comments so far
Submission checks complete
On 23 Apr, 2020
Editorial decision: Accept
On 23 Apr, 2020
No comments provided
Submission checks complete
On 15 Apr, 2020
Editorial decision: Minor revision
On 15 Apr, 2020
No comments provided
Editorial decision: Minor revision
On 01 Apr, 2020
Review #2 received
Received 31 Mar, 2020
Review #1 received
Received 17 Mar, 2020
Reviewer #2 agreed
On 03 Mar, 2020
Reviewer #1 agreed
On 27 Feb, 2020
Reviewers invited
Invitations sent on 26 Feb, 2020
Editor assigned
On 17 Feb, 2020
Submission checks complete
On 16 Feb, 2020
Editor invited
On 16 Feb, 2020
No comments provided
Editorial decision: Major revision
On 07 Jan, 2020
Review #2 received
Received 03 Jan, 2020
Review #1 received
Received 27 Dec, 2019
Reviewer #1 agreed
On 12 Dec, 2019
Reviewer #2 agreed
On 12 Dec, 2019
Reviewers invited
Invitations sent on 12 Dec, 2019
Editor assigned
On 09 Dec, 2019
Submission checks complete
On 05 Dec, 2019
Editor invited
On 05 Dec, 2019
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Maternal & Fetal Medicine
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published article at BMC Pregnancy and Childbirth.
Background. Depression is a common and severe disorder among low-income adolescent mothers in low-and middle-income countries where resources for treatment are limited. We wished to identify factors influencing health service utilization for adolescent perinatal depression, in Nigeria to inform new strategies of care delivery.
Methods. Focus Group Discussions (FGDs) were conducted among purposively selected low-income young mothers (with medical histories of adolescent perinatal depression), and separately with primary care clinicians treating this condition in Ibadan, Nigeria. Participants from this community-based study were from the database of respondents who participated in a previous randomized control trial (RCT) conducted between 2014 and 2016 in 28 primary health care facilities in the 11 Local government areas in Ibadan. Semi-structured interview guides, framed by themes of the Behavioral Model for Vulnerable Populations, was developed to obtain views of participants on the factors that promote or hinder help-seeking and engagement (see additional files 1 & 2). FGDs were conducted, and saturation of themes was achieved after discussions with six groups. Transcripts were analyzed using content analysis.
Results. A total of 42 participants, 17 mothers (who were adolescents at the time of the RCT), and 25 care providers participated in 6 FGDs. The availability of care for perinatal depression at the primary care level was an important enabling factor in healthcare utilization for the adolescents. Perceived health benefits of treatment received for perinatal depression were strong motivation for service use. Significant stigma and negative stereotypes expressed by care providers towards adolescent pregnancy and perinatal depression were obstacles to care. However, individual patient resilience was a major enabling factor, facilitating service engagement. Providers trained in the management of perinatal depression were perceived to deliver more tolerant and supportive care that adolescent mothers valued.
Conclusions. Participants identified unsupportive and stigmatizing clinic environments towards pregnant and parenting adolescents as significant barriers to accessing available care. Interventions to reduce stigma among healthcare providers may improve services for this vulnerable population.
Figure 1
This is a list of supplementary files associated with this preprint. Click to download.
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