“Someone like us”: Delivering maternal mental health through peers in two South Asian contexts
Open accessAbstract
Background Peer-led psychosocial interventions are one solution to address the great paucity of skilled mental health human resources in South Asia. The aim of this study was to explore peer-delivered care for maternal depression in two diverse contexts in South Asia.Methods The study was carried out in the urban setting of Goa, India and rural setting in Rawalpindi, Pakistan. In total, 61 in-depth interviews (IDIs) and 3 focus group discussions (FGDs), and 38 IDIs and 10 FGDs, were conducted with multiple stakeholders in urban Goa and rural Rawalpindi respectively. We used the framework approach to analyze data.Results Peers from the same community were the most preferred delivery agents of a community-based psychosocial intervention in both sites. There were contextual similarities and differences between the two sites. Preferred characteristics among peers included local, middle-aged, educated mothers with similar experiences to participants, good communication skills and a good character. Key differences between the two contexts included a greater emphasis on the peer׳s family social standing in rural Rawalpindi and financial incentives as motivators for individual peers in urban Goa.Limitations Generalizability of our findings is limited to two specific contexts in a vast and diverse region.Discussion Our study demonstrates that peers have the potential to deliver maternal psychosocial interventions in low-income settings. There are contextual differences in the preferred characteristics and motivators between the sites, and these should be carefully considered in program implementation.
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Singla's formative study in Goa, India and Rawalpindi, Pakistan showed contextual differences such as levels of urbanisation, education and emancipation of women, can influence stakeholders' viewpoint about an ideal peer, and the peers' own expectations from this role.
“Singla’s formative study in Goa, India and Rawalpindi, Pakistan showed contextual differences such as levels of urbanisation, education and emancipation of women, can influence stakeholders’ viewpoint about an ideal peer, and the peers’ own expectations from this role [34].”
From Barefoot therapists: barriers and facilitators to delivering maternal mental health care through peer volunteers in Pakistan: a qualitative study (2016) · cites this paper as [34]
Such findings highlight the significance of giving careful attention to contextual differences when peer-delivered programmes are being considered for implementation-this applies especially to the concept of volunteerism-a 'one size fit all' approach may be inappropriate for diverse contexts.
“Such findings highlight the significance of giving careful attention to contextual differences when peer-delivered programmes are being considered for implementation—this applies especially to the concept of volunteerism—a ‘one size fit all’ approach may be inappropriate for diverse contexts [34, 48].”
From Barefoot therapists: barriers and facilitators to delivering maternal mental health care through peer volunteers in Pakistan: a qualitative study (2016) · cites this paper as [34]
Mental health patients' greater concern about confidentiality is especially true in closely-knit rural communities.
“This is especially true in closely-knit rural communities [34, 51].”
From Barefoot therapists: barriers and facilitators to delivering maternal mental health care through peer volunteers in Pakistan: a qualitative study (2016) · cites this paper as [34]
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- Authors
- Singla, D., Lazarus, A., Atif, N., Sikander, S., Bhatia, U., Ahmad, I., Nisar, A., Khan, S., Fuhr, D., Patel, V., & Rahman, A.
- Affiliations
- McGill University (CA)
- Sangath (IN)
- Human Development Research Foundation (PK)
- London School of Hygiene & Tropical Medicine (GB)
- Corresponding author
- Patel, Vikram
- ORCID
- Venue
- Journal of Affective Disorders
- Publisher
- Elsevier BV
- Published
- 2014-10
- Volume
- 168
- Pages
- 452-458
- ISSN
- 0165-0327 (ISSN-L)
- PMC
- PMC4157588
- OpenAlex
- W2018083048
- Cited by
- 71
- References
- 38
- Citations by year
- 2026: 7 · 2025: 5 · 2024: 3 · 2023: 4 · 2022: 6 · 2021: 16 · 2020: 8 · 2019: 7 · 2018: 4 · 2017: 4 · 2016: 5 · 2015: 2
- FWCI
- 3.65
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of Affective Disorders (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- LSHTM Research Online (London School of Hygiene and Tropical Medicine) (submittedVersion)
- Funders
- Wellcome Trust (084674, 100714)
- National Institutes of Health
- National Institute of Mental Health (U19MH095687, U19MH1095687)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Maternal Mental Health During Pregnancy and Postpartum
- Health Sciences › Health Professions › General Health Professions › Mental Health and Patient Involvement
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Keywords
- maternal depression, peer support, psychosocial interventions, community mental health, South Asia, Goa, Rawalpindi, stakeholder perspectives, peer characteristics, financial incentives, low-income settings, mental health workforce shortage
- MeSH terms
- Adult, Delivery of Health Care, Family, Female, Humans, India, Male, Maternal Health Services, Maternal Welfare, Mental Health, Mental Health Services, Middle Aged, Pakistan, Peer Group, Poverty, Pregnancy, Rural Population, Focus Groups
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