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Cited by 96Maternal Mental Health During Pregnancy and PostpartumMental Health and Patient InvolvementMental Health Treatment and Access

The DOI matches its Crossref record; 56 of the 56 references it cites were found in a registry or an index; none of the 60 sources its claims cite is checked for support yet.

Barefoot therapists: barriers and facilitators to delivering maternal mental health care through peer volunteers in Pakistan: a qualitative study

Open access
Atif, Najia, Lovell, Karina, Husain, Nusrat, Sikander, Siham, Patel, Vikram, Rahman, Atif·2016·International Journal of Mental Health Systems
DOI 10.1186/s13033-016-0055-9PMC PMC4793537
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Abstract

BACKGROUND: Perinatal depression is a public health problem in low and middle income countries. Although effective psychosocial interventions exist, a major limitation to their scale up is the scarcity of mental health professionals. The aim of this study was to explore the facilitators and barriers to the acceptability of peer volunteers (PVs)-volunteer lay women from the community with shared socio-demographic and life experiences with the target population-as delivery agents of a psychosocial intervention for perinatal depression in a rural area of Pakistan. METHODS: This qualitative study was embedded in the pilot phase of a larger peer-delivered mental health programme. Forty nine participants were included: depressed mothers (n = 21), PVs (n = 8), primary health care staff (n = 5), husbands (n = 5) and mothers-in-law (n = 10). Data were collected through in-depth interviews and focus groups and analysed using the Framework Analysis approach. RESULTS: The PVs were accepted as delivery agents by all key stakeholders. Facilitators included the PVs' personal attributes such as being local, trustworthy, empathetic, and having similar experiences of motherhood. The perceived usefulness and cultural appropriateness of the intervention and linkages with the primary health care (PHC) system was vital to their legitimacy and credibility. The PVs' motivation was important, and factors influencing this were: appropriate selection; effective training and supervision; community endorsement of their role, and appropriate incentivisation. Barriers included women's lack of autonomy, certain cultural beliefs, stigma associated with depression, lack of some mothers' engagement and resistance from some families. CONCLUSION: PVs are a potential human resource for the delivery of a psychosocial intervention for perinatal depression in this rural area of Pakistan. The use of such delivery agents could be considered for other under-resourced settings globally.

Overview

AI snapshot

Written from the paper’s full text.

TL;DR

Peer volunteers (PVs) were acceptable to mothers, families, PVs, and primary health care staff as delivery agents for a psychosocial intervention for perinatal depression in rural Pakistan. Acceptability depended on PV characteristics, intervention appropriateness, health-system linkage, and PV motivation, while stigma, cultural restrictions, and family resistance were barriers.

Key findings

  • PVs were accepted as delivery agents by all key stakeholder groups; facilitators included being local, trustworthy, empathetic, and having similar motherhood experiences, plus perceived usefulness and cultural appropriateness of the intervention and linkage with the primary health care (PHC) system.
  • PV motivation was influenced by appropriate selection, effective training and supervision, community endorsement, and appropriate incentivisation; barriers included women’s lack of autonomy, cultural beliefs, stigma associated with depression, lack of some mothers’ engagement, and resistance from some families.
  • The study included 49 participants: depressed mothers (n = 21), PVs (n = 8), PHC staff (n = 5), husbands (n = 5), and mothers-in-law (n = 10); data came from 34 in-depth interviews and 2 focus group discussions.
  • The authors present a six-area, 21-factor checklist (CHAMPs) for assessing peer-volunteer acceptance and motivation before implementation.

Methods

  • Qualitative study embedded in the pilot phase of the Thinking Healthy Programme peer-delivered (THPP), conducted in 2013–2014 in the rural sub-district of Rawalpindi, Punjab, Pakistan.
  • Participants were purposively sampled from the pilot study: mothers with perinatal depression, PVs, significant family members, and local PHC staff; PVs were lay women with at least 10 years of education, deployed for 6 months to deliver home-based and group sessions to 21 mothers.
  • Data were collected through in-depth interviews and focus groups, with separate topic guides, and analysed using the Framework Analysis approach; triangulation and reflexivity were used to support rigour.

Limitations

  • The paper states that the study was short-term, covering 6 months of PV deployment, so long-term consequences for PV acceptability and motivation could not be explored.
  • The paper states that it was conducted in one specific rural area of Pakistan, so findings need to be generalised with caution; social desirability may have influenced responses, and PVs’ aspirations for continued community work could have led them to paint a more positive picture.
  • Evident from the text: the sample was drawn from participants in a single pilot study, and the qualitative design relies on self-reported experiences, which may limit transferability and causal inference.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1186/s13033-016-0055-9

Cites

56 of 56 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Verification

Claims the paper makes

0 of 60 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    PVs with shared socio-demographic and life experiences of the mothers were acceptable as delivery agents of the psychosocial intervention.

    “Results found that PVs with shared socio-demographic and life experiences of the mothers, were acceptable as delivery agents of the psychosocial intervention.”
    • Also stated in: § Conclusion · plain
      “Qualitative data from a rural area of Pakistan showed that PVs were acceptable as delivery agents of a psychosocial intervention for perinatal depression to all the stakeholders.”
    Quote in the paperSubstantial claim
  • Findingown data

    In the current study, all stakeholders found the intervention relevant to the mothers' needs.

    “In the current study, all stakeholders found the intervention to be culturally appropriate, relevant to the mothers’ needs and helpful in improving the mothers’ mood, social skills and overall wellbeing, thus contributing to their acceptability.”
    Quote in the paperSubstantial claim
  • Findingown data

    Resistance from some families was a barrier to community acceptability.

    “resistance from some families.”
    Quote in the paperNot a substantial claim
  • Findingown data

    In the current study, all stakeholders found the intervention helpful in improving the mothers' mood, social skills and overall wellbeing.

    “In the current study, all stakeholders found the intervention to be culturally appropriate, relevant to the mothers’ needs and helpful in improving the mothers’ mood, social skills and overall wellbeing, thus contributing to their acceptability.”
    Quote in the paperSubstantial claim
  • Findingown data

    In the current study, there were many similarities between the mothers and PVs in terms of their age group, locality, language, number of children, gender and family structure.

    “In this study, there were many similarities between the mothers and PVs in terms of their age group, locality, language, number of children, gender and family structure.”
    Quote in the paperSubstantial claim
  • It may state two separate claims as one. 27
  • The quote only partly states this claim. 2
  • Probably not a substantial claim. 35

  • It may state two separate claims as one.

    Findingown data

    The study found high levels of need and good receptivity towards the intervention, and this contributed to its acceptability.

    “Our study found high levels of need and good receptivity towards the intervention, and this contributed to its acceptability.”
    Quote in the paperSubstantial claim

  • It may state two separate claims as one.

    Findingown data

    The intervention was perceived to be useful by the community, which contributed to both the acceptability and motivation of the PVs.

    “Our study has indicated that the intervention was perceived to be useful by the community, which contributed to both the acceptability and motivation of the PVs.”
    Quote in the paperSubstantial claim

  • It may state two separate claims as one.

    Findingown data

    PVs' personal attributes such as being local, approachable, empathic, trustworthy, enjoying a good reputation, having motherhood experience, and similar experiences of motherhood contributed to their acceptability.

    “Other factors that contributed to their acceptability were: being perceived trustworthy and respected members of the community; having motherhood experience; able to relate and empathise with the mothers, and befriending the mothers.”
    • Also stated in: § Conclusion · plain
      “The PVs’ personal attributes such as being local, approachable, empathic, trustworthy, enjoying a good reputation and having similar experiences of motherhood contributed to their acceptability.”
    Quote in the paperSubstantial claim

  • It may state two separate claims as one.

    Findingown data

    PVs' motivation was related to perceived personal gain from the role, their community's endorsement, and good training and supervision.

    “Their motivation was related to perceived personal gain from the role, their community’s endorsement, and good training and supervision.”
    • Also stated in: § Conclusion · plain
      “Factors influencing their motivation were effective training and supervision, perception of personal gain from the programme, and endorsement from their families and the community.”
    Quote in the paperSubstantial claim

  • It may state two separate claims as one.

    Findingown data

    Majority of the mothers found the intervention beneficial, which contributed to the PVs' acceptability.

    “Furthermore majority of the mothers found the intervention beneficial which contributed to the PVs’ acceptability.”
    Quote in the paperSubstantial claim

  • It may state two separate claims as one. The quote only partly states this claim.

    Findingown data

    Key factors contributing to the acceptability of PVs were their desirable personal characteristics, being local, having similar experiences of motherhood, and an ability to form a trustworthy and empathetic relationship with the mother and family.

    “Facilitators included the PVs’ personal attributes such as being local, trustworthy, empathetic, and having similar experiences of motherhood.”
    • Also stated in: § Synthesis of the results · plain
      “Our study found that the key factors contributing to the acceptability of the PVs was their desirable personal characteristics, being local and having an ability to form a trustworthy and empathetic relationship with the mother and family.”
    Quote in the paperSubstantial claim

  • It may state two separate claims as one.

    Findingown data

    PVs' level of acceptability was dependent on their personal characteristics (e.g., empathy and trustworthiness), being local and linked to the health system, and the intervention perceived as beneficial.

    “The PVs level of acceptability was dependent upon a number of key factors, including their personal characteristics (e.g., empathy and trustworthiness), being local and linked to the health system, and the intervention perceived as beneficial.”
    Quote in the paperSubstantial claim

  • It may state two separate claims as one.

    Findingown data

    Factors influencing PVs' motivation included appropriate selection, effective training and supervision, community endorsement of their role, and appropriate incentivisation.

    “factors influencing this were: appropriate selection; effective training and supervision; community endorsement of their role, and appropriate incentivisation.”
    Quote in the paperSubstantial claim

  • The quote only partly states this claim.

    Findingown data

    Women's lack of autonomy was a barrier to community acceptability.

    “Barriers included women’s lack of autonomy”
    Quote in the paperNot a substantial claim

  • It may state two separate claims as one.

    Findingown data

    The PVs found supervisory support adequate in enhancing their skills and in dealing with work related issues and challenges.

    “However, the PVs’ found supervisory support adequate in enhancing their skills and in dealing with work related issues and challenges.”
    Quote in the paperSubstantial claim

  • It may state two separate claims as one.

    Findingreasoning

    Personal development potentially led to improved confidence, self-esteem and social status.

    “Other key motivator were altruistic gains, and personal development through improvement in knowledge and skills, potentially leading to improved job opportunities, better understanding of own emotional issues and improved confidence, self-esteem and social status.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim.

    Findingown data

    The families felt that female elders of the families were best to educate mothers on maternity and child-rearing practices.

    “The families felt that female elders of the families were best to educate mothers on maternity and child-rearing practices and PV was not required unless her input is supplemented by monetary or other tangible incentives such as medicines or dietary supplements.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim. The paper’s conclusions may not depend on it.

    Premisecitation

    Globally, in women of child-bearing age, depression accounts for the largest proportion of the burden associated with mental or neurological disorders.

    “Globally, in women of child-bearing age, depression accounts for the largest proportion of the burden associated with mental or neurological disorders [1].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [1] Rahman A, et al. Grand challenges: integrating maternal mental health into maternal and child health programmes. PLoS Med. 2013;10(5):e1001442. source

  • Probably not a substantial claim. The paper’s conclusions may not depend on it.

    Premisecitation

    Over 67% of Pakistan's population resides in rural areas.

    “Over 67 % of Pakistan’s population resides in rural areas [12]”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [12] Goverment of Pakistan. Pakistan social and living standards measurement survey. Islamabad: Pakistan Bureau of Statistics, Goverment of Pakistan; 2013.

  • Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.

    Premisecitation

    In Pakistan, perinatal depression rates are higher than most LMICs, reported to range between 25 and 38%.

    “In Pakistan, these rates are even higher than most LMICs, reported to range between 25 and 38 % [3, 4].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [3] Husain N, et al. Prevalence and psychosocial correlates of perinatal depression: a cohort study from urban Pakistan. Arch Womens Ment Health. 2011;14(4):395–403. source
    • cites [4] Shaikh K, et al. The association between parity, infant gender, higher level of paternal education and preterm birth in Pakistan: a cohort study. BMC Pregnancy Childbirth. 2011;11(88):1–10.

  • It may state two separate claims as one.

    Premisecitation

    In rural Pakistan, only out-patient services are available through PHC facilities, which are proportionately few and generally provide no maternal mental health care.

    “where only out-patient services are available through PHC facilities, which include Rural Health Centres, Basic Health Units and government dispensaries. These facilities are proportionately few and generally provide no maternal mental health care [13].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [13] Economic Survey of Pakistan. Economic Survey of Pakistan, Goverment of Pakistan 2013–2014. Islamabad: Finance Division Economic Adviser’s Wing, Goverment of Pakistan; 2013.

  • Probably not a substantial claim. The paper’s conclusions may not depend on it.

    Premisecitation

    The rates of perinatal depression in lower and middle income countries (LMICs) range from 15.6% during pregnancy to 19.8% in the postpartum period.

    “The rates of perinatal depression in lower and middle income countries (LMICs) range from 15.6 % during pregnancy to 19.8 % in the postpartum period [2].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [2] Fisher J, 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;90:139G–49G. source

  • Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.

    Study design and conductnone given

    Interviews were recorded and transcribed verbatim for consenting participants; for others, notes were taken during the interview.

    “Interviews of all participants, who gave their consent, were recorded and were transcribed verbatim. For those who did not give their consent for recording, notes were taken during the interview.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim. The paper’s conclusions may not depend on it.

    Premisecitation

    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].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [34] Singla D, et al. “Someone like us”: delivering maternal mental health through peers in two SouthAsian contexts. J Affect Disord. 2014;168:452–8. source

  • It may state two separate claims as one.

    Premisecitation

    Peers have been successfully used in the delivery of maternal mental health care, but most studies were conducted in high-income countries and focus on quantitative outcomes.

    “Peers have been successfully used in the delivery of maternal mental health care, but most studies were conducted in high-income countries and focus on quantitative outcomes [24, 26, 27].”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [24] Dennis CL. The effect of peer support on postpartum depression: a pilot randomized controlled trial. Can J Psychiatry. 2003;48(2):115–24. source
    • cites [26] Dennis CL, et al. Effect of peer support on prevention of postnatal depression among high risk women: multisite randomised controlled trial. BMJ. 2009;338:a3064. source
    • cites [27] Letourneau N, et al. Effect of home-based peer support on maternal-infant interactions among women with postpartum depression: a randomized, controlled trial. Int J Ment Health Nurs. 2011;20(5):345–57. source

  • Probably not a substantial claim. The paper’s conclusions may not depend on it.

    Study design and conductnone given

    All summaries included in the chart were referenced to allow audit trail of the findings.

    “All summaries included in the chart were referenced to allow audit trail of the findings.”
    Quote in the paperNot a substantial claim

  • It may state two separate claims as one.

    Premisecitation

    Studies from similar settings in Pakistan have found lack of awareness of mental illnesses and stigma of depression as barriers to receiving help.

    “Studies from similar settings in Pakistan have found lack of awareness of mental illnesses and stigma of depression as barriers to receiving help [39].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [39] Rahman A. Challenges and opportunities in developing a psychological intervention for perinatal depression in rural Pakistan–a multi-method study. Arch Womens Ment Health. 2007;10(5):211–9. source

  • Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.

    Study design and conductnone given

    Reflexivity was ensured through maintaining field notes and engaging in regular discussions with the research teams in Pakistan and UK.

    “Reflexivity was ensured through maintaining field notes and engaging in regular discussions with the research teams in Pakistan and UK.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.

    Study design and conductown data

    Separate topic guides were developed for each participant group and pilot-tested.

    “Separate topic guides were developed for mothers, PVs, the PHC staff and mothers’ significant family members and pilot-tested.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim. The paper’s conclusions may not depend on it.

    Premisecitation

    A few experimental studies from LMICs have shown positive mental health outcomes from peer-delivered interventions.

    “A few experimental studies from LMICs have shown positive mental health outcomes from peer-delivered interventions [29–33].”
    Quote in the paperNot a substantial claim0 of 5 sources checked
    • cites [29] Chibanda D, et al. Group problem-solving therapy for postnatal depression among HIV-positive and HIV-negative mothers in Zimbabwe. J Int Assoc Provid AIDS Care. 2014;13(4):335–41. source
    • cites [30] Ali NS, et al. Effectiveness of counseling for anxiety and depression in mothers of children ages 0–30 months by community workers in Karachi, Pakistan: a quasi experimental study. BMC Psychiatry. 2010;10:57. source
    • cites [31] Clarke K, et al. Understanding psychological distress among mothers in rural Nepal: a qualitative grounded theory exploration. BMC Psychiatry. 2014;14(1):60. source
    • cites [32] Tripathy P, et al. Effect of a participatory intervention with women’s groups on birth outcomes and maternal depression in Jharkhand and Orissa, India: a cluster-randomised controlled trial. Lancet. 2010;375(9721):1182–92. source
    • cites [33] Futterman D, et al. Mamekhaya: a pilot study combining a cognitivebehavioral intervention and mentor mothers with PMTCT services in South Africa. AIDS Care. 2010;22(9):1093. source

  • Probably not a substantial claim.

    Premisecitation

    For a psychological intervention to be acceptable, emphasis has to be laid on its cultural appropriateness, contextual relevance and usefulness to the target population.

    “A recent systematic review has highlighted that for a psychological intervention to be acceptable, emphasis has to be laid on its cultural appropriateness, contextual relevance and usefulness to the target population [38].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [38] Chowdhary N, et al. The content and delivery of psychological interventions for perinatal depression by non-specialist health workers in low and middle income countries: a systematic review. Best Pract Res Clin Obstet Gynaecol. 2014;28(1):113–33. source

  • It may state two separate claims as one.

    Premisecitation

    A major barrier to the scale-up of THP is the burden of work of LHWs; their heavy work-load often leaves them little capacity to deliver mental health care as part of their routine work.

    “However, a major barrier to the scale-up of THP is the burden of work of LHWs. They are the front-line work-force for communicable diseases as well as provision of basic PHC, and their heavy work-load often leaves them little capacity to deliver mental health care as part of their routine work [22].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [22] Haq Z, Iqbal Z, Rahman A. Job stress among community health workers: a multi-method study from Pakistan. Int J Ment Health Syst. 2008;2:2–15. source

  • Probably not a substantial claim. The paper’s conclusions may not depend on it.

    Study design and conductcitation

    The study followed a framework for applied research focusing on core principles of quality: transparency and systematicity.

    “In order to ensure the rigour of the study, a framework for applied research focusing on core principles of quality: transparency and systematicity was followed [37], along with the procedures of triangulation and reflexivity.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [37] Meyrick J. What is good qualitative research? A first step towards a comprehensive approach to judging rigour/quality. J Health Psychol. 2006;11(5):799–808. source

  • Probably not a substantial claim. The paper’s conclusions may not depend on it.

    Premisecitation

    Systematic reviews from HICs on peer support indicated promising results, in terms of increased empowerment, confidence, self-esteem, hope, social support and functioning, for both the peers and persons with mental illness.

    “Systematic reviews from HICs on peer support indicated promising results, in terms of increased empowerment, confidence, self-esteem, hope, social support and functioning, for both the peers and persons with mental illness [25, 28].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [25] Repper J, Carter T. A review of the literature on peer support in mental health services. J Mental Health. 2011;20(4):392–411. source
    • cites [28] Walker G, Bryant W. Peer support in adult mental health services: a metasynthesis of qualitative findings. Psychiatr Rehabil J. 2013;36(1):28–34. source

  • Probably not a substantial claim. The paper’s conclusions may not depend on it.

    Interpretationnone given

    Three out of four key stakeholders (mothers, their families, and community health workers) can be conceptualized as 'the community' that might have a varying level of acceptability for the PVs.

    “Three out of these four key stakeholders, the mothers, their families, and community health workers, can be conceptualized as ‘the community’ that might have a varying level of acceptability for the PVs.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim.

    Study design and conductown data

    Triangulation of data sources was achieved through collecting data from different sets of participants and analysing similarities and differences to achieve greater understanding and more confidence in the findings.

    “Triangulation of data sources was achieved through collecting data from different sets of participants (mothers, their husbands and mothers-in-law, PVs and PHC staff) and analysing the similarities and differences to achieve greater understanding of the topic and more confidence in the findings.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim. The paper’s conclusions may not depend on it.

    Study design and conductnone given

    All recorded data were transcribed by trained transcribers.

    “All recorded data were transcribed by trained transcribers.”
    Quote in the paperNot a substantial claim

  • It may state two separate claims as one.

    Premisecitation

    Other studies found that peers offered friendship, shared personal experience, used empathic skills to build rapport, and were perceived as respected members of the community.

    “This is consistent with findings from other studies in which peers offered friendship, shared personal experience [42], and used empathic skills to build rapport [28, 43, 44] and were perceived respected members of the community [45].”
    Quote in the paperNot a substantial claim0 of 5 sources checked
    • cites [42] Murphy CA, Cupples ME, Percy A, Halliday HL, Stewart MC. Peer-mentoring for first-time mothers from areas of socio-economic disadvantage: A qualitative study within a randomised controlled trial. BMC Health Serv Res. 2008;8:46. source
    • cites [28] Walker G, Bryant W. Peer support in adult mental health services: a metasynthesis of qualitative findings. Psychiatr Rehabil J. 2013;36(1):28–34. source
    • cites [43] Alcock GA, et al. Community-based health programmes: role perceptions and experiences of female peer facilitators in Mumbai’s urban slums. Health Educ Res. 2009;24(6):957–66. source
    • cites [44] Nkonki LL, Daniels KL, P.-E.S. group. Selling a service: experiences of peer supporters while promoting exclusive infant feeding in three sites in South Africa. Int Breastfeed J. 2010;5:17–17. source
    • cites [45] Nankunda J, et al. “She would sit with me”: mothers’ experiences of individual peer support for exclusive breastfeeding in Uganda. Int Breastfeed J. 2010;5(16):4–13.

  • Probably not a substantial claim. The paper’s conclusions may not depend on it. The paper may give no reason why it holds.

    Interpretationnone given

    The level of acceptability of PVs is dependent on the peers' own level of motivation for the work they are undertaking.

    “This level of acceptability would, in turn, be dependent on the peers’ own level of motivation for the work they are undertaking.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim. The paper’s conclusions may not depend on it. The paper may give no reason why it holds.

    Study design and conductnone given

    The PVs' aspirations for continued community work could have resulted in them painting a more positive picture of their experience to give a good impression of their work.

    “Additionally, the PVs’ aspirations for continued community work could have resulted in them painting a more positive picture of their experience to give a good impression of their work.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim. The paper’s conclusions may not depend on it.

    Study design and conductnone given

    Framework Analysis allowed for a systematic, transparent and thorough analysis of the data.

    “Framework Analysis allowed for a systematic, transparent and thorough analysis of the data.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim. It may be too vague to check against evidence. The paper’s conclusions may not depend on it.

    Study design and conductreasoning

    The study applied robust qualitative research methodology.

    “The study applied robust qualitative research methodology.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim. It may state two separate claims as one.

    Interpretationcitation

    Training and supervision are crucial to ensure PVs have adequate skills and continuous motivation, which is essential for any programme.

    “These are crucial to ensure PVs have the adequate skills and continuous motivation, which is essential for any programme.”
    Quote in the paperSubstantial claim

  • It may state two separate claims as one.

    Interpretationreasoning

    Challenges such as families' lack of awareness, role ambiguity, and lack of monetary incentive could be demotivating for the PVs.

    “Such challenges could be demotivating for the PVs and needed to be addressed during supervision.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim. The paper’s conclusions may not depend on it. The paper may give no reason why it holds.

    Interpretationnone given

    The findings are supported by studies conducted in other LMICs that have used peers as delivery agents for maternal health conditions.

    “The findings are supported by studies conducted in other LMICs that have used peers as delivery agents for maternal health conditions.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim. The paper’s conclusions may not depend on it. The paper may give no reason why it holds. It may state two separate claims as one.

    Study design and conductreasoning

    The participants of the pilot study were recruited from the local community, and therefore the sample was representative of the rural population of Pakistan.

    “The participants of the pilot study were recruited from the local community, and therefore the sample was representative of the rural population of Pakistan.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim. It may be too vague to check against evidence. It may state two separate claims as one.

    Interpretationcitation

    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].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [34] Singla D, et al. “Someone like us”: delivering maternal mental health through peers in two SouthAsian contexts. J Affect Disord. 2014;168:452–8. source
    • cites [48] Maes KC, Kohrt BA, Closser S, et al. Culture, status and context in community health worker pay:pit falls and opportunities for policy research. A commentary on Glenton. Soc Sci Med. 2010;71(8):1375–8. source

  • Probably not a substantial claim. The paper’s conclusions may not depend on it. The paper may give no reason why it holds.

    Study design and conductnone given

    Reflexivity was ensured to maintain the author's objectivity during data collection and data analysis process.

    “In addition, reflexivity was ensured to maintain the author’s objectivity during data collection and data analysis process.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim. The paper’s conclusions may not depend on it.

    Premisecitation

    Peers, particularly from LMICs such as India, South Africa and Bangladesh, found the social aspect of volunteerism as one of motivators.

    “Peers, particularly from LMICs such as India, South Africa and Bangladesh found the social aspect of volunteerism as one of motivators [49, 57].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [49] Alcock GA, et al. Community-based health programmes: role perceptions and experiences of female peer facilitators in Mumbai’s urban slums. Health Educ Res. 2009;24(6):957–66. source
    • cites [57] Nankunda J, Soltvedt A, Semiyaga N, Ndeezi G, Tylleskär T. Community based peer counsellors for support of exclusive breastfeeding: experiences from rural Uganda. Int Breastfeed J. 2006;1:19. source

  • Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.

    Premisecitation

    Other studies have indicated similar advantages of adopting a collaborative model and the significance of synergy between goals to strengthen the partnership.

    “Evidence from other studies have also indicated similar advantages of adopting a collaborative model [46] and the significance of synergy between their goals to strengthen the partnership [47].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [46] Glenton C, et al. Barriers and facilitators to the implementation of lay health worker programmes to improve access to maternal and child health: qualitative evidence synthesis. Cochrane Database Syst Rev. 2013;10:CD010414.
    • cites [47] Pinto BM, Waldemore M, Rosen R. A community-based partnership to promote exercise among cancer survivors: lessons learned. Int J Behav Med. 2014;22(3):328–35. source

  • It may state two separate claims as one.

    Premisecitation

    Other studies have indicated similar factors as the driving force behind volunteering, including willingness to help others, increase in social and personal knowledge, better job prospects, and improved overall wellbeing.

    “Other studies have also indicated similar factors as the driving force behind volunteering. Factors such as willingness to help others [53–56], increase in social and personal knowledge [49, 53], better job prospects [25] and improved overall wellbeing [28] are the common motivators reported by the peers in several studies.”
    Quote in the paperNot a substantial claim0 of 6 sources checked
    • cites [53] Dennis CL. Peer support for postpartum depression: volunteers’ perceptions, recruitment strategies and training from a randomized controlled trialfrom a randomized controlled trial. Health Promot Int. 2012;28(2):187–96. source
    • cites [54] Withers M, Browner CH, Aghaloo T. Promoting volunteerism in global health: lessons from a medical mission in Northern Mexico. J Commun Health. 2013;38:374–84. source
    • cites [55] Black W, Living R. Volunteerism as an occupation and its relationship to health and wellbeing. Br J Occup Ther. 2004;67(12):526. source
    • cites [56] Stijn R, Graaf NDD. National context, religiosity and volunteering: results from 53 countries. Am Sociol Rev. 2006;71(2):191–201. source
    • cites [49] Alcock GA, et al. Community-based health programmes: role perceptions and experiences of female peer facilitators in Mumbai’s urban slums. Health Educ Res. 2009;24(6):957–66. source
    • cites [25] Repper J, Carter T. A review of the literature on peer support in mental health services. J Mental Health. 2011;20(4):392–411. source

  • Probably not a substantial claim. It may be too vague to check against evidence.

    Study design and conductreasoning

    The findings need to be generalised with caution to other settings.

    “Therefore, the findings need to be generalised with caution to other settings.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.

    Study design and conductreasoning

    Data was collected from all participants of the pilot study, representing a range of ages and experiences, which increased the chances of establishing a realistic picture of participant experiences.

    “Data was collected from all participants of the pilot study, representing a range of ages and experiences, which increased the chances of establishing a realistic picture of participant experiences.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim. The paper’s conclusions may not depend on it.

    Premisecitation

    Mechanic and Meyer found mental health patients more concerned about confidentiality issues as compared to patients with physical health problems.

    “Mechanic and Meyer also found mental health patients more concerned about confidentiality issues as compared to patients with physical health problems [50].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [50] Mechanic D, Meyer S. Concepts of trust among patients with serious illness. Soc Sci Med. 2000;51:657–68. source

  • Probably not a substantial claim. The paper’s conclusions may not depend on it.

    Study design and conductreasoning

    The long-term consequences of volunteering on the PVs acceptability and motivation could not be explored.

    “Therefore the long-term consequences of volunteering on the PVs acceptability and motivation could not be explored.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.

    Premisecitation

    Other studies highlighted training and supervision as crucial to maintain community health volunteers' interest and motivation, to enhance their credibility, and for the success of the peer support role.

    “The significance of training and supervision was also highlighted in other studies as crucial to maintain community health volunteers’ interest and motivation [48], to enhance their credibility [49] and for the success of the peer support role [28].”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [48] Maes KC, Kohrt BA, Closser S, et al. Culture, status and context in community health worker pay:pit falls and opportunities for policy research. A commentary on Glenton. Soc Sci Med. 2010;71(8):1375–8. source
    • cites [49] Alcock GA, et al. Community-based health programmes: role perceptions and experiences of female peer facilitators in Mumbai’s urban slums. Health Educ Res. 2009;24(6):957–66. source
    • cites [28] Walker G, Bryant W. Peer support in adult mental health services: a metasynthesis of qualitative findings. Psychiatr Rehabil J. 2013;36(1):28–34. source

  • Probably not a substantial claim. The paper’s conclusions may not depend on it.

    Premisecitation

    According to Daniels et al., the emotional support provided through supervision was particularly helpful in settings where lay workers had not previously worked outside of their own homes.

    “According to Daniels et al., the emotional support provided through supervision was particularly helpful in settings where lay workers had not previously worked outside of their own homes [52].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [52] Daniels K, et al. Supervision of community peer counsellors for infant feeding in South Africa: an exploratory qualitative study. Human Resour Health. 2010;8:6. source

  • Probably not a substantial claim. The paper’s conclusions may not depend on it. The paper may give no reason why it holds.

    Study design and conductnone given

    Social desirability might have influenced the responses of the participants.

    “Social desirability might have influenced the responses of the participants.”
    Quote in the paperNot a substantial claim
53 of 53

  • The paper relies on this without support.

    No studies in LMIC have been conducted exploring in depth stakeholders’ experiences of a peer volunteer-delivered psychosocial intervention in a rural, close-knit community.

    “To our knowledge no studies in LMIC have been conducted exploring in depth stakeholders’ experiences of a peer volunteer-delivered psychosocial intervention in a rural, close-knit community.”
1 of 1

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Interventions are often enhanced by having task-sharing providers with strong existing community ties and credibility, shared lived experience, and non-stigmatizing attitudes.

    “Interventions s are often enhanced by having task-sharing providers with strong existing community ties and credibility, shared lived experience, and non-stigmatizing attitudes [91, 92].”

    From Barriers and facilitators to implementation of evidence-based task-sharing mental health interventions in low- and middle-income countries: a systematic review using implementation science frameworks (2022) · cites this paper as [91]

    The Discussion (page not provided) identifies locally based, trusted and respected peer volunteers with similar life experiences as factors in community acceptability, and says a local health-system partnership enhanced their credibility. The Results identify stigma of mental illness as a barrier, but do not establish that providers’ non-stigmatizing attitudes enhanced the intervention. (LLM, conf=0.85)

    Experimental — accuracy not yet measured

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • One PV is said not to be a mother, but all PVs are listed as having children

    Minor

    The results say one PV was not a mother, while Table 2 gives the PVs' number-of-children range as 1-4, which would mean every PV had at least one child.

  • An India-based study is cited as evidence from Pakistan

    Minor

    The text describes both cited studies as being from Pakistan, but the title of reference 7 explicitly places that study in India.

2 of 2

Citations

Cites

Flagged first, then by citations

Research works printed but not linked: 4

  1. Goverment of Pakistan. Pakistan social and living standards measurement survey. Islamabad: Pakistan Bureau of Statistics, Goverment of Pakistan; 2013.
  2. Economic Survey of Pakistan. Economic Survey of Pakistan, Goverment of Pakistan 2013–2014. Islamabad: Finance Division Economic Adviser’s Wing, Goverment of Pakistan; 2013.
  3. World Health Organisation. Mental Health Atlas 2011. Geneva: Department of Mental Health and Substance Abuse. World Health Organization; 2011.
  4. Alcock GA, et al. Community-based health programmes: role perceptions and experiences of female peer facilitators in Mumbai’s urban slums. Health Educ Res. 2009;24(6):957–66. · DOI · Paper page

Cited by

Sorted by citations

Related

Metadata

Authors
Atif, N., Lovell, K., Husain, N., Sikander, S., Patel, V., & Rahman, A.
Affiliations
  • University of Manchester (GB)
  • Human Development Research Foundation (PK)
  • London School of Hygiene & Tropical Medicine (GB)
Corresponding author
Atif, Najia
ORCID
Venue
International Journal of Mental Health Systems
Publisher
Springer Science and Business Media LLC
Published
2016-03-15
Volume
10
Issue
1
Pages
24-24
ISSN
1752-4458 (ISSN-L)
DOI
10.1186/s13033-016-0055-9
PMC
PMC4793537
OpenAlex
W2302330634
Semantic Scholar
2533e7baced1010442c96ed54c177e10a022a444
Cited by
96
References
56
Citations by year
2026: 9 · 2025: 9 · 2024: 18 · 2023: 10 · 2022: 13 · 2021: 13 · 2020: 14 · 2019: 6 · 2018: 1 · 2017: 2 · 2016: 1
FWCI
3.31
Type
journal article
Language
en
Open access
Licence
Locations
  • International Journal of Mental Health Systems (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Research Explorer (The University of Manchester) (publishedVersion, cc-by)
  • LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
Funders
National Institute of Mental Health (1U19MH095687-01)
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
  • Health Sciences › Medicine › Psychiatry and Mental health › Mental Health Treatment and Access
Keywords
perinatal depression, peer volunteers, lay health workers, maternal mental health care, psychosocial interventions, barriers and facilitators, acceptability, cultural appropriateness, stigma, primary care integration, rural Pakistan, women's autonomy

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

A language model drew the claims from the paper on 2026-10-07, under version 3 of the claim definition (model deepseek-v4.1-flash, prompt extract-v3).

A second model labelled each claim on 2026-10-07 (model jev-1.13-20260917, definition revision gold-guideline-v0.2).

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

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