Enhancing Access to Mental Health Services for Antepartum and Postpartum Women Through Telemental Health Services at Wellbeing Centers in Selected Health Facilities in Bangladesh: Implementation Research
BackgroundGlobally, 10% of pregnant women and 13% of postpartum women experience mental disorders. In Bangladesh, nearly 50% of mothers face common mental disorders, but mental health services and trained professionals to serve their needs are scarce. To address this, the gov...
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JMIR Publications
2025-01-01
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| Series: | JMIR Pediatrics and Parenting |
| Online Access: | https://pediatrics.jmir.org/2025/1/e65912 |
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| author | Aniqa Tasnim Hossain Md Hafizur Rahman Ridwana Maher Manna Ema Akter SM Hasibul Islam Md Alamgir Hossain Tasnu Ara Nasimul Ghani Usmani Pradip Chandra Maruf Ahmed Khan SM Mustafizur Rahman Helal Uddin Ahmed Muhammad Kamruzzaman Mozumder Jesmin Mahmuda Juthi Fatema Shahrin Sadia Afrose Shams Fahmida Afroze Mukta Jahan Banu Shafiqul Ameen Sabrina Jabeen Anisuddin Ahmed Mohammad Robed Amin Shams El Arifeen Mohammad Sohel Shomik Ahmed Ehsanur Rahman |
| author_facet | Aniqa Tasnim Hossain Md Hafizur Rahman Ridwana Maher Manna Ema Akter SM Hasibul Islam Md Alamgir Hossain Tasnu Ara Nasimul Ghani Usmani Pradip Chandra Maruf Ahmed Khan SM Mustafizur Rahman Helal Uddin Ahmed Muhammad Kamruzzaman Mozumder Jesmin Mahmuda Juthi Fatema Shahrin Sadia Afrose Shams Fahmida Afroze Mukta Jahan Banu Shafiqul Ameen Sabrina Jabeen Anisuddin Ahmed Mohammad Robed Amin Shams El Arifeen Mohammad Sohel Shomik Ahmed Ehsanur Rahman |
| author_sort | Aniqa Tasnim Hossain |
| collection | DOAJ |
| description |
BackgroundGlobally, 10% of pregnant women and 13% of postpartum women experience mental disorders. In Bangladesh, nearly 50% of mothers face common mental disorders, but mental health services and trained professionals to serve their needs are scarce. To address this, the government of Bangladesh’s Non-Communicable Disease Control program initiated “Wellbeing Centers,” telemental health services in selected public hospitals.
ObjectiveThis study examines implementation outcomes, including adoption, accessibility, acceptability, feasibility, usefulness, need, experience, perception, and expectations of the Wellbeing Centers, with a focus on antepartum and postpartum women.
MethodsBetween January 2023 and August 2024, we interviewed 911 antepartum and postpartum women receiving mental health services and 168 health care providers at 6 Wellbeing Centers in 4 districts in Bangladesh. Data collection involved both quantitative and qualitative methods. Implementation outcomes were measured following the World Health Organization’s implementation research framework. Depression and anxiety symptoms were assessed using the Patient Health Questionnaire-9 and Generalized Anxiety Disorder-7 questionnaires. Descriptive statistics and adjusted odds ratios (aORs) with 95% CIs were used to evaluate the implementation outcomes. Qualitative information was obtained through in-depth interviews and key-informant interviews.
ResultsAlmost all health care providers (165/168, 98.2%) reported that the Wellbeing Centers were feasible to implement in their health facilities; however, about half (84/168, 50%) felt that trained staff to operate them were insufficient. Almost all women agreed that the Wellbeing Centers were acceptable (906/911, 99.8%), useful (909/911, 99.8%), and enhanced access to mental health care (906/911, 99.5%). Patients visiting district-level hospitals had higher odds of access (aOR 1.5, 95% CI 1.1-2.0) to Wellbeing Centers. Moreover, 77.4% (705/911) of women experienced depression symptoms, and 76.7% (699/911) experienced anxiety symptoms. About 51.8% (472/911) experienced tiredness or lack of energy, 50.9% (464/911) felt nervous, anxious, or on edge, 57.2% (521/911) felt worried, and 3.8% (35/911) had suicidal ideation almost every day. Patients visiting district hospitals had higher odds (aOR 2.6, 95% CI 1.8-3.78) of depression and anxiety symptoms compared to the patients visiting subdistrict-level hospitals. Decreasing trends in Patient Health Questionnaire-9 scores (from mean 14.4, SD 0.47 to mean 12.9, SD 0.47) and Generalized Anxiety Disorder-7 scores (from mean 13.3, SD 0.49 to mean 12.5, SD 0.48) between 2 counseling sessions indicated improved mental health in the antepartum and postpartum women. The Wellbeing Centers’ services were appreciated for their privacy and being free and accessible. However, stigma, postpartum illness, and long waiting times prevented some women from using these services.
ConclusionsTo our knowledge, this is the first implementation research assessing telemental health in public health facilities involving trained psychologists and psychiatrists. Our study highlighted the increased accessibility, feasibility, acceptability, and utility of Wellbeing Centers for antepartum and postpartum women in Bangladesh, supporting their scale-up in similar settings. |
| format | Article |
| id | doaj-art-1cd834f1541c47279f7f042113816e63 |
| institution | Kabale University |
| issn | 2561-6722 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | JMIR Publications |
| record_format | Article |
| series | JMIR Pediatrics and Parenting |
| spelling | doaj-art-1cd834f1541c47279f7f042113816e632025-01-03T21:46:03ZengJMIR PublicationsJMIR Pediatrics and Parenting2561-67222025-01-018e6591210.2196/65912Enhancing Access to Mental Health Services for Antepartum and Postpartum Women Through Telemental Health Services at Wellbeing Centers in Selected Health Facilities in Bangladesh: Implementation ResearchAniqa Tasnim Hossainhttps://orcid.org/0000-0003-4868-6729Md Hafizur Rahmanhttps://orcid.org/0000-0002-2742-049XRidwana Maher Mannahttps://orcid.org/0000-0002-3782-7859Ema Akterhttps://orcid.org/0000-0003-4772-5431SM Hasibul Islamhttps://orcid.org/0009-0002-2938-7192Md Alamgir Hossainhttps://orcid.org/0000-0003-4514-1934Tasnu Arahttps://orcid.org/0000-0002-1105-7876Nasimul Ghani Usmanihttps://orcid.org/0009-0002-3824-6711Pradip Chandrahttps://orcid.org/0000-0002-3958-0546Maruf Ahmed Khanhttps://orcid.org/0009-0001-7008-6909SM Mustafizur Rahmanhttps://orcid.org/0009-0002-1669-2120Helal Uddin Ahmedhttps://orcid.org/0000-0003-4106-218XMuhammad Kamruzzaman Mozumderhttps://orcid.org/0000-0001-5369-3339Jesmin Mahmuda Juthihttps://orcid.org/0009-0004-7510-6106Fatema Shahrinhttps://orcid.org/0009-0006-8103-5628Sadia Afrose Shamshttps://orcid.org/0009-0003-5115-3031Fahmida Afrozehttps://orcid.org/0009-0004-4998-3586Mukta Jahan Banuhttps://orcid.org/0009-0007-6568-1934Shafiqul Ameenhttps://orcid.org/0000-0002-3208-8663Sabrina Jabeenhttps://orcid.org/0000-0002-0231-2070Anisuddin Ahmedhttps://orcid.org/0000-0001-6030-0468Mohammad Robed Aminhttps://orcid.org/0000-0002-5500-5103Shams El Arifeenhttps://orcid.org/0000-0002-5372-5932Mohammad Sohel Shomikhttps://orcid.org/0000-0002-8192-6862Ahmed Ehsanur Rahmanhttps://orcid.org/0000-0001-9216-1079 BackgroundGlobally, 10% of pregnant women and 13% of postpartum women experience mental disorders. In Bangladesh, nearly 50% of mothers face common mental disorders, but mental health services and trained professionals to serve their needs are scarce. To address this, the government of Bangladesh’s Non-Communicable Disease Control program initiated “Wellbeing Centers,” telemental health services in selected public hospitals. ObjectiveThis study examines implementation outcomes, including adoption, accessibility, acceptability, feasibility, usefulness, need, experience, perception, and expectations of the Wellbeing Centers, with a focus on antepartum and postpartum women. MethodsBetween January 2023 and August 2024, we interviewed 911 antepartum and postpartum women receiving mental health services and 168 health care providers at 6 Wellbeing Centers in 4 districts in Bangladesh. Data collection involved both quantitative and qualitative methods. Implementation outcomes were measured following the World Health Organization’s implementation research framework. Depression and anxiety symptoms were assessed using the Patient Health Questionnaire-9 and Generalized Anxiety Disorder-7 questionnaires. Descriptive statistics and adjusted odds ratios (aORs) with 95% CIs were used to evaluate the implementation outcomes. Qualitative information was obtained through in-depth interviews and key-informant interviews. ResultsAlmost all health care providers (165/168, 98.2%) reported that the Wellbeing Centers were feasible to implement in their health facilities; however, about half (84/168, 50%) felt that trained staff to operate them were insufficient. Almost all women agreed that the Wellbeing Centers were acceptable (906/911, 99.8%), useful (909/911, 99.8%), and enhanced access to mental health care (906/911, 99.5%). Patients visiting district-level hospitals had higher odds of access (aOR 1.5, 95% CI 1.1-2.0) to Wellbeing Centers. Moreover, 77.4% (705/911) of women experienced depression symptoms, and 76.7% (699/911) experienced anxiety symptoms. About 51.8% (472/911) experienced tiredness or lack of energy, 50.9% (464/911) felt nervous, anxious, or on edge, 57.2% (521/911) felt worried, and 3.8% (35/911) had suicidal ideation almost every day. Patients visiting district hospitals had higher odds (aOR 2.6, 95% CI 1.8-3.78) of depression and anxiety symptoms compared to the patients visiting subdistrict-level hospitals. Decreasing trends in Patient Health Questionnaire-9 scores (from mean 14.4, SD 0.47 to mean 12.9, SD 0.47) and Generalized Anxiety Disorder-7 scores (from mean 13.3, SD 0.49 to mean 12.5, SD 0.48) between 2 counseling sessions indicated improved mental health in the antepartum and postpartum women. The Wellbeing Centers’ services were appreciated for their privacy and being free and accessible. However, stigma, postpartum illness, and long waiting times prevented some women from using these services. ConclusionsTo our knowledge, this is the first implementation research assessing telemental health in public health facilities involving trained psychologists and psychiatrists. Our study highlighted the increased accessibility, feasibility, acceptability, and utility of Wellbeing Centers for antepartum and postpartum women in Bangladesh, supporting their scale-up in similar settings.https://pediatrics.jmir.org/2025/1/e65912 |
| spellingShingle | Aniqa Tasnim Hossain Md Hafizur Rahman Ridwana Maher Manna Ema Akter SM Hasibul Islam Md Alamgir Hossain Tasnu Ara Nasimul Ghani Usmani Pradip Chandra Maruf Ahmed Khan SM Mustafizur Rahman Helal Uddin Ahmed Muhammad Kamruzzaman Mozumder Jesmin Mahmuda Juthi Fatema Shahrin Sadia Afrose Shams Fahmida Afroze Mukta Jahan Banu Shafiqul Ameen Sabrina Jabeen Anisuddin Ahmed Mohammad Robed Amin Shams El Arifeen Mohammad Sohel Shomik Ahmed Ehsanur Rahman Enhancing Access to Mental Health Services for Antepartum and Postpartum Women Through Telemental Health Services at Wellbeing Centers in Selected Health Facilities in Bangladesh: Implementation Research JMIR Pediatrics and Parenting |
| title | Enhancing Access to Mental Health Services for Antepartum and Postpartum Women Through Telemental Health Services at Wellbeing Centers in Selected Health Facilities in Bangladesh: Implementation Research |
| title_full | Enhancing Access to Mental Health Services for Antepartum and Postpartum Women Through Telemental Health Services at Wellbeing Centers in Selected Health Facilities in Bangladesh: Implementation Research |
| title_fullStr | Enhancing Access to Mental Health Services for Antepartum and Postpartum Women Through Telemental Health Services at Wellbeing Centers in Selected Health Facilities in Bangladesh: Implementation Research |
| title_full_unstemmed | Enhancing Access to Mental Health Services for Antepartum and Postpartum Women Through Telemental Health Services at Wellbeing Centers in Selected Health Facilities in Bangladesh: Implementation Research |
| title_short | Enhancing Access to Mental Health Services for Antepartum and Postpartum Women Through Telemental Health Services at Wellbeing Centers in Selected Health Facilities in Bangladesh: Implementation Research |
| title_sort | enhancing access to mental health services for antepartum and postpartum women through telemental health services at wellbeing centers in selected health facilities in bangladesh implementation research |
| url | https://pediatrics.jmir.org/2025/1/e65912 |
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