Integrating perinatal mental health screening into primary maternal healthcare services in Vietnam - a realist evaluation

Introduction

Prevalence of common perinatal mental disorders (CPMDs) in Vietnam ranges from 16.9% to 39.9%, and substantial treatment gaps exist across health systems levels. This paper reports a realist evaluation of an intervention which aimed to integrate screening for CPMDs using the Self Reporting Questionnaire 20 (SRQ 20) at antenatal care services in primary healthcare facilities in Bac Giang province, Vietnam.

Methods

We conducted a realist evaluation of the intervention’s implementation to understand the context, mechanisms and outcomes of integrated maternal mental healthcare provision at primary care level in Vietnam. We report results from a quantitative survey, qualitative focus groups and interviews with key health system actors and pregnant women. Survey results were analysed using the Kirkpatrick evaluation approach, and qualitative results were analysed retroductively against the initial program theory.

Results

The intervention was implemented over six months during May-October 2023. Over this period 1,265 pregnant women at the District Hospitals and 504 at the Commune Health Centers were screened using the SRQ-20, respectively. Maternity care providers recognized the importance of perinatal mental health and care provision at the primary care level. Their self-efficacy and confidence in CPMD management were enhanced after continuing medical education courses on mental health management. The intervention contributed to improve health systems responsiveness to mental health needs among pregnant women at primary healthcare facilities.

Conclusion

Our work indicates that integrated screening of CPMDs using SRQ-20 into routine antenatal care services at the primary care level is feasible in Vietnam. The findings advance the understanding of the contexts, mechanisms, and outcomes of how the intervention works, and provide explanations for what is required for effective integration of perinatal mental health at primary care level in Vietnam.