A Common Elements-based Intervention to Improve Maternal Psychological Well-being and Mother-infant Interaction

NCT ID: NCT04252807

Last Updated: 2022-08-03

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

250 participants

Study Classification

INTERVENTIONAL

Study Start Date

2020-02-07

Study Completion Date

2021-12-31

Brief Summary

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Background: Millions of children in low resource settings are at high risk of poor development due to factors such as undernutrition, inadequate stimulation and maternal depression. Evidence based interventions to address these risk factors exist, but often as a separate and overlapping packages delivered through disjointed systems, therefore posing problems in scale-up. A common elements approach based intervention that combines evidence-based elements from packages of care addressing early stimulation, responsive feeding and maternal distress have been developed.

Objectives: The current study aims to develop an online training curriculum to train lay health workers in common elements based intervention to improve maternal psychological well-being and improve mother-infant interaction among distressed mothers in low resource rural community settings of Pakistan. The impact of intervention on maternal well-being, infant growth, nutrition and development will be evaluated at 12-months post-partum.

Method: A two arm, single blind, individual randomized controlled trial (RCT) will be carried out in the community settings of the rural sub-district of Gujar Khan in Rawalpindi, Pakistan. 250 Pregnant women in third trimester of pregnancy, screened positive for psychological distress on Self-Reporting Questionnaire (SRQ), cut-off score ≥ 9, will be randomized on 1:1 allocation ratio into intervention (n=125) and Treatment as Usual (TAU) arms (n=125). The participants in the intervention arm will receive 15 monthly sessions of intervention by community volunteers at home. First three sessions will be delivered in the third trimester of pregnancy followed by one monthly session for 12 months. The primary outcome will be caregiver-infant interaction at 12-months post-partum. The maternal secondary outcomes include maternal psychological wellbeing, quality of life, social support and empowerment. Maternal outcomes will be measured at baseline, 6-months and 12-months post-partum. Infant secondary outcomes include growth, nutrition and development and will be measured at 12 months. A mixed-methods process monitoring and evaluation will be conducted to inform the feasibility of intervention delivery.

Discussion: The outcomes of the study will be a common-elements based online training curriculum for training of community volunteers in intervention to improve maternal psychological well-being and mother-infant interaction in low resource rural community settings at-scale.

Detailed Description

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Conditions

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Maternal Distress Perinatal Depression Development Delay Language Delay Cognitive Developmental Delay Nutrition Poor Growth Delay Motor Delay Maternal Behavior Infant Development Infant Malnutrition Infant Behavior

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Single blind, two arm, individual randomized controlled trial
Primary Study Purpose

TREATMENT

Blinding Strategy

DOUBLE

Investigators Outcome Assessors
Study investigators and outcome assessors will be blind to the allocations status of participants. To ensure blinding, participants will be instructed to not disclose their allocation during assessment.

Fidelity of masking will be ensured by having assessors guess the allocation status of participants at the end of assessments.

Study Groups

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Intervention arm

Distressed mothers randomized to intervention arm will receive a common elements based integrated intervention that combines evidence based elements from packages of care addressing early stimulation, responsive feeding and perinatal depression. The integrated intervention is expected to a) improve mother psychological distress, b) improve family support, c) improve child development and d) promote mother-infant interaction.

The participants will receive 15 monthly sessions at home by lay health workers. First three sessions will be delivered to the participants in the third trimester of pregnancy, followed by 12 monthly sessions afterwards.

Group Type EXPERIMENTAL

Intervention arm

Intervention Type BEHAVIORAL

In addition to the routine care delivered by Lady Health Workers (LHWs), the participants in the intervention arm will receive common elements based integrated intervention. The providers of the intervention are lay health workers who will be trained in the intervention using an online course. The lay health worker will complete the online training course in a group, with interactive group activities and role plays. Lay health workers will be supported online and in-person by the trainers in monthly supervision meetings. The lay health workers will deliver intervention to distressed mothers in 15 monthly sessions. The intervention consists of three modules including 1) mothers' well-being, 2) infant nutrition,early stimulation and breastfeeding and 3) mother-infant interaction.

Treatment as Usual (TAU)

The participants in the control arm will receive the routine monthly visits by the trained Lady Health Workers (LHWs) of their respective areas.

Group Type ACTIVE_COMPARATOR

Treatment as Usual

Intervention Type OTHER

The participants in the control arm will receive the routine visits by LHWs of their respective areas. The LHWs are trained to provide antenatal care and referral, immunization services and support to community mobilization, provision of family planning and basic curative care via door to door visits to the households of their allocated areas.

Interventions

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Intervention arm

In addition to the routine care delivered by Lady Health Workers (LHWs), the participants in the intervention arm will receive common elements based integrated intervention. The providers of the intervention are lay health workers who will be trained in the intervention using an online course. The lay health worker will complete the online training course in a group, with interactive group activities and role plays. Lay health workers will be supported online and in-person by the trainers in monthly supervision meetings. The lay health workers will deliver intervention to distressed mothers in 15 monthly sessions. The intervention consists of three modules including 1) mothers' well-being, 2) infant nutrition,early stimulation and breastfeeding and 3) mother-infant interaction.

Intervention Type BEHAVIORAL

Treatment as Usual

The participants in the control arm will receive the routine visits by LHWs of their respective areas. The LHWs are trained to provide antenatal care and referral, immunization services and support to community mobilization, provision of family planning and basic curative care via door to door visits to the households of their allocated areas.

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

* Pregnant with third trimester (28 gestational week)
* Age 18-40 years
* Intent to reside in the study areas until the completion of the study
* Score ≥9 on the SRQ

Exclusion Criteria

* Women who require immediate or on-going medical or psychiatric care reported.
* Severe previous or current obstetric morbidity including eclampsia and antepartum hemorrhage;
* Medical disorders that require inpatient management (e.g., diabetes, hypertension, thromboembolism, cardiac disease)
Minimum Eligible Age

18 Years

Maximum Eligible Age

40 Years

Eligible Sex

FEMALE

Accepts Healthy Volunteers

No

Sponsors

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World Health Organization

OTHER

Sponsor Role collaborator

University of Liverpool

OTHER

Sponsor Role collaborator

WHO Collaborating Center for mental health research, Institute of Psychiatry, Rawalpindi, Pakistan

UNKNOWN

Sponsor Role collaborator

Human Development Research Foundation, Pakistan

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Syed Usman Hamdani, PhD

Role: PRINCIPAL_INVESTIGATOR

Human Development Research Foundation, Pakistan

Locations

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Human Development Research Foundation

Islamabad, , Pakistan

Site Status

Countries

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Pakistan

References

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Rasheed MA, Yousafzai AK. The development and reliability of an observational tool for assessing mother-child interactions in field studies- experience from Pakistan. Child Care Health Dev. 2015 Nov;41(6):1161-71. doi: 10.1111/cch.12287. Epub 2015 Sep 9.

Reference Type BACKGROUND
PMID: 26350208 (View on PubMed)

Albers CA, Grieve AJ. Test review: Bayley, N.(2006). Bayley scales of infant and toddler development-third edition. San Antonio, TX: Harcourt assessment. Journal of Psychoeducational Assessment. 2007;25(2):180-90.

Reference Type BACKGROUND

Squires J, Bricker DD, Twombly E. Ages & stages questionnaires: Paul H. Brookes Baltimore, MD; 2009.

Reference Type BACKGROUND

Caldwell BM, Bradley RH. Home observation for measurement of the environment: University of Arkansas at Little Rock Little Rock; 1984

Reference Type BACKGROUND

Committee WE. Physical status: the use and interpretation of anthropometry. http://helid digicollection Org/en/d/Jh0211e/. 1995.

Reference Type BACKGROUND

Sikander S, Maselko J, Zafar S, Haq Z, Ahmad I, Ahmad M, Hafeez A, Rahman A. Cognitive-behavioral counseling for exclusive breastfeeding in rural pediatrics: a cluster RCT. Pediatrics. 2015 Feb;135(2):e424-31. doi: 10.1542/peds.2014-1628. Epub 2015 Jan 12.

Reference Type BACKGROUND
PMID: 25583916 (View on PubMed)

Beusenberg M, Orley JH, Organization WH. A User's guide to the self reporting questionnaire (SRQ. Geneva: World Health Organization; 1994.

Reference Type BACKGROUND

Varni JW, Seid M, Rode CA. The PedsQL: measurement model for the pediatric quality of life inventory. Med Care. 1999 Feb;37(2):126-39. doi: 10.1097/00005650-199902000-00003.

Reference Type BACKGROUND
PMID: 10024117 (View on PubMed)

Zimet GD, Dahlem NW, Zimet SG, Farley GKJJopa. The multidimensional scale of perceived social support. 1988;52(1):30-41.

Reference Type BACKGROUND

Üstün TB, Kostanjsek N, Chatterji S, Rehm J. Measuring health and disability: Manual for WHO disability assessment schedule WHODAS 2.0: World Health Organization; 2010.

Reference Type BACKGROUND

Rahman A, Sikander S, Malik A, Ahmed I, Tomenson B, Creed F. Effective treatment of perinatal depression for women in debt and lacking financial empowerment in a low-income country. Br J Psychiatry. 2012 Dec;201(6):451-7. doi: 10.1192/bjp.bp.112.109207. Epub 2012 Nov 8.

Reference Type BACKGROUND
PMID: 23137731 (View on PubMed)

Huma ZE, Gillani A, Shafique F, Rashid A, Mahjabeen B, Javed H, Wang D, Rahman A, Hamdani SU. Evaluating the impact of a common elements-based intervention to improve maternal psychological well-being and mother-infant interaction in rural Pakistan: study protocol for a randomised controlled trial. BMJ Open. 2021 Jul 7;11(7):e047609. doi: 10.1136/bmjopen-2020-047609.

Reference Type DERIVED
PMID: 34233989 (View on PubMed)

Other Identifiers

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GCC definitive cRCT

Identifier Type: -

Identifier Source: org_study_id

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