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

• Published in: JMIR pediatrics and parenting 2025-01, Vol.8, p.e65912
• Main Authors: Hossain, Aniqa Tasnim, Rahman, Md Hafizur, Manna, Ridwana Maher, Akter, Ema, Islam, S M Hasibul, Hossain, Md Alamgir, Ara, Tasnu, Usmani, Nasimul Ghani, Chandra, Pradip, Khan, Maruf Ahmed, Rahman, S M Mustafizur, Ahmed, Helal Uddin, Mozumder, Muhammad Kamruzzaman, Juthi, Jesmin Mahmuda, Shahrin, Fatema, Shams, Sadia Afrose, Afroze, Fahmida, Banu, Mukta Jahan, Ameen, Shafiqul, Jabeen, Sabrina, Ahmed, Anisuddin, Amin, Mohammad Robed, Arifeen, Shams El, Shomik, Mohammad Sohel, Rahman, Ahmed Ehsanur
• Format: Article
• Language: English
• ISSN: 2561-6722; 2561-6722
• DOI: 10.2196/65912

Globally, 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. This 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. Between 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. Almost 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