Co-design of FOotpaths foR Adolescent MAternal Mental HeAlth (FOR MAMA): a guided preventive mental health intervention for pregnant adolescents in Malawi

BackgroundAdolescents in LMICs face heightened risks for perinatal mental health problems due to an abundance of psychosocial adversities and a lack of service capacity. Efforts to develop scalable selective prevention programmes for this group require active involvement from key stakeholders. AimThis study aimed to gain insights into stakeholders’ priorities and preferences for a scalable intervention for common mental problems among perinatal adolescents in Malawi. MethodsParticipatory stakeholder workshops (n=9) were conducted iteratively according to the principles of the Person-Based Approach. Three stakeholder groups were recruited from one urban and one rural primary health centre in Zomba district, Malawi: perinatal adolescents (n=10), their family members (n=8), and healthcare workers (n=10). Framework analysis was conducted using intervention descriptors from the TIDieR checklist Results Participants emphasised the need for information on causes and symptoms of common mental problems, and for developing coping strategies: a) those focused on external stressors – problem-solving, financial literacy and interpersonal skills, and b) emotion-focused approach behaviours – behavioural activation, relaxation, and anger management. There was a strong preference for healthcare workers as intervention providers. Participants agreed on a brief antenatal intervention to be delivered weekly using both group and individual formats. There were positive views on both self-help and guided formats. Importantly, all stakeholder groups felt there was need for follow-up to ensure that adolescents correctly engaged with the intervention material. Hence, a guided self-help format was agreed upon.ConclusionFindings informed the design of a brief multi-component guided intervention for adolescents in the antenatal period.