Title: The Feasibility and Acceptability of Implementing Simplified Cognitive Behavioral
Therapy Approaches to Support Postpartum Mental Health and Address Associated Social
andBehavioral Barriers to Postpartum Family Planning in Amhara, Ethiopia: A qualitative study
Version: 1 Date: 27 Oct 2023
Reviewer's report:
Overview
This research examines the relationship between postpartum depression, a significant mental
health concern, and family planning in young women aged 16-25 years in Amhara, Ethiopia.
The study introduces an intervention known as "Mother's Time," drawing from the Cognitive
Behavioral Therapy (CBT) framework, particularly WHO's "Thinking Healthy" module. Unlike
traditional individual-centered approaches, "Mother's Time" is designed as a group-centered
intervention. This study holds relevance as it not only sheds light on an additional facet of family
planning challenges but also presents a novel tool for addressing postpartum depression within
resource-constrained environments. However, the study does have some shortcomings, which
are detailed below.
General comments
- In the methods section of the abstract, it would be good for the authors to provide a concise
description of the components of "Mother’s Time," elucidate the participant selection process,
and define their specific use of the "Framework approach."
- In the first paragraph of the introductory section, it is important for the authors to provide a
clear and comprehensive explanation of the term "unmet need" to ensure that readers have a
complete understanding of its significance.
- In concluding the introductory section, the authors state that they had to first examine the
feasibility of community health workers to deliver the intervention. However, I feel this should
not be one of the main objectives of the study.
- In the methods section, the authors stated that in choosing women who qualified for inclusion
in the study, the participants had to score 5 and 14 on the PHQ-9 screener and/or between 5
and 14 on the GAD-7 screener, why the choice of 5 and 14? is this a recognized scale range in
literature? The authors need to provide clarifications for this range.
- The authors mentioned that they conducted in-depth interviews with the study participants.
To enhance the reproducibility of their work, it would be valuable if they included the survey
questions they used in an appendix section for reference and transparency.
- Also, the authors stated that they created analytical frameworks for the study, it will be good
if the authors provide the analytical framework they developed (as an appendix section)
- In recruiting community members, though the authors stated the number of participants they
included, they did not state how they recruited the participants, was it by convenience or
purposive sampling? The authors need to clarify this.
- Also, looking at the study design, the authors only made use of an intervention group. However,
I feel it would have been better if the authors used both a control and intervention group, that
way, other confounding variables/ underlying factors that brought about improvement will be
controlled for.
- In the first paragraph of the results section, the authors provide the characteristics of mothers
included in the study, though the study is qualitative, it will be good if the authors can provide
tables showing descriptive characteristics of the study participants.
- Also, for the results section, it would be good if the authors provided a brief description of
the study area describing the characteristics of the population and what their demographics look
like. Also, the geographical coordinates of the area.
- Generally, the results section seems a bit disaggregated, the authors need to organize them into
themes to ensure coherence.
- The sections and subsections in the paper should be numbered.