Salutogenesis and Self-efficacy-based Childbirth Education Programme for Preventing Postpartum Depression

Effectiveness of Childbirth Education Based on Salutogenic Perspective and Self-Efficacy Theory in Preventing Postpartum Depression Among Ethiopian Teenage Mothers: a Pilot RCT Study

Although the transition to motherhood is often a joyful experience, there is evidence that teenage motherhood can present many stressful challenges, potentially leading to the development of postpartum depression. Postpartum depression (PPD) remains a public health issue with negative consequences for both mothers and their babies. The aim of this study is to assess the feasibility of implementing childbirth education underpinned by salutogenic and self-efficacy perspectives among teenage mothers in low-income settings. The study also aims to provide preliminary findings on the intervention's effectiveness in preventing postpartum depression among Ethiopian teenage mothers. The theoretical based childbirth education approach can enhance the psychosocial well-being of first-time teenage mothers. The intervention consists of six sessions: three during the antenatal period and three in the postpartum period. These sessions contain two individual face-to-face educations (each lasting 60-90 minutes), two phone calls (each lasting 30 minutes), and two group discussion (each lasting 90-120 minutes), as supported by the existing evidence. The study expected to support the feasibility of the study design. Preliminary findings are anticipated to show a significant difference in postpartum depression scores between the intervention and control groups, with teenage mothers in the intervention group having a lower risk of postpartum depression compared to those in the control group. Integrating sense of coherence and self-efficacy theories into maternity care services could provide empirical support for preventive efforts against postpartum depression. The findings of this study may address research gaps regarding the psychosocial wellbeing of teenage mothers, serving as baseline evidence for large scale interventional studies that consider the sociocultural and economic contexts of low-income countries.

Postpartum depression (PPD) is a common mental health disorder that occur following childbirth. It typically develops within the first 12 weeks of the postpartum period, although researchers and public health experts consider PPD to be prevalent up to one year after giving birth. Although postpartum depression remains a global public health concern, it is often overlooked in the maternal healthcare system, particularly in low-and middle-income countries. The existing maternity care service often prioritizes addressing obstetrical issues while neglecting the mental well-being of labouring mothers. In Ethiopia, the prevalence of PPD among teenage mothers has reached 37%, which is much higher than the global average of 18%. Consequently, depression following childbirth continues to pose a significant risk to the overall well-being of both mothers and newborns. This study is significant in providing evidence to policymakers and health stakeholders, urging them to integrate mental health and health promotion interventions in maternity care services without imposing an additional financial burden on the healthcare system.

The role of maternity care provision during the antenatal and postnatal period is to enhance mothers' birth preparedness and complication readiness to achieve optimal maternal and infant health. However, it is crucial to practically evaluate the effectiveness of childbirth education underpinned by salutogenesis and self-efficacy perspectives in preventing PPD by enhancing mothers' sense of coherence, parenting self-efficacy, and perception of social support throughout the transition to motherhood. The findings of this study provide significant evidence for the integrating of the current disease prevention-focused approach of maternal care services with health-protective salutogenic interventions to maintain mothers' psychosocial well-being during childbirth and the parenting experience. Furthermore, the evidence may encourage countries, including Ethiopia, to implement childbirth classes that are not yet conducting in maternity care.

Inclusion Criteria:

• married first-time teenage mothers aged 13-19 years attending antenatal follow-up in the selected hospitals
• a single pregnancy with 28-30 weeks of gestational age
• no pregnancy complications contraindicating vaginal delivery
• plan to have institutional delivery and postnatal visits at the selected health hospitals and who reside for a minimum of 12 weeks postdelivery around the selected hospitals

Exclusion Criteria:

• have self-reported history or current mental health problems
• participated in similar interventional programmes
• have serious medical and obstetrics problems
• having foetus with diagnosed congenital anomalies