Co-designing an adolescent perinatal mental health intervention in Kenya and Mozambique: the INSPIRE project

Background Interventions to support adolescent perinatal mental health are limited and largely developed for delivery in high-income countries. This study aimed to co-design an intervention to improve mental health outcomes among pregnant and post-partum adolescent girls in Mozambique and Kenya. Methods 159 adolescent girls (aged 15–19 years) and young women (aged 20–24 years) with experience of a pregnancy during adolescence, their partners and family members, service providers and community influencers were recruited in Kilifi County, Kenya and Moatize District, Mozambique. Those who consented took part in individual interviews, focus group discussions, observations, and workshops to identify key priorities for supporting adolescent perinatal mental health, and co-design an intervention addressing those priorities. Findings Four priority challenges to adolescent perinatal mental health were identified by adolescents and young women: (1) increase understanding of pregnancy and childbirth; (2) provide sexual health knowledge; (3) address the lack of money to pay for essential items for themselves and their babies; and (4) strengthen caregiving skills. Additional priorities (supporting adolescent perinatal mental health and supporting good mental health, planning for the future, and improving girls’ social support networks) were included based on existing evidence and insights from other stakeholder groups. The Thriving Mamas Programme addressees these priorities through a nine-meeting intervention delivered in peer-group, individual and family group formats by trained mothers from the community. Interpretation This study has highlighted the complex and interconnected challenges to mental health perinatal adolescents face. While priority challenges were addressed through an adolescent-focused intervention, the identified barriers to good mental health during this time highlight the need for a package of interventions to also address mental health stigma at community and family levels, in addition to partner and service provider needs. As the priority challenges and experiences of pregnancy described by adolescents echo the global literature, the Thriving Mamas Programme, if shown to be effective, has the potential for wider generalisability across high-, middle- and low-income countries.