Antenatal group-based psychoeducation to improve postpartum depression literacy in primary health care institutions in Ethiopia: A cluster randomized controlled trial

Marta Tessema ^1* Muluemebet Abera Wordofa ² Zewdie Birhanu ³

• ¹ School of Midwifery, Faculty of Health Sciences, Institute of Health, Jimma University, Jimma, Ethiopia
• ² Department of Population and Family Health, Faculty of Public Health, Institute of Health, Jimma University, Jimma, Oromia Region, Ethiopia
• ³ Department of Health Behavior and Society, Faculty of Public Health, Institute of Health, Jimma University, Jimma, Oromia Region, Ethiopia

Background: Postpartum depression literacy assists mothers in recognizing and preventing postpartum depression(PPD). So, this study assessed the effectiveness of antenatal group psychoeducation in improving PPD literacy among pregnant women in Jimma, Ethiopia.A cluster randomized controlled trial was conducted from March 28 to December 1, 2022, involving 32 non-adjusted health centers that were randomized into two groups (16 health centers for each arm). The study enrolled 550 participants who scored (0-9) on the Patient Health Questionnaire-9. The intervention group received standard antenatal care and group psychoeducation, while the control group received only standard care. Postpartum depression literacy was assessed in face-to-face interviews at 12-20 weeks gestation and 6 weeks postpartum using the PPD literacy scale. Higher scores indicated higher literacy.An intention-totreat analysis was used. Demographic factors were compared between groups using χ² and independent sample t-tests, indicating no significant differences except for educational status and parity. General linear models and mixed-effect models assessed intervention effects and outcome variable predictors, respectively. Results: The overall response rate was 92.9%. The study demonstrated a significant difference between groups regarding the overall mean PPD literacy score (intervention, 3.75±.46; control, 3.48±.46; ηp²=.07), ability to recognize PPD (intervention, 4.30±.64; control, 3.94±.75; ηp²=.06), knowledge of risk factors and causes (intervention, 4.03±.69; control, 3.67±.70; ηp²=.05), and access to PPD information (intervention, 3.28±1.25; control, 2.01±1.13; ηp²=.21) at p=.001, with marginal significance regarding self-care activities (intervention 4.37±.54, control 4.26±.50, ηp²=.01, P =.051). Conversely, there were no significant differences in knowledge of professional help (intervention 2.97±1.13, control 2.83±.80, •p²=.00, P=.303), beliefs regarding professional help (intervention 2.67±.89, control 2.50±.72, •p²=.01, P=.063), and attitudes towards PPD recognition and help-seeking (intervention 3.91±1.02, control 3.91±1.02, •p²=.00, P=.586). Moreover, partner emotional support (AOR = .1, 95% CI = .02-.17), maladaptive coping (AOR = -.14, 95% CI = -.22-(-.07)), and multiparty (AOR = -.15, 95% CI = -.22-(-.08)) showed significant associations with overall PPD literacy score. Conclusions:The study showed that antenatal group psychoeducation,had a moderate effect on overall PPD literacy score. However, further research is required to effectively change negative attitudes towards seeking formal help.