5 Pillars Approach to Maternal Psychosocial Well-Being

The 5P approach is an integrated intervention for large-scale maternal and child health programs. Its key feature is that it can be integrated into the main intervention instead of serving as a stand-alone element, facilitating the existing work of community health workers instead of adding to it.

The 5P approach was developed after several years of research in Pakistan, using the principles of cognitive behavioral therapy. It involves five components, which are implemented by trained lady health workers during cognitive behavioral therapy sessions at homes with mothers. The lady health worker training consists of:

• Five-day program: 1.5 days of training, with skills practice for the remaining days
• Emphasized hands-on practice with role-play
• Short video clips portraying each component
• Observation and discussion of good and bad practices
• Tool-kit containing training manual, trainers with step-wise instructions for every visit, counselling cue cards, pictorial counselling cards for sessions, and a health calendar for the families

The 5P approach is integrated into monthly sessions delivered at home to the mother and family. In practice the approach works as follows:

Empathic listening

Each session begins with an open-ended conversation, allowing the woman to talk freely. The lady health worker uses active listening skills to convey empathy and makes a list of problems the woman faced in performing the desired behaviors that may have been suggested in a prior visit.

Family engagement

The initial home visits emphasize family participation, encouraging active participation for the duration of the program. Strategies to engage key household decision-markers are emphasized.

Guided discovery

Pictures conveying health messages related to play, stimulation or nutrition of the child are conveyed as the lady health worker discusses both undesired and desired behaviors. She is trained not to impose her views, but rather to allow the mother and the family to consider each viewpoint and come to their own conclusions.

Behavioral activation

Once the message is received and accepted, the activities related to it are made manageable so the participants feel as though they have mastered it. Lady health workers are trained to recognize how each nutrition or play-related task can be broken down and monitored with the help of family members.

Problem solving

The lady health worker discusses the problems the woman faced in carrying out the tasks suggest in the previous sessions(s). She discusses possible solutions through supervision or a family discussion.

The 5P approach is a long-term investment to increase program value, assisting with strengthening weak health systems. It is expected that mothers will become more empowered, informed and psychologically functional and in turn will be more receptive to the program.