Strategies for spreading, scaling and sustaining perinatal mental health interventions in low- and middle-income countries (LMICs): A scoping review and thematic synthesis

Common perinatal mental health conditions are especially prevalent in low- and middle-income countries (LMICs) and are associated with numerous adverse effects. While complex interventions have been developed and tested, there has been limited exploration of how these interventions can be implemented and sustained at scale. This scoping review aims to explore the strategies discussed for scaling, spreading and sustaining complex perinatal mental health interventions in LMICs. We conducted a systematic search in APA PsycINFO, Cinahl, Medline (EBSCOhost), Embase, MIDIRS (Ovid Online) and ProQuest for reports published between January 2010 and November 2023, using search terms related to scaling innovations, perinatal mental health and LMICs. We also conducted a grey literature search using the websites of organisations that focus on maternal mental health. We identified 42 information sources. Using thematic synthesis, scale, spread and sustainability strategies regarding workforce diversity, integration of health services, tool and method development, adaptation, training, supervision and support and stakeholder engagement were identified. The study identified persistent gaps in the literature around how interventions move beyond early adaptation and implementation phases. These included the need for more consistency and shared understanding around terminology and increased interdisciplinary collaboration, especially drawing on fields such as implementation science. The findings from this review open new avenues for research and policy on expanding perinatal mental health interventions in LMICs, with an emphasis on long-term sustainability and interdisciplinary perspectives.