Early Health and Well-being
Year of Investment and Stage:
2022| Developing and testing to validate problem solution fit
Early Proof of Concept
The Secret History Mobile Application (SHiMA), developed by Perinatal Mental Health Project (PMHP), is a mobile training app intended for frontline maternity healthcare workers. Its primary objective is to enhance the mental health outcomes of pregnant mothers and caregivers of young children, thereby also positively influencing the mental well-being of children. The app focuses on improving the skills of maternity healthcare providers in key areas such as respectful maternity care, empathic engagement, and self-care.
SHiMA is based on the Secret History Training Method, an approach that aims to integrate an ethos of empathy, care and compassion in healthcare providers. Before this method, the training of nurses primarily focused on medical conditions. This consisted of manuals and guidelines to ensure that nurses are familiarised with as many medical conditions as possible to be able to identify, diagnose, treat and monitor them accordingly. The training neglected the emotional side of caring for patients. SHiMA helps nurses understand and value the emotions involved in healthcare.
Research has shown that women living in low-resourced areas in South Africa are likely to experience psychological stress during pregnancy and after birth. Reasons for this include economic marginalisation, having children at a young age, intimate partner violence and lack of support from friends and family. These factors are associated with a range of hormonal, genetic, behavioural and social disorders in mothers and their children.
One of the key sources of stress in pregnant mothers is the disrespect and abuse (D&A) imposed by a healthcare worker towards expecting mothers. According to the World Health Organization, D&A imposed by healthcare providers, is described as “outright physical abuse, profound humiliation and verbal abuse, coercive or unconsented medical procedures (including sterilisation), lack of confidentiality, failure to get fully informed consent, refusal to give pain medication, gross violations of privacy,and or refusal of admission to health facilities. This has been shown to have a negative impact on routine visits to healthcare facilities and ultimately on the health outcomes of mothers and their newborn children.
The job of healthcare workers comes with a lot of challenges that can affect their relationships with patients and the quality of care they provide. These include an inadequate distribution of resources, insufficiently funded facilities, limited training and mentorship opportunities, case overload and an extremely high demand for healthcare services.
The underlying challenge is that maternal healthcare providers are not adequately trained to provide empathic care and primary level mental health support to pregnant women and mothers of young children in South Africa. Capacity-building institutions do not prioritise mental healthcare. The theory of change suggests that if the Secret History Training Method can be developed into a gamified mobile app, more healthcare workers will be able to build the skills they need to deliver empathetic care.
The PMHP team sees SHiMA as an enabler for the improvement of mother and child mental health outcomes through the positive development of the mental well-being of healthcare providers. The idea is that if healthcare providers have the appropriate knowledge, skills and awareness of how to care for themselves, and ensure that they are able to care for others, this will translate to the empathetic care they provide to perinatal women. If a woman feels more supported and less vulnerable to stigma and obstetric violence, that feeling will be transferred to both the woman and their child during the child’s first years of life. Thus, leading to healthier development and a positive life trajectory.
How It works
The SHiMA app uses a ‘Choose your own Adventure’ approach, otherwise known as adaptive learning. The aim of an adaptive learning method is to customise the learning experience according to the user’s interactions. It has been recognised because of its ability to improve the learning experience through personalisation. Each response provided by the healthcare provider is tailored to their individual level of understanding of the concepts, and therefore addresses key gaps in their knowledge. The healthcare provider is prompted to follow clinical narratives and a scenario that depict engagements between healthcare providers and patients. The participants are asked to select a response to questions depending on the scenarios depicted and will have different scenarios unfold according to the choices they have made.
By giving the healthcare providers an opportunity to control their learning experience and engage with the app in a way that speaks to their personal experience, SHiMA may help them improve their skills on a larger scale. It also allows them to deepen their knowledge through self-administered activities, without having to worry about being judged or feeling pressured.
Why We Invested
Research has shown that when a woman is stressed during her pregnancy, her child is more likely to develop behavioural,cognitive and physical challenges by the age of two years old.
By supporting this venture, IE intends to gather data around whether a mobile application like SHiMA can influence the behaviour of healthcare providers and reduce instances of psychological stress during pregnancy and after birth.
The Project Team
Associate Professor Simone Honikman- Founder and Director
Simone is the Founder and Director of PMHP responsible for the strategic leadership, relationship management among key stakeholders, and the development of the tools that are central to the initiative. Her role includes leading the development of questionnaires, referral systems, feedback tools and monitoring and evaluation systems.
Simone has a medical degree and an MPhil in Maternal and Child Health from the University of Cape Town (UCT) and has worked as a medical officer in psychiatry, paediatrics, obstetrics, gynaecology and HIV medicine. She has collaborated in several global mental health research groups and has published journal papers and book chapters on maternal mental health. Simone also writes policy documents and guidelines, engages in advocacy work and multi-media resource development for maternal mental health in low-resourced communities. She is also the co-creator of the Secret History Training Method upon which the SHiMA is based.
Dr Emma McKinney Senior Research Officer
Emma is the Senior Research Officer at PMHP. Her background includes a number of research and consultancy roles in the context of disability and inclusion. Emma completed her Master of Education, Inclusive Education at the University of the Witwatersrand and her PhD in Business Administration (Disability Integration) at the Graduate School of Business, UCT. Emma is also the Disability Ambassador and Global Research Board member for parkrun SA and the Founder of Disability Included, an organisation that focuses on employment integration and retention of people with disabilities.
Dr Lea-Ann Pileggi- Research Psychologists and Neuroscientist
Lea-Ann is a Research Psychologist and Neuroscientist. She completed her PhD in Psychology at UCT, and is a registered Neuropsychologist with 10 years teaching at UCT specialising in Research Design, Psychometrics, Statistics, and Neuropsychology. She joined the PMHP team as a Research Consultant in 2022, where she is involved with the design and the statistical analysis stages of projects. Her current area of investigation alongside the support she is providing to the PMHP team, is based on the study of empathy.
Sally Field – Research Associate and Development Consultant
Sally is the Research Associate and Development Consultant at PMHP. With particular interest in health systems development, she designs PMHP’s service development and implementation protocols, as well as its rigorous monitoring, evaluation and data management frameworks.
She has a BA in Psychology and Sociology from UCT and an Honours Degree in Psychology from Rhodes University. Sally obtained a Master of Arts in Video for Development through the University of Southampton in the United Kingdom, focusing on participatory practices for development. Her experiences range from film-making to advocacy and development work in rural Sri Lanka.
Tyla Prinsloo – Mental Health Counsellor
Tyla is the Mental Health Counsellor at PMHP. She graduated with her Bachelor’s degree in Psychology in 2020. She has a keen interest in working with intergenerational trauma and community psychology. Providing mental health care in underserved communities is a passion of hers, as well as advocating for social change. Working with families through the Perinatal Mental Health Project is important to her as she is focused on empowering the family system.
Thanya April – Operations Coordinator
Thanya joined the PMHP team in 2016 as an Administrative Assistant. She holds a Diploma in Office and Business Administration from Montrose Business College, and an undergraduate degree in Psychology from the South African College of Applied Psychology. In 2022, she was appointed as Operations Coordinator and is responsible for the administrative and financial management of all PMHP focus areas.