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‘You Are Not Alone’: An Interdisciplinary Effort to Tackle Postpartum Depression
A researcher and designer paired up to raise awareness of mothers’ mental health in India.
When psychiatric nurse practitioner Amy Szajna first visited India six years ago, she was confronted with a stark reality: the country has less than 1 psychiatrist for every 100,000 residents, and many fear the stigma that mental health conditions carry. She was there to help address high rates of postpartum depression (PPD), but with so many hurdles in her way, she knew she’d need to be creative.
“There’s still very much a stigma related to mental health and mental illness in India,” says Szajna. “It’s very hard to access care.”
That creative problem-solving spirit took Szajna to an unexpected place: a meeting with designer and Jefferson alumna Laura Moyer. The two went back and forth, sketching ideas, referencing traditional Indian design motifs, and translating text between English, Marathi, and Kannada. The result of months of their collaboration was a brightly-hued poster, featuring two women embracing each other and their children, imprinted with a message for Indian mothers: “You are not alone.”
While roughly the one in ten new mothers in America suffer from PPD, it’s estimated to affect 1 in 5 mothers in rural areas of India. The condition can make it difficult for mothers to bond with their children, complete daily tasks, and connect with friends and family, and, if left untreated, PPD may evolve into long-term mental health issues. In some regions, it’s common for new mothers to stay with their in-laws after giving birth, and women may remain isolated at home for weeks or months postpartum.
Szajna hopes to hang and distribute these posters around the southwestern Indian city of Belgaum. To address the lack of mental healthcare in the area, she and collaborators at KLE University have been training community health workers to screen for PPD at standard pediatric vaccination appointments, and to follow up with a simple intervention for mothers with signs of PPD. The intervention uses the evidence-backed technique of behavioral activation, which encourages people to set goals and schedule tasks to break unhealthy loops of avoidance and withdrawal.
Her initial results are promising: in a pilot study of 24 mothers with signs of PPD, regular check-ins with community health workers and the behavioral activation intervention helped every woman feel better after just a few weeks.
“It was a good experience,” said one mother in the study. “It strengthened my personality and my mood.”
Szajna hopes as the program expands, she can display and distribute the poster to further raise awareness of PPD for women in the region. Moyer and Szajna say they worked to design the poster in a way that would best resonate for the local community, rather than relying on conventional notions of medical design and communication styles.
“If I designed something very minimalist,” says Moyer, “it might not resonate with that audience at all.” Szajna agrees; she explains that in a culture full of bright, colorful imagery, a black-and-white pamphlet might not engage people the way they need it to.
The collaborative process between myself and my project partner was very unique and particularly special as I was able to collaborate on both the research process and the poster creation. This allowed me more perspective and an opportunity to learn about how the research has evolved since my involvement. After discussions with my project partner we strived to showcase community, influence, and shared experiences among the African American community, while addressing the mistrust rooted in racism. We presented an important and familiar message of “Black Health Matters” calling the community to make their voices heard through participation in clinical trials. By Iman Morsy (designer) and Lisa Whitfield-Harris (researcher).
This study focused on evaluating the effectiveness of simulation teaching to impart a variety of skills, including after-hours consulting, recognizing signs of trauma in children, and developing a collaborative care plan with other professionals. We spoke about the growing importance of simulation teaching, to better prepare graduate nursing students who primarily learn in an online environment. I boiled it down to one line that captures the idea: Practice makes professional. I created a grid that showcases the overlapping interactions between individuals, breaking through the boundaries that normally separate patients and providers, creating a healthier, more connected world. By Jessica Eversmeyer (designer) and Laura Roettger (researcher).
This poster was inspired by the need for support at every level as well as showing that, at the end of the day, the common goal of mother and nurse is to deliver and provide the best opportunity for the baby. Often, due to stigma, support is lacking for mother and nurse in complex situations that involve substance use. Funding, education, or even just basic compassion may all be lacking. The poster is meant to create the feeling of a safe space for women looking for this service. Only they have the information the nurse needs to help, and if they don’t feel comfortable to communicate openly, crucial information can be overlooked. It is important to come together to give everyone the best opportunity to make sure the child has the best possible outcome. By Stephen Andrea (designer) and Stephen DiDonato (researcher)
This poster is inspired by the lack of movement Full Practice Authority (FPA) has had in terms of legislation in Pennsylvania. Despite constant passage in the PA senate, it fails every time in the PA House. The tone needed to be authoritative…it’s about trying to persuade legislation on the state level. I opted to keep the look and structure of existing house bills/legal documents, likely printed out on single-color (black) printers, or photocopied over and over. This helps correlate to the idea of the same thing happening over and over again. The way legislation is written, tends to be a lot of words to say, well, not a lot, so there needed to be a clear and simple Call-to-Action/Headline that could cut through the “noise” of bill text. Using redacted text to create the shape of Pennsylvania, it provided a perfect canvas to say what needs to happen in a direct and authoritative way to state lawmakers, while maintaining that this is specific to Pennsylvania. By Jon Weed (designer) and Janice Miller (researcher)
The poster was part of a larger project spearheaded by Dr. Joanne Robinson, Associate Dean of Research and Global Engagement, Gabrielle Santulli, Senior Director of Strategy and Innovation, both with Jefferson College of Nursing, and Maribeth Kradel-Weitzel, director of the Master of Science in Health Communication Design program and director of Jefferson’s Creativity Core Curriculum. The three connected Jefferson researchers with designers in the MS in Health Communication Design program or alumni of the undergraduate Visual Communication Design program to help translate research into impactful messages captured with large-scale works of art.
A generous gift from the Stratton Foundation supported the College of Nursing in funding the faculty-led health services research pilot projects and corresponding posters along with launching the College’s Office of Research and Global Engagement, led by Dr. Joanne Robinson.
Through months of collaboration, 26 pairs of designers and researchers, like Moyer and Szajna, created posters to improve research understanding and community engagement. Other posters raised awareness of end-of-life healthcare options, promoted policies expanding practice authority for nurse practitioners, and encouraged participation of the Black community in clinical trials.
Robinson, Santulli, and Kradel-Weitzel say these posters are a proud example of what can be accomplished when artists and scientists collaborate. They were thrilled that the “You are not alone” poster was recognized as the Conceptual Art Winner in Jefferson’s Research Art Competition 2023.
“I think we live in a complicated world with large, ambiguous problems that no one person can possibly have the knowledge to solve,” says Kradel-Weitzel. “So, I appreciate opportunities to showcase the interdisciplinary ability to tackle complexity.”
