Table 1.

Differences between the Original THPP and the adapted version of THPP and comments from study findings

Domain	Original THPP	Adapted version of THPP	Comments
Language (appropriateness, cultural applicability of terms and comprehension)	Language - English	Translated into Local language (Chichewa) – Simplified further using daily spoken words and common idioms	Participants recommended simplified Chichewa as they had challenges to comprehend some literal translated words - explored idioms used for key words and daily spoken words/language
Provider of the intervention	Female peer volunteer	Female peer volunteer	A female volunteer was viewed culturally acceptable by majority of participants. Few indicated that they would consider male volunteers with consent from family
Illustrations and pictures	Illustrations and stories consistent with Asian culture	Redesigned all Illustrations and stories to a local Malawian context	Illustrations were not consistent with local Malawian culture, they conveyed different messages to different participants. Just like one participant said; “There are things that are not adding up in these pictures.... looks like she [the woman in the picture] is smoking, or touching her mouth... the facial expressions need to be improved”.
Content (Cultural appropriateness and context)	Content - Focus on the mother and baby. Utilizing core elements of CBT – building empathetic relationship, family involvement, focusing on the here and now, behavior activation and problem solving	Content - Focus on the mother and baby. Utilizing core elements of CBT – building empathetic relationship, family involvement, focusing on the here and now, behavior activation and problem solving -These were maintained using simplified Chichewa	Participants recommended the focus of the intervention and strategies used
Implementation (frequency of sessions and place)	Place – home Frequency – 10 individual sessions, 4 group sessions	Place – home Frequency – 7 individual sessions and 4 group sessions	Participants did not recommend specific number of sessions, rather flexibility on number of sessions depending on the need. From available evidence, a minimum of 8 sessions are considered effective (Vanobberghen et al, 2020), hence the adapted version has a minimum of 7 sessions and maximum 10 sessions; 4 sessions during pregnancy (Session 1: Introductory Session, Session 2: Mother's Personal Health Session 3: Mother's Relationship with people around her and Session 4: Mother Child Relationship) then 3 sessions following child birth (Session 5: Mother's Personal Health, Session 6: Mother's Relationship with people around her, Session 7: Mother's Child Relationship) The remaining 3 sessions, sessions 8–10 can be delivered if the mother still screens positive for depression after session 8, (Session 8: Mothers Personal Health Session 9: Mother's Relationship with people around her and Session 10: Mother Child Relationship).