Implementation Science
Volume 11, Issue 1, 2016

Factors affecting implementation of perinatal mental health screening in women of refugee background (Article) (Open Access)

Nithianandan N. , Gibson-Helm M. , McBride J. , Binny A. , Gray K.M. , East C. , Boyle J.A.*
  • a Monash University, Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, 43-51 Kanooka Grove, Clayton, VIC 3168, Australia
  • b Monash University, Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, 43-51 Kanooka Grove, Clayton, VIC 3168, Australia
  • c Monash Health, Monash Health Refugee Health and Wellbeing, Clayton, VIC, Australia
  • d Monash University, Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, 43-51 Kanooka Grove, Clayton, VIC 3168, Australia
  • e Monash University, Centre for Developmental Psychiatry and Psychology, Department of Psychiatry, School of Clinical Sciences, Clayton, VIC, Australia
  • f Monash Health, Monash Women's Maternity Services, Clayton, VIC, Australia, Monash University, School of Nursing and Midwifery, Clayton, VIC, Australia
  • g Monash University, Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, 43-51 Kanooka Grove, Clayton, VIC 3168, Australia

Abstract

Background: For women of refugee background, the increased risk of mental illness associated with pregnancy is compounded by pre- and post-settlement stressors. In Australia, antenatal screening for depression and anxiety symptoms using the Edinburgh Postnatal Depression Scale is recommended for all women. Despite this, screening is not routinely implemented and little is known about barriers and enablers to implementation for women of refugee background. Methods: Semi-structured interviews were conducted with a range of health professionals (n = 28: midwives, obstetricians, perinatal mental health and refugee health experts, interpreters) and women of refugee background (n = 9). Themes generated from thematic analysis were examined in relation to the Theoretical Domains Framework and Cultural Competence Conceptual Framework, followed by identification of effective behaviour change techniques to address the barriers and enablers identified by participants. These techniques formed the basis of recommendations to inform sustainable implementation of screening and referral. Results: Almost all participants perceived perinatal mental health screening to be necessary and most recognised the importance of post-traumatic stress disorder (PTSD) screening. Barriers and enablers were identified and related to eight domains: knowledge, skills, professional roles, beliefs about capabilities and consequences, environmental context, social influences and behavioural regulation. Conclusions: This research clarifies how mental health screening may be integrated into routine antenatal care for women of refugee background, in order to improve provision of recommended care. These theory-informed recommendations include an inter-disciplinary approach, coordinating care within and across services, addition of PTSD screening, and effective communication with women. © 2016 The Author(s).

Author Keywords

Post-traumatic stress disorder Prenatal care Pregnancy Perinatal Depression Mental health Refugees Anxiety Health services research

Index Keywords

refugee pregnancy complication Pregnancy Complications human Refugees Victoria Clinical Competence social support Mental Disorders health personnel attitude Attitude of Health Personnel mental disease Humans female pregnancy self concept Health Knowledge, Attitudes, Practice standards Perinatal Care Delivery of Health Care attitude to health health care delivery
Link
https://www.scopus.com/inward/record.uri?eid=2-s2.0-84996671009&doi=10.1186%2fs13012-016-0515-2&partnerID=40&md5=80c676d4e9d70461d2cd3dbf62994a18
DOI: 10.1186/s13012-016-0515-2
ISSN: 17485908
Cited by: 8
Original Language: English