Factors affecting implementation of perinatal mental health screening in women of refugee background

Nishani Nithianandan, Melanie Gibson-Helm, Jacquie McBride, Amanda Binny, Kylie M. Gray, Christine East, Jacqueline Boyle

Research output: Contribution to journalArticleResearchpeer-review

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.
Original languageEnglish
Article number150
Number of pages12
JournalImplementation Science
Volume11
Issue number150
DOIs
Publication statusPublished - 2016

Keywords

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

Cite this

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title = "Factors affecting implementation of perinatal mental health screening in women of refugee background",
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.",
keywords = "Refugees, Pregnancy, Prenatal care, Mental health, Depression, Anxiety, Post-traumatic stress disorder, Perinatal, Health services research",
author = "Nishani Nithianandan and Melanie Gibson-Helm and Jacquie McBride and Amanda Binny and Gray, {Kylie M.} and Christine East and Jacqueline Boyle",
year = "2016",
doi = "10.1186/s13012-016-0515-2",
language = "English",
volume = "11",
journal = "Implementation Science",
issn = "1748-5908",
publisher = "Springer-Verlag London Ltd.",
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}

Factors affecting implementation of perinatal mental health screening in women of refugee background. / Nithianandan, Nishani; Gibson-Helm, Melanie; McBride, Jacquie; Binny, Amanda; Gray, Kylie M.; East, Christine; Boyle, Jacqueline.

In: Implementation Science, Vol. 11, No. 150, 150, 2016.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Factors affecting implementation of perinatal mental health screening in women of refugee background

AU - Nithianandan, Nishani

AU - Gibson-Helm, Melanie

AU - McBride, Jacquie

AU - Binny, Amanda

AU - Gray, Kylie M.

AU - East, Christine

AU - Boyle, Jacqueline

PY - 2016

Y1 - 2016

N2 - 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.

AB - 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.

KW - Refugees

KW - Pregnancy

KW - Prenatal care

KW - Mental health

KW - Depression

KW - Anxiety

KW - Post-traumatic stress disorder

KW - Perinatal

KW - Health services research

U2 - 10.1186/s13012-016-0515-2

DO - 10.1186/s13012-016-0515-2

M3 - Article

VL - 11

JO - Implementation Science

JF - Implementation Science

SN - 1748-5908

IS - 150

M1 - 150

ER -