Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Implementation Science
Published in: Implementation Science 1/2015

Open Access 01-12-2016 | Research

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

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

Published in: Implementation Science | Issue 1/2015

Login to get access

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.
Appendix
Available only for authorised users
Literature
1.
O'Hara MW, Swain AM. Rates and risk of postpartum depression—a meta-analysis. Int Rev Psychiatry. 1996;8(1):37–54.CrossRef
2.
Fisher J, Mello MCD, Patel V, Rahman A, Tran T, Holton S, et al. Prevalence and determinants of common perinatal mental disorders in women in low- and lower-middle-income countries: a systematic review. Bull World Health Organ. 2012;90(2):139–49.CrossRef
3.
Green J, Murray D. The use of the Edinburgh Postnatal Depression Scale in research to explore the relationship between antenatal and postnatal dysphoria. London: Gaskell; 1994. p. 180–98.
4.
Wenzel A, Haugen EN, Jackson LC, Robinson K. Prevalence of generalized anxiety at eight weeks postpartum. Arch Women's Ment Health. 2003;6(1):43–9.CrossRef
5.
Austin MP, Tully L, Parker G. Examining the relationship between antenatal anxiety and postnatal depression. J Affect Disord. 2007;101(1-3):169–74.CrossRefPubMed
6.
Austin MP, Highet N, The Guidelines Expert Advisory Committee. Clinical practice guidelines for depression and related disorders – anxiety, bipolar disorder and puerperal psychosis – in the perinatal period. A guideline for primary care health professionals. Melbourne: beyondblue: the national depression initiative; 2011.
7.
Collins CH, Zimmerman C, Howard LM. Refugee, asylum seeker, immigrant women and postnatal depression: rates and risk factors. Arch Women's Ment Health. 2011;14(1):3–11.CrossRef
8.
Fazel M, Wheeler J, Danesh J. Prevalence of serious mental disorder in 7000 refugees resettled in western countries: a systematic review. Lancet. 2005;365(9467):1309–14.CrossRefPubMed
9.
Steel Z, Chey T, Silove D, Marnane C, Bryant RA, Van Ommeren M. Association of torture and other potentially traumatic events with mental health outcomes among populations exposed to mass conflict and displacement: a systematic review and meta-analysis. JAMA. 2009;302(5):537–49.CrossRefPubMed
10.
Department of Health, State of Victoria. The Victorian refugee and asylum seeker health action plan 2014–2018. Melbourne: State Government of Victoria; 2014.
11.
Priest SR, Barnett B. Perinatal anxiety and depression: issues, outcomes and interventions. 2008.
12.
Beck CT. The effects of postpartum depression on child development: a meta-analysis. Arch Psychiatr Nurs. 1998;12(1):12–20.CrossRefPubMed
13.
O'Connor TG, Heron J, Glover V, The ALSPAC Study Team. Antenatal anxiety predicts child behavioral/emotional problems independently of postnatal depression. J Am Acad Child Adolesc Psychiatry. 2002;41(12):1470–7.CrossRefPubMed
14.
Halligan SL, Murray L, Martins C, Cooper PJ. Maternal depression and psychiatric outcomes in adolescent offspring: a 13-year longitudinal study. J Affect Disord. 2007;97(1-3):145–54.CrossRefPubMed
15.
Murray L, Cooper PJ. The impact of postpartum depression on child development. Int Rev Psychiatry. 1996;8(1):55–63.CrossRef
16.
Yelland J, Brown SJ. Asking women about mental health and social adversity in pregnancy: results of an Australian population-based survey. Birth. 2014;41(1):79–87.CrossRefPubMed
17.
Australian Health Ministers’ Advisory Council. Clinical Practice Guidelines: Antenatal Care - Module 1. Canberra: Australian Government Department of Health and Ageing; 2012.
18.
Yelland J, Sutherland GA, Wiebe JL, Brown SJ. A national approach to perinatal mental health in Australia: exercising caution in the roll-out of a public health initiative. Med J Aust. 2009;191(5):276–9.PubMed
19.
Buist A, Bilszta J. The beyondblue National Postnatal Screening Program, Prevention and Early Intervention 2001–2005, Final Report. Melbourne: beyondblue: the national depression initiative; 2006.
20.
Darwin Z, McGowan L, Edozien LC. Antenatal mental health referrals: review of local clinical practice and pregnant women׳s experiences in England. Midwifery. 2015;31(3):e17–22.CrossRefPubMed
21.
Correa-Velez I, Ryan J. Developing a best practice model of refugee maternity care. Women Birth. 2012;25(1):13–22.CrossRefPubMed
22.
Stapleton H, Murphy R, Correa-Velez I, Steel M, Kildea S. Women from refugee backgrounds and their experiences of attending a specialist antenatal clinic. Narratives from an Australian setting. Women Birth. 2013;26(4):260–6.CrossRefPubMed
23.
Kokanovic R, Niner S, Cho V, Cuthbert D. Pilot study on perinatal depression (PD) in refugee communities. 2012. Research report prepared for beyondblue. Melbourne.
24.
Stapleton H, Murphy R, Kildea S. Lost in translation: staff and interpreters' experiences of the edinburgh postnatal depression scale with women from refugee backgrounds. Issues Ment Health Nurs. 2013;34(9):648–57.CrossRefPubMed
25.
Johnson-Agbakwu CE, Allen J, Nizigiyimana JF, Ramirez G, Hollifield M. Mental health screening among newly arrived refugees seeking routine obstetric and gynecologic care. Psychol Serv. 2014;11(4):470–6.CrossRefPubMedPubMedCentral
26.
Cheng I, Russell G, Bailes M, Block A. An evaluation of the primary healthcare needs of refugees in South East Metropolitan Melbourne. Melbourne: Southern Academic Primary Care Research Unit; 2011.
27.
28.
Liamputtong P. The science of words and the science of numbers: research methods as foundations for evidence-based practice in health. Research methods in health: foundations for evidence-based practice. 2010. p. 3–26.
29.
Harding J. Qualitative data analysis from start to finish: Sage. 2013.
30.
Liamputtong P. Performing qualitative cross-cultural research: Cambridge University Press. 2010.CrossRef
31.
Cane J, O’Connor D, Michie S. Validation of the theoretical domains framework for use in behaviour change and implementation research. Implement Sci. 2012;7(1):37.CrossRefPubMedPubMedCentral
32.
Balcazar FE, Suarez-Balcazar Y, Taylor-Ritzler T. Cultural competence: development of a conceptual framework. Disabil Rehabil. 2009;31(14):1153–60.CrossRefPubMed
33.
French SD, Green SE, O’Connor DA, McKenzie JE, Francis JJ, Michie S, et al. Developing theory-informed behaviour change interventions to implement evidence into practice: a systematic approach using the Theoretical Domains Framework. Implementation Sci. 2012;7(1):38.CrossRef
34.
Michie S, Johnston M, Francis J, Hardeman W, Eccles M. From theory to intervention: mapping theoretically derived behavioural determinants to behaviour change techniques. Applied psychology. 2008;57(4):660–80.CrossRef
35.
Francis JJ, O’Connor D, Curran J. Theories of behaviour change synthesised into a set of theoretical groupings: introducing a thematic series on the theoretical domains framework. Implement Sci. 2012;7(1):35.CrossRefPubMedPubMedCentral
36.
Tavender EJ, Bosch M, Gruen RL, Green SE, Michie S, Brennan SE, et al. Developing a targeted, theory-informed implementation intervention using two theoretical frameworks to address health professional and organisational factors: a case study to improve the management of mild traumatic brain injury in the emergency department. Implement Sci. 2015;10:74.CrossRefPubMedPubMedCentral
37.
Greenhalgh T, Robert G, Macfarlane F, Bate P, Kyriakidou O. Diffusion of innovations in service organizations: systematic review and recommendations. Milbank Q. 2004;82(4):581–629.CrossRefPubMedPubMedCentral
38.
D'Amour D, Ferrada-Videla M, San Martin Rodriguez L, Beaulieu M-D. The conceptual basis for interprofessional collaboration: core concepts and theoretical frameworks. J Interprof Care. 2005;19(S1):116–31.CrossRefPubMed
39.
Perinatal OM, Services MMH. Council Report CR88. London: Royal College of Psychiatrists; 2000.
40.
Laungani P. Postnatal depression across cultures: conceptual and methodological considerations. International Journal of Health Promotion and Education. 2000;38(3):86–94.CrossRef
41.
Kumar M, Ongeri L, Mathai M, Mbwayo A. Translation of EPDS questionnaire into Kiswahili: understanding the cross-cultural and translation issues in mental health research. J Pregnancy Child Health. 2015;2(1):134. doi: 10.​4172/​2376-127X.​1000134.
42.
Department of Health, Government of Western Australia. Edinburgh Postnatal Depression Scale (EPDS): translated versions—validated. Perth: State Perinatal Mental Health Reference Group; 2006.
43.
O'Mahony J, Donnelly T. Immigrant and refugee women's post‐partum depression help‐seeking experiences and access to care: a review and analysis of the literature. J Psychiatr Ment Health Nurs. 2010;17(10):917–28.CrossRefPubMed
Metadata
Title
Factors affecting implementation of perinatal mental health screening in women of refugee background
Authors
Nishani Nithianandan
Melanie Gibson-Helm
Jacquie McBride
Amanda Binny
Kylie M. Gray
Christine East
Jacqueline A. Boyle
Publication date
01-12-2016
Publisher
BioMed Central
Published in
Implementation Science / Issue 1/2015
Electronic ISSN: 1748-5908
DOI
https://doi.org/10.1186/s13012-016-0515-2

Other articles of this Issue 1/2015

Implementation Science 1/2015 Go to the issue

Research

A theory-based process evaluation alongside a randomised controlled trial of printed educational messages to increase primary care physicians’ prescription of thiazide diuretics for hypertension [ISRCTN72772651]

Research

The GRADE evidence-to-decision framework: a report of its testing and application in 15 international guideline panels

Research

Integrating evidence-based practices for increasing cancer screenings in safety net health systems: a multiple case study using the Consolidated Framework for Implementation Research

Methodology

A review of methods and tools to assess the implementation of government policies to create healthy food environments for preventing obesity and diet-related non-communicable diseases

Research

Forging a link between mentoring and collaboration: a new training model for implementation science

Systematic review

Factors that influence the implementation of e-health: a systematic review of systematic reviews (an update)