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Implementation Science

, 11:150

First Online: 18 November 2016Received: 23 May 2016Accepted: 24 October 2016DOI: 10.1186-s13012-016-0515-2

Cite this article as: Nithianandan, N., Gibson-Helm, M., McBride, J. et al. Implementation Sci 2016 11: 150. doi:10.1186-s13012-016-0515-2


BackgroundFor 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.

MethodsSemi-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.

ResultsAlmost 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.

ConclusionsThis 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.

KeywordsRefugees Pregnancy Prenatal care Mental health Depression Anxiety Post-traumatic stress disorder Perinatal Health services research AbbreviationsCCCFCultural Competence Conceptual Framework

CRCommunity representative

EPDSEdinburgh Postnatal Depression Scale

HPHealth professional

MHSMental health services

PTSDPost-traumatic stress disorder

TDFTheoretical Domains Framework

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

Fuente: https://link.springer.com/

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