Follow-up Care After Screening For Postpartum Depression: Barriers And Facilitators From Health Care Workers' views.

Abstract

Title: Follow-up care after screening for postpartum depression. Background: Postpartum depression (PPD) is a common and under-diagnosed complication after childbirth. Therefore, youth health care centers in the east of the Netherlands implemented routinely screening for PPD using the Edingburgh Postnatal Depression Scale. However, it is important to not only implement routinely screening but also make sure that an adequate follow-up process is provided. Therefore, factors influencing participation, execution and realization of a successful process of screening and follow-up need to be identified before a strategy can be designed for implementation throughout The Netherlands. Aim: To identify barriers, facilitators and suggestions for improvement of the follow-up process of PPD from the perspective of all involved health care workers (HCW). Method: A qualitative deductive design was used. The study population was a purposeful, heterogeneous sample consisting of seventeen HCW from different professions. Data was collected using individual, face-to-face, semi-structured interviews. Results: Stigma, support and lack of knowledge about PPD are the main barriers for patients concerning help seeking and treatment. Barriers on provider level were lack of knowledge, indistinctness about involved health care workers, treatment options and responsibilities and lack of communication and consultation between health care workers. Finances were a barrier across all levels. Main facilitators on patient and provider level were education, support and home visits. Conclusion: HCW identified barriers on patient- provider and system level. Most importantly, Stigma is of great concern. The multidisciplinary collaboration as it is now is not working optimally and the referral process is unstructured and decentralized. Recommendations: Patients’ and providers’ perspective should be combined into an implementation strategy for improving the multidisciplinary follow-up process for PPD in the Netherlands.