Barriers and facilitators for referring women with positive perinatal depression screening results in China: a qualitative study

Abstract

Background Timely screening and referral can improve the outcomes of perinatal depression (PND). However, uptake rates of referral after PND screening are low in China and the reasons are unclear. The aim of this article is to explore the barriers and facilitators for referring women with positive results of PND screening in the Chinese primary maternal health care system. Methods Qualitative data were collected from four primary health centers located in four different provinces of China. Each of the four investigators conducted 30 days of participant observations in the primary health centers from May to August 2020. Data were collected via participant observations and semi-structured in-depth interviews with new mothers who had positive results of PND screening, their family members, and primary health providers. Two investigators analyzed qualitative data independently. A thematic analysis was conducted, and data were framed using the social ecological model. Results A total of 870 hours of observation and 46 interviews were carried out. Five themes were identified: individual (new mothers’ knowledge of PND, perceived need to seek help), interpersonal (new mothers’ attitudes towards providers, family support), institutional (providers’ perception of PND, lack of training, time constraints), community (accessibility to mental health services, practical factors), and public policy (policy requirements, stigma). Conclusions The likelihood of new mothers accepting PND referral is related to factors in five areas. Intervention strategies can be developed around these themes and may include educating new mothers and their families about PND, training primary health providers to improve their awareness of condition and indication for referral, building mental health support in routine postpartum home visits, and providing support through mobile technology.

Awareness, Attitudes, and Help-seeking Intention towards Perinatal Depression among Women from Different Ethnic Groups in Western Rural China

“…Meanwhile, over 60% of women believed that medical insurance coverage could alleviate the economic burden associated with using such services. These ndings align with another study conducted in Changsha city, China [30]. In addition to awareness raising, we recommend addressing individual and sociocultural factors to support women in rural areas seeking quality mental health care.…”

“…Knowledge-attitude-practice theory posits that acquired knowledge and attitudes of women towards perinatal depression treatment play a pivotal role in mediating their help-seeking behaviors [7,14,26,29]. In particular, women with more positive attitudes towards depression treatment are more likely to have stronger intentions to seek help and a higher likelihood of actually doing so [7,21,30]. While several studies have explored women's attitudes and help-seeking intentions towards perinatal depression in countries like the US and Portugal [15,19], there remains a signi cant research gap in understanding these aspects in the context of China, particularly among ethnic minority women.…”