title: Healthcare worker's perceptions of barriers to care by immigrant women with postpartum depression: an exploratory qualitative study.
abstract: OBJECTIVE
  We interviewed healthcare workers working in Toronto, Canada, regarding their experience of providing care to recent immigrant women suffering from postpartum depression. The objective was two-fold: 1) to identify potential barriers to care that recent immigrant women may encounter as perceived by healthcare workers; and 2) to identify challenges healthcare workers felt that they faced as providers of care to this population.
  
  
  METHODS
  Qualitative semi-structured interviews were conducted with 16 key informants from various disciplines employed by healthcare agencies providing care to postpartum immigrant women in Toronto. Constant comparative analysis was used to analyze the data.
  
  
  RESULTS
  Two main categories of barriers to care for recent immigrant women were identified: 'practical barriers' and 'culturally determined barriers'. Practical barriers included knowing where and how to access services, and language difficulties. Cultural barriers included fear of stigma and lack of validation of depressive symptoms by family and society. The challenges experienced by healthcare providers working with this population were organized into two other categories: 'professional limitations', and 'social/cultural barriers'. 'Professional limitations' included fear of incompetence, language barriers, and inadequate assessment tools. 'Social/cultural barriers' included the experience of cultural uncertainty.
  
  
  CONCLUSIONS
  The results suggest that not only are there important barriers to accessing postpartum care for recent immigrant women, but it can also be challenging for healthcare workers to deliver such needed care. Understanding some of these barriers and challenges from the perspective of healthcare providers is an important step to remedying gaps and obstacles in the service system.
authors.affiliation: University of Toronto, Toronto, Canada.
authors.forename: L
authors.initials: L
authors.lastname: Teng
authors.forename: E
authors.initials: E
authors.lastname: Robertson Blackmore
authors.forename: D E
authors.initials: DE
authors.lastname: Stewart
mesh_terms: D000328:Adult; D001294:Attitude to Health / Q000208:ethnology*; D003144:Communication Barriers; D003153:Community Health Services / Q000706:statistics & numerical data; D019052:Depression, Postpartum / Q000453:epidemiology / Q000451:nursing*; D004641:Emigration and Immigration / Q000706:statistics & numerical data*; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D008913:Minority Groups / Q000706:statistics & numerical data; D015404:Nursing Methodology Research; D009864:Ontario; D010342:Patient Acceptance of Health Care / Q000208:ethnology* / Q000706:statistics & numerical data; D011181:Postnatal Care / Q000706:statistics & numerical data*; D036301:Qualitative Research; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D016387:Women's Health