title: OB CARES--The Obstetric Clinics and Resources Study: providers' perceptions of addressing perinatal depression--a qualitative study.
abstract: OBJECTIVE
  We conducted a qualitative study to understand how prenatal care providers perceive influences on their delivery of perinatal depression care. Given that depression screening protocols were in place at the clinics where we sampled providers, we hypothesized that clinic- and system-level factors such as resources, training opportunities and coordination would be dominant in influencing provider decisions.
  
  
  METHODS
  We conducted semistructured interviews with 20 prenatal care providers from six obstetric clinics. We performed a thematic analysis, including within-case and cross-case comparisons, and built a conceptual model of provider decision making from the data.
  
  
  RESULTS
  Although depression screening protocols were in place at our study clinics, we found that decisions to address perinatal depression were largely made at the level of the individual provider and were undefined on a clinic level, resulting in highly variable practice patterns. In addition, while providers acknowledged externally derived influences, such as logistical resources and coordination of care, they spoke of internally derived influences, including familiarity with consultants, personal engagement styles and perceptions of role identity, as more directly relevant to their decision making.
  
  
  CONCLUSIONS
  Our results highlight the pivotal role of internal factors in decisions to deliver perinatal depression care. Future interventions in obstetric settings should target the intrinsic motivations of providers.
authors: Department of Obstetrics and Gynecology, Georgia Health Sciences University, GA, USA. cpalladino@georgiahealth.edu
authors: Christie Lancaster
authors: CL
authors: Palladino
authors: Gina L
authors: GL
authors: Fedock
authors: Jane H
authors: JH
authors: Forman
authors: Matthew M
authors: MM
authors: Davis
authors: Erin
authors: E
authors: Henshaw
authors: Heather A
authors: HA
authors: Flynn