title: A theory-based educational intervention to pediatricians in order to improve identification and referral of maternal depression: a quasi-experimental study.
abstract: BACKGROUND
  Maternal depression has a negative impact on both the mother and child's physical and mental health, as well as impairs parenting skills and pediatric health care utilization. The pediatricians' role in identification and management of maternal depression is well established. Although it can be successfully and easily treated, maternal depression remains under-recognized and under-treated. Despite the heightened emphasis, there is lack of interventions to pediatricians in order to improve detection and management of maternal depression.
  
  
  METHODS
  To address this gap, an educational intervention based on the 'Health Belief Model' was developed, implemented, and evaluated. The present quasi-experimental study, aimed to assess the pediatricians' knowledge, self-efficacy, beliefs, and attitudes toward maternal depression at baseline and post-intervention measurements. A total of 43 randomly selected primary care pediatricians residing in Athens completed a 59-item survey by mail in 2011. Pediatricians in the intervention group received a toolkit about the recognition and management of maternal depression, while pediatricians in the control group received a leaflet about mental health. Descriptive statistics, t test, chi-square, Fisher's exact test, and analysis of variance were used for the statistical analysis.
  
  
  RESULTS
  Post-intervention measurement revealed differences at a statistical significance level between the two groups, in the following variables: beliefs, attitudes, self- efficacy, perceived barriers, and management practices of maternal depression. Furthermore, at post-measurement, pediatricians in the intervention group demonstrated increased perceived responsibility and increased self-efficacy for detection and referral of maternal depression.
  
  
  CONCLUSIONS
  Educational interventions to pediatricians seem to be beneficial for the improvement of the pediatricians' knowledge, self-efficacy, and attitudes regarding maternal depression. Studies using large, representative population samples are needed to provide evidence if the training interventions to pediatricians for maternal depression are translated to changes in their clinical practice and improved the patients' health outcomes.
authors.affiliation: Center for Health Services Research, Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Alexandroupoleos st, 25, Athens 115 27, Greece. eagapidaki@gmail.com.
authors.forename: Eirini
authors.initials: E
authors.lastname: Agapidaki
authors.forename: Kyriakos
authors.initials: K
authors.lastname: Souliotis
authors.forename: Stylianos
authors.initials: S
authors.lastname: Christogiorgos
authors.forename: Lannis
authors.initials: L
authors.lastname: Zervas
authors.forename: Angeliki
authors.initials: A
authors.lastname: Leonardou
authors.forename: Gerasimos
authors.initials: G
authors.lastname: Kolaitis
authors.forename: George
authors.initials: G
authors.lastname: Giannakopoulos
authors.forename: Christina
authors.initials: C
authors.lastname: Dimitrakaki
authors.forename: Yannis
authors.initials: Y
authors.lastname: Tountas