title: Engaging stakeholders to develop a depression management decision support tool in a tribal health system.
abstract: OBJECTIVE
  Southcentral Foundation, an Alaska Native tribal health organization, has had a depression screening program in primary care since 2001. Program monitoring identified gaps in antidepressant refills and patients' follow-up with behavioral health services. With extensive stakeholder participation, we developed an electronic, patient-centered, depression-management decision support tool (DM-DST). Quality of life and other outcomes are being assessed in a separate study; this case study reports on the multi-year stakeholder engagement process.
  
  
  METHODS
  Data sources included interviews with patients and providers from integrated primary care teams, notes from research meetings, steering committee meetings, and consultations with tribal health system leadership, human subjects review committees, providers, and software designers, and a pilot test of the DS-DMT with patients and providers. We analyzed these sources using qualitative methods to assess the impact of stakeholder input on project processes and outcomes.
  
  
  RESULTS
  One comprehensive, iPad-based tool was originally planned to facilitate discussions about depression management. Stakeholder input emphasized the role of family and cultural context of depression and management and improving the usability of the DM-DST. Stakeholder direction led us to split the DM-DST into: (1) a brief iPad-based tool to facilitate conversations between patients and providers during clinic visits; and (2) a complementary Web site that provides detailed information and allows patients flexibility and time to learn more about depression and share information and preferences with family and friends.
  
  
  CONCLUSIONS
  Stakeholder input across the project substantially modified the DM-DST to ensure cultural applicability to patients and providers and facilitate integration into clinics.
authors.affiliation: Department of Bioethics and Humanities, University of Washington, Box 357120, Seattle, WA, 98195-7120, USA, tigiba@u.washington.edu.
authors.forename: Helene
authors.initials: H
authors.lastname: Starks
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Shaw
authors.forename: Vanessa
authors.initials: V
authors.lastname: Hiratsuka
authors.forename: Denise A
authors.initials: DA
authors.lastname: Dillard
authors.forename: Renee
authors.initials: R
authors.lastname: Robinson
mesh_terms: D000328:Adult; D003153:Community Health Services / Q000379:methods*; D019058:Community Networks; D003625:Data Collection; D003658:Decision Making, Computer-Assisted; D003866:Depressive Disorder / Q000175:diagnosis / Q000628:therapy*; D005260:Female; D006801:Humans; D007198:Indians, North American / Q000523:psychology*; D008297:Male; D008403:Mass Screening / Q000379:methods; D011320:Primary Health Care / Q000379:methods*; D011788:Quality of Life; D012107:Research Design