title: Factors affecting implementation of perinatal mental health screening in women of refugee background.
abstract: For women of refugee background, the increased risk of mental illness associated with pregnancy is compounded by pre- and post-settlement stressors. In Australia, antenatal screening for depression and anxiety symptoms using the Edinburgh Postnatal Depression Scale is recommended for all women. Despite this, screening is not routinely implemented and little is known about barriers and enablers to implementation for women of refugee background.
  
  
  
  Semi-structured interviews were conducted with a range of health professionals (n = 28: midwives, obstetricians, perinatal mental health and refugee health experts, interpreters) and women of refugee background (n = 9). Themes generated from thematic analysis were examined in relation to the Theoretical Domains Framework and Cultural Competence Conceptual Framework, followed by identification of effective behaviour change techniques to address the barriers and enablers identified by participants. These techniques formed the basis of recommendations to inform sustainable implementation of screening and referral.
  
  
  
  Almost all participants perceived perinatal mental health screening to be necessary and most recognised the importance of post-traumatic stress disorder (PTSD) screening. Barriers and enablers were identified and related to eight domains: knowledge, skills, professional roles, beliefs about capabilities and consequences, environmental context, social influences and behavioural regulation.
  
  
  
  This research clarifies how mental health screening may be integrated into routine antenatal care for women of refugee background, in order to improve provision of recommended care. These theory-informed recommendations include an inter-disciplinary approach, coordinating care within and across services, addition of PTSD screening, and effective communication with women.
authors.affiliation: Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, 43-51 Kanooka Grove, Clayton, 3168, Victoria, Australia.
authors.forename: Nishani
authors.initials: N
authors.lastname: Nithianandan
authors.affiliation: Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, 43-51 Kanooka Grove, Clayton, 3168, Victoria, Australia.
authors.forename: Melanie
authors.initials: M
authors.lastname: Gibson-Helm
authors.affiliation: Monash Health Refugee Health and Wellbeing, Monash Health, Clayton, Victoria, Australia.
authors.forename: Jacquie
authors.initials: J
authors.lastname: McBride
authors.affiliation: Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, 43-51 Kanooka Grove, Clayton, 3168, Victoria, Australia.
authors.forename: Amanda
authors.initials: A
authors.lastname: Binny
authors.affiliation: Centre for Developmental Psychiatry and Psychology, Department of Psychiatry, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia.
authors.forename: Kylie M
authors.initials: KM
authors.lastname: Gray
authors.affiliation: Monash Women's Maternity Services, Monash Health, Clayton, Victoria, Australia.|School of Nursing and Midwifery, Monash University, Clayton, Victoria, Australia.
authors.forename: Christine
authors.initials: C
authors.lastname: East
authors.affiliation: Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, 43-51 Kanooka Grove, Clayton, 3168, Victoria, Australia. jacqueline.boyle@monash.edu.
authors.forename: Jacqueline A
authors.initials: JA
authors.lastname: Boyle
mesh_terms: D001291:Attitude of Health Personnel; D001294:Attitude to Health; D002983:Clinical Competence / Q000592:standards; D003695:Delivery of Health Care; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D001523:Mental Disorders / Q000175:diagnosis*; D018743:Perinatal Care / Q000592:standards*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis*; D012036:Refugees; D012649:Self Concept; D012944:Social Support; D014739:Victoria
keywords: Anxiety; Depression; Health services research; Mental health; Perinatal; Post-traumatic stress disorder; Pregnancy; Prenatal care; Refugees