Perinatal depression has become a focus area for statewide public health outreach efforts due to its documented impact on the longitudinal health and emotional well-being of both mothers and infants (Field et al., 2010; Segre et al., 2010). However, there is a lack of evidence around which to develop public policy specifically addressing professional education and training needs for health care providers (Kozhimannil et al., 2011; Yonkers et al., 2009). This study describes a successful statewide social work and public health partnership which aims to inform perinatal depression screening and intervention efforts across service sectors. The study's objectives are 1) to articulate and test a program theory which informs future professional educational interventions, and 2) to utilize survey data and program theory testing to establish practice and policy priorities for depression screening and mental health service enhancement for women of reproductive age statewide.
Methods
A random sample of state licensed health care providers including physicians, nurse practitioners, certified nurse midwifes, registered nurses and social workers (N=1,498) were surveyed using an expert-panel developed instrument. Providers were specifically asked about their practices with, and perceptions of, perinatal depression and related system capacities and barriers. First, extensive descriptive data analysis was conducted and subsequent logistic regression, confirmatory factor analysis (CFA) and structural equation models (SEM) were developed. SPSS Statistics 19, and MPlus 6.1 were used in the analyses.
Results
Descriptive analysis revealed a range of provider beliefs and practices, highlighting differences among specializations. Bivariate analysis and logistic regression models identified significant patient, provider and system-capacity barriers that influence practice. Interestingly, these analyses also vary significantly based on urban/suburban/rural status and provider case management experience. Latent variables of provider confidence in the ability to diagnose and treat and the importance placed on screening and referral to treatment were identified and confirmed through CFA models; these constructs were integrated into an SEM model which predicts the causal relationships between importance and confidence (two essential aspects often addressed through motivational interviewing) and provider's inclusion of perinatal depression screening and treatment/referral in their practice. Both CFA and SEM models are complete and will be presented visually.
Conclusions and Implications
The provisional program theory identified for health providers encompasses the constructs of importance and confidence which are consistent with intervention models based in motivational interviewing (Miller & Rollnick, 2002). Providers across the state are being trained to incorporate this theory of behavior change with their clients. The program theory model identified suggests that increasing provider confidence and/or augmenting perceived importance through motivational interviewing may also provide a plausible intervention approach for assisting health care providers translate their own professional knowledge into practice. Ultimately, study findings will be used to garner legislative and funding support for the development and expansion of perinatal depression programs and policy throughout the state.
This project was supported by the Virginia Department of Health Maternal Child Health Block Grant and the National Institutes of Health (UL1RR031990).
