Table 3 Recommendations for implementation of perinatal mental health screening in women of refugee background
From: Factors affecting implementation of perinatal mental health screening in women of refugee background
Behavioural determinant | Behavioural change techniquesa | Examples to support health professionals (HPs) | Examples to support women |
|---|---|---|---|
Knowledge | Information regarding behaviour, outcome | Provide information for HPs regarding rationale for screening; clinical guidelines and evidence-practice gap; appropriate EPDS administration, scoring and actions; and PTSD screening | Provide information (e.g. culturally appropriate group sessions, translated printed materials) at earlier appointments about perinatal mental illness, routine screening, and MHS |
Skills | Goal/target specified: behaviour or outcome Increasing skills: problem solving, decision making, goal setting Rehearsal of relevant skills | Organisation to set target of routine screening; individual HPs to set targets for skills attainment Provide training for HPs regarding identification and prioritisation of refugee health needs; appropriate use, scoring and actions to EPDS; and cultural competence (including approach to mental health and managing family members) Provide opportunities to practise skills | Â |
Social/professional role and identity | Social processes of encouragement, pressure, support | Involve refugee health nurse, bicultural worker, perinatal mental health nurse and senior staff to support referral Balance inter-disciplinary approach with clear delineation of roles Ensure clear communication between antenatal and postnatal services and identify women already receiving mental health care | Â |
Beliefs about capabilities | Increasing skills: problem solving, decision making, goal setting Social processes of encouragement, pressure, support | Provide training for HPs (i.e. sensitive administration of trauma screening tool, management of women at risk of suicide or self-harm) Engage staff by communicating the rationale for screening and benefits for women | Â |
Beliefs about consequences | Persuasive communication Information regarding behaviour, outcome | Provide information for mental HPs regarding the provision of refugee appropriate mental health care (e.g. practical advice about managing symptoms) | HPs to normalise screening; provide culturally appropriate mental health information at earlier appointments; manage expectations regarding referrals; and communicate professionalism of interpreters and usefulness of follow-up mental health care |
Environmental context and resources | Environmental changes (e.g. objects to facilitate behaviour) | Select the most appropriate time(s) to screen with input from HPs administering the EPDS (e.g. second antenatal visit and again in third trimester). Allow HPs discretion to screen earlier or later or to forgo screening if guided by MHS already involved in care Management to work with HPs to allow appropriate appointment length and flexibility to manage disclosures and make immediate referrals Map MHS in the area and confirm capacity and sustainability of services prior to implementation | Incorporate rigorously translated screening tools into routine maternity care Provide skilled, onsite, female interpreters for common refugee languages and standardised instructions for appropriate EPDS translation Screen in a private setting Provide advice around transport |
Social influences | Social processes of encouragement, pressure, support | Ensure a ‘go-to’ or support person for HPs (e.g. refugee health nurse, senior staff, psychiatry liaison), regular team meetings and debrief opportunities | Ensure continuity of care Include referral pathways to social work, women’s groups and language services HPs to explain to family members what screening and potential follow-up involves; however screening to be undertaken privately |
Behavioural regulationb | Planning, implementation Prompts, triggers, cues | Establish robust referral pathways, feedback mechanisms to confirm receipt of referrals, communication channels between services, and clear documentation at all stages of pathways Clearly communicate pathways (e.g. flowcharts) and contact numbers for to HPs | Establish various pathways for different needs while minimising referral points Use on-site services where possible (e.g. social worker) |