HER Team and Department of Maternal and Child Health, Xiangya School of Public Health, Central South University, Hunan 410013, China.
HER Team and Department of Maternal and Child Health, Xiangya School of Public Health, Central South University, Hunan 410013, China; FuRong Laboratory, Changsha 410078, Hunan, China; Institute of Applied Health Research, University of Birmingham, B15 2TT, Birmingham, UK; Department of Psychiatry, University of Rochester, Rochester, New York, USA.
Midwifery. 2024 Nov;138:104148. doi: 10.1016/j.midw.2024.104148. Epub 2024 Aug 18.
Postpartum depression (PPD) significantly impacts mothers and children's health. China aims to incorporate PPD screening in postpartum home visits, but research on implementation barriers and facilitators is scarce. We designed and implemented a new PPD screening program in Changsha, China, requiring maternal health workers to integrate PPD screening into their postpartum home visits.
To identify real-world barriers and facilitators associated with integrating PPD screening into routine home visits from the perspective of maternal health workers.
We employed a mixed-methods approach. Maternal health workers involved in the newly introduced PPD screening program were included. Guided by Normalization Process Theory (NPT), quantitative data were collected using the NoMAD instrument, and qualitative data were obtained through semi-structured interviews. Data were analyzed using descriptive statistics for the survey and thematic analysis for the interviews.
All 42 maternal health workers involved in the new PPD program completed the quantitative survey, and nine participated in qualitative interviews. The NoMAD survey revealed high scores for Coherence and Cognitive Participation, but lower scores for Collective Action, particularly regarding insufficient skills and resource adequacy. Thematic analysis identified several barriers, including workload concerns, the need for enhanced psychological healthcare capacity, and lack of economic incentives. Facilitators included the integration of structured feedback and clear referral pathways.
Addressing identified barriers through targeted skill training, well-defined referral pathways, and formal recognition of the screening program in performance evaluations could help achieve successful normalization.
产后抑郁症（PPD）显著影响母婴健康。中国旨在将 PPD 筛查纳入产后家访，但对实施障碍和促进因素的研究很少。我们在中国长沙设计并实施了一项新的 PPD 筛查计划，要求产妇健康工作者将 PPD 筛查纳入产后家访。
从产妇健康工作者的角度确定与将 PPD 筛查纳入常规家访相关的实际障碍和促进因素。
我们采用混合方法。纳入参与新引入的 PPD 筛查计划的产妇健康工作者。在规范化进程理论（NPT）的指导下，使用 NoMAD 工具收集定量数据，并通过半结构化访谈获得定性数据。使用调查的描述性统计和访谈的主题分析来分析数据。
所有参与新 PPD 计划的 42 名产妇健康工作者都完成了定量调查，其中 9 人参加了定性访谈。NoMAD 调查显示，一致性和认知参与度得分较高，但集体行动得分较低，特别是在技能和资源充足性方面。主题分析确定了一些障碍，包括工作量问题、需要增强心理保健能力以及缺乏经济激励措施。促进因素包括结构化反馈和明确的转诊途径的整合。
通过有针对性的技能培训、明确的转诊途径以及在绩效评估中正式认可筛查计划，可以解决已确定的障碍，有助于实现规范化。
