Social workers' perceptions of barriers to interpersonal therapy implementation for treating postpartum depression in a primary care setting in Israel.

Research on evidence-based practice (EBP) implementation in social work often neglects to include evaluation of application barriers. This qualitative study examined social workers' perspectives of provider- and organisational-related barriers to implementing a brief eight-session interpersonal therapy (IPT) intervention, a time-limited EBP that addresses reducing depressive symptoms and improving interpersonal functioning. Implementation took place in a primary care setting in Israel and was aimed at treating women who have postpartum depression (PPD) symptoms. Using purposeful sampling, 25 primary care licensed social workers were interviewed between IPT training and implementation regarding their perceived barriers to implementing IPT in practice. Data analysis was facilitated using a phenomenological approach, which entails identifying the shared themes and shared experiences of research participants regarding barriers to implementing IPT. Three themes emerged from the analysis of interviews: Perceived lack of flexibility of IPT intervention in comparison with more familiar methods social workers previously applied, specifically regarding the number of sessions and therapeutic topics included in the IPT protocol; insecurity and hesitance to gain experience with a new method of intervention; and organisational barriers, including difficulties with referrals, the perception of HMOs as health facilities not suitable for therapy, and time constraints. Addressing perceived barriers of social workers toward implementing EBPs, such as IPT for postpartum depression, during the training phase is crucial for enabling appropriate implementation. Future training should include examining practitioners' attitudes toward implementation of EBPs, as part of standardised training protocols.

The relationship between personal knowledge and decision self-efficacy in choosing trial of labor after cesarean.

INTRODUCTION: The number of women in the United States giving birth via cesarean remains high as the number of vaginal births after cesarean (VBAC) declines. The purpose of this study was to explore how personal knowledge and decision self-efficacy of women who had a prior cesarean birth affected their decision about mode of birth in a subsequent pregnancy. METHODS: A sample of 45 pregnant women with a history of a prior cesarean birth between 10 and 22 weeks' gestation were surveyed to assess their knowledge of the risks and benefits of trial of labor after cesarean (TOLAC) and elective repeat cesarean delivery (ERCD), and their degree of decision self-efficacy related to their choice of mode of birth for the present pregnancy. RESULTS: Decision self-efficacy was not a significant predictor of choice for mode of birth (P = 0.58). Knowledge scores of women who chose ERCD ranged from 0 to 10 (mean [SD], 4.64 [2.94]). Of women who chose TOLAC, knowledge scores ranged from 0 to 13 (mean [SD], 5.90 [3.64]) out of a total possible score of 14. Knowledge was found to be a significant factor in the decision-making process for mode of birth (P = 0.03). Among women who were deemed to have high knowledge, 55% chose TOLAC, whereas 24% of women with high knowledge chose ERCD. The likelihood of a woman with high knowledge scores choosing a TOLAC was 3.9 (95% confidence interval [CI], 1.09-13.81) times the odds of a woman with low knowledge scores choosing ERCD. DISCUSSION: In this study, more knowledge about the risks and benefits of TOLAC and ERCD was found to be positively associated with the decision for TOLAC. This finding is important for health care providers when counseling women who have had a prior cesarean about their choices regarding mode of birth during a subsequent pregnancy. Supplying women with complete and accurate information about the risks and benefits of both choices may help increase the number of women who opt for TOLAC.

Postpartum practices and depression prevalences: technocentric and ethnokinship cultural perspectives.

Reports of non-Western prevalence of postpartum depression (PPD) are highly variable. This variation may indicate that the label of PPD may be unacceptable in some groups or not used, that manifestations may vary by culture, or that cross-cultural diagnostic standards do not match Western clinical criteria. These factors complicate efforts to explore the relationship of postpartum traditional practices to PPD between Western and non-Western cultures. Although Stern and Kruckman viewed PPD as a culture-bound phenomenon of Western culture, an expanding international literature has demonstrated that PPD occurs in a variety of countries. To address these issues, the authors examined the literature to describe cultural postpartum traditions, to explore possible relationships among practices and PPD prevalence, to critique the culture-bound theory, and to discuss clinical practice implications.

Antepartum care in the twenty-first century.

Major factors impacting on antepartum care in the twenty-first century were reviewed in this article, including the impact of managed care and collaborative health care teams, the malpractice crisis, antepartum visits and the quality of care, increased use of the Internet and computer technology, the increasing age of childbearing, advances in genetic and prenatal diagnosis, the importance of evidence-based medicine, the goals of Healthy People 2010 [11], the Safe Mother Initiative, and the use of complementary and alternative medicine. Recommendations for antepartum care in the twenty-first century include; the formation of integrated collaborative health care teams to deal with the effects of managed care; development of a more sensitive health care system to assist all parties involved with medical malpractice; increased expertise in the use of the Internet and computer technology; acknowledging and preparing for the increased population of older gravidas; becoming aware of advances in genetic and prenatal diagnosis; increasing the ability to critically evaluate research and incorporate well-founded study findings into clinical practice; incorporating the goals of Healthy People 2010 [11] when providing care to antepartum patients; contributing resources and manpower to the Safe Mother Initiative to decrease maternal mortality in developing countries; becoming knowledgeable, obtaining adequate training, and utilizing or performing evidence-based studies to validate the use of complementary and alternative medicine in antepartum practice; and finally to find a balance between the factors impacting on prenatal care and the ability to continue to provide safe, high-quality, continuous, sensitive, and humane antepartum care.