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Barriers to integrating routine depression screening into community low vision rehabilitation services: a mixed methods study

Nollett, Claire ORCID:, Bartlett, Rebecca, Man, Ryan, Pickles, Timothy ORCID:, Ryan, Barbara and Acton, Jennifer H. ORCID: 2020. Barriers to integrating routine depression screening into community low vision rehabilitation services: a mixed methods study. BMC Psychiatry 20 , p. 419. 10.1186/s12888-020-02805-8

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Background:Undetected depression is common in people withlow vision and depression screening has beenrecommended. However, depression screening is a complex procedure for which low vision practitioners need training. Thisstudy examined the integration of routine depression screening, using two questions, and referral pathways into a nationallow vision service in Wales at 6 months following practitioner training, and identified key barriers to implementation.Methods:This pre-post single group study employed a convergent mixed methods design to collect quantitativequestionnaire and qualitative interview data on low vision practitioners’clinical practice and perceived barriers toimplementing depression screening. Forty practitioners completed questionnaires pre-, immediately post- and 6 monthspost-training and nine engaged in interviews 6 months post-training. Ordinal questionnaire scores were Rasch-transformedinto interval-level data before linear regression analyses were performed to determine the change in scores over time andthe association between perceived barriers and clinical practice. Thematic Analysis was applied to the interviews and thenarrative results merged withthe questionnaire findings.Results:Before training, only one third of practitioners (n= 15) identified depression in low vision patients, increasing toover 90% (n= 37) at 6 months post-training, with a corresponding increase in those using validated depression screeningquestions from 10% (n= 4) to 80% (n= 32). Six months post-training, practitioners reported taking significantly moreaction in response to suspected depression (difference in means = 2.77, 95% CI 1.93 to 3.61,p< 0.001) and perceived lessbarriers to addressing depression (difference in means =−0.95, 95% CI−1.32 to−0.59,p<0.001).However,thescreening questions were not used consistently. Some barriers to implementation remained, including perceived patientreluctance to discuss depression, time constraints and lack of confidence in addressing depression.Conclusions:The introduction of depression screening service guidelines and training successfully increased the numberof low vision practitioners identifying and addressing depression. However, standardized screening of all low visionattendees has not yet been achieved and several barriers remain. Healthcare services need to address these barriers whenconsidering mental health screening, and further research could focus on the process from the patients’perspective, todetermine the desire for and acceptability of screening.

Item Type: Article
Date Type: Publication
Status: Published
Schools: Optometry and Vision Sciences
Centre for Trials Research (CNTRR)
Publisher: BioMed Central
ISSN: 1471-244X
Funders: Thomas Pocklington Trust
Date of First Compliant Deposit: 27 August 2020
Date of Acceptance: 3 August 2020
Last Modified: 07 Nov 2022 11:06

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