The Gap between Knowing and Doing: Health Workers' Perceptions and Screening of Postpartum Depression

Abstract

Background: Postpartum depression (PPD) is a prevalent yet under-recognized complication of childbirth with severe implications for maternal and child well-being. Despite global recommendations advocating for routine screening, implementation in low-resource settings remains inconsistent, creating a significant gap between clinical knowledge and practical application.
Objective: This study investigates the "gap between knowing and doing" regarding PPD among health workers at Babcock University Teaching Hospital, Nigeria. Specifically, it explores health workers' understanding of PPD and examines their approaches to screening and management in routine clinical practice.
Methods: A qualitative exploratory design was employed. In-depth interviews were conducted with 15 frontline health workers, including nurses, midwives, community health officers, and medical officers directly involved in maternal and child health services. Data were analyzed using thematic analysis and interpreted through the lens of the Social Ecological Model to understand individual, interpersonal, and institutional factors.
Results: Findings reveal that while participants possess basic awareness of PPD, their clinical understanding is superficial, often normalizing symptoms as typical postnatal distress. Crucially, no routine screening protocols or standardized tools, such as the Edinburgh Postnatal Depression Scale, are utilized. Instead, detection relies on subjective observation and patient complaints, leading to inconsistent identification. Management is limited to basic counseling and referrals, hindered by a lack of formal training, absent clinical guidelines, heavy workloads, and deep-seated sociocultural stigma. The disconnect between knowledge and practice is identified as systemic, driven by organizational constraints and community-level barriers rather than individual deficits alone.
Conclusion: The study concludes that bridging the gap in PPD care requires multi-level interventions. Recommendations include integrating standardized screening tools into routine maternal care, providing structured capacity-building training, developing clear clinical protocols, and addressing sociocultural barriers through community engagement. These strategies are essential for transforming PPD care from a reactive to a proactive model, ensuring timely support for affected mothers and improving long-term developmental outcomes for children.