DNP-820 Report: Implementation of Evidence into Practice Analysis

This report examines the implementation of evidence-based practice in healthcare, specifically focusing on the screening for postpartum depression. It discusses the importance of evidence-based interventions and highlights the gap between research and clinical practice. The report analyzes a study by the Agency for Healthcare Research and Quality (AHRQ) on the efficacy of postpartum depression screening. It assesses the extent to which this practice is implemented, citing statistics on prevalence and recommendations from organizations like the American College of Obstetricians and Gynecologists and the American Academy of Pediatrics. The report identifies barriers to implementation, including cultural misconceptions, socioeconomic factors, and lack of insurance coverage, and proposes solutions such as patient education, subsidized counseling, and community outreach programs. It also emphasizes the importance of resource availability, referencing the AHRQ's systematic review. The report concludes by advocating for home-based screening services and educational interventions to overcome barriers and improve patient outcomes.

Running head: IMPLEMENTATION OF EVIDENCE INTO PRACTICE
IMPLEMENTATION OF EVIDENCE INTO PRACTICE
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1IMPLEMENTATION OF EVIDENCE INTO PRACTICE
Introduction
To ensure the deliverance of optimum healthcare and quality clinical services for
adequate safety and comprehensive recovery across patients, healthcare professionals must
engage in the administration of evidence based professional interventions. Evidence based
practice implies that interventions and decisions administered in terms of healthcare, must be
supported by scientifically valid, significant and recent research (Kalb et al., 2015). Despite the
importance of evidence based practice, there continues to be a lack of its implementation and a
relevant gap between theoretical research and actual healthcare professional practice (da Silva et
al., 2015). The following essay will aim to discuss relevant gaps in practice considering a topic
of comparative effectiveness researched by the Agency for Healthcare Research and Quality
(AHRQ).
Discussion
Discussion of Practice
The field of practice researched by the Agency for Healthcare Research and Quality
(AHRQ), for the evaluation of scientific comparative effectiveness includes the safety and
efficacy associated with the screening of post partum depression. According to the systematic
review by the AHRQ as a part of its ‘Effective Healthcare Program’, it has been evidenced that
implementation of a comprehensive screening and assessment underlying evaluation of post
partum depression has been associated with the positive health outcomes among women as
compared to women who did not undergo any form of screening. There is a need for future
research however, on the role of aspects of timing, sensitivity, specificity and frequency on the

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effectiveness and safety underlying implementation of a post partum screening procedure
(Agency for Healthcare Research and Quality, 2019).
Implementation
There continues to remain considerable awareness and evidence on the detrimental
psychological and physiological health outcomes associated with untreated post partum
depression. In the United States, post partum depression continues to prevail at rates of 12.8%,
with the lowest rates observed in Maine (6.6%) and highest rates observed in Arkansas (22.3%)
(Corrigan, Kwasky & Groh, 2015). As part of its objectives, Healthy People 2020 necessitates
immediate resolution and reduction in prevalence of post partum depression across the nation.
Further, the American College of Obstetricians and Gynecologists, recommend early assessment
of post partum depression among women at the perinatal state, while the American Academy of
Pediatrics recommends pediatricians to undertake post partum screening among mothers at
frequent time periods, during the first month, second month and fourth month, respectively.
However, the condition continues to remain unreported and undiagnosed among 68% of mother
across the nation, with only an estimated half of the population receiving treatment interventions
for the same (Mukherjee et al., 2018).
Prevalent Barriers
The observed lack of implementation underlying the timely screening of post partum
depression continues to prevail due to the presence of several barriers. Cultural misconceptions
and barriers continue to be a major barrier to implementation in practice, especially among
cultural groups like Hispanics and Blacks, where women believe that seeking mental health
assistance is a sign of ‘craziness’ and results in inappropriate societal labeling. Additional
barriers include stereotypical misconceptions ostracizing women with claims that perceptions of

3IMPLEMENTATION OF EVIDENCE INTO PRACTICE
sadness are not compliant to practice of ‘good motherhood’ (Hansotte, Payne & Babich, 2017).
Further, mothers belonging to economically underprivileged, refugee or immigrant families may
face reduced affordability to screening and treatment as well as accessibility to facilities of
transport to healthcare organization or issues pertaining to childcare when traveling to treatment
locations. Addition barriers include a lack of insurance coverage for such conditions due to
misconceptions that post partum depression area difficult condition to treat (Lara-Cinisomo et
al., 2016).
Overcoming Barriers
The prevalent cultural misconceptions and stereotypes contributing as barriers to
screening and treatment of post partum depression can be mitigated through the provision of
patient education during reception of maternal and childcare services. To combat the barriers
associated with financial unfeasibility, provision of subsidized or free-of-cost psychological
counseling, prior to and after childbirth among economically underprivileged women may prove
to be beneficial (O’connor et al., 2016). Administration of self help and support groups may also
be beneficial in providing assistance and motivation for mothers to undergo timely assessment
and mitigation of post partum depression. Considering a major barrier preventing women from
undertaking screening and assessment of post partum depression includes issue with
transportation and caring for the child at home, a key solution to overcome the same would
comprise of healthcare organizations providing door-to-door maternal screening and care
services (Wilkinson, Anderson & Wheeler, 2017). Further, it must be considered that women as
well as families may lack awareness and information on the signs and symptoms of post partum
depression, the negative health implications associated with lack of diagnosis as well as the
possible benefits underlying treatment strategies such as counseling, screening or medication

4IMPLEMENTATION OF EVIDENCE INTO PRACTICE
administration. Hence, healthcare organizations can collaborate with public health or community
health organizations and advocacy groups to implement public health campaigns providing
educational and free of cost screening resources for mitigation of the above barriers and high
prevalence rates of the condition (Gorman, 2017). Further, through collaboration with media
platforms, healthcare organizations providing maternity care screening and services can
disseminate brochures, advertisements, flyer, emails or text notifications on benefits of post
partum depression prevalence and screening. To further ensure long term patient adherence to
post partum screening and awareness on the same, as well as prevention of high rates of
prevalence, healthcare organizations must conduct follow up screening and behavioral or
psychotherapeutic interventions post childbirth (Ko et al., 2017).
Resource Availability
One of the key resources which can be proved to be beneficial in the translation of the
above evidenced based research is the AHRQ’s systematic review demonstrating the
effectiveness of timely screening interventions to assess post partum depression. Further
resources include the AHRQ’s evidenced based collection of literature which comprises of a
discussion on the prevalence and features of post partum depression screening across low income
group populations (Agency for Healthcare Research and Quality, 2019).
Conclusion
Hence, it can be observed that, post partum depression is still a prevalent issue in the
United States. Despite the recommendations and research by the AHRQ on the evidence based
benefits of timely screening, there continues to be a lack of implementation, due to a number of
cultural, educational, social and financial barriers. To conclude, healthcare organizations must

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consider dissemination of home based, subsidized screening services coupled with patient
educational interventions to combat such barriers.

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References
Agency for Healthcare Research and Quality. (2019). Efficacy and Safety of Screening for
Postpartum Depression. Retrieved from
https://effectivehealthcare.ahrq.gov/sites/default/files/pdf/depression-postpartum-
screening_research.pdf.
Agency for Healthcare Research and Quality. (2019). Screening for post-traumatic stress
disorder in prenatal care: prevalence and characteristics in a low-income population |
AHRQ Academy. Retrieved from
https://integrationacademy.ahrq.gov/products/literature-collection/literature/screening-
post-traumatic-stress-disorder-prenatal-care.
Corrigan, C. P., Kwasky, A. N., & Groh, C. J. (2015). Social support, postpartum depression,
and professional assistance: A survey of mothers in the Midwestern United States. The
Journal of perinatal education, 24(1), 48-60.
da Silva, T. M., Costa, L. D. C. M., Garcia, A. N., & Costa, L. O. P. (2015). What do physical
therapists think about evidence-based practice? A systematic review. Manual
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Gorman, J. (2017). Postpartum Depression and Opinions on Screening.
Hansotte, E., Payne, S. I., & Babich, S. M. (2017). Positive postpartum depression screening
practices and subsequent mental health treatment for low-income women in Western
countries: a systematic literature review. Public Health Reviews, 38(1), 3.

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Kalb, K. A., O'Conner-Von, S. K., Brockway, C., Rierson, C. L., & Sendelbach, S. (2015).
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Ko, J. Y., Rockhill, K. M., Tong, V. T., Morrow, B., & Farr, S. L. (2017). Trends in postpartum
depressive symptoms—27 states, 2004, 2008, and 2012. MMWR. Morbidity and
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Lara-Cinisomo, S., Girdler, S. S., Grewen, K., & Meltzer-Brody, S. (2016). A biopsychosocial
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Mukherjee, S., Fennie, K., Coxe, S., Madhivanan, P., & Trepka, M. J. (2018). Racial and ethnic
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O’connor, E., Rossom, R. C., Henninger, M., Groom, H. C., & Burda, B. U. (2016). Primary care
screening for and treatment of depression in pregnant and postpartum women: evidence
report and systematic review for the US Preventive Services Task Force. Jama, 315(4),
388-406.
Wilkinson, A., Anderson, S., & Wheeler, S. B. (2017). Screening for and treating postpartum
depression and psychosis: a cost-effectiveness analysis. Maternal and child health
journal, 21(4), 903-914.