The Construction And Clinical Translation Of Perinatal Depression Management Program Based On The Knowledge-To-Action Framework

Objectives:It is well recognized that perinatal depression(PND)has a profound impact on mother and child and that scientific management provides a means to promote comprehensive mental health during pregnancy and after birth.Obstetrics and gynecology are the main arenas of PND management,but the current state of PND management in this field is not ideal,and a scientific management plan should be established.Based on the Knowledge-to-Action(KTA)framework,this study constructed a PND management plan suitable for domestic obstetrics and gynecology;then implemented the plan in clinical practice to verify its effectiveness.Method:The research consists of three stages under the guidance of the KTA framework.1.Make a questionUsing qualitative research,explore the current status of PND management in obstetrics and gynecology,focusing on clinical problems.2.Knowledge CreationUsing evidence-based medicine,summarize the latest and best evidence for the management of PND.Survey pregnant women to identify their values and preferences for the evidence described above.By using expert argumentation,the evidence is deleted and modified locally,and the strength of each recommendation is determined.Establish a PND management plan based on the 5W1H principle.As a result,the PND information management system is developed.3.Action cycleAssesses gaps between evidence and practice by converting evidence into an Evidence-Based Practice Behavioral Implementation Rate Review Checklist.Providing tailored evidence through quantitative and qualitative research.Analyze the factors influencing the management of PND through systematic reviews and qualitative research.Identify a clinical translation strategy and formulate an optimized PND management plan.Using a non-concurrent before and after control trial,evaluate the implementation effect of the program.Results:1.Identify PND management issuesBy conducting qualitative interviews on PND management,describe the clinical problems associated with the implementation of PND management in obstetrics and gynecology:(1)lack of standardized screening tools;(2)different screening frequency and frequencies;(3)limited intervention populations;and(4)limited intervention content.2.Establishment of a PND management ProgramFollowing the above questions,a systematic literature search was conducted,which resulted in the inclusion of three guidelines,two evidence summaries,five expert consensuses,and five systematic reviews.Based on demonstrations by pregnant women and experts,37 recommendations are developed in five areas:screening,evaluation criteria for screening results,routine intervention content,intervention content for low-risk groups,and intervention content for high-risk or diagnosed groups.By the "5W1H" principle,the PND management plan was developed,including intervention targets,intervention objects,service personnel,intervention content,intervention timing,and frequency.A PND information management system,including a WeChat public account for pregnant women and an information management platform for staff,was developed to achieve automatic assessment and classification of the psychological state of pregnant women,as well as to provide complete information on all pregnant women.3.Clinical Translational Research for PND Management ProgramBringing PND management programs into the clinic and identifying large gaps between evidence and practice.In the end,30 pieces of evidence were retained after the evidence was deleted and adjusted.Identified seven major factors influencing clinical translation of evidence and developed four major intervention strategies,including dissemination strategy,implementation process strategy,integration strategy,and capacity building strategy,for developing an optimized plan for managing PND in clinical practice.As a result of PND management,maternal mental health levels,PND knowledge,belief,and practice,exclusive breastfeeding rates,and natural childbirth rates were significantly improved.A participation rate of 97.62%was achieved by pregnant and lying-in women,while a withdrawal rate of 21.95%was recorded.Knowledge,belief,and practice level of nurses regarding PND have improved.Different mental health care technologies,rules and regulations,and job responsibilities have been standardized during the implementation process,and PND management is sustainable in this institution.Conclusion:There is evidence to support the effectiveness of the evidence-based PND management plan as it is scientifically based and feasible,and can effectively improve the mental health of pregnant and lying-in women.It is widely accessible,widely adopted,and is highly reliable.