Depression screening in low vision rehabilitation services in Australia: exploring barriers and solutions to implementation using a theoretical framework

Rationale: Depression is commonly co-morbid with vision impairment yet often remains undetected and therefore untreated. This study aimed to use a theoretical framework of behaviour change to identify issues surrounding the implementation of depression screening in a low vision rehabilitation service in Australia. Evidence-based strategies to address barriers are highlighted.Method: Twenty-two low vision rehabilitation staff, who had undergone training in using a depression screening tool, took part in semi-structured interviews covering 11 theoretical domains of behaviour change. Interviews were audio-taped and transcribed. Two researchers independently coded the transcripts from each interview and assigned a score to determine whether the transcript showed evidence of poor, partial, or good implementation within each domain.Results: Major barriers to depression screening included lack of time, face-to-face contact with clients and private workspace. Limited referral options and concerns about the efficacy of referrals to primary care services were highlighted. Negative emotions anticipated during depression screening (e.g., feeling awkward, uncomfortable or nervous) and concerns that depression screening would have a detrimental impact on the client and client relationship were also barriers to depression screening in practice.Conclusions: Enhancing knowledge and skill around depression screening is not sufficient to create change. Practical-based training needs to be combined with the development of strong referral pathways to ensure implementation success.