Abstract: Nurturing Equity in Screening for Perinatal Treatment (NEST).
Depression during pregnancy is an important public health concern, with national recommendations calling for universal screening throughout prenatal care. However, recent analysis within the Sanford Health system (2011-2021) found that depression during pregnancy was diagnosed in 11.20% of all pregnancies but in only 4.55% of Black pregnancies, suggesting underdiagnosis in this population. This study aims to identify barriers to effective prenatal depression screening for Black women and assess potential solutions to improve provider practices and patient outcomes. This qualitative study will involve up to 25 semi-structured informational interviews with prenatal care providers within the Sanford Health system. Providers will be recruited via email using a voluntary participation approach. Interviews will last 15-20 minutes and be conducted in person or via phone in a private setting. Recruitment will continue until thematic saturation, anticipated within 12-25 interviews. We anticipate identifying several recurring themes representing provider-perceived barriers to screening for depressive symptoms during Black pregnancy. Based on preliminary literature and project rationale, expected themes may include time constraints in clinical workflow, limited training in culturally sensitive screening, differences in patient-provider communication, provider uncertainty regarding follow-up procedures, and perceived stigma surrounding mental health. Additional themes may reflect systemic, cultural, or institutional gaps that influence screening practices across clinics. Identifying provider-perceived barriers will inform targeted recommendations for improving depression screening during Black pregnancy within the Great Plains region. Insights from this study may guide development of provider training initiatives, workflow modifications, and system-level supports that promote equitable mental health screening. Ultimately, this work aims to support earlier identification and treatment of depression, reduce disparities in prenatal care, and strengthen culturally responsive practices within regional health systems.