Screening for depression after stroke: an exploration of professionals' compliance with guidelines

Objective: National guidelines recommend screening for poststroke depression, but compliance is low. This research studied staff compliance in stroke units using the theory of planned behaviour to investigate influences upon screening. Design: The study used a questionnaire based on a semi-structured interview and measuring the theory of planned behaviour components. Setting: Sixteen stroke units throughout the UK were included. Subjects: Seventy-five health care professionals in stroke services participated. Main measures: A postal questionnaire with 7-point rating scales and open-ended questions was used. Results: Response rates were low, but the 75 returns demonstrated poor compliance for screening, despite positive attitudes towards it. Five variables, including three of the theory of planned behaviour components, predicted intention to screen: perceived control over screening, perceived expectations of others (direct and indirect normative beliefs), awareness of guidelines and screening being part of routine assessment. Perceived expectations of others, perceived control and awareness of guidelines also differentiated those intending to screen from 'non-intenders'. Being knowledgeable about screening, having screening in the job role and belief in its clinical value were additional facilitating factors, while time pressure and concerns about screening tests were barriers. Profession and psychology input were not associated with screening. Conclusions: The theory of planned behaviour provides a framework for understanding screening intentions. Both individual and organizational factors were associated with screening. Compliance may be enhanced by: training to increase knowledge and skills, providing evidence of the utility, increasing awareness of guidelines, support from colleagues and integrating mood assessment into job roles and routine assessment.