Experiences of using the Edinburgh Postnatal Depression Scale in the context of antenatal care for Aboriginal mothers: Women and midwives' perspectives.

Abstract Problem Routine administration of the Edinburgh Postnatal Depression Scale (EPDS) is intended to promote early detection and preventative support for those who may be at risk of perinatal depression and anxiety. The cultural suitability of the EPDS has not been validated in the Aboriginal Australian context. Background Marked differences in health outcomes and service access between Australian Aboriginal and non-Aboriginal women and infants continue to exist. Aim This study aimed to explore the cultural validity of the EPDS through understanding the experiences of Aboriginal women and midwives. Methods Qualitative data was drawn from semi-structured interviews/yarns with 13 Perth-based Aboriginal antenatal women and 10 non-Aboriginal midwives. Findings Utilising a grounded theory approach, thematic analysis of verbatim transcripts revealed that, surprisingly, women expressed generally favourable views of the EPDS, especially when the relationships between women and midwives were focused on. Midwives, however, expressed reservations about administering the EPDS and used the EPDS as a conversation-starter rather than as a standardised, standalone tool. Discussion In attempt to reconcile conflicting perspectives, analysis of recordings extended to evaluate micro-processes in the interviews. At the process level, it was clear that demand characteristics operated in some interviews, including socially desirable response biases, demand biases and acquiescent response styles. Conclusion This highlights the need for researchers and clinicians to be trained in non-leading interview questioning techniques and in yarning methodology. Researchers and clinicians should also be aware of the cognitive biases and demand characteristics that may influence responding, likely perpetuated by dominant forces of a colonised society.