The Gap between Knowing and Doing: Health Workers' Perceptions and Screening of Postpartum Depression

Background: Postpartum depression (PPD) is a prevalent yet under-recognized complication of childbirth with severe implications for maternal and child well-being. Despite global recommendations advocating for routine screening, implementation in low-resource settings remains inconsistent, creating a significant gap between clinical knowledge and practical application.
Objective: This study investigates the "gap between knowing and doing" regarding PPD among health workers at Babcock University Teaching Hospital, Nigeria. Specifically, it explores health workers' understanding of PPD and examines their approaches to screening and management in routine clinical practice.
Methods: A qualitative exploratory design was employed. In-depth interviews were conducted with 15 frontline health workers, including nurses, midwives, community health officers, and medical officers directly involved in maternal and child health services. Data were analyzed using thematic analysis and interpreted through the lens of the Social Ecological Model to understand individual, interpersonal, and institutional factors.
Results: Findings reveal that while participants possess basic awareness of PPD, their clinical understanding is superficial, often normalizing symptoms as typical postnatal distress. Crucially, no routine screening protocols or standardized tools, such as the Edinburgh Postnatal Depression Scale, are utilized. Instead, detection relies on subjective observation and patient complaints, leading to inconsistent identification. Management is limited to basic counseling and referrals, hindered by a lack of formal training, absent clinical guidelines, heavy workloads, and deep-seated sociocultural stigma. The disconnect between knowledge and practice is identified as systemic, driven by organizational constraints and community-level barriers rather than individual deficits alone.
Conclusion: The study concludes that bridging the gap in PPD care requires multi-level interventions. Recommendations include integrating standardized screening tools into routine maternal care, providing structured capacity-building training, developing clear clinical protocols, and addressing sociocultural barriers through community engagement. These strategies are essential for transforming PPD care from a reactive to a proactive model, ensuring timely support for affected mothers and improving long-term developmental outcomes for children.

Postpartum depression, health workers

1. Ackerman, A., Afzal, N., Lautarescu, A., Wilson, C. A., & Nadkarni, A. (2024). Non-specialist delivered psycho-social interventions for women with perinatal depression living in rural communities: A systematic review. PLOS Global Public Health, 4(7), e0003031. https://doi.org/10.1371/JOURNAL.PGPH.0003031 [Google Scholar] [Crossref]

2. Adeyemo, E. O., Oluwole, E. O., Kanma-Okafor, O. J., Izuka, O. M., & Odeyemi, K. A. (2020). Prevalence and predictors of postpartum depression among postnatal women in lagos, nigeria. African Health Sciences, 20(4), 1943–1954. https://doi.org/10.4314/ahs.v20i4.53 [Google Scholar] [Crossref]

3. Akinsolu, F. T., Abodunrin, O. R., Lawale, A. A., Bankole, S. A., Adegbite, Z. O., Adewole, I. E., Olagunju, M. T., Ola, O. M., Dabar, A. M., Sanni-Adeniyi, R. A., Gambari, A. O., Njuguna, D. W., Salako, A. O., & Ezechi, O. C. (2023). Depression and perceived stress among perinatal women living with HIV in Nigeria. Frontiers in Public Health, 11, 1259830. https://doi.org/10.3389/FPUBH.2023.1259830/BIBTEX [Google Scholar] [Crossref]

4. Alkhawaldeh, A., Albashtawy, M., Rayan, A., Abdalrahim, A., Musa, A., Eshah, N., Khait, A. A., Qaddumi, J., Khraisat, O., & Albashtawy, S. (2023). Application and Use of Andersen’s Behavioral Model as Theoretical Framework: A Systematic Literature Review from 2012–2021. Iranian Journal of Public Health, 52(7), 1346. https://doi.org/10.18502/IJPH.V52I7.13236 [Google Scholar] [Crossref]

5. Alyafei, A., & Easton-Carr, R. (2024). The Health Belief Model of Behavior Change. StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK606120/ [Google Scholar] [Crossref]

6. Amer, S. A., Zaitoun, N. A., Abdelsalam, H. A., Abbas, A., Ramadan, M. S., Ayal, H. M., Ba-Gais, S. E. A., Basha, N. M., Allahham, A., Agyenim, E. B., & Al-Shroby, W. A. (2024). Exploring predictors and prevalence of postpartum depression among mothers: Multinational study. BMC Public Health 2024 24:1, 24(1), 1308-. https://doi.org/10.1186/S12889-024-18502-0 [Google Scholar] [Crossref]

7. Ayinde, O. O., Oladeji, B. D., Abdulmalik, J., Jordan, K., Kola, L., & Gureje, O. (2018). Quality of perinatal depression care in primary care setting in Nigeria. BMC Health Services Research 2018 18:1, 18(1), 879-. https://doi.org/10.1186/S12913-018-3716-3 [Google Scholar] [Crossref]

8. Choongo, J., Apenteng, B., Nkemjika, S., & Telfair, J. (2023). Social ecological approach to factors influencing perinatal mental health service provision among providers in Bulloch County, GA. Women and Health, 63(3), 229–240. https://doi.org/10.1080/03630242.2023.2169806;JOURNAL:JOURNAL:WWAH20;WGROUP:STRING:PUBLICATION [Google Scholar] [Crossref]

9. Dimcea, D. A. M., Petca, R. C., Dumitrașcu, M. C., Șandru, F., Mehedințu, C., & Petca, A. (2024). Postpartum Depression: Etiology, Treatment, and Consequences for Maternal Care. Diagnostics, 14(9), 865. https://doi.org/10.3390/DIAGNOSTICS14090865 [Google Scholar] [Crossref]

10. Gowon, N. D., Mshelia, S. E., Ogbaji, F. I., Meshak, D. J., Ojiugo, T. O. T., Chidi, E., Sanya, J. A. U., Obayi, E. C., Nshe, M. D., Haruna, G., & Booth, A. (2024). Understanding lived experiences and perceptions of perinatal depression in Nigeria: a qualitative evidence synthesis. Journal of Global Health Reports, 8, 2024. https://doi.org/10.29392/001C.122278 [Google Scholar] [Crossref]

11. Goyal, D., Rabemananjara, K. M., Lara-Cinisomo, S., & Le, H. N. (2023). Healthcare worker’s understanding of perinatal depression and maternal mental health service needs in rural Kenya. Mental Health & Prevention, 29, 200260. https://doi.org/10.1016/J.MHP.2023.200260 [Google Scholar] [Crossref]

12. Gupta, J., Kaushal, S., & Priya, T. (2023). Knowledge, attitude, and practices of healthcare providers about perinatal depression in Himachal Pradesh—A cross-sectional study. Journal of Family Medicine and Primary Care, 12(3), 478–483. https://doi.org/10.4103/JFMPC.JFMPC_1170_22 [Google Scholar] [Crossref]

13. Gyimah, L., Agyepong, I. A., Owiredu, D., Awini, E., Yevoo, L. L., Ashinyo, M. E., Aye, S. G. E. V., Abbas, S., Cronin de Chavez, A., Mirzoev, T., & Danso-Appiah, A. (2024). Tools for screening maternal mental health conditions in primary care settings in sub-Saharan Africa: systematic review. Frontiers in Public Health, 12, 1321689. https://doi.org/10.3389/FPUBH.2024.1321689/FULL [Google Scholar] [Crossref]

14. Haque, A., Namavar, A., & Breene, K.-A. (2015a). Prevalence and Risk Factors of Postpartum Depression in Middle Eastern/Arab Women. Journal of Muslim Mental Health, 9(1). https://doi.org/10.3998/jmmh.10381607.0009.104 [Google Scholar] [Crossref]

15. Haque, A., Namavar, A., & Breene, K.-A. (2015b). Prevalence and Risk Factors of Postpartum Depression in Middle Eastern/Arab Women. Journal of Muslim Mental Health, 9(1). https://doi.org/https://doi.org/10.3998/jmmh.10381607.0009.104 [Google Scholar] [Crossref]

16. Harris, K., Choongo, J., & Chopak-Foss, J. (2020). Applying the Socio-Ecological Model to Improving Maternal Mental Health in Georgia. Jiann-Ping Hsu College of Public Health Publications. https://doi.org/10.1016/j.genhosppsych.2013.07.011 [Google Scholar] [Crossref]

17. Iheanacho, T., Chu, C., Aguocha, C. M., Nwefoh, E., & Dike, C. (2024). Integrating mental health into primary care in Nigeria: Implementation outcomes and clinical impact of the HAPPINESS intervention. Cambridge Prisms: Global Mental Health, 11, e9. https://doi.org/10.1017/GMH.2024.4 [Google Scholar] [Crossref]

18. Isah, A., Aluh, D. O., Ugwoke, M. O., & Anene-Okeke, C. G. (2025). Mental health literacy on postpartum depression among university staff in Nigeria. Discover Mental Health, 5(1). https://doi.org/10.1007/S44192-025-00249-8 [Google Scholar] [Crossref]

19. Isma’il Tsiga-Ahmed, F., Usman Umar, M., Lawal Adamu, A., Sulaiman, S. K., Taiwo Gboluwaga, A., Jalo, R. I., Ibrahim, U. M., Kwaku Ayaba, A., Ahmed, Z. D., Sunusi, S. M., Abdullahi, N. T., Kabir, H. S., Abu, S. M., Hadiza, &, & Galadanci, S. (2024). Incidence of postpartum depression among women with postpartum haemorrhage in Kano, northern Nigeria. Npj Women’s Health 2024 2:1, 2(1), 32-. https://doi.org/10.1038/s44294-024-00031-1 [Google Scholar] [Crossref]

20. Kendall-Tackett, K. A., & Kendall-Tackett, K. A. (2024). Screening for Perinatal Depression: Barriers, Guidelines, and Measurement Scales. Journal of Clinical Medicine 2024, Vol. 13, 13(21). https://doi.org/10.3390/JCM13216511 [Google Scholar] [Crossref]

21. Khadka, N., Fassett, M. J., Oyelese, Y., Mensah, N. A., Chiu, V. Y., Yeh, M., Peltier, M. R., & Getahun, D. (2024). Trends in Postpartum Depression by Race, Ethnicity, and Prepregnancy Body Mass Index. JAMA Network Open, 7(11), e2446486–e2446486. https://doi.org/10.1001/JAMANETWORKOPEN.2024.46486 [Google Scholar] [Crossref]

22. Leslie, T., Victoria, A., Leslie, D. D., & Dominic, O. (2024). Assessment Of The Knowledge And Attitude Of Mothers Towards Postpartum Depression In Selected Sagamu Community Health Centers, Ogun State. A Cross-Sectional Study. Student’s Journal of Health Research Africa, 5(6), 12. https://doi.org/10.51168/sjhrafrica.v5i6.1163 [Google Scholar] [Crossref]

23. Maloleka, N., Rathobei, L. M., & Naranjee, N. (2024a). Perceptions of Lesotho nurse-midwives regarding post-partum depression management. Curationis, 47(1), 8. https://doi.org/10.4102/CURATIONIS.V47I1.2624 [Google Scholar] [Crossref]

24. Maloleka, N., Rathobei, L. M., & Naranjee, N. (2024b). Perceptions of Lesotho nurse-midwives regarding post-partum depression management. Curationis, 47(1). https://doi.org/10.4102/CURATIONIS.V47I1.2624 [Google Scholar] [Crossref]

25. Martínez, P., Vöhringer, P. A., & Rojas, G. (2016). Barriers to access to treatment for mothers with postpartum depression in primary health care centers: a predictive model. Revista Latino-Americana de Enfermagem, 24. https://doi.org/10.1590/1518-8345.0982.2675 [Google Scholar] [Crossref]

26. McCauley, M., Abigail, B., Bernice, O., & Van Den Broek, N. (2019). “I just wish it becomes part of routine care”: healthcare providers’ knowledge, attitudes and perceptions of screening for maternal mental health during and after pregnancy: a qualitative study. BMC Psychiatry 2019 19:1, 19(1), 279-. https://doi.org/10.1186/S12888-019-2261-X [Google Scholar] [Crossref]

27. Mohammed-Durosinlorun, A., Mamoon, N., & Yakasai, B. A. (2022). Screening for postpartum depression by health-care workers in Kaduna, North-Western Nigeria: A cross sectional study. Journal of Clinical Sciences, 19(2), 49–56. https://doi.org/10.4103/JCLS.JCLS_38_21 [Google Scholar] [Crossref]

28. Nahidi, F., Dolatian, M., Roozbeh, N., Asadi, Z., & Shakeri, N. (2017). Effect of health-belief-model-based training on performance of women in breast self-examination. Electronic Physician, 9(6), 4577. https://doi.org/10.19082/4577 [Google Scholar] [Crossref]

29. Nechaeva, E., Kharkova, O., Postoev, V., Grjibovski, A. M., Darj, E., & Odland, J. Ø. (2024a). Awareness of postpartum depression among midwives and pregnant women in Arkhangelsk, Arctic Russia. Global Health Action, 17(1), 2354008. https://doi.org/10.1080/16549716.2024.2354008 [Google Scholar] [Crossref]

30. Nechaeva, E., Kharkova, O., Postoev, V., Grjibovski, A. M., Darj, E., & Odland, J. Ø. (2024b). Awareness of postpartum depression among midwives and pregnant women in Arkhangelsk, Arctic Russia. Global Health Action, 17(1). https://doi.org/10.1080/16549716.2024.2354008 [Google Scholar] [Crossref]

31. Nkurunziza, A., Smye, V. L., Jackson, K. T., Wathen, C. N., Cechetto, D. F., Tryphonopoulos, P., Gishoma, D., & Muhayimana, A. (2024). “… I carry their stories home …”: experiences of nurses and midwives caring for perinatal adolescent mothers in primary health care settings in Rwanda. BMC Nursing 2024 23:1, 23(1), 609-. https://doi.org/10.1186/S12912-024-02247-7 [Google Scholar] [Crossref]

32. Nortey, M. A., & Asampong, E. (2024). Nurse’s Knowledge, Attitudes and Practices Toward Perinatal Depression—A Study Among Nurses in Southern Ghana. Nursing & Midwifery Research Journal, 20(4), 245–259. https://doi.org/10.1177/0974150X241296600 [Google Scholar] [Crossref]

33. Nweke, M., Ukwuoma, M., Adiuku-Brown, A. C., Okemuo, A. J., Ugwu, P. I., & Nseka, E. (2024). Burden of postpartum depression in sub-Saharan Africa: An updated systematic review. South African Journal of Science, 120(1–2), 1–12. https://doi.org/10.17159/SAJS.2024/14197 [Google Scholar] [Crossref]

34. Nweke, M., Ukwuoma, M., Adiuku-Brown, A. C., Ugwu, P., & Nseka, E. (2022). Characterization and stratification of the correlates of postpartum depression in sub-Saharan Africa: A systematic review with meta-analysis. Women’s Health, 18, 17455057221118772. https://doi.org/10.1177/17455057221118773 [Google Scholar] [Crossref]

35. Oladeji, B. D., Ayinde, O. O., Bello, T., Kola, L., Zelkowitz, P., Seedat, S., & Gureje, O. (2025). Screening and detection of perinatal depression by non-physician primary healthcare workers in Nigeria. BMC Primary Care 2025 26:1, 26(1), 35-. https://doi.org/10.1186/S12875-025-02730-3 [Google Scholar] [Crossref]

36. Onofa, L. E. U., Adebowale, T., & Gater, R. (2024). Integrating Mental Health into Primary Health Care Settings in Ogun State: An Example of a Sustainable Mental Health Project in Nigeria. Journal of Psychiatry Research & Reports. https://www.asrjs.com/pdfs/integrating-mental-health-into-primary-health-care-settings-in-ogun-state-an-example-of-a-sustainable-mental-health-project-in-nig-92.pdf?utm_source=chatgpt.com [Google Scholar] [Crossref]

37. Paricio-Del-Castillo, R. (2024). Integration of Perinatal Mental Health into Maternal and Child Care: Progress and Challenges from the World Health Organization’s Perspective. European Journal of Mental Health, 19, 1–7. https://doi.org/10.5708/EJMH.19.2024.0032 [Google Scholar] [Crossref]

38. Poreddi, V., Thomas, B., Paulose, B., Jose, B., Daniel, B. M., Somagattu, S. N. R., & B.V., K. (2020). Knowledge and attitudes of family members towards postpartum depression. Archives of Psychiatric Nursing, 34(6), 492–496. https://doi.org/10.1016/j.apnu.2020.09.003 [Google Scholar] [Crossref]

39. Prina, E., Ceccarelli, C., Abdulmalik, J. O., Amaddeo, F., Cadorin, C., Papola, D., Tol, W. A., Lund, C., Barbui, C., & Purgato, M. (2023). Task-sharing psychosocial interventions for the prevention of common mental disorders in the perinatal period in low- and middle-income countries: A systematic review and meta-analysis. International Journal of Social Psychiatry, 69(7), 1578–1591. https://doi.org/10.1177/00207640231174451;SUBPAGE:STRING:ABSTRACT;WEBSITE:WEBSITE:SAGE;WGROUP:STRING:PUBLICATION [Google Scholar] [Crossref]

40. Radoš, S. N., Akik, B. K., Žutić, M., Rodriguez-Muñoz, M. F., Uriko, K., Motrico, E., Moreno-Peral, P., Apter, G., & den Berg, M. L. van. (2024). Diagnosis of peripartum depression disorder: A state-of-the-art approach from the COST Action Riseup-PPD. Comprehensive Psychiatry, 130, 152456. https://doi.org/10.1016/J.COMPPSYCH.2024.152456 [Google Scholar] [Crossref]

41. Richards, M. C., Ferrario, C. A., Yan, Y., & McDonald, N. M. (2024). The Impact of Postpartum Depression on the Early Mother-Infant Relationship during the COVID-19 Pandemic: Perception versus Reality. International Journal of Environmental Research and Public Health 2024, Vol. 21, Page 164, 21(2), 164. https://doi.org/10.3390/IJERPH21020164 [Google Scholar] [Crossref]

42. Robbins, C. L., Ko, J. Y., D’Angelo, D. V., von Essen, B. S., Bish, C. L., Kroelinger, C. D., Tevendale, H. D., Warner, L., & Barfield, W. (2023). Timing of Postpartum Depressive Symptoms. Preventing Chronic Disease, 20. https://doi.org/10.5888/PCD20.230107 [Google Scholar] [Crossref]

43. Ruhul, M., & Id, K. (2021). Adopting Andersen’s behavior model to identify factors influencing maternal healthcare service utilization in Bangladesh. PLOS ONE, 16(11), e0260502. https://doi.org/10.1371/JOURNAL.PONE.0260502 [Google Scholar] [Crossref]

44. Shorey, S., Chee, C. Y. I., Ng, E. D., Chan, Y. H., Tam, W. W. S., & Chong, Y. S. (2018). Prevalence and incidence of postpartum depression among healthy mothers: A systematic review and meta-analysis. Journal of Psychiatric Research, 104, 235–248. https://doi.org/10.1016/j.jpsychires.2018.08.001 [Google Scholar] [Crossref]

45. Singh, D. R., Sunuwar, D. R., Adhikari, S., Singh, S., & Karki, K. (2021). Determining factors for the prevalence of depressive symptoms among postpartum mothers in lowland region in southern Nepal. PLOS ONE, 16(1), e0245199. https://doi.org/10.1371/JOURNAL.PONE.0245199 [Google Scholar] [Crossref]

46. Slomian, J., Honvo, G., Emonts, P., Reginster, J. Y., & Bruyère, O. (2019). Consequences of maternal postpartum depression: A systematic review of maternal and infant outcomes. Women’s Health, 15, 1745506519844044. https://doi.org/10.1177/1745506519844044 [Google Scholar] [Crossref]

47. Stewart, D. E., & Vigod, S. N. (2019). Postpartum depression: Pathophysiology, treatment, and emerging therapeutics. Annual Review of Medicine, 70(Volume 70, 2019), 183–196. https://doi.org/10.1146/ANNUREV-MED-041217-011106/CITE/REFWORKS [Google Scholar] [Crossref]

48. Turner, R. E., & Honikman, S. (2016). Maternal mental health and the first 1 000 days : CME | South African Medical Journal. https://journals.co.za/doi/abs/10.7196/SAMJ.2016.v106i12.12129 [Google Scholar] [Crossref]

49. Arinze, Q. U., Manoj, S., Onu, S. N., Goodness, U. . C., Ogbusu, D. . C., A., O. F. ., G., O. F., I., O. C. ., Sandra, E. E., Paraskevas, K., Priscilla, A. O., Sethi, P., Saudje, T., Ada, O. D., Habiba, L., & Precious, A. J. (2025). Prevalence of Postpartum Anxiety and Depression among Postpartum Mothers: A Study at Postnatal Clinics in Enugu and Delta States, Nigeria. International Neuropsychiatric Disease Journal, 22(4), 176–197. https://doi.org/10.9734/INDJ/2025/V22I4505 [Google Scholar] [Crossref]

50. Vilarim, M., Rebelo, F., Vieira, I., Mazzoli, F., Nardi, A., & Marano, D. (2023). Prevalence of postpartum depression symptoms in developed and developing countries in the COVID-19 pandemic: a systematic review with meta-analysis. Population Medicine, 5(Supplement). https://doi.org/10.18332/POPMED/165297 [Google Scholar] [Crossref]

51. Wang, H., Xu, F., Li, R., Pan, T., Tang, S., & Sun, M. (2025). Factors associated with knowledge, beliefs, and practices related to perinatal depression screening among rural maternal and child health workers: a multi-center cross-sectional study. BMC Pregnancy and Childbirth, 25(1), 717. https://doi.org/10.1186/S12884-025-07831-6 [Google Scholar] [Crossref]

52. Wang, Z., Liu, J., Shuai, H., Cai, Z., Fu, X., Liu, Y., Xiao, X., Zhang, W., Krabbendam, E., Liu, S., Liu, Z., Li, Z., & Yang, B. X. (2021). Mapping global prevalence of depression among postpartum women. Translational Psychiatry 2021 11:1, 11(1), 543-. https://doi.org/10.1038/s41398-021-01663-6 [Google Scholar] [Crossref]

53. WHO. (2022a). Country Analysis of Data from The Global Survey On Maternal and Perinatal Health. World Health Organization (WHO), 66. https://www.who.int/publications/i/item/9789240057142 [Google Scholar] [Crossref]

54. WHO. (2022b). Launch of the WHO guide for integration of perinatal mental health in maternal and child health services. https://www.who.int/news/item/19-09-2022-launch-of-the-who-guide-for-integration-of-perinatal-mental-health?utm_source=chatgpt.com [Google Scholar] [Crossref]

55. Woolhouse, H., Gartland, D., Mensah, F., Giallo, R., & Brown, S. (2016). Maternal depression from pregnancy to 4 years postpartum and emotional/behavioural difficulties in children: results from a prospective pregnancy cohort study. Archives of Women’s Mental Health, 19(1), 141–151. https://doi.org/10.1007/S00737-015-0562-8 [Google Scholar] [Crossref]

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