Professional, organizational and policy-level barriers and facilitators to perinatal mental health care in the United Arab Emirates: A qualitative study.

The study identified 31 barriers and 33 facilitators across three ecological levels shaping perinatal mental health care delivery in the UAE.

• Barriers and facilitators were categorized across professional, organizational, and policy/political levels.
• 43 healthcare professionals were recruited using purposeful sampling.
• Data were collected through semi-structured interviews and focus group discussions.
• Thematic analysis was employed to identify key themes.

Major professional-level barriers to perinatal mental health care included awareness and training gaps, low self-efficacy, and role-based avoidance among healthcare professionals.

• PMH awareness and training gaps were identified as a primary professional-level barrier.
• Low self-efficacy among frontline healthcare professionals hampered their effectiveness in identifying and addressing PMH concerns.
• Role-based avoidance was identified as a distinct professional barrier.
• These barriers affected a diverse group of HCPs including lactation consultants, midwives, maternity nurses, obstetricians, family physicians, paediatricians, and psychiatrists/psychologists.

Major organizational-level barriers included fragmented services, staffing shortages, and unclear protocols for perinatal mental health care.

• Fragmented services were identified as a key organizational barrier limiting integrated PMH care.
• Staffing shortages contributed to organizational-level barriers.
• Unclear protocols were identified as a significant organizational barrier.
• Limited insurance coverage was also identified as a barrier, spanning organizational and policy levels.

The multicultural healthcare workforce in the UAE was identified as a critical facilitator for providing culturally competent perinatal mental health care.

• The multicultural nature of the UAE healthcare workforce was described as a 'significant facilitator' for culturally competent care.
• This finding was highlighted as a 'critical finding' of the study.
• Leveraging the strengths of the multicultural workforce was identified as essential for developing effective, culturally sensitive PMH services.
• Cultural competence was framed as a systems-level asset unique to the UAE context.

Key facilitators to perinatal mental health care encompassed professional development initiatives, core provider qualities, interprofessional collaboration, and integrated care models.

• 33 total facilitators were identified across the three ecological levels.
• Core provider qualities identified as facilitators included empathy and advocacy.
• Interprofessional collaboration was identified as a facilitator at the organizational level.
• Government-led training programs were identified as a policy-level facilitator.
• Supportive organizational policies and integrated care models were also identified as facilitators.

Significant gaps persist in the integration of perinatal mental health into routine maternity care in the UAE.

• Frontline healthcare professionals are described as 'central to identifying and addressing PMH concerns' but their effectiveness is 'often hampered by multi-level barriers.'
• The study was motivated by the lack of PMH integration into routine maternity care in the UAE.
• A descriptive qualitative design was employed to examine these gaps from the HCP perspective.
• Participants included seven professional categories: lactation consultants, midwives, maternity nurses, obstetricians, family physicians, paediatricians, and psychiatrists/psychologists.

Addressing perinatal mental health barriers in the UAE requires a systemic approach including standardized PMH training, integrated care pathways, clear protocols, and policy reforms for insurance coverage.

• Standardized PMH training was recommended as a systemic intervention.
• Integrated care pathways were recommended to address fragmented services.
• Clear protocols were recommended to replace the unclear protocols identified as a barrier.
• Policy reforms for insurance coverage were recommended to address limited coverage identified as a barrier.
• The authors state these findings 'can guide the development of strategies to support HCPs and improve mental health outcomes for mothers and families.'