PURPOSE We wanted to describe the unique issues encountered by our research team in testing an intervention to reduce perinatal depression in real-world community health centers.METHOD We used a case study of an experience in conducting a randomized controlled trial designed to test the effectiveness of a low-cost multimodal psychosocial intervention to reduce prenatal and postpartum depression. Low-income minority women (N = 187) with low-risk pregnancies were randomly assigned to the intervention or treatment as usual. Outcomes of interest were depressive symptoms and social support assessed at 3 months' postpartum.
RESULTSOur intervention was not associated with changes in depressive symptoms or social support. Challenges in implementation were related to participant retention and intervention delivery. Turnover of student therapists affected continuity in participant-therapist relationships and created missed opportunities to deliver the intervention. The academic-community partnership that was formed also required more involvement of health center personnel to facilitate ownership at the site level, especially for fi delity monitoring. While attentive to cultural sensitivity, the project called for more collaboration with participants to defi ne common goals and outcomes. Participatory research strategies could have anticipated barriers to uptake of the intervention and achieved a better match between outcomes desired by researchers and those of participants.CONCLUSION Several criteria for future research planning emerged: assessing what the population is willing and able to accept, considering what treatment providers can be expected to implement, assessing the setting's capacity to accommodate intervention research, and collecting and using emerging unanticipated data.
INTRODUCTIOND uring the past 3 decades, primary care practice-based research has made notable progress in establishing its feasibility and potential to address questions important to primary care and the communities we serve.1-5 Practice-based research can answer questions of greater relevance to primary care practice, test effectiveness of treatments in undifferentiated patient populations, 3 and engage clinicians in the generation of new knowledge that can be readily assimilated into practice.5 Despite gains made, researchers note that challenges persist in successful implementation of studies in primary care settings.6-8 Moving psychosocial intervention research into urban community-based primary care settings that are not research oriented remains highly challenging. Disappointing results of well-designed intervention research may be due to practical diffi culties of implementing studies in unpredictable community-based health centers rather than to lack of intervention effi cacy. pected, to implementing intervention research in community-based settings will remain 1,2,12 and will likely be exacerbated in the unique setting of safety net sites.
13In this article, we describe logistical hurdles encountered in testing an interven...