Implementation of Maternal Depression Treatment in Pediatric Asthma Care: Preparing for a Clinical Trial

Social risk factors contribute to inequities in asthma morbidity among Black children and mental health among Black women. Depression affects nearly half of mothers of Black children with asthma and is associated with greater asthma morbidity. Effective maternal depression treatment improves child health outcomes but remains difficult to access. Delivering co-located care for maternal depression and childhood asthma has the potential to improve outcomes for mothers and children. This study examined barriers and facilitators of delivering Brief Interpersonal Psychotherapy (IPT-B), a maternal depression treatment, in an urban clinic to inform the development of a Hybrid Type 1 randomized clinical trial.

Guided by the Consolidated Framework for Implementation Research 2.0, we conducted qualitative interviews with asthma clinic leadership and staff and psychologists with expertise in co-located maternal mental health care and focus groups with Black mothers of children with asthma. We used rapid qualitative analysis to analyze the data.

We conducted 14 interviews with staff and 4 focus groups with mothers. Anticipated facilitators included the relative advantage and adaptability of IPT-B, compatibility with existing workflow, recipient-centered clinic culture, and mothers' need for treatment. Anticipated barriers included the staff's lack of self-efficacy in discussing mental health and mothers' practical and psychological barriers.

We identified anticipated facilitators and barriers to inform a clinical trial of IPT-B for maternal depression treatment in an urban asthma clinic. Addressing these determinants prior to implementation will support co-located treatment, meeting a critical need for mothers and advancing health equity in this population.