Beyond the Silence: COM-B-Informed Provider Barriers to Depression Screening Among Filipino American Patients

Background/Objectives: Routine depression screening is recommended in primary care, yet depression may remain underdetected among Filipino American patients. Provider-level factors, including culturally responsive preparation, communication challenges, workflow constraints, and attitudes toward mental health screening, may influence opportunities for early identification and referral. This exploratory cross-sectional study examined provider perspectives on barriers to depression screening and mental health discussions with Filipino American patients using the Capability, Opportunity, Motivation, and Behavior (COM-B) framework as an implementation-informed organizing lens. Methods: A cross-sectional survey was conducted among healthcare providers (N = 81) with experience caring for Filipino American patients in the United States. Survey items assessed provider confidence, perceived adequacy of mental health training, cultural and communication barriers, perceived stigma-related concerns, comfort discussing mental health, and interest in additional culturally responsive resources. Items from the adapted Attitudes Toward Assisting Filipino American Patients with Mental Health Symptoms (ATFA) scale and one item from the Mental Illness Clinicians' Attitudes scale were conceptually mapped to the COM-B domains. Descriptive statistics, internal consistency estimates, and nonparametric tests were used to summarize findings and explore differences by provider characteristics. Results: Most providers recognized that Filipino cultural beliefs and customs may influence mental health help-seeking and symptom expression. Although many providers reported confidence identifying mental health symptoms, fewer reported adequate training to assess mental health concerns among Filipino American patients. Communication barriers, stigma-related concerns, and interest in additional culturally tailored resources were commonly reported. COM-B domain scores were not significantly associated with provider role or years of clinical experience. Providers who identified as Filipino reported greater perceived capability and opportunity related to initiating mental health discussions compared with non-Filipino providers. Conclusions: Findings suggest that provider motivation to address mental health concerns may be present, while capability- and opportunity-related barriers, including culturally responsive training, communication support, workflow integration, and referral resources, may remain important targets for future implementation efforts. Because this exploratory study used a modest convenience sample and an adapted measure that requires further psychometric validation, the findings should be interpreted with caution. Larger studies using validated instruments are needed to examine further provider-level determinants of culturally responsive depression screening among Filipino American patients.