Implementing a Telehealth Perinatal Depression Prevention Program: Perspectives of Rural and Urban Clinical Staff

Nurses are key stakeholders in telehealth intervention implementation. Nurses are also instrumental in the management of perinatal depression, a common complication during pregnancy and postpartum. Telehealth interventions are a promising approach to addressing perinatal depression; however, its successful integration into routine maternal care remains challenging, particularly across diverse clinical settings. This qualitative study examined how registered nurses in the United States and other clinical staff perceived and navigated the implementation of a telehealth perinatal depression prevention program.

A qualitative descriptive study was conducted with a purposive sample of 24 participants including nurses, medical assistants, lactation consultants, community health workers, and hospital administrators at rural and urban health facilities. Seven virtual focus groups were conducted with participants between March and December 2024. To foreground workflow integration, we focused on nonprovider clinical staff directly involved in patient flow. Focus groups were video- and audio-recorded, transcribed, and analyzed in NVivo (Version 14) using codebook thematic analysis, guided by the Theoretical Domains Framework. Rigor was established and maintained throughout the study.

Facilitators included provider endorsement, training, workflow alignment, and perceived patient benefit. Barriers included stigma, limited technology access and literacy, competing workflow demands, and inconsistent provider engagement. Rural clinical staff underscored privacy concerns and structural digital access barriers, whereas urban staff emphasized provider endorsement and electronic health record integration as central implementation levers. Recommendations focused on strengthening endorsement, improving education and workflow integration, enhancing marketing strategies, and increasing flexibility in intervention delivery.

Addressing barriers is critical for successful integration of telehealth perinatal depression prevention into routine maternal care. Context-sensitive implementation strategies may mitigate rural-urban inequities in access to digital maternal mental health support.

Nurse managers should address workflow constraints and evaluate duty allocation to facilitate smooth incorporation of the telehealth perinatal depression prevention program into routine maternal care.