Stakeholder perspectives on depression management and decision-making in an Alaska natve/American Indian primary care setting

Behavioral health conditions are commonly seen in primary care settings with variable outcomes. Although there has been considerable focus in recent decades on improving depression screening and management, lack of engagement with the multitude of therapeutic options remains a concern. Objective/Methods: To inform future development of a decision support tool, we conducted semi-structured interviews with a total of 36 customer-owners, providers, and leaders in a tribally owned and operated primary care center. Interviews elicited participants' preferences and needs regarding depression management decisions. Interviews were transcribed and inductively analyzed for key themes. Results: Key themes for customer-owners included having trust in providers; mitigating stigma and labels associated with depression; having access to information about benefits, burdens and availability of various resources (including biomedical and “alternative” clinical therapies, social support and lifestyle options); and cultural compatibility of the decision-making process with regard to factors of time and communication. Clinician and leader narratives also focused on these themes, as well as the need to assess customer readiness for change, to educate providers in culturally appropriate communication and to situate symptoms in a broader context of personal and cultural histories. Conclusion: Discussions about treatment should begin by normalizing depression and validating customer-owners' experiences related to depression to establish trust. The next phase of this project is to use these data to develop and test a decision support tool to better match customer-owner' needs and preferences with available depression management resources and improve health outcomes.