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Table 4 Outcomes from merging the questionnaire, record card and interview results

From: How do community-based eye care practitioners approach depression in patients with low vision? A mixed methods study

Q1: Current practice
 Identification of depression
The quantitative data suggest only a minority of practitioners currently try to identify depression in low vision assessments.The majority of practitioners interviewed reported trying to identify if a patient was depressed.Discordance
 Practitioners do not use a screening tool
On the questionnaire, a substantial majority (88%) of practitioners reported not using a screening tool to identify depression.None of the practitioners interviewed used a screening tool. They revealed that: 1) they did not know what screening questions to ask and 2) wanted to avoid broaching the subject of depression directly with the patients, to avoid causing harm. Instead they considered the patient’s demeanour and weighed up the conversation, looking for ‘red flags’ which gave them a ‘general feeling’ or ‘impression’ that the patient might be depressed.Expansion
Q2: Influences on current practice
 Confidence level
Reported level of confidence was associated with intention to try to identify depression and likelihood of taking any action in response to suspected depression.‘Practitioners lack confidence in their knowledge and skills to address depression’ was a key theme identified in the qualitative analysis and was shown to affect practice. Most lacked confidence in their communication skills and were reluctant to ask about possible depression for fear they might cause ‘more harm than good’. Therefore, when they suspected depression, they approached the discussion about support options in a roundabout manner and found it difficult to gain consent for referral, thus limiting the action they could take. Many also expressed a lack of confidence in their knowledge in recognising depression, which influenced their response with regard to GP referrals – only those with ‘serious’ or ‘obvious’ depression were referred.Expansion
 Perceived barriers
Practitioners who perceived more barriers to working with people with depression were less likely to action in response to suspected depression.‘Patient themselves are a barrier to addressing depression’ was a key theme. Practitioners suggested patients were unwilling to discuss their mental health and frequently declined support, leaving the practitioner with limited options for responding to suspected depression. Other barriers to taking action included their lack of knowledge of suitable referral pathways and what a General Practitioner might be able to offer.Expansion