PATIENT ENGAGEMENT SPECIAL SECTION Engaging stakeholders to develop a depression management decision support tool in a tribal health system Helene Starks • Jennifer L. Shaw • Vanessa Hiratsuka • Denise A. Dillard • Renee Robinson Accepted: 16 September 2014 Ó Springer International Publishing Switzerland 2014 Abstract Purpose Southcentral Foundation, an Alaska Native tri- bal health organization, has had a depression screening program in primary care since 2001. Program monitoring identified gaps in antidepressant refills and patients’ fol- low-up with behavioral health services. With extensive stakeholder participation, we developed an electronic, patient-centered, depression-management decision support tool (DM-DST). Quality of life and other outcomes are being assessed in a separate study; this case study reports on the multi-year stakeholder engagement process. Methods Data sources included interviews with patients and providers from integrated primary care teams, notes from research meetings, steering committee meetings, and consultations with tribal health system leadership, human subjects review committees, providers, and software designers, and a pilot test of the DS-DMT with patients and providers. We analyzed these sources using qualitative methods to assess the impact of stakeholder input on pro- ject processes and outcomes. Results One comprehensive, iPad-based tool was origi- nally planned to facilitate discussions about depression management. Stakeholder input emphasized the role of family and cultural context of depression and management and improving the usability of the DM-DST. Stakeholder direction led us to split the DM-DST into: (1) a brief iPad- based tool to facilitate conversations between patients and providers during clinic visits; and (2) a complementary Web site that provides detailed information and allows patients flexibility and time to learn more about depression and share information and preferences with family and friends. Conclusions Stakeholder input across the project sub- stantially modified the DM-DST to ensure cultural appli- cability to patients and providers and facilitate integration into clinics. Keywords Stakeholder engagement Á Case study Á Decision support tools Á Depression Á Clinical management Á Organizational change Introduction Stakeholder engagement is important to the successful development and implementation of clinic- and commu- nity-based health interventions. [1] The primary goal of stakeholder engagement in developing and adapting health interventions is to integrate input from multiple groups of people (patients, providers, and leaders) who are affected by changes to health systems. The benefits from stake- holder engagement in developing healthcare interventions are premised on two notions: (1) involving stakeholders during intervention development and implementation maximizes efficient use of time and other resources; [1, 2] H. Starks Department of Bioethics and Humanities, University of Washington, Box 357120, Seattle, WA 98195-7120, USA e-mail: tigiba@u.washington.edu J. L. Shaw Á V. Hiratsuka Á D. A. Dillard Á R. Robinson (&) Research Department, Southcentral Foundation, 4105 Tudor Centre Drive, Suite 200, Anchorage, AK 99508, USA e-mail: rrobinson@southcentralfoundation.com J. L. Shaw e-mail: jshaw@southcentralfoundation.com V. Hiratsuka e-mail: vhiratsuka@southcentralfoundation.com D. A. Dillard e-mail: dadillard@southcentralfoundation.com 123 Qual Life Res DOI 10.1007/s11136-014-0810-9