An innovative screen-and-advice model for psychopathology and psychosocial problems among urban pregnant women: an exploratory study

Abstract

Background: Increased adverse pregnancy outcomes related to psychiatric and psychosocial problems can be observed for urban areas when compared to national averages. We developed a personal digital assistant (PDA)-based self-report screening model that produces tailored intervention advices. After having adapted the model to local care pathways, we tested the reliability, validity and feasibility of the model in routine antenatal care.

Methods: Observational study among pregnant women in a Dutch urban area included women with a booking visit. Women answered questions posed by the PDA-tool while waiting for their appointment. If the tool suggested specific interventions (screen result), this was discussed during booking visit. A randomly selected subsample of participants completed the questionnaire again at a subsequent pregnancy check (retest). After the study was conducted, prenatal caregivers and assistants were interviewed for feasibility judgments. Psychometric and diagnostic performance of this approach was established.

Results: Response rate among invited pregnant women was 94% on weighted average (n=621). Internal reliability ranged 0.88-0.90, test-retest reliability ranged 0.64-1.00. Positive predictive value was 86% and negative predictive value was 97%. No interpractice psychometrical differences were observed. Migrant women more often received an intervention advice than native women (p<0.001). The approach was well accepted among prenatal caregivers for its time efficiency and patient-friendliness.

Conclusion: Psychometric properties of our screen-and-advice tool were favorable under routine conditions, and the feasibility of this integral approach appeared good. The technical flexibility renders the model suitable for broader application. Local care pathways can easily be incorporated. We suggest implementation of this model in prenatal care in urbanized settings in order to make tailored mental healthcare broadly available.