Implementing routine assessment of perinatal anxiety: case studies

Abstract

Background During pregnancy and the first postnatal year, a substantial proportion of women experience perinatal anxiety, which is associated with increased risk of adverse birth, maternal and child development outcomes. Identification of perinatal anxiety is recommended in various countries, but there is a lack of consensus on the most effective, acceptable and feasible measure to use. The Methods of Assessing Perinatal Anxiety study previously found the Stirling Antenatal Anxiety Scale to be diagnostically accurate and acceptable to women. Objectives This study aimed to determine the acceptability and feasibility of implementing new assessment of perinatal anxiety in healthcare services. Design and methods Implementation case studies of perinatal anxiety assessment using the Stirling Antenatal Anxiety Scale in three National Health Service sites in the United Kingdom. Semistructured interviews and focus groups were conducted before and after implementation with healthcare professionals working in maternity, primary care and psychological services that had contact with perinatal women. Preimplementation data collection was used to develop an implementation and training strategy for each site. Interviews and focus groups were conducted with the same participants post implementation. Data were analysed using framework analysis and a combined inductive-deductive approach. Setting and participants Two National Health Service trusts in England and one National Health Service health board in Scotland. Participants were healthcare professionals, including midwives, health visitors, clinical psychologists and mental health nurses, who used the scale during the implementation period. Other stakeholders such as service managers and team leads were also interviewed. Sites were selected to represent different types of service and pathways of care. The sample comprised 37 participants at preimplementation and 27 at the postimplementation stage. Intervention Implementation of new assessment of perinatal anxiety in National Health Service services. Results At the English sites, one focus group and two interviews were conducted at site E1, and five interviews at site E2. At the Scottish site, two focus groups and six interviews were conducted. Evaluation findings were categorised into 5 themes (experience of change in practice, barriers/facilitators to implementation, acceptability, feasibility, improvements to implementation strategy) with 16 subthemes. The experience of introducing a new assessment tool in clinical practice was generally seen as positive, with the scale enabling more focused conversations with women about their symptoms and different types of anxiety. Potential barriers to conducting assessments included women not having English as first language and stigma towards anxiety in some cultures. The scale overall was acceptable to healthcare professionals. Recommendations to improve the implementation strategy included adding the tool to patients’ electronic notes and getting wider buy-in from senior management. Limitations Healthcare practitioners mainly used paper versions of the scale, while most National Health Service services are moving towards patients’ electronic notes. Only 73% of participants were interviewed at the postimplementation stage. Variation in clinical pathways and services means results may not be generalisable to other settings. Conclusions Implementation of a new measure of perinatal anxiety was perceived positively overall. Future work Further research should explore the use of a digital version of the tool and translated versions. Replication in National Health Service services with different care pathways is also recommended.