title: Feasibility of screening patients for emotional risk factors before in vitro fertilization in daily clinical practice: a process evaluation.
abstract: OBJECTIVE
  Is patient screening for emotional risk factors before starting IVF treatment feasible?
  
  
  CONCLUSIONS
  Introduction of screening for emotional risk factors by a validated instrument (SCREENIVF) in couples treated by IVF or ICSI is feasible, indicated by a moderate to high and stable uptake rate, a high acceptance of the process of SCREENIVF, and a high acceptability of the presented risk profile by the patients.
  
  
  BACKGROUND
  SCREENIVF is a validated screening tool to identify women at risk for emotional maladjustment preceding the start of their IVF/ICSI treatment.
  
  
  METHODS
  This was a prospective cohort study, including data of two cohorts of patients (304 and 342 patients), with a duration of 3 months per cohort. For the first cohort, we sent a process evaluation to 210 patients and it was completed by 91 patients.
  
  
  METHODS
  All 304 patients (male and female) who started IVF/ICSI between 1 December 2009 and 28 February 2010 in our tertiary IVF clinic were eligible. The uptake rate of SCREENIVF was assessed as the response rate to the screening questionnaire. One year later, we re-assessed the uptake rate in 342 new patients to assess the stability of the uptake rate. A non-responder assessment in patients who did not complete SCREENIVF was carried out. Finally, patients' characteristics and their experiences with SCREENIVF as well as their consequent actions were assessed by an additional process evaluation questionnaire sent some months later to 210 patients.
  
  
  RESULTS
  The uptake rate of SCREENIVF was 78-80%. One-third of the responders were found to be at risk for emotional maladjustment, which was comparable with previous studies using SCREENIVF. Of 27 non-responders to SCREENIVF, 41% explained non-response by 'no actual need for psychological help' and 19% forgot to complete the screening. The response rate to the process evaluation was 43% (n = 91). Of these, 90% found the screening was useful, and almost all patients were positive about the SCREENIVF questionnaire. Furthermore, 93% recognized themselves in the risk profile based on SCREENIVF. Of the patients at risk, 21% reported planning to seek professional help, but 46% of the at-risk patients experienced travelling distance as an obstacle to seek psychological help. We concluded that screening patients for emotional risk factors is feasible. In future, psychosocial care offered by the Internet may be promising in meeting the barrier of travelling distance.
  
  
  CONCLUSIONS
  People were asked to fill in SCREENIVF for clinical purposes pretreatment. There might be a selection bias in the people who did not fill in SCREENIVF, which may be due to already existing psychological problems or language problems. The low response rate of the process evaluation questionnaire and the mono-centre evaluation may be confounders and may have influenced our analysis opportunities.
  
  
  CONCLUSIONS
  The generalizability of this data is unknown with respect to other ethnic groups. Furthermore, more research is needed to evaluate psychosocial factors in male partners. Future research should also focus on the barriers and facilitators for help-seeking behaviour.
  
  
  BACKGROUND
  There was no funding for this study and no conflict of interest.
authors.affiliation: Department of Obstetrics and Gynaecology, Radboud University Nijmegen Medical Centre, PO Box 9101, 6500 HB, Nijmegen, The Netherlands. a.vandongen@obgyn.umcn.nl
authors.forename: A J C M
authors.initials: AJ
authors.lastname: Van Dongen
authors.forename: J A M
authors.initials: JA
authors.lastname: Kremer
authors.forename: N
authors.initials: N
authors.lastname: Van Sluisveld
authors.forename: C M
authors.initials: CM
authors.lastname: Verhaak
authors.forename: W L D M
authors.initials: WL
authors.lastname: Nelen
mesh_terms: D000328:Adult; D000342:Affective Symptoms / Q000209:etiology / Q000523:psychology*; D015331:Cohort Studies; D004644:Emotions; D005240:Feasibility Studies; D005260:Female; D005307:Fertilization in Vitro / Q000523:psychology*; D006801:Humans; D007246:Infertility / Q000208:ethnology / Q000523:psychology; D020407:Internet; D008297:Male; D010043:Outcome and Process Assessment, Health Care; D011446:Prospective Studies; D012307:Risk Factors; D011795:Surveys and Questionnaires; D013813:Therapy, Computer-Assisted