title: Pregnant Women's Views on the Feasibility and Acceptability of Web-Based Mental Health E-Screening Versus Paper-Based Screening: A Randomized Controlled Trial.
abstract: Major international guidelines recommend mental health screening during the perinatal period. However, substantial barriers to screening have been reported by pregnant and postpartum women and perinatal care providers. E-screening offers benefits that may address implementation challenges.
  
  
  
  The primary objective of this randomized controlled trial was to evaluate the feasibility and acceptability of Web-based mental health e-screening compared with paper-based screening among pregnant women. A secondary objective was to identify factors associated with women's preferences for e-screening and disclosure of mental health concerns.
  
  
  
  Pregnant women recruited from community and hospital-based antenatal clinics and hospital-based prenatal classes were computer-randomized to a fully automated Web-based e-screening intervention group or a paper-based control group. Women were eligible if they spoke or read English, were willing to be randomized to e-screening, and were willing to participate in a follow-up diagnostic interview. The intervention group completed the Antenatal Psychosocial Health Assessment and the Edinburgh Postnatal Depression Scale on a tablet computer, while controls completed them on paper. All women completed self-report baseline questions and were telephoned 1 week after randomization by a blinded research assistant for a MINI International Neuropsychiatric Interview. Renker and Tonkin's tool of feasibility and acceptability of computerized screening was used to assess the feasibility and acceptability of e-screening compared with paper-based screening. Intention-to-treat analysis was used. To identify factors associated with preference for e-screening and disclosure, variables associated with each outcome at P<.20 were simultaneously entered into final multivariable models to estimate adjusted odds ratios (AORs) and 95% CIs.
  
  
  
  Of the 675 eligible women approached, 636 agreed to participate (participation rate 94.2%) and were randomized to the intervention (n=305) or control (n=331) groups. There were no significant baseline differences between groups. More women in the e-screening group strongly or somewhat agreed that they would like to use a tablet for answering questions on emotional health (57.9%, 175/302 vs 37.2%, 121/325) and would prefer using a tablet to paper (46.0%, 139/302 vs 29.2%, 95/325), compared with women in the paper-based screening group. There were no differences between groups in women's disclosure of emotional health concerns (94.1%, 284/302 vs 90.2%, 293/325). Women in the e-screening group consistently reported the features of e-screening more favorably than controls (more private or confidential, less impersonal, less time-consuming). In the multivariable models, being in the e-screening group was significantly associated with preferring e-screening (AOR 2.29, 95% CI 1.66-3.17), while no factors were significantly associated with disclosure.
  
  
  
  The findings suggest that mental health e-screening is feasible and acceptable to pregnant women.
  
  
  
  Clinicaltrials.gov NCT01899534; https://clinicaltrials.gov/ct2/show/NCT01899534 (Archived by WebCite at http://www.webcitation.org/6ntWg1yWb).
authors.affiliation: Faculty of Nursing, University of Calgary, Calgary, AB, Canada.
authors.forename: Dawn
authors.identifier: 0000-0002-7183-2803
authors.initials: D
authors.lastname: Kingston
authors.affiliation: University of New South Wales, Sydney, Australia.
authors.forename: Marie-Paule
authors.identifier: 0000-0002-6957-0656
authors.initials: MP
authors.lastname: Austin
authors.affiliation: Division of Gastroenterology, University of Alberta, Edmonton, AB, Canada.
authors.forename: Sander
authors.identifier: 0000-0002-1702-8750
authors.initials: S
authors.lastname: Veldhuyzen van Zanten
authors.affiliation: Faculty of Nursing, University of Calgary, Calgary, AB, Canada.
authors.forename: Paula
authors.identifier: 0000-0003-4446-1872
authors.initials: P
authors.lastname: Harvalik
authors.affiliation: Murdoch Childrens Research Institute, Royal Children's Hospital, Parkville, Australia.
authors.forename: Rebecca
authors.identifier: 0000-0002-1065-2921
authors.initials: R
authors.lastname: Giallo
authors.affiliation: McMaster University, Hamilton, ON, Canada.
authors.forename: Sarah D
authors.identifier: 0000-0002-4461-2178
authors.initials: SD
authors.lastname: McDonald
authors.affiliation: University of Calgary, Calgary, AB, Canada.
authors.forename: Glenda
authors.identifier: 0000-0003-3352-6781
authors.initials: G
authors.lastname: MacQueen
authors.affiliation: Faculty of Nursing, University of Calgary, Calgary, AB, Canada.
authors.forename: Lydia
authors.identifier: 0000-0002-7995-731X
authors.initials: L
authors.lastname: Vermeyden
authors.affiliation: College of Nursing, University of Saskatchewan, Regina, SK, Canada.
authors.forename: Gerri
authors.identifier: 0000-0001-5478-3520
authors.initials: G
authors.lastname: Lasiuk
authors.affiliation: University of Ottawa, Ottawa, ON, Canada.
authors.forename: Wendy
authors.identifier: 0000-0003-0378-2266
authors.initials: W
authors.lastname: Sword
authors.affiliation: Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.
authors.forename: Anne
authors.identifier: 0000-0002-0865-9091
authors.initials: A
authors.lastname: Biringer
mesh_terms: D000328:Adult; D001007:Anxiety / Q000175:diagnosis*; D003863:Depression / Q000175:diagnosis*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D020407:Internet; D008403:Mass Screening / Q000379:methods; D008603:Mental Health; D010209:Paper; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D011247:Pregnancy / Q000523:psychology*; D011248:Pregnancy Complications / Q000523:psychology; D017216:Telemedicine / Q000379:methods*
keywords: computers; mental health; pregnancy; prenatal care; screening