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. 1998 Sep 22;159(6):677–684.

Using the ALPHA form in practice to assess antenatal psychosocial health

A J Reid 1, A Biringer 1, J D Carroll 1, D Midmer 1, L M Wilson 1, B Chalmers 1, D E Stewart 1
PMCID: PMC1229699  PMID: 9780969

Abstract

BACKGROUND: The assessment of the psychosocial health of pregnant women and their families, although recommended, is not carried out by most practitioners. One reason is the lack of a practical and evidence-based tool. In response, a multidisciplinary group created the Antenatal Psychosocial Health Assessment (ALPHA) form. This article describes the development of this tool and experience with it in an initial field trial. METHODS: A systematic literature review revealed 15 antenatal psychosocial risk factors associated with poor postpartum family outcomes of woman abuse, child abuse, postpartum depression, marital/couple dysfunction and increased physical illness. The ALPHA form, incorporating these risk factors, was developed and refined through several focus groups. It was then used by 5 obstetricians, 10 family physicians, 7 midwives and 4 antenatal clinic nurses in various urban, rural and culturally diverse locations across Ontario. After 3 months, these health care providers met in focus groups to discuss their experiences. A sample of pregnant women assessed using the ALPHA form were interviewed about their experience as well. Results were analysed according to qualitative methods. RESULTS: The final version of the ALPHA form grouped the 15 risk factors into 4 categories--family factors, maternal factors, substance abuse and family violence--with suggested questions for each area of enquiry. The health care providers uniformly reported that the form helped them to uncover new and often surprising information, even when the women were well known to them. Incorporating the form into practice was usually accomplished after a period of familiarization. Most of the providers said the form was useful and would continue to use it if it became part of standard care. The pregnant women in the sample said they valued the enquiry and felt comfortable with the process, unless there were large cultural barriers. INTERPRETATION: The ALPHA form appears to be an important tool in assessing psychosocial health in pregnancy and to be readily integrated into practice. More study is required to quantify the number of risks identified and resources used, to determine the form's reliability and validity and, ultimately, to assess the effect of its use on postpartum outcomes.

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Selected References

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  1. Brown J. B., Lent B., Brett P. J., Sas G., Pederson L. L. Development of the Woman Abuse Screening Tool for use in family practice. Fam Med. 1996 Jun;28(6):422–428. [PubMed] [Google Scholar]
  2. Carroll J. C., Reid A. J., Biringer A., Wilson L. M., Midmer D. K. Psychosocial risk factors during pregnancy. What do family physicians ask about? Can Fam Physician. 1994 Jul;40:1280–1289. [PMC free article] [PubMed] [Google Scholar]
  3. Culpepper L., Jack B. Psychosocial issues in pregnancy. Prim Care. 1993 Sep;20(3):599–619. [PubMed] [Google Scholar]
  4. Curry M. A., Campbell R. A., Christian M. Validity and reliability testing of the Prenatal Psychosocial Profile. Res Nurs Health. 1994 Apr;17(2):127–135. doi: 10.1002/nur.4770170208. [DOI] [PubMed] [Google Scholar]
  5. Førde R., Malterud K., Bruusgaard D. Antenatal care in general practice. 1: A questionnaire as a clinical tool for collection of information on psychosocial conditions. Scand J Prim Health Care. 1992 Dec;10(4):266–271. doi: 10.3109/02813439209014072. [DOI] [PubMed] [Google Scholar]
  6. Holden J. M., Sagovsky R., Cox J. L. Counselling in a general practice setting: controlled study of health visitor intervention in treatment of postnatal depression. BMJ. 1989 Jan 28;298(6668):223–226. doi: 10.1136/bmj.298.6668.223. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Hutchison B. G., Milner R. Reliability of the Guide to Pregnancy Risk Grading of the Ontario Antenatal Record in assessing obstetric risk. CMAJ. 1994 Jun 15;150(12):1983–1987. [PMC free article] [PubMed] [Google Scholar]
  8. Kitzman H., Olds D. L., Henderson C. R., Jr, Hanks C., Cole R., Tatelbaum R., McConnochie K. M., Sidora K., Luckey D. W., Shaver D. Effect of prenatal and infancy home visitation by nurses on pregnancy outcomes, childhood injuries, and repeated childbearing. A randomized controlled trial. JAMA. 1997 Aug 27;278(8):644–652. [PubMed] [Google Scholar]
  9. MacMillan H. L., MacMillan J. H., Offord D. R. Periodic health examination, 1993 update: 1. Primary prevention of child maltreatment. The Canadian Task Force on the Periodic Health Examination. CMAJ. 1993 Jan 15;148(2):151–163. [PMC free article] [PubMed] [Google Scholar]
  10. Midmer D., Wilson L., Cummings S. A randomized, controlled trial of the influence of prenatal parenting education on postpartum anxiety and marital adjustment. Fam Med. 1995 Mar;27(3):200–205. [PubMed] [Google Scholar]
  11. Norwood S. L. The Social Support Apgar: instrument development and testing. Res Nurs Health. 1996 Apr;19(2):143–152. doi: 10.1002/(SICI)1098-240X(199604)19:2<143::AID-NUR6>3.0.CO;2-M. [DOI] [PubMed] [Google Scholar]
  12. Nuckolls K. B., Kaplan B. H., Cassel J. Psychosocial assets, life crisis and the prognosis of pregnancy. Am J Epidemiol. 1972 May;95(5):431–441. doi: 10.1093/oxfordjournals.aje.a121410. [DOI] [PubMed] [Google Scholar]
  13. Oakley A. Measuring the effectiveness of psychosocial interventions in pregnancy. Int J Technol Assess Health Care. 1992;8 (Suppl 1):129–138. doi: 10.1017/s0266462300013027. [DOI] [PubMed] [Google Scholar]
  14. Olds D. L., Eckenrode J., Henderson C. R., Jr, Kitzman H., Powers J., Cole R., Sidora K., Morris P., Pettitt L. M., Luckey D. Long-term effects of home visitation on maternal life course and child abuse and neglect. Fifteen-year follow-up of a randomized trial. JAMA. 1997 Aug 27;278(8):637–643. [PubMed] [Google Scholar]
  15. Orr S. T., James S. A., Casper R. Psychosocial stressors and low birth weight: development of a questionnaire. J Dev Behav Pediatr. 1992 Oct;13(5):343–347. [PubMed] [Google Scholar]
  16. Wall E. M. Assessing obstetric risk. A review of obstetric risk-scoring systems. J Fam Pract. 1988 Aug;27(2):153–163. [PubMed] [Google Scholar]
  17. Wilson L. M., Reid A. J., Midmer D. K., Biringer A., Carroll J. C., Stewart D. E. Antenatal psychosocial risk factors associated with adverse postpartum family outcomes. CMAJ. 1996 Mar 15;154(6):785–799. [PMC free article] [PubMed] [Google Scholar]

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