Abstract
Objective: To describe the development of an assessment tool for antenatal psychosocial risk factors associated with poor postpartum outcomes.
Methods: A survey of Ontario family physicians established a need for an antenatal psychosocial health assessment (ALPHA) form. A critical literature review identified important antenatal factors for inclusion on the form. Focus groups of obstetrical care providers indicated acceptance of the provider-completed ALPHA; their feedback led to the development of a self-report ALPHA. Satisfaction, yield and reliability of the self-report and provider-completed ALPHA forms were studied and found to be comparable.
Results: Physicians and patients reported good satisfaction and usefulness of the ALPHA form in identifying antenatal psychosocial risk factors. The provider ALPHA was further tested in clinical practice. ALPHA endorsement was obtained from physicians, nurses and midwives.
Conclusion: A program planning process, which included multidisciplinary involvement, evaluation and endorsement by professional organizations, aided the development, refinement and application of the ALPHA forms as primary care tools. ALPHA topic headings are incorporated into the official 2000 Ontario Antenatal Record and the ALPHA adopted for use on Prince Edward Island.
Résumé
Objectif: Décrire l’élaboration et l’implantation d’un outil exhaustif d’évaluation des risques psychosociaux de la grossesse associés à de mauvais résultats en post-partum.
Méthode: Le besoin d’un questionnaire d’évaluation anténatale des risques psychosociaux a déjà été établi par les médecins de famille ontariens. Une analyse documentaire critique a confirmé la pertinence des composantes de l’outil d’évaluation (ALPHA). L’Outil a été modifié à la suite de groupes de discussion avec des obstétriciens, médecins de famille, sage-femmes, infirmières, travailleurs sociaux et éducateurs anténataux. Un vidéo d’enseignement et un guide de l’utilisateur furent élaborés. Un groupe de consommatrices a aussi exprimé ses opinions lors d’entrevues.
Résultats: Patientes et médecins semblent satisfaits de l’outil ALPHA pour l’identification des risques psychosociaux durant la période anténatale. Des fonds de recherche ont été obtenus pour l’évaluation de l’outil en pratique clinique. L’Outil a été approuvé par divers groupes de médecins, infirmières et sage-femmes. Les en-têtes d’ALPHA ont été adoptés pour la nouvelle formule de dossier anténatale de l’Ontario, et l’outil ALPHA a été incorporé au dossier de l’Île-du-PrinceÉdouard.
Conclusion: Le feedback multidisciplinaire ainsi que la base scientifique de l’outil ALPHA ont aidé à son élaboration, son perfectionnement et son application en première ligne.
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