Pregnant women and new mothers at one central Illinois public health clinic will soon receive depression screenings using mobile health -- also called mHealth -- technology.
Researchers from the School of Social Work at the University of Illinois are collaborating with staff members at Champaign-Urbana Public Health District on a project that will provide perinatal depression screenings using tablet computers.
"We've talked to clinicians at other sites, and the mHealth technology is a no-brainer -- it's easy, people are comfortable with it, it's faster and it's paperless -- there are so many great things about it," said principal investigator Karen M. Tabb Dina, a professor of social work. "But clinics across the country are struggling with how to implement universal screening, and from what we've learned, they're implementing it without getting staff feedback first."
Early in the project, focus groups were held with Public Health staff members to gain their perspectives about the clinic's paper-based screening system and the possibility of using technology to overcome language barriers and other obstacles.
Tabb Dina is the lead author on a paper about the project that is forthcoming in the journal General Hospital Psychiatry. She also is the principal investigator for Identifying Depression through Early Assessment, a multidisciplinary project that is exploring the prevalence of perinatal depression among women in Brazil and the U.S.
Perinatal depression -- which begins during pregnancy or up to a year after childbirth -- may affect up to 20 percent of women worldwide. Some recent studies suggested that the disease might be twice as prevalent among low-income women.
Under a 2008 Illinois law, clinics and hospitals that provide prenatal care, labor and delivery services are required to screen women for perinatal depression.
Champaign-Urbana Public Health District serves about 3,100 pregnant women and postpartum women each month, administering a depression questionnaire at least once during each client's pregnancy and again after delivery.
"The paper-based screenings are great if you complete them and score them immediately, but sometimes there's a little bit of delay, which can be a barrier if you have to find the client later," said Brandon Meline, director of maternal and child health management at Public Health. "We have a pretty transient population, so we try to get everything done -- education, interventions and referrals -- while the client is here."
The tablets are equipped with electronic versions of the Edinburgh Postnatal Depression Scale, a 10-item questionnaire commonly used by clinics. Currently, Public Health provides the paper form in English, French and Spanish, although it frequently treats clients who speak other languages, such as Korean, Mandarin and Turkish.
Women who rely upon their partners to help them complete the forms may be reluctant to disclose their symptoms, Public Health staff members said.
Because the software provides the questionnaire in numerous languages, clients can complete the screening in the language they are most comfortable using. And audio technology enables even women with poor literacy skills to complete the screening independently, Tabb Dina said.
"Most of our moms come in with smartphones, so they're savvy to the use of mobile technology and touch-screen functionality," said Meline, adding that data will not be stored on the tablets but in the clinic's electronic medical records system.
"One of the main concerns that clinicians had was that the tablets could get lost, broken or stolen," said doctoral student Maria Pineros-Leano, who analyzed the focus group data and is the lead author on a related paper published online recently by the journal Family Practice. "We're considering bright covers or protectors, so that even if a tablet falls on the floor it's unlikely to break."
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