Abstract
BackgroundTo design and develop an intervention to support women with symptoms of mild to moderate anxiety in pregnancy.MethodsThe development followed the MRC framework for complex interventions, utilising psychological theory, review level evidence and professional and public involvement. Two systematic reviews were completed which helped identify potentially beneficial intervention components. The theory underpinning the components was explored to consider the potential benefit for women with mild to moderate anxiety symptoms in pregnancy. Methods of delivering the intervention within maternity services were explored. The intervention comprised: group discussions, one to one support and assisted self-help resources. Midwives were identified as ideally placed to facilitate the intervention supported by midwifery support workers. A bespoke training package was provided by subject experts to prepare the facilitators.ResultsThe absence of established interventions and a paucity of evidence based approaches for pregnant women with symptoms of mild to moderate anxiety indicated the need for a rigorous and systematic approach to the intervention design. This approach led to the development of an intervention feasible for implementation in maternity care systems tailored to the needs of pregnant women. The involvement of a multi-professional advisory team and active engagement of service users helped to consider the acceptability of the intervention for women and the feasibility of delivering the intervention in the context of maternity care.ConclusionThe MRC Framework provided useful overarching guidance to develop a midwife facilitated intervention for women with symptoms of anxiety in pregnancy. The framework assisted the development of a robust rationale for each intervention component and considered the processes of evaluation and implementation into maternity care systems.
Highlights
To design and develop an intervention to support women with symptoms of mild to moderate anxiety in pregnancy
This paper reports the stages of an intervention development utilising the Medical Research Council (MRC) framework for developing complex interventions [24]
The MRC described complex interventions as: 1) including several interacting components; 2) sensitive to the context in which they are delivered; 3) having a causal chain linking the intervention to outcomes; 4) having a range of possible outcomes [24]
Summary
To design and develop an intervention to support women with symptoms of mild to moderate anxiety in pregnancy. Anxiety disorders are reported as the sixth leading cause of disability globally, with women accounting for 65% of disability adjusted life years. Costs of additional use of public services, productivity losses and quality adjusted life year lost for women with anxiety in the perinatal period. Mild anxiety in pregnancy is a normal adaptive process, symptoms become problematic when they consume a large proportion of a woman’s time, when a woman is unable to focus on other tasks and when symptoms interfere with everyday life Wenzel [81]. Antenatal anxiety has been reported to have a negative impact on women’s confidence in mothering, satisfaction with their infants and predict post-traumatic stress disorder and postnatal depression [36, 38, 42]
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