Missingness patterns in a comprehensive instrument identifying psychosocial and substance use risk in antenatal care

ABSTRACT

Background

Psychosocial vulnerabilities (e.g. inadequate social support, financial insecurity, stress) and substance use elevate risks for adverse perinatal outcomes and maternal mental health morbidities. However, various barriers, including paucity of validated, simple and usable comprehensive instruments, impede execution of the recommendations to screen for such vulnerabilities in the first antenatal care visit. The current study presents findings from a newly implemented self-report tool created to overcome screening barriers in outpatient antenatal clinics.

Methods

This was a retrospective chart-review of 904 women who completed the Profile for Maternal & Obstetric Treatment Effectiveness (PROMOTE) during their first antenatal visit between June and December 2019. The PROMOTE includes the 4-item NIDA Quick Screen and 15 additional items that each assess a different psychosocial vulnerability. Statistical analysis included evaluation of missing data, and exploration of missing data patterns using univariate correlations and hierarchical clustering.

Results

Three quarters of women (70.0%) had no missing items. In the entire sample, all but four PROMOTE items (opioid use, planned pregnancy, educational level, and financial state) had < 5% missing values, suggesting good acceptability and feasibility. Several respondent-related characteristics such as lower education, less family support, and greater stress were associated with greater likelihood of missing items. Instrument-related characteristics associated with missing values were completing the PROMOTE in Spanish or question positioning at the end of the instrument.

Conclusions and Implications

Conducting a comprehensive screening of theoretically and clinically meaningful vulnerabilities in an outpatient setting is feasible. Study findings will inform modifications of the PROMOTE and subsequent digitisation.

KEYWORDS:

• Psychosocial screening
• antenatal care
• substance use risk
• instrument evaluation
• missingness patterns

Acknowledgments

The authors would like to thank colleagues from Stony Brook Medicine that played a significant role in propelling the PROMOTE project: Elsa Singh and Nichole Seda (outpatient prenatal care administration) and Marianna Lawrence (Regional Perinatal Center) who contributed to the development and implementation of the PROMOTE and who have been supportive of its goals, Kristen Alarcon and Nancy Bowden (obstetric Nurse Practitioners) for their input regarding the PROMOTE, Elena Davidiak who assisted in translating the PROMOTE to Spanish, and Elizabeth Roemer, Deidre Lee, and Rosalinda Barba (Department of Obstetrics, Gynecology and Reproductive Medicine Research Support), who assisted in the collection of the data presented in this manuscript.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Geolocation information

40.915236835731, −73.122478554817

Additional information

Funding

The study was funded by SUNY Research Seed Grant Program - Multidisciplinary Small Team Award (#201059.2). Research reported in this manuscript was supported by National Institute on Drug Abuse under award number R21DA049827.