The psychological impact of screening for preeclampsia : a qualitative study

Dodd, Zoe (2020) The psychological impact of screening for preeclampsia : a qualitative study. (PhD thesis), Kingston University, .


Background: The screening test, to establish risk status for pre-term preeclampsia (PE), is a relatively recent medical advancement. Although the psychological impact of screening for various maternal conditions is well established, it is currently unknown as to the impact of screening for pre-term PE. PE is a condition which can affect not only the mother’s health but also the health of her unborn child. Aims: The primary aim of this thesis was to explore the psychological impact of screening for pre-term PE risk status, comparing the illness representations of women identified as high-risk with those identified as low-risk. The studies in this thesis also address how women reflect on their experiences of screening for pre-term PE, the factors that influenced them to take part, and how they would feel about participating in pre-term PE risk screening in the future. Finally, the studies in this thesis ran in conjunction with a medicated RCT, investigating the effects of aspirin versus a placebo in reducing pre-term PE incidence. This thesis also sought to establish the factors that influence participation or non-participation in the RCT. Methods: This is a qualitative thesis; semi-structured interviews were conducted with high- and low-risk women, after they had been screened and found out their risk status. The interview template was informed by the Common-Sense Model of illness representations and transcripts were analysed using Template Analysis. Results: The women who participated in these studies did not report experiencing any adverse psychological effects as a result of the screening process or finding out their risk status for pre-term PE. Women held positive views towards prenatal screening in general and also screening for pre-term PE risk. Low-risk women felt reassured as results provided comfort. High-risk women were encouraged that they would receive appropriate medical care and be more aware themselves of signs or symptoms of PE. For those high-risk women invited to participate in a medicated RCT, women demonstrated good knowledge of the trial suggesting they made fully informed decisions. The main factor that influenced non-participation in the trial was negative attitudes towards taking medication during pregnancy and worries around potential side effects. Participants of the trial reported that their main reason for taking part was the close medical attention they would receive. They believed the extra medical awareness from the trial, and extra scan appointments, would be beneficial and reassuring, regardless of whether they were included in the active or placebo arm of the RCT. Conclusions: The current research indicates that women did not, generally, experience adverse psychological effects from being screened or receiving their result for pre-term PE. This contributes and supports the previous research suggesting screening for pre-term PE risk should be recommended. This study also suggests that in order to increase uptake, in both medicated pregnancy RCTs and with aspirin for the prevention of pre-term PE, women would benefit from receiving more knowledge and understanding around the safety of taking such medications during pregnancy, from medical staff.

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