The feasibility and acceptability of self-testing for proteinuria during pregnancy: a mixed methods approach

TY - JOUR

T1 - The feasibility and acceptability of self-testing for proteinuria during pregnancy: a mixed methods approach

AU - Tucker, Katherine L.

AU - Bowen, Liza

AU - Crawford, Carole

AU - Malon, Philippa

AU - Hinton, Lisa

AU - Lee, Mei-Man

AU - Oke, Jason

AU - Taylor, Kathryn S.

AU - Heneghan, Carl

AU - Bankhead, Clare

AU - Mackillop, Lucy

AU - James, Tim

AU - Oakeshott, Pippa

AU - Chappell, Lucy C

AU - McManus, Richard J.

PY - 2017/11/23

Y1 - 2017/11/23

N2 - Objective To investigate feasibility and acceptability of self-testing for proteinuria during pregnancy. Study Design Mixed methods approach which included: an accuracy study where pregnant women (n=100) and healthcare professionals (n=96) tested seven synthetic protein samples and completed a questionnaire, a feasibility study where pregnant women who were self-monitoring their blood pressure were asked to self-test for proteinuria (n=30), and an online questionnaire about women’s experiences of self-testing (n=200). Main outcome measures Sensitivity and specificity of testing and questionnaire results. Results There were no significant differences in the accuracy of synthetic sample testing by pregnant women (sensitivity 0.81 (95% confidence intervals (CI) 0.78-0.85), specificity 0.93 (95% CI 0.91-0.95) and healthcare professionals: (sensitivity 0.83 (95% CI 0.79-0.86), specificity 0.92 (95% CI 0.90-0.94)). Automated readers had significantly better sensitivity (0.94 (0.91-0.97) (p≤ 0.001 in each case), but worse specificity 0.78 (0.69-0.85). Similar results were gained using self-tested urine samples compared to staff-testing using a reference standard of laboratory urine protein-creatinine ratio (uPCR). Women who completed the online survey with experience of self-testing (n=39, 20%) generally found it easy, and with support from healthcare professionals felt it improved involvement in their care and reduced anxiety. Conclusions Self-testing for proteinuria by pregnant women had similar accuracy to healthcare professional testing and was acceptable to both groups. Self-testing of urine combined with self-monitoring of blood pressure could provide a useful adjunct to clinic-based surveillance for the detection of pre-eclampsia. Such novel strategies warrant further research. Funding NIHR School of Primary Care Research

AB - Objective To investigate feasibility and acceptability of self-testing for proteinuria during pregnancy. Study Design Mixed methods approach which included: an accuracy study where pregnant women (n=100) and healthcare professionals (n=96) tested seven synthetic protein samples and completed a questionnaire, a feasibility study where pregnant women who were self-monitoring their blood pressure were asked to self-test for proteinuria (n=30), and an online questionnaire about women’s experiences of self-testing (n=200). Main outcome measures Sensitivity and specificity of testing and questionnaire results. Results There were no significant differences in the accuracy of synthetic sample testing by pregnant women (sensitivity 0.81 (95% confidence intervals (CI) 0.78-0.85), specificity 0.93 (95% CI 0.91-0.95) and healthcare professionals: (sensitivity 0.83 (95% CI 0.79-0.86), specificity 0.92 (95% CI 0.90-0.94)). Automated readers had significantly better sensitivity (0.94 (0.91-0.97) (p≤ 0.001 in each case), but worse specificity 0.78 (0.69-0.85). Similar results were gained using self-tested urine samples compared to staff-testing using a reference standard of laboratory urine protein-creatinine ratio (uPCR). Women who completed the online survey with experience of self-testing (n=39, 20%) generally found it easy, and with support from healthcare professionals felt it improved involvement in their care and reduced anxiety. Conclusions Self-testing for proteinuria by pregnant women had similar accuracy to healthcare professional testing and was acceptable to both groups. Self-testing of urine combined with self-monitoring of blood pressure could provide a useful adjunct to clinic-based surveillance for the detection of pre-eclampsia. Such novel strategies warrant further research. Funding NIHR School of Primary Care Research

KW - Proteinuria

KW - Pregnancy

KW - Pre-eclampsia

KW - Self-testing

U2 - 10.1016/j.preghy.2017.11.009

DO - 10.1016/j.preghy.2017.11.009

M3 - Article

SN - 2210-7789

JO - Pregnancy Hypertension

JF - Pregnancy Hypertension

ER -