Healthy Mothers, Happy Children : Prenatal Assessment For Psychosocial Risk Factors Using The KINDEX In Public Health Settings In Spain, Greece And Peru

Abstract

The present thesis explored the psychometric properties of the KINDEX Spanish and Greek version and the feasibility of prenatal screening for psychosocial risks in public health settings in three countries, Spain, Greece and Peru. The KINDEX, a brief and easy to apply screening instrument, was originally developed by Schauer and Ruf-Leuschner, in the University of Konstanz, and assesses eleven factors that have been identified in the current literature to be risks for both the mother and the fetus. The psychometric properties of the KINDEX German Version have been explored and the validity has been examined through validation studies in Germany (Schauer & Ruf-Leuschner submitted; Ruf-Leuschner & Schauer, submitted). The risks that have been proven to have negative impact on mother’s and fetus health, on pregnancy outcomes, and child’s development, include adolescent pregnancy (Panduro Baron et al., 2012), immigrant and/or ethnic minority parental status (Giscombé & Lobel, 2005), lack of social support (Collins, Dunkel-Schetter, Lobel, & Scrimshaw, 1993; Elsenbruch et al., 2006), poverty and financial difficulties (Tanya Nagahawatte & Goldenberg, 2008; Larson, 2007), high stress levels (Talge, Neal, Glover, & The Early Stress, Translational Research and Prevention Science Network: Fetal and Neonatal Experience on Child and Adolescent Mental Health, 2007; Loomans et al., 2012), negative maternal-fetal attachment (Goecke et al., 2012; Alhusen, Hayat, & Gross, n.d.), substances consumption (O’Leary, Jacoby, Bartu, D’Antoine, & Bower, 2013; Falgreen Eriksen et al., 2012), medical risks, pregnancy complications and physical complaints (Munch, Korst, Hernandez, Romero, & Goodwin, 2010; Okun, Schetter, & Glynn, 2011), traumatic experiences during childhood physical and sexual abuse; (Gilson & Lancaster, 2008; Mezey, Bacchus, Bewley, & White, 2005), intimate partner violence (Silverman, Decker, Reed, & Raj, 2006; Rosen, Seng, Tolman, & Mallinger, 2007) and maternal psychiatric history (Dunkel Schetter & Tanner, 2012; Alder, Fink, Bitzer, Hösli, & Holzgreve, 2007).In the first study the KINDEX was translated and culturally adapted into Spanish and was used by medical staff in the Maternity Hospital of Granada, Spain to interview one hundred nineteen pregnant women. The validity of the KINDEX was examined through validation interviews carried out in the same Hospital using established instruments for the assessment of psychosocial variables. Findings permitted the examination of the psychometric properties and validity of the instrument and confirmed the feasibility of prenatal assessment in public health settings in Spain.The second study applied a similar methodological design in public health settings and a Social-Medical center in Crete Island, Greece. Again, medical staff used the KINDEX to interview pregnant women, nevertheless in this case they were instructed to identify high-risk women through the interview and refer them to the mental health services of the Hospital or medical center the women were attending. From the ninety-three women that were interviewed, thirteen were referred by the medical staff. The results show that decision making of the medical staff was precise and that they correctly identified high-risk women. Validation interviews were once again carried through and findings permitted the exploration of the psychometric properties of the KINDEX and the validity testing of the KINDEX Greek Version.The third study was carried out in a different cultural ambient from the ones in the previous studies; in a suburban crime-ridden area in Lima, Peru. Midwives of the gynecological department of a General Public Hospital interviewed ninety-five pregnant women. These are considered to be a high-risk population due to their low SES and other sociodemographic characteristics such as high percentage of adolescent pregnancy. Clinical Expert interviews were once again carried out, and the feasibility of the KINDEX was assessed in this setting. Additionally we examined the relationship between the KINDEX and the risk areas of maternal perceived stress, psychopathology symptoms during pregnancy and trauma load. The specific relationship between each risk factor assessed by the KINDEX also and the three risk areas assessed in the Clinical Expert Interview was also examined. Results have proven the feasibility of prenatal assessment using the KINDEX in public health settings serving high-risk population in urban Peru. The KINDEX and the specific risks were related significantly with the three risk areas assessed in the Clinical Expert Interview.