USING THE ALPHA-FORM IN PRACTICE TO ASSESS ANTENATAL PSYCHOSOCIAL HEALTH

Background: The assessment of the psychosocial health of pregnant wome n and their families, although recommended, is not carried out by most practitioners. One reason is the lack of a practical and evidence-bas ed tool. In response, a multidisciplinary group created the Antenatal Psychosocial Health Assessment (ALPHA) form. This article describes th e development of this tool and experience with it in an initial field trial. Methods: A systematic literature review revealed 15 antenatal p sychosocial risk factors associated with poor postpartum family outcom es of woman abuse, child abuse, postpartum depression, marital/couple dysfunction and increased physical illness. The ALPHA form, incorporat ing these risk factors, was developed and refined through several focu s groups. It was then used by 5 obstetricians, 10 family physicians, 7 midwives and 4 antenatal clinic nurses in various urban, rural and cu lturally diverse locations across Ontario. After 3 months, these healt h care providers met in focus groups to discuss their experiences. A s ample of pregnant women assessed using the ALPHA form were interviewed about their experience as well. Results were analysed according to qu alitative methods. Results: The final version of the ALPHA form groupe d the 15 risk factors into 4 categories - family factors, maternal fac tors, substance abuse and family violence - with suggested questions f or each area of enquiry. The health care providers uniformly reported that the form helped them to uncover new and often surprising informat ion, even when the women were well known to them; Incorporating the fo rm into practice was usually accomplished after a period of familiariz ation. Most of the providers said the form was useful and would contin ue to use it if it became part of standard care. The pregnant women in the sample said they valued the enquiry and felt comfortable with the process, unless there were large cultural barriers. Interpretation: T he ALPHA form appears to be an important tool in assessing psychosocia l health in pregnancy and to be readily integrated into practice. More study is required to quantify the number of risks identified and reso urces used, to determine the form's reliability and validity and, ulti mately, to assess the effect of its use on postpartum outcomes.