Developing a complex intervention to support pregnant women with mild to moderate anxiety: application of the Medical Research Council framework

Evans, Kerry; Spiby, Helen; Morrell, C. Jane

Abstract

Background: To design and develop an intervention to support women with symptoms of mild to moderate anxiety in pregnancy. Methods: The development followed the MRC framework for complex interventions, utilising psychological theory, review level evidence and professional and public involvement. Two systematic reviews were completed which helped identify potentially beneficial intervention components. The theory underpinning the components was explored to consider the potential benefit for women with mild to moderate anxiety symptoms in pregnancy. Methods of delivering the intervention within maternity services were explored. The intervention comprised: group discussions, one to one support and assisted self-help resources. Midwives were identified as ideally placed to facilitate the intervention supported by midwifery support workers. A bespoke training package was provided by subject experts to prepare the facilitators. Results: The absence of established interventions and a paucity of evidence based approaches for pregnant women with symptoms of mild to moderate anxiety indicated the need for a rigorous and systematic approach to the intervention design. This approach led to the development of an intervention feasible for implementation in maternity care systems tailored to the needs of pregnant women. The involvement of a multi-professional advisory team and active engagement of service users helped to consider the acceptability of the intervention for women and the feasibility of delivering the intervention in the context of maternity care. Conclusion: The MRC Framework provided useful overarching guidance to develop a midwife facilitated intervention for women with symptoms of anxiety in pregnancy. The framework assisted the development of a robust rationale for each intervention component and considered the processes of evaluation and implementation into maternity care systems.

Citation

Evans, K., Spiby, H., & Morrell, C. J. (2020). Developing a complex intervention to support pregnant women with mild to moderate anxiety: application of the Medical Research Council framework. BMC Pregnancy and Childbirth, 20(1), Article 777. https://doi.org/10.1186/s12884-020-03469-8

• Journal Article Type: Article
• Acceptance Date: Dec 1, 2020
• Online Publication Date: Dec 14, 2020
• Publication Date: Dec 14, 2020
• Deposit Date: Dec 7, 2020
• Publicly Available Date: Dec 15, 2020
• Journal: BMC Pregnancy and Childbirth
• Electronic ISSN: 1471-2393
• Publisher: Springer Verlag
• Peer Reviewed: Peer Reviewed
• Volume: 20
• Issue: 1
• Article Number: 777
• DOI: https://doi.org/10.1186/s12884-020-03469-8
• Keywords: Obstetrics and Gynecology
• Public URL: https://nottingham-repository.worktribe.com/output/5125592
• Publisher URL: https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-020-03469-8
• Additional Information: Received: 30 June 2020; Accepted: 1 December 2020; First Online: 14 December 2020; : No ethical approval was needed as this paper does not report primary research. The study involved secondary analysis of data. (Health Research Authority decision tool: ExternalRef removed; : Not applicable.; : The authors declare that they have no competing interests.