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Implementation of depression screening in antenatal clinics through tablet computers: results of a feasibility study

Marcano-Belisario, José S., Gupta, Ajay, O’Donoghue, John, Ramchandani, Paul, Morrison, Cecily and Car, Josip (2017) Implementation of depression screening in antenatal clinics through tablet computers: results of a feasibility study BMC Medical Informatics and Decision Making, 17 (1).

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Mobile devices may facilitate depression screening in the waiting area of antenatal clinics. This can present implementation challenges, of which we focused on survey layout and technology deployment.


We assessed the feasibility of using tablet computers to administer a socio-demographic survey, the Whooley questions and the Edinburgh Postnatal Depression Scale (EPDS) to 530 pregnant women attending National Health Service (NHS) antenatal clinics across England. We randomised participants to one of two layout versions of these surveys: (i) a scrolling layout where each survey was presented on a single screen; or (ii) a paging layout where only one question appeared on the screen at any given time.


Overall, 85.10% of eligible pregnant women agreed to take part. Of these, 90.95% completed the study procedures. Approximately 23% of participants answered Yes to at least one Whooley question, and approximately 13% of them scored 10 points of more on the EPDS. We observed no association between survey layout and the responses given to the Whooley questions, the median EPDS scores, the number of participants at increased risk of self-harm, and the number of participants asking for technical assistance. However, we observed a difference in the number of participants at each EPDS scoring interval (p = 0.008), which provide an indication of a woman’s risk of depression. A scrolling layout resulted in faster completion times (median = 4 min 46 s) than a paging layout (median = 5 min 33 s) (p = 0.024). However, the clinical significance of this difference (47.5 s) is yet to be determined.


Tablet computers can be used for depression screening in the waiting area of antenatal clinics. This requires the careful consideration of clinical workflows, and technology-related issues such as connectivity and security. An association between survey layout and EPDS scoring intervals needs to be explored further to determine if it corresponds to a survey layout effect. Future research needs to evaluate the effect of this type of antenatal depression screening on clinical outcomes and clinic workflows.

Item Type: Article
Divisions : Faculty of Health and Medical Sciences > School of Health Sciences
Authors :
Marcano-Belisario, José
Gupta, Ajay
O’Donoghue, John
Ramchandani, Paul
Morrison, Cecily
Car, Josip
Date : 10 May 2017
Funders : National Institute for Health Research (NIHR)
DOI : 10.1186/s12911-017-0459-8
Copyright Disclaimer : © The Author(s). 2017 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (, which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.
Uncontrolled Keywords : Antenatal depression; Mental health; Edinburgh Postnatal Depression Scale (EPDS); Whooley questions; Population screening; Patient self-report; Mobile health (mHealth); Apple ® iPad®; Tablet computers; Survey layout
Depositing User : Diane Maxfield
Date Deposited : 15 Jan 2019 15:28
Last Modified : 04 Feb 2019 15:50

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