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

• Published in: Pregnancy hypertension 2018-04, Vol.12, p.161-168
• Main Authors: Tucker, Katherine L., Bowen, Liza, Crawford, Carole, Mallon, Philippa, Hinton, Lisa, Lee, Mei-Man, Oke, Jason, Taylor, Kathryn S., Heneghan, Carl, Bankhead, Clare, Mackillop, Lucy, James, Tim, Oakeshott, Pippa, Chappell, Lucy C., McManus, Richard J.
• Format: Article
• Language: English
• Subjects: Attitude of Health Personnel; Automation; Biomarkers - urine; Blood Pressure Monitoring, Ambulatory; Feasibility Studies; Female; Humans; Observer Variation; Patient Acceptance of Health Care; Patient Participation; Pre-eclampsia; Pre-Eclampsia - diagnosis; Pre-Eclampsia - physiopathology; Pre-Eclampsia - urine; Predictive Value of Tests; Pregnancy; Proteinuria; Proteinuria - diagnosis; Proteinuria - physiopathology; Proteinuria - urine; Reagent Strips; Reproducibility of Results; Self Care - instrumentation; Self Care - methods; Self-testing; Surveys and Questionnaires; Urinalysis - instrumentation
• ISSN: 2210-7789; 2210-7797
• DOI: 10.1016/j.preghy.2017.11.009

•Healthcare professional testing and self-testing for protein had similar accuracy.•Self-testing was feasible and acceptable to both women and health care professionals.•Self-testing for protein could add to clinic-based surveillance for pre-eclampsia. To investigate feasibility and acceptability of self-testing for proteinuria during pregnancy. 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). Sensitivity and specificity of testing and questionnaire 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 ≤ .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. 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.