The feasibility and acceptability of self-testing for proteinuria during pregnancy: A mixed methods approach
Katherine L.Tucker, Liza Bowen, Carole Crawford, Philipp Mallon, Lisa Hinton, Mei-Man Lee, Jason Oke, Kathryn S.Taylor, Carl Heneghan, Clare Bankhead, Lucy Mackillop, Tim James, Pippa Oakeshott, Lucy C.Chappell, Richard J.McManus
Objective: To investigate feasibility and acceptability of self-testing for proteinuria during pregnancy. Study design: 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). Main outcome measures: Sensitivity and specificity of testing and questionnaire results. 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. Conclusions: 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.