Table 1 Main indicators and measurement methods in previous assessments
Main indicators | Measurement Method | |
|---|---|---|
Primary outcome indicators | ||
|  | Quality of decision-making process | The core indicator of quality of decision-making process is the decisional conflict, i.e. the inner uncertainty of the patient about the treatment option to be chosen during the medical activity. The level of decisional conflict will be measured by the Decisional Conflict Scale (DCS). This scale is the most widely used tool for evaluating decisional conflict and consists of five dimensions: informed, i.e., the extent to which patients understand the potential benefits and risks of the options available to them; value clarification, i.e., the extent to which patients are clear about their values (to measure the benefits and risks); decision support, i.e., the extent to which patients feel supported in their decision; uncertainty, i.e., the extent to which patients are certain about the decision being made; decision validity, which is the patient’s perceived effectiveness, or satisfaction, with the decision. The Chinese version of the scale has also been widely used in studies with good reliability and validity. |
Secondary outcome indicators | ||
|  | Shared decision-making | Shared decision-making will be measured based on an adapted decision expectancy scale (control preference scale, CPS). This scale was originally used to measure patients’ willingness to participate in health care decision-making. In its adaptation, it can also measure patients’ actual participation in decision making in a given decision situation and can classify patients into three types: active decision makers, negative decision makers, and shared decision makers. This is one of the most commonly used and concise tools for measuring shared decision-making. |
| Â | Mental health service utilization | A self-administered questionnaire will be used to investigate whether mothers are diagnosed by a psychiatrist with a mental disorder such as PND and the utilization of subsequent mental health services, including all mental health services such as counseling, psychotherapy, and psychiatric services received by mothers at the study site and other institutions or settings (e.g., number of visits, number of counseling sessions, length of medication, etc.). |
| Â | Cost | A self-administered questionnaire will be used to measure the costs associated with maternal mental health service seeking. The self-administered scale will be developed with reference to the Treatment Inventory of Costs in Psychiatric Patients and will consist of: direct medical costs, including the costs of maternal psychiatric services, psychotherapy, counseling, etc. (including maternal and health insurance paid costs); direct non-medical costs, including transportation and accommodation fees for maternity and their companions seeking mental health services; indirect costs, including labor losses such as lost wages for maternity and their companions as a result of seeking mental health services. As the related costs are incurred within six months, no discounting is required. Self-administered questionnaires will also be used to measure the cost of conducting the interprofessional shared decision-making model and subsequent mental health services, including mainly depreciation of fixed assets and staff labor costs, among medical staff and hospital administrators. |
|  | Depressive symptoms | Women’s depressive symptoms will be measured by the EPDS, a 10-item maternal self-report of depression over the past 7 days. Higher EPDS scores indicate more severe depression. The EPDS is the most commonly used screening tool for perinatal depression in maternal health care and has good reliability. |
| Â | Health-related quality of life | Health-related quality of life will be measured based on the SF-6D, a utility measurement tool created based on the MOS 36-item short-form health survey (SF-36), which is widely used to measure health-related quality of life and can be used to calculate utility values. The SF-6D health classification system consists of 6 dimensions: somatic functioning, role limitation, social functioning, pain, mental health, and vitality. Previous literature has shown that the SF-6D works well in measuring health-related quality of life in mental health and that the SF-6D is more likely to capture the effects of interventions than the EQ-5D in the area of perinatal mental health. |
Control variables | ||
|  | Decision-making preferences | Decision-making preferences will be measured by the Control Preference Scale, which is commonly used to measure patients’ willingness preferences to participate in healthcare decision-making. The scale consists of 5 entries that can classify patients into 3 types: active decision makers, negative decision makers, and shared decision makers. |
| Â | Mental health literacy and stigma | The Multicomponent Mental Health Literacy Measure (MMHLM), which is commonly used internationally, is applied in this study to measure maternal mental health literacy and stigma. The 22-item MMHLM, which contains three dimensions of knowledge, beliefs, and resources, has good reliability and validity, is suitable for assessing mental literacy in adult populations, and is also a good predictor of mental health service utilization behavior. The Chinese version of the questionnaire has been tested for reliability and validity in a domestic population. |