title: Developing and testing a theory-informed intervention to promote the psychological well-being of Chinese women undergoing an abortion
Creators: name: Wang, Na
Publisher: name: Griffith University
Year: 2022
Subjects: subject: abortion
subject: psychological well-being
subject: Chinese socio-political environment
subject: Behavioural economics principles

description: Worldwide each year, approximately 70 million women experience an abortion. Not all pregnancies are planned, and some women may not wish to proceed with the pregnancy for various reasons. As the most populous country in the world, China conducted about 10 million abortions in 2019. Although undergoing an abortion is stressful for most women, little attention has been given to promoting their psychosocial well-being during this time. The Transactional Model of Stress and Coping (TSC) suggests that women can adjust their appraisal of circumstances to achieve positive coping and psychological outcomes after abortion. However, few interventions to improve women’s coping have been tested. This PhD program aimed to systematically develop and test a TSC-based intervention to promote positive coping behaviours and alleviate depression symptoms among Chinese women undergoing an abortion. The program was a sequential multi-method study conducted in four phases (I–IV), underpinned by the UK Medical Research Council guidance for evaluating and developing complex interventions. Phase I (presented as a published paper) is a systematic review that synthesises and integrates evidence about the design and effectiveness of existing interventions that promote the psychological well-being of women experiencing abortion. Although ten studies were identified, methodological limitations were common across studies. Only one study was conducted in China and no studies used a theoretical framework to guide the design and evaluation of the intervention. Phase II (presented as a published paper) aimed to determine the extent of stress and depression among women seeking abortion services in China. The clinic-based survey recruited 253 women who completed the Perceived Stress Scale-10 (PSS-10) and Patient Health Questionnaire-9 (PHQ-9). Prevalence of high perceived stress was ii 25.3% and moderate to severe depression was 22.5%. Results indicated that psychological support for Chinese women undergoing an abortion was required. Phase III (presented as a paper under review) aimed to address the identified gaps through the development of a needs-oriented, theory-informed intervention to promote the psychological well-being of Chinese women undergoing an abortion. A five-step iterative approach informed by Intervention Mapping was undertaken to determine the intervention design. Step 1 used in-depth interviews with 14 Chinese women undergoing an abortion to assess real-life stressors and support needs. Step 2 used a focus group discussion with care providers to select modifiable stressors that impact negative psychological outcomes. Step 3 integrated these results with components of the TSC model to determine specific strategies to eliminate or mitigate modifiable stressors. Step 4 identified change mechanisms which were integrated into different intervention components and resulted in a preliminary intervention design. Step 5 involved consultation with 10 women who had undergone abortion in the previous 2–6 weeks, to confirm content validity. Intervention components included: 1) a 30-minute face-to-face nurse consultation prior to abortion; 2) a WeChat-based public profile page with self-care information; and 3) a telephone hotline. The intervention was titled STress-And-Coping suppoRT (START). Phase IV (one paper published, one under review) involved a two-arm randomised controlled trial (RCT) that aimed to explore the feasibility and preliminary effects of the START intervention in a real-world setting. The protocol was registered with the Chinese Clinical Trial Register (no. CHiCTR2100046101). Women undergoing an abortion (n = 110) were recruited and randomly allocated (on a 1:1 allocation ratio) to receive either the START intervention in addition to standard abortion care, or standard abortion care only. All participants were contacted to complete a follow-up survey at iii two- and six-weeks post-abortion. Findings indicated that START was associated with lower depression scores, more effective coping behaviours, and better perceptions of controllability, social support, self-efficacy, and personal growth at two weeks post-abortion. However, there was no evidence that these effects were maintained at six weeks post-abortion. Recruitment and retention rates and acceptability indicated feasibility. In summary, this PhD program developed and tested a theory-based intervention (START) to promote the psychological well-being of Chinese women undergoing an abortion. The intervention was informed by the best available evidence. While developing the intervention, women and clinicians were engaged from the outset, and insights from appropriate theoretical frameworks were included to ensure the appropriateness and effectiveness of the intervention design. The RCT results demonstrated the feasibility and preliminary effectiveness of the START intervention in improving Chinese women’s coping behaviours and depression symptoms following an abortion. Although trial findings should be considered preliminary due to the single-centre and nonblinded study design, START is the first program of its kind to potentially improve psychological well-being among Chinese women undergoing an abortion. This research paves the way for a new approach to addressing the psychological needs of women experiencing abortion in China. Further research is needed to draw definitive conclusions about the impact of the START intervention, as well as how women perceive and respond to START.