Cognitive testing of the PHQ-9 for depression screening among pregnant and postpartum women in Kenya
Abstract Background African women face high rates of depression, particularly during pregnancy or postpartum or after a recent HIV diagnosis. The Patient Health Questionnaire-9 (PHQ-9) depression screening tool has been quantitatively validated and extensively used to identify depression and link in...
| Main Authors: | , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2020-01-01
|
| Series: | BMC Psychiatry |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12888-020-2435-6 |
| _version_ | 1818615818885267456 |
|---|---|
| author | Jennifer Velloza John Njoroge Kenneth Ngure Nicholas Thuo Catherine Kiptinness Richard Momanyi Snaidah Ayub Stephen Gakuo Nelly Mugo Jane Simoni Renee Heffron |
| author_facet | Jennifer Velloza John Njoroge Kenneth Ngure Nicholas Thuo Catherine Kiptinness Richard Momanyi Snaidah Ayub Stephen Gakuo Nelly Mugo Jane Simoni Renee Heffron |
| author_sort | Jennifer Velloza |
| collection | DOAJ |
| description | Abstract Background African women face high rates of depression, particularly during pregnancy or postpartum or after a recent HIV diagnosis. The Patient Health Questionnaire-9 (PHQ-9) depression screening tool has been quantitatively validated and extensively used to identify depression and link individuals to care. However, qualitative work is necessary to identify important opportunities to improve PHQ-9 question comprehension and performance among Kenyan women. Methods We administered the Kiswahili or English PHQ-9 (based on preference) to 29 pregnant and postpartum women in Thika, Kenya. Following administration, we conducted cognitive interviews with a purposive sample of 20 women. We used analytic memos and data matrices to identify themes around scale acceptability, comprehension, and decision and response processes. Results Most participants preferred to answer the PHQ-9 in Kiswahili (N = 15; 52%). Among the 20 interview participants, 12 (60%) had scores ≥5, indicating depressive symptoms. Overall, participants found the scale acceptable as an interviewer-administered tool. Participants reported few problems related to comprehension but had difficulty answering items not relevant to their lives (e.g., “watching television”) and double-barreled items (e.g., “poor appetite or overeating”). They were hesitant to endorse items related to “duties as a wife and mother” and suicidal ideation. Most participants had difficulty distinguishing between response options of “several days” and “more than half the days”. Conclusions We detected several problems related to PHQ-9 comprehension, decision processes, and response processes. We provide recommended changes to instructions and item wording to improve PHQ-9 validity among Kenyan women. |
| first_indexed | 2024-12-16T16:39:57Z |
| format | Article |
| id | doaj.art-84aa88837f81447c9b5d1e9ebeea0a81 |
| institution | Directory Open Access Journal |
| issn | 1471-244X |
| language | English |
| last_indexed | 2024-12-16T16:39:57Z |
| publishDate | 2020-01-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Psychiatry |
| spelling | doaj.art-84aa88837f81447c9b5d1e9ebeea0a812022-12-21T22:24:21ZengBMCBMC Psychiatry1471-244X2020-01-0120111410.1186/s12888-020-2435-6Cognitive testing of the PHQ-9 for depression screening among pregnant and postpartum women in KenyaJennifer Velloza0John Njoroge1Kenneth Ngure2Nicholas Thuo3Catherine Kiptinness4Richard Momanyi5Snaidah Ayub6Stephen Gakuo7Nelly Mugo8Jane Simoni9Renee Heffron10Department of Global Health, University of WashingtonPartners in Health and Research DevelopmentDepartment of Community Health Jomo Kenyatta University of Agriculture and TechnologyPartners in Health and Research DevelopmentPartners in Health and Research DevelopmentPartners in Health and Research DevelopmentPartners in Health and Research DevelopmentPartners in Health and Research DevelopmentDepartment of Global Health, University of WashingtonDepartment of Global Health, University of WashingtonDepartment of Global Health, University of WashingtonAbstract Background African women face high rates of depression, particularly during pregnancy or postpartum or after a recent HIV diagnosis. The Patient Health Questionnaire-9 (PHQ-9) depression screening tool has been quantitatively validated and extensively used to identify depression and link individuals to care. However, qualitative work is necessary to identify important opportunities to improve PHQ-9 question comprehension and performance among Kenyan women. Methods We administered the Kiswahili or English PHQ-9 (based on preference) to 29 pregnant and postpartum women in Thika, Kenya. Following administration, we conducted cognitive interviews with a purposive sample of 20 women. We used analytic memos and data matrices to identify themes around scale acceptability, comprehension, and decision and response processes. Results Most participants preferred to answer the PHQ-9 in Kiswahili (N = 15; 52%). Among the 20 interview participants, 12 (60%) had scores ≥5, indicating depressive symptoms. Overall, participants found the scale acceptable as an interviewer-administered tool. Participants reported few problems related to comprehension but had difficulty answering items not relevant to their lives (e.g., “watching television”) and double-barreled items (e.g., “poor appetite or overeating”). They were hesitant to endorse items related to “duties as a wife and mother” and suicidal ideation. Most participants had difficulty distinguishing between response options of “several days” and “more than half the days”. Conclusions We detected several problems related to PHQ-9 comprehension, decision processes, and response processes. We provide recommended changes to instructions and item wording to improve PHQ-9 validity among Kenyan women.https://doi.org/10.1186/s12888-020-2435-6DepressionPHQ-9PregnancyKenyaWomen |
| spellingShingle | Jennifer Velloza John Njoroge Kenneth Ngure Nicholas Thuo Catherine Kiptinness Richard Momanyi Snaidah Ayub Stephen Gakuo Nelly Mugo Jane Simoni Renee Heffron Cognitive testing of the PHQ-9 for depression screening among pregnant and postpartum women in Kenya BMC Psychiatry Depression PHQ-9 Pregnancy Kenya Women |
| title | Cognitive testing of the PHQ-9 for depression screening among pregnant and postpartum women in Kenya |
| title_full | Cognitive testing of the PHQ-9 for depression screening among pregnant and postpartum women in Kenya |
| title_fullStr | Cognitive testing of the PHQ-9 for depression screening among pregnant and postpartum women in Kenya |
| title_full_unstemmed | Cognitive testing of the PHQ-9 for depression screening among pregnant and postpartum women in Kenya |
| title_short | Cognitive testing of the PHQ-9 for depression screening among pregnant and postpartum women in Kenya |
| title_sort | cognitive testing of the phq 9 for depression screening among pregnant and postpartum women in kenya |
| topic | Depression PHQ-9 Pregnancy Kenya Women |
| url | https://doi.org/10.1186/s12888-020-2435-6 |
| work_keys_str_mv | AT jennifervelloza cognitivetestingofthephq9fordepressionscreeningamongpregnantandpostpartumwomeninkenya AT johnnjoroge cognitivetestingofthephq9fordepressionscreeningamongpregnantandpostpartumwomeninkenya AT kennethngure cognitivetestingofthephq9fordepressionscreeningamongpregnantandpostpartumwomeninkenya AT nicholasthuo cognitivetestingofthephq9fordepressionscreeningamongpregnantandpostpartumwomeninkenya AT catherinekiptinness cognitivetestingofthephq9fordepressionscreeningamongpregnantandpostpartumwomeninkenya AT richardmomanyi cognitivetestingofthephq9fordepressionscreeningamongpregnantandpostpartumwomeninkenya AT snaidahayub cognitivetestingofthephq9fordepressionscreeningamongpregnantandpostpartumwomeninkenya AT stephengakuo cognitivetestingofthephq9fordepressionscreeningamongpregnantandpostpartumwomeninkenya AT nellymugo cognitivetestingofthephq9fordepressionscreeningamongpregnantandpostpartumwomeninkenya AT janesimoni cognitivetestingofthephq9fordepressionscreeningamongpregnantandpostpartumwomeninkenya AT reneeheffron cognitivetestingofthephq9fordepressionscreeningamongpregnantandpostpartumwomeninkenya |