The use of an innovative clinical decision support system focused on psychosocial vulnerabilities during pregnancy: the Born in Belgium Professionals Platform

Abstract

Background Clinical Decision Support Systems (CDSS) assist care providers in enhancing their care processes. However, uptake—also called adoption, defined as the intent, initial decision, or action to try or employ an intervention at the provider or organisational level—is essential to their success. The Born in Belgium Professionals (BIB-Pro) platform—a CDSS—supports care providers in detecting and managing antenatal psychosocial indicators that may signal antenatal psychosocial vulnerability. It has been implemented across different antenatal care settings, including medical and social care settings.

Aim Due to limited research on CDSS uptake, especially in antenatal care settings, we aimed to assess the uptake of the BIB-Pro in real-life antenatal care settings. Additionally, we aimed to determine the prevalence of psychosocial indicators identified during pregnancy.

Methods This cross-sectional observational study was conducted between November 2020 and January 2024. Uptake was assessed among active users and settings through user uptake (i.e., the extent to which care providers used the platform and how this use evolved over time) and content uptake (i.e. progression through platform workflow pages). Data output included the prevalence of psychosocial indicators identified during screening and the registered care actions (i.e., registration of relevant care information, additional assessment, or referral to a care provider) undertaken within care pathways following identification of a psychosocial indicator. Data output analyses were restricted to the first registered file per woman.

Findings The platform was used in 39 antenatal care settings (15 hospitals, 14 primary care, 9 social care, and self-employed midwives grouped as one setting) and by 269 users. Uptake increased over time, with hospitals showing consistent use. Of all consented files, 95.1% (n = 4303/4522) underwent psychosocial screening. Among screened files, 80.4% (3461/4303) had at least one identified psychosocial indicator and were therefore eligible for action; of these, 85.2% (n = 2950/3461) had at least one documented action. Based on the first registered file per woman, 96.8% of screened women (n = 4138/4273) had at least one identified psychosocial indicator. The most prevalent indicators were low educational level (46.8%), medication use during pregnancy (37.4%), occupational status (31.5%), and psychological antecedents (28.7%). Depressive symptoms were identified in 19.5% of women, while 15.4% reported financial difficulties.

Conclusion The BIB-Pro platform showed promising uptake in real-life antenatal care settings and generated structured data on psychosocial indicators identified during pregnancy and related care actions. Its integration suggests potential to support antenatal psychosocial care and strengthen the identification and follow-up of psychosocial needs during pregnancy.

Clinical trial number Not applicable.