Walk With Me for Perinatal Grief

Primary outcomes

1. Traumatic Stress - Intrusion Subscale

   Time frame: Baseline (immediately following loss), 4 weeks and 8 weeks post loss

   Impact of Event Scale-Revised (IES-R) includes 22 items on the past 7 days that represent symptoms of distress self-rated on a five-point scale: 0 indicates that the symptom occurs "not at all"; 1, "a little bit"; 2, "moderately"; 3, "quite a bit"; and 4, "extremely." Participants will be instructed to relate the IES-R items specifically to the loss of their child. Three scale scores are computed including intrusions (8 items), avoidance (8 items) and hyperarousal (6 items). Each subscale ranges from 0 to 4 with higher scores indicating greater levels of distress/trauma.

2. Traumatic Stress - Avoidance Subscale

   Time frame: Baseline (immediately following loss), 4 weeks and 8 weeks post loss

   Impact of Event Scale-Revised includes 22 items on the past 7 days that represent symptoms of distress self-rated on a five-point scale: 0 indicates that the symptom occurs "not at all"; 1, "a little bit"; 2, "moderately"; 3, "quite a bit"; and 4, "extremely." Participants will be instructed to relate the IES-R items specifically to the loss of their child. Three scale scores are computed including intrusions (8 items), avoidance (8 items) and hyperarousal (6 items). Each subscale ranges from 0 to 4 with higher scores indicating greater levels of distress/trauma.

3. Traumatic Stress - Hyperarousal Subscale

   Time frame: Baseline (immediately following loss), 4 weeks and 8 weeks post loss

   Impact of Event Scale-Revised includes 22 items on the past 7 days that represent symptoms of distress self-rated on a five-point scale: 0 indicates that the symptom occurs "not at all"; 1, "a little bit"; 2, "moderately"; 3, "quite a bit"; and 4, "extremely." Participants will be instructed to relate the IES-R items specifically to the loss of their child. Three scale scores are computed including intrusions (8 items), avoidance (8 items) and hyperarousal (6 items). Each subscale ranges from 0 to 4 with higher scores indicating greater levels of distress/trauma.

4. Grief Intensity - Reality Subscale

   Time frame: Baseline (immediately following loss), 4 weeks and 8 weeks post loss

   The Perinatal Grief Intensity Scale is 12 items that asks about an individuals' experiences with perinatal loss. Items are on a four-point scale from strongly disagree (1) to strongly agree (4). Three mean scale scores are computed including reality (5 items), congruence (4 items), and ability to confront others (2 items). Scores can range from 1 to 4 and higher scores indicate greater levels of grief intensity.

5. Grief Intensity - Congruence Subscale

   Time frame: Baseline (immediately following loss), 4 weeks and 8 weeks post loss

   The Perinatal Grief Intensity Scale is 12 items that asks about an individuals' experiences with perinatal loss. Items are on a four-point scale from strongly disagree (1) to strongly agree (4). Three mean scale scores are computed including reality (5 items), congruence (4 items), and ability to confront others (2 items). Scores can range from 1 to 4 and higher scores indicate greater levels of grief intensity.

6. Grief Intensity - Ability to Confront Others Subscale

   Time frame: Baseline (immediately following loss), 4 weeks and 8 weeks post loss

   The Perinatal Grief Intensity Scale is 12 items that asks about an individuals' experiences with perinatal loss. Items are on a four-point scale from strongly disagree (1) to strongly agree (4). Three mean scale scores are computed including reality (5 items), congruence (4 items), and ability to confront others (2 items). Scores can range from 1 to 4 and higher scores indicate greater levels of grief intensity.

7. Grief Management Self-efficacy

   Time frame: Baseline (immediately following loss), 4 weeks and 8 weeks post loss

   Three items that rate the bereaved parents' confidence in their ability to cope with grief, use knowledge of mindfulness skills to cope, and engage in positive behaviors to help coping. Scores are on a six-point scale (1 to 6) with a mean total score that ranges from 1 to 6. Higher scores indicate greater self-efficacy.

8. Negative Attitudes on Personal Grief

   Time frame: Baseline (immediately following loss), 4 weeks and 8 weeks post loss

   6 items of experiences of care at the time of loss and follow-up appointments after loss. Responses on a 4-point scale from 1 (strongly disagree) to 4 (strongly agree) to indicate level of agreement. A means score was computed and could range from 1 to 4. Higher scores indicate more negative experiences.

9. Difficulties in Emotional Regulation - Nonacceptance of Emotional Response Subscale

   Time frame: Baseline (immediately following loss), 4 weeks and 8 weeks post loss

   11 items from the Difficulties in Emotional Regulation Scale (DERS) were assessed using a response option that ranged from 1 (almost never) to 5 (almost always). Two mean scale scores were computed including nonacceptance of emotional response (6 items) and lack of emotional awareness (5 items). Scale score could range from 1 to 5 with higher scores indicating greater difficulty regulating emotions.

10. Difficulties in Emotional Regulation - Lack of Emotional Response Subscale

    Time frame: Baseline (immediately following loss), 4 weeks and 8 weeks post loss

    11 items from the Difficulties in Emotional Regulation Scale (DERS) were assessed using a response option that ranged from 1 (almost never) to 5 (almost always). Two mean scale scores were computed including nonacceptance of emotional response (6 items) and lack of emotional awareness (5 items). Scale score could range from 1 to 5 with higher scores indicating greater difficulty regulating emotions.

11. Usability

    Time frame: Post-Treatment (8 weeks post loss)

    The System Usability Scale is commonly used 10-item scale that measures subjective perceptions of usability on a 5-point Likert-scale. The participant's scores for each question are converted to a new number, added together and then multiplied by 2.5 to convert the original scores of 0-40 to 0-100. Higher scores indicate the technology is more usable.

12. Acceptability

    Time frame: Post-Treatment (8 weeks post loss)

    Developed as part of the current study, 7 items were designed to measure the degree, on a 5-point Likert-type scale (1 = strongly or somewhat disagree, 5 = strongly or somewhat agree) to which parents found the program helpful, acceptable, and suited to their needs. A mean score was computed across all items and could range from 1 to 5. Higher scores indicate greater acceptability.

13. Program Use - Days Using the Program

    Time frame: Access to the program through through the study completion which was on average 2-months.

    Program metrics on the backend of the program were used to track the total number of days the program was used.

14. Program Use - Modules Completed

    Time frame: Access to the program through through the study completion which was on average 2-months.

    Program metrics on the backend of the program were used to track the the total number of modules completed out of the 6 modules.