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Assessing perinatal depression identifying abilities among maternal and child health workers in rural China using smartphone-based virtual patients: a multi-center cross-sectional study.

Hongjuan Wang·Fan Xu·Rongzhi Li·Ting Pan·Zhenzhen Li·James Wiley·Siyuan Tang·Mei Sun
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Abstract

OBJECTIVE: To assess rural maternal and child health (MCH) workers' virtual patients (VPs)-assessed performance in identifying perinatal depression (PND) using smartphone-based VPs, and to identify factors associated with this performance in rural Hunan, China. METHODS: A multicentre cross-sectional study was conducted in Hunan Province, China. A standardized questionnaire collected demographic and work-related characteristics of rural MCH workers. Smartphone-based VPs were used to assess PND identification performance in a simulated clinical scenario. An overall score ≥60 was used as a prespecified operational benchmark across consultation, ancillary assessment, diagnosis, management, and health education domains. Data were analyzed using SPSS 26.0. RESULTS: A total of 375 rural MCH workers participated, yielding an effective response rate of 90.4%. Only 25.9% met the prespecified operational benchmark for VP-assessed PND identification performance. The mean accuracy scores for consultation, ancillary assessment, diagnosis, management, and health education were 94%, 48%, 64%, 58%, and 74%, respectively. Complete consultation accuracy was higher among MCH workers from township health centers than among those from county-level MCH hospitals. MCH workers aged 18-39 years showed higher odds of complete diagnostic accuracy for PND than those aged ≥40 years. CONCLUSIONS: Smartphone-based VP assessment was feasible in rural MCH settings and revealed suboptimal PND identification performance. Mobile VPs may help identify frontline performance gaps and inform targeted training, but further validation against real-world clinical performance, or standardized patient encounters is needed before large-scale implementation. These findings may support targeted capacity-building for rural MCH workers and more equitable perinatal mental health care.

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HumansCross-Sectional StudiesFemaleChinaAdultSmartphoneSurveys and QuestionnairesRural PopulationPregnancyHealth PersonnelDepressionMass ScreeningAdolescentDigital healthMaternal and child health workersPerinatal depressionRural healthSmartphone-based virtual patientsJournal ArticleMulticenter Study

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Hongjuan Wang, Fan Xu, Rongzhi Li, Ting Pan, Zhenzhen Li, James Wiley, Siyuan Tang, Mei Sun. 2026-06-25. Assessing perinatal depression identifying abilities among maternal and child health workers in rural China using smartphone-based virtual patients: a multi-center cross-sectional study.. https://doi.org/10.1016/j.midw.2026.104906

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Adolescent subjectAdult subjectChina subjectCross-Sectional Studies subjectDepression subjectDigital Health subjectFemale subjectHumans subjectJournal Article subjectJournal Article; Multicenter Study resourceMulticenter Study subject

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