Context Current care guidelines recommend that pregnant women receive advice about the important health behaviours which may influence pregnancy outcomes. These behaviours are associated with pregnancy-related and long-term health outcomes for both the mother and infant. Poor pregnancy outcomes can result in increased costs of health care delivery through longer hospital admissions and intensive care admissions. Although provision of behavioural advice to pregnant women is recommended, most educational materials provide limited and inconsistent information. There is a clear need for widespread delivery of evidence-based information and skill-development strategies to influence pregnancy health behaviours. One avenue of information is via the pregnancy health records (PHRs) provided by maternity health services that women carry for the duration of their pregnancy. Objective My research sought to develop, implement, and evaluate a handheld health record for use in pregnancy (the “Pregnancy Pocketbook”) in an urban population of women with a high proportion of disadvantaged women. Study Overview My research comprised two phases, a development phase, and an implementation and evaluation phase. I identified specific behaviours (cigarette smoking, fruit and vegetable intake, and physical activity) requiring intervention and reviewed evidence-based frameworks, behaviour change theories, and guidelines for the presentation of written information to support behaviour change. I developed and refined the Pregnancy Pocketbook through a number of studies. Studies 1, 2, and 3 The Pregnancy Pocketbook was refined through a qualitative evaluation of a PHR enhanced with behaviour change tools (Study 1), focus groups held with women from the target group to investigate PHR preferences (Study 2), and strategy testing of the Pregnancy Pocketbook activities with women from the target group (Study 3). The focus group results combined with those from the qualitative evaluation suggested the Pregnancy Pocketbook should be a women-held, woman-focussed resource providing essential and comprehensive information on recommended pregnancy health behaviours. It should include tools to facilitate appropriate behaviour changes and tools for women to monitor pregnancy progress and record questions and notes to facilitate communication with their health carers. Strategy testing demonstrated that the Pregnancy Pocketbook content, screening questions and activities were well received by a small sample of women, with minor changes made following testing to improve the understanding and usability of the various sections of the Pregnancy Pocketbook. The final intervention (Study 4) The final version of the Pregnancy Pocketbook was a 73-page interactive resource, designed to be used according to the 5As self-management framework (Assess, Advise, Agree, Assist, Arrange), with screening tools, information, goal setting and self-monitoring activities with information for further referral for greater support when required. It was presented in an A5 plastic ring-bound folder, with dividers, labelled ‘Your health goals’, ‘Tracking your health goals’, ‘Your first antenatal visit’, ‘Pregnancy progress’, ‘Birth summary’, ‘Glossary’, and ‘Emergency contacts and general numbers’. The Pocketbook was evaluated using a quasi-experimental two-group design. Women were recruited from two antenatal clinics within the same health service district. Women received the PP during their first antenatal clinic appointment in one clinic (PP:n = 163) and women in the other clinic received usual care (UC: n = 141). Smoking, fruit and vegetable intake, and physical activity were assessed at baseline (service entry), 12-weeks post-service-entry and 24 weeks post-service-entry. Behaviour-specific self-efficacy was also measured during pregnancy. I also assessed the PP implementation process through adherence of the staff and organisation to planned implementation processes. Results At 12-weeks post-service-entry, a significantly greater proportion of women in the Pregnancy Pocketbook (PP) group had stopped smoking (7.6% vs 2.1%), compared with the Usual Care (UC) group, p <0.05. There was a net (non-significant) increase of 5% more women meeting physical activity guidelines (PP: 1.2% increase vs. UC: 3.5% decrease) and a net 20 minute difference in median minutes of physical activity (PP: 10 minute increase vs. UC: 10 minute decrease). Both groups increased their fruit and vegetable intake. Approximately two-thirds of women reported receiving the Pregnancy Pocketbook, many without introduction or explanation. Few women completed sections of the Pregnancy Pocketbook that required health professional assistance, suggesting minimal interaction about the resource between health staff and the women in their care. Conclusion and future recommendations There were low levels of adherence to health behaviour recommendations for pregnancy in this sample. The Pregnancy Pocketbook produced significant effects on smoking cessation, even under limited delivery conditions. A refocus of antenatal care towards primary prevention is required to more consistently provide essential health information and behaviour change tools for improved maternal and infant pregnancy health outcomes. Future studies must include process evaluations and apply the theory of dissemination to enhance uptake of the interventions.
| Identifer | oai:union.ndltd.org:ADTP/254132 |
| Creators | Shelley Wilkinson |
| Source Sets | Australiasian Digital Theses Program |
| Detected Language | English |
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