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Background: Personal Health Records [PHR, a private, secure, online environment for patients] have been reported to empower patients, to achieve better collaboration between health care professionals and to improve outcome. This process evaluation study explores the feasibility of the introduction of PHR in Dutch maternity care and possibilities for sustainable implementation. Methods: A process evaluation study was carried out alongside the entire period of the effect study. Quantitative and qualitative methods were used and described reach, dose delivered en dose received of the intervention. Results: 88% of the target population was reached, while 4% started a PHR [dose delivered] and 83% [out of 4%] used the PHR as intended [dose received]. It took more time for the professionals to integrate this new intervention into their care process than expected before. Pregnant women did not start a PHR when they favoured an alternative way to communicate with the health care professional or when they felt the PHR lacked additional value. Active involvement of the professional in the patients PHR is explicitly mentioned as desirable by pregnant women. Conclusions: The introduction of a PHR in maternity care is feasible, requiring the following steps: a dialogue between patients and professionals about expectations and wishes, sufficient time for the implementation, using early adopters as part of the implementation and integration of the PHR in standard care.

BackgroundA personal health record (PHR) is an online application through which individuals can access, manage, and share their health information in a private, secure, and confidential environment. Personal health records empower patients, facilitate collaboration among healthcare professionals, and improve health outcomes. Given these anticipated positive effects, we want to implement a PHR, named MyPregn@ncy, in a Dutch maternity care setting and to evaluate its effects in routine care. This paper presents the study protocol.Methods/designThe effects of implementing a PHR in maternity care on patients and professionals will be identified in a stepped-wedge, cluster-randomised, controlled trial. The study will be performed in the region of Nijmegen, a Dutch area with an average of 4,500 births a year and more than 230 healthcare professionals involved in maternity care. Data analyses will describe the effects of MyPregn@ncy on health outcomes in maternity care, quality of care from the patients’ perspectives, and collaboration among healthcare professionals. Additionally, a process evaluation of the implementation of MyPregn@ncy will be performed. Data will be collected using data from the Dutch perinatal registry, questionnaires, interviews, and log data.DiscussionThe study is expected to yield new information about the effects, strengths, possibilities, and challenges to the implementation and usage of a PHR in routine maternal care settings. Results may lead to new insights and improvements in the quality of maternal and perinatal care.Trial registrationNetherlands Trial Register: NTR4063

To improve both the active involvement of pregnant women in their maternal health and multidisciplinary collaboration between maternal care professionals, we introduced a personal health record (PHR) in routine maternity care. We studied the effects of this intervention on the percentage of uncomplicated births, women’s perspectives on quality of care, and the collaboration between health care professionals. We performed a stepped-wedge cluster randomized controlled trial with four clusters and 13 maternity health centers (community-based midwife practices and hospitals) in one collaborative area. In total, 7350 pregnant women and 220 health care professionals participated. Uncomplicated births accounted for 51.8% (95% CI 50.1–53.9%) of total births in the control group and 55.0% (CI 53.5–56.5%) of total births in the intervention group (p = 0.289). Estimated means revealed that the differences detected in the stepped-wedge study were due to time and not the intervention. Women’s perspectives on quality of care and collaboration between health care professionals revealed no relevant differences between the control and intervention groups. The introduction of the PHR resulted in no significant effect on the chosen measures of quality of maternal care. The suggested positive effect in the raw data was a local trend which was less visible in the national database, and thus might be related to subtle changes toward an improved collaborative culture in the study region.