Background Τhe Baby Buddy Cyprus webapp was co-created with parents and health professionals within a Participatory Action Research framework. While using Baby Buddy in routine consultations can support the educational role of mother–child healthcare providers (HP), antenatal education (AE) may be currently perceived as a formal activity within the physical space of the antenatal class. We aimed to gain an understanding of influences on midwives engaging in an educational role during routine appointments and identify potential interventions using the Behaviour Change Wheel (BCW) framework. Methods This is a formative mixed-methods research study, with a convergent parallel design, guided by the COM-B model and related Theoretical Domains Framework (TDF). Complimentary methods were used to collect information from in-training and registered midwives: focus group (N = 11), questionnaire survey (N = 24) and Nominal Group Technique during workshops (N = 40). Deductive content analysis of qualitative data and quantitative survey analysis shaped the behaviour diagnosis along the 6 COM-B and 14 TDF domains, and informed the selection of relevant intervention functions and related Behaviour Change Techniques from the BCW taxonomy. Results AE is viewed as a core function of the professional role, yet neither supported nor prioritized by current practices. Problematic areas relate to organizational context, such as weak interprofessional collaboration and lack of policy, protocols and resources. In addition, medicalization of birth and related socio-cultural norms, pertaining to users and providers, are sustaining alienation of the midwife and conditions of power dynamics. AE was perceived as a means to enhance the autonomy of the profession but there might be issues with procedural knowledge and the need for skill development was identified. Several intervention functions were identified as promising, however cognitive re-framing through strategic communication and modelling may also be needed both in terms of providing “credible models” for the role itself as well as re-framing AE through the concept of “making every contact count”. Conclusions AE is currently perceived to be a ‘bad fit’ with routine practice. The study identified several barriers to the educational role of midwives, influencing Capacity, Opportunity and Motivation. While digital tools, such as Baby Buddy, can facilitate aspects of the process, a much wider behaviour and system change intervention is needed to enhance midwives’ educational role and professional identity. In addition to proposing a theory-driven research-informed intervention, the process functioned as a participatory learning experience through collective reflection.
Background Internet use in pregnancy is very prevalent. However, there are issues with information quality as well as acceptance by healthcare providers which can add to the frustration. Methods An online anonymous survey, shared via Baby Buddy Cyprus, addressed women who are pregnant or recently gave birth in Cyprus. Adapting previously used questionnaires, the survey covered reasons and patterns of internet use, perceptions of trustworthiness, appraisal means and usefulness in decision-making. Results Among 357 responses so far in this ongoing survey (38% pregnant, 62% new mums, 66% primiparas, 42% C/S, 78% private sector), searching online seems very frequent, even though 70% report coming across wrong or misleading information often. Checking for consistency across sites and/or with information by healthcare provider (HP) is the most common technique for assessing trustworthiness. While the majority discuss information with HP, only half characterize their reception as positive and welcoming. As many as 89% believe that HP should recommend sites, but only 6.5% report their HP made recommendations. The role of the internet in assisting decision-making is rated as moderate (M = 3.0, SD = 1.0 on 5-point scale averaged across 11 items); yet more than half search online to be prepared and have control over decisions. Among reasons cited for using the internet is insufficient time with HP and/or is unclear or unsatisfactory information. While only 11.6% prepare material for the next appointment, 54.5 % use the internet to verify information given by HP or for a second opinion. Conclusions While a prevalent source of information, the flow is problematic as it appears that women are more likely to search online to verify information rather than discuss this information with their providers. Insights about characteristics and attributes of internet use in pregnancy suggest that health services need to engage with, rather than ignore, this reality and offer appropriate guidance. Key messages • Pregnant women in Cyprus search for information online, due to insufficient time or information by healthcare providers, even though they recognize there are issues with quality and expect guidance. • In a landscape of unguided information-seeking, searching for consistency and verification, a shift in current practices is needed whereby healthcare providers and services engage with this reality.
Background Τhe Baby Buddy Cyprus webapp was co-created with parents and health professionals within a Participatory Action Research framework. Baby Buddy can support the educational role of mother-child healthcare providers (HP); however, antenatal education (AE) may be currently perceived as a formal activity within the physical space of the antenatal class. We aimed to gain an understanding of influences on midwives engaging in an educational role during routine appointments and propose, on the basis of the ‘behaviour diagnosis’, a potential intervention using the Behaviour Change Wheel (BCW) framework. Methods This is a formative research study guided by the COM-B model and related Theoretical Domains Framework (TDF). Complimentary methods were used to collect information from in-training and registered midwives: focus group (N = 11), questionnaire survey (N = 24) and Nominal Group Technique during workshops (N = 40). Deductive content analysis of qualitative data and quantitative survey analysis, tapping on 6 COM-B and 14 TDF domains, guided the design of a multicomponent intervention. Results AE is viewed as a core function of the professional role, yet neither supported nor prioritized by current practices. Problematic areas relate to organizational context, such as weak interprofessional collaboration and lack of policy, protocols and resources. In addition, medicalization of birth and related socio-cultural norms, pertaining to users and providers, are sustaining alienation of the midwife and conditions of power dynamics. AE was perceived as a means to enhance the autonomy of the profession but there are might be issues with procedural knowledge and the need for skill development was identified. Several intervention functions were identified as promising, however cognitive re-framing through strategic communication and modelling may also be needed both in terms of providing “credible models” for the role itself as well as re-framing AE through the concept of “making every contact count”. Conclusions AE is currently perceived to be a ‘bad fit’ with routine practice. The study proposed an intervention to enhance midwives’ educational role and professional identity, while embedding Baby Buddy in clinical practice to facilitate the process. In addition to designing a theory-driven research-informed potential intervention, the process functioned as a participatory learning experience through collective reflection.
Background Traditional approaches to antenatal education have been questioned as to their effectiveness. The use of the internet for information-seeking is very prevalent, however sources are of varied quality. We explored the information-seeking behaviour of pregnant women in the context of health literacy skills and informed decision-making. Methods In a mixed-method descriptive study, 12 focus groups with a culturally diverse set of pregnant women and new mothers (N = 62), a non-participant observation study of antenatal education classes and a web-based questionnaire survey were performed (N = 200). The survey explored use and critical appraisal of internet sources of information, perceived role in assisting decision-making, user-provider interaction, alliance and autonomy in decision making. Results Six themes emerged: in a generally “unsupportive system”, pregnant women want to have a “confident voice” but find themselves “self-navigating” in parallel worlds of formal and informal information, using a process of “supplementing and filtering”, sometimes instinctively and selectively, ending up in a state of “doubt and faith” with regards to the trustworthiness of the information and physician dominance in communication, while the “art of communication” is essential to break the cycle. Internet information-searching is very prevalent, even though 60% characterize the information as misleading and 90% would like health professionals to recommend trusted sites. While the majority report discussing this information with their healthcare providers, only 57% characterize the reception as positive. Conclusions Women want to have control over decisions affecting their pregnancy. While the internet is a prevalent information source, they value the communication with their healthcare providers and want direction. Maternity healthcare professionals need to recognize the phenomenon, offer appropriate guidance and support shared decision-making. Key messages “Traditional” antenatal education arrangements are not effective in supporting informed decision-making. In a landscape of prevalent internet use, a shift is needed from current practices of unguided information-searching.
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