Developing a Complex Intervention to Support Pregnant Women with Mild to Moderate Anxiety: Application of the Medical Research Council Framework

Abstract

<jats:title>Abstract</jats:title> <jats:p><jats:bold>Aim: </jats:bold>To design and develop an intervention to support women with symptoms of mild to moderate anxiety in pregnancy.<jats:bold>Methods: </jats:bold>The development followed the MRC framework for complex interventions, utilising psychological theory, review level evidence and professional and public involvement.<jats:bold> </jats:bold>Two systematic reviews were completed which helped identify potentially beneficial intervention components. The theory underpinning the components was explored to consider the potential benefit for women with mild to moderate anxiety symptoms in pregnancy. Methods of delivering the intervention within maternity services were explored. The intervention comprised: group discussions, one to one support and assisted self-help resources. Midwives were identified as ideally placed to facilitate the intervention supported by midwifery support workers. A bespoke training package was provided by subject experts to prepare the facilitators. <jats:bold>Discussion: </jats:bold>The absence of established interventions and a paucity of evidence based approaches for pregnant women with symptoms of mild to moderate anxiety indicated the need for a rigorous and systematic approach to the intervention design. This approach led to the development of an intervention feasible for implementation in maternity care systems tailored to the needs of pregnant women. The involvement of a multi-professional advisory team and active engagement of service users helped to consider the acceptability of the intervention for women and the feasibility of delivering the intervention in the context of maternity care.<jats:bold>Conclusion:</jats:bold> The MRC Framework provided useful overarching guidance to develop a midwife facilitated intervention for women with symptoms of anxiety in pregnancy. The framework assisted the development of a robust rationale for each intervention component and considered the processes of evaluation and implementation into maternity care systems.</jats:p>

Collective prenatal care facilitated by educational technology: perception of pregnant women

“…Conceiving assistance and collective prenatal care from the perspective of complexity thinking challenges the historical hegemonic tradition in the obstetric field, characterized by prescriptive and hierarchical dynamics, where a subject-object relationship prevailed. In this traditional vertical model, the pregnant woman was not encouraged to be autonomous and make decisions 1,22 . (Re)constructing this model requires that health professionals not only embrace new educational approaches and technologies, but also undergo a reform or evolution of their mindset, resulting in a new professional-user relationship.…”

“…Pregnancy is a unique and intricate process in the life of a woman and her family. Every pregnant woman has a distinct organization that involves physical, emotional, social, economic and cultural aspects 1 . Therefore, the gestational period requires unique and multidimensional perception and assistance on the part of professionals, especially in the context of Primary Health Care (PHC).…”

Qualificação Interprofissional Da Atenção Pré-Natal No Contexto Da Atenção Primária À Saúde

“…O desenvolvimento de medidas para qualificar o pré-natal, internacionalmente aceitas e validadas, limitam-se no número de consultas pré-natais, grupos de gestantes, programas de prevenção de doenças, inclusão do acompanhante ou pessoa próxima desde o pré-natal ao nascimento, ampliação e fortalecimento da atuação dos Enfermeiros Obstétricos, dentre outras (AMEYAW et al, 2021). Essas medidas visam contribuir para a eficácia da atenção através do desenvolvimento de saberes e práticas acolhedoras e interativas às gestantes na rede de serviços de saúde (EVANS et al, 2020;OVE et al, 2021).…”