Health literate-sensitive shared decision-making in maternity care: needs for support among maternity care professionals in the Netherlands

Abstract

Background Shared decision-making (SDM) in maternity care is challenging when clients have insufficient health literacy (HL) skills. This study gained insight in how professionals apply HL-sensitive SDM in Dutch maternity care and their needs for support therein. Methods Maternity care professionals (n = 30) completed a survey on SDM and the role of HL. Midwives (n = 13) were observed during simulated conversations discussing pain relief options and interviewed afterwards. The client-actors were instructed to portrait specific inadequate HL skills. Observation items focused on adapting communication to HL, and SDM (OPTION-5). Results In the survey, professionals indicated experiencing most challenges when estimating clients’ information comprehension. Observations showed that most midwives created choice awareness and informed clients about options, whereas exploring preferences and actual decision-making together with clients were observed less frequently. Their perceived HL-related obstacles and needs for support related to clients’ information comprehension. In the interviews, midwives reported putting much effort into explaining available options in maternity care, but also that decisions about pain relief are often postponed until the moment of labour. Conclusion Professionals’ self-reported needs focus on clients’ information comprehension. However, observations indicate that it is not the stage of informing, but rather value clarification and actual decision-making that need improvement in HL-sensitive SDM.

Co-creation of a health literate-sensitive training and conversation aid to support shared decision-making in maternity care

“…This study describes the systematic development of an SDM training and tool building on our earlier needs assessment studies among clients and HCPs. [ 15 , 17 ] We combined elements of the Intervention Mapping protocol (IM) [ 18 ] with User-centered design (see Fig. 1 for a schematic overview of the study design).…”

“…Note that the objectives may relate to particular steps in SDM, but need not. Next, HCPs were asked to rank the objectives from ‘most difficult to achieve’ to ‘least difficult to achieve’ by means of a short survey (findings reported elsewhere; [ 15 ].…”

“…Our earlier needs assessment study among clients in Dutch maternity care showed that those with low functional HL levels and primigravidas mainly perceived difficulties in finding reliable information, understanding probabilistic information, constructing preferences based on benefit/harm information, and preparing for consultations. [ 14 ] Our needs assessment study among maternity care professionals showed that they experienced difficulties in supporting low HL clients, for example with regard to estimating whether the client understands information in general and with low HL clients specifically [ 15 ]. Other studies have also shown increased chances for misunderstanding between HCPs and patients among HCPs who in general lack recommended skills to communicate with low HL patients.…”