Framework for the establishment of a feasible, tailored and effective perinatal education programme

Background: Antenatal education needs to be renewed and adapted to the needs of women. Objectives: to assess women needs, identify factors that influence the desired outcomes, and propose a framework for developing new perinatal education based on the guidance published by the UK Medical Research Council for the development and evaluation of complex interventions in primary care. Methods: For this study: (a) four focus group sessions were held from October to November 2010 in Bizkaia (Spain) with 30 women exploring their needs during pregnancy and postpartum; (b) two literature reviews were conducted on women's needs at these times and theoretical models of healthcare education; and (c) seven discussion and consensus sessions were run with a group of experts composed of midwifes, gynaecologists, paediatricians, and paediatric and postpartum nurses. Results: Various areas for improvement were identified: needs assessment of each woman/family, consideration of pregnancy and childbirth as normal physiological processes, participation of fathers, establishment of social networks, continuity of postpartum care, better access to and training for midwives, and more flexible format and contents for the programme. We propose a woman-focused framework that includes three exploratory interviews during pregnancy, personalized interventions coordinated between professionals, empowerment to choose the type of birth, and postpartum activities. Conclusion: New perinatal education should be on-going and focused on each woman. It is necessary to assess the feasibility of implementing this type of programme, depending on the context, professionals' readiness for change and characteristics of the proposed interventions. Then, its effectiveness and sustainabilityThis study was funded by the Department of Health of the Basque Government (Health Technology Assessment-OSTEBA, Grant no. 2009/10.) and supported by the Health Research Fund (Fondo de Investigaciones Sanitarias, FIS), grant number PI13/02632 from the Institute of Health Carlos III (Spain)

Attitudes toward medicalization in childbirth and their relationship with locus of control and coping in a Spanish population

[EN] The dominant model of childbirth in most Western countries is medicalized childbirth. Women's beliefs about whether childbirth should be a medicalized process to a greater or lesser degree may be related, in addition to contextual factors, to internal factors. The objective of the study is to find out if women's locus of control (LC) and stress coping strategies (CS) are related to having a more favourable or less favourable attitude towards medicalization (ATMC). A cross-sectional study was carried out with the participation of 248 women recruited in primary care centres by their midwives. All the women filled in answers on a mobile phone app with various different measurement instruments: the questionnaire created by Benyamini to evaluate their ATMC; the Spanish version of the Wallston MLC to evaluate their LC; and the Spanish adaptation of the "Revised Prenatal Coping Inventory (NuPCI)" scale for the assessment of their CS. The women presented a favourable attitude towards medicalization, with a mean ATMC score of 3.42. Both the LC and the CS of women during pregnancy are related to this attitude. Specifically, having an internal LC and using preparative CS both lower the probability of presenting a favourable attitude towards medicalization, while the lack of a paid job raises the probability. For each point in internal locus and preparatory coping, the ATMC score decreased by 0.02 and 0.23 points, respectively, while it increased by 0.18 for not having a paid job. The influence of these psychological factors must be taken into account in the development of content and interventions that promote a more natural birth.The grant received by the Institute of Health Carlos III, file number PI20/00899, within the State R&D&I Plan 2017-2020 and co-financed by the ISCII-Sub directorate-General Evaluation and Promotion of Fund Research European Regional Development Fund (FEDER). This study has been co-financed by the Basque Government Department of Health. File n: 2018111087

Necesidades percibidas por las mujeres respecto a su maternidad. Estudio cualitativo para el rediseño de la educación maternal

Objetivo: Explorar las necesidades expresadas por las mujeres a lo largo del proceso de convertirse en madre y sus demandas relacionadas con la educación maternal. Diseño: Estudio cualitativo con grupos focales. Emplazamiento: Área de salud de Bizkaia, Servicio Vasco de Salud/Osakidetza. Participantes: Treinta mujeres seleccionadas de forma consecutiva por matronas de atención primaria de 6 centros de salud diferentes. Métodos: Entre septiembre y noviembre de 2010 se formaron 4 grupos focales estratificados por situación socioeconómica y etapa del proceso (embarazo/puerperio). Para recoger las preocupaciones de las embarazadas, de las puérperas y su opinión sobre la educación maternal se siguió el método de análisis del contenido temático con el apoyo del software ATLAS.ti. Resultados: El foco de preocupación de las mujeres va cambiando con el tiempo. Pasaba de la necesidad de confirmar que «todo va bien» a necesitar más apoyo emocional y confianza para enfrentarse a sus miedos al parto y al cuidado de los hijos. Necesitaban mayor acompañamiento en el puerperio y menos presión con la lactancia materna. En cuanto a la educación maternal, demandaban un programa de educación perinatal en lugar de solo prenatal, más actualizado, con mayor participación de su pareja, más interactivo y flexible.Objectives: To assess women's perceptions of their needs during the process of becoming a mother and identify what they want from maternal education. Design: Qualitative study with focus groups. Setting: Bizkaia health region, Basque Health Service (Osakidetza), Spain. Participants: Thirty one women were recruited consecutively by midwives at six Osakidetza health centres. Methods: Four sessions were held from September to November 2010 in Bizkaia (Spain), the four groups being stratified by socioeconomic status and stage of the process (pregnancy vs. postnatal period). To collate the information related to the various topics discussed, we used manifest content analysis that was facilitated by use of ATLAS.ti software. Results: The focus of the women worries changes over time. In early pregnancy, women's main concern was for "everything to go well". As the pregnancy progressed, they needed more emotional support and wanted to feel confident and be self-reliant to face their fears of the birth and care for their child. They needed greater accompaniment in the puerperium and less pressure concerning breastfeeding. They also wanted an extended programme of perinatal rather than just antenatal education, which was more participatory and flexible and greater participation of their partner. Conclusion: Women have the same social and family networks needs, regardless of cultural differences between Anglo-Saxon and Southern European countries. We recommend an perinatal education to empower women to manage their own health and that of their family and link the health system with other networks of personal and social support for women. (C) 2016 Elsevier Espana, S.L.U. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)

Design and process of the EMA Cohort Study: the value of antenatal education in childbirth and breastfeeding

© 2008 Paz-Pascual et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution Licens

Consensus on priorities in maternal education: results of Delphi and nominal group technique approaches

BackgroundMaternal education is wide-ranging and covers many areas from pregnancy to the immediate postpartum period and childrearing. However, for it to be effective, more resources need to be assigned to key topics. The goal of this study was to identify and prioritize the most important issues in maternal education, so that specific objectives could subsequently be set and learning outcomes evaluated.MethodsWe drew up a comprehensive list of topics addressed in existing maternal education programs, based on a systematic review of information obtained from the Internet and the experience of the research team. The topics were presented to a multidisciplinary panel whose members were asked to rate them from 1 to 9, and consensus of opinion was reached using a two-round Delphi survey, with consensus defined beforehand as 80% agreement among panelists in awarding a score of 7, 8 or 9. The most highly-rated topics were then discussed and again prioritized by a multidisciplinary team of healthcare and non-healthcare experts, using a nominal group technique.ResultsInitially, 650 topics were identified and grouped into 80 categories which were then prioritized by 54 healthcare and non-healthcare experts using a Delphi survey with a study participation rate of around 20%. 63 topics were considered very important, so criteria were restricted and only the 24 highest-scoring selected (95% of agreement on scores >= 7 or 80% of agreement on scores >= 8). Using the nominal group technique, a group of 12 experts identified the following priorities: initiation and establishment of breastfeeding, development of a birth plan, identification of problems and self-care postpartum, nutrition and a healthy lifestyle, options for pain management in labor and birth and characteristics of a normal newborn/looking after a newborn baby.ConclusionThis study, with a Delphi study and the Consensus among Experts: the nominal group technique, has succeeded in identifying priority topics in maternal education. We need to assess women's needs in relation to these topics, design an intervention to respond to these needs and evaluate its effectiveness.This work was supported by the Carlos III Institute of Health (ISCIII) [grant number PI13/02632], under the 2013-2016 Spanish National Plan for Scientific and Technical Research and Innovation and co-financed by the ISCIII Sub-Directorate General for Research Assessment and Promotion and the European Regional Development Fund

Necesidades percibidas por las mujeres respecto a su maternidad. Estudio cualitativo para el rediseño de la educación maternal

Objetivo: Explorar las necesidades expresadas por las mujeres a lo largo del proceso de convertirse en madre y sus demandas relacionadas con la educación maternal. Diseño: Estudio cualitativo con grupos focales. Emplazamiento: Área de salud de Bizkaia, Servicio Vasco de Salud/Osakidetza. Participantes: Treinta mujeres seleccionadas de forma consecutiva por matronas de atención primaria de 6 centros de salud diferentes. Métodos: Entre septiembre y noviembre de 2010 se formaron 4 grupos focales estratificados por situación socioeconómica y etapa del proceso (embarazo/puerperio). Para recoger las preocupaciones de las embarazadas, de las puérperas y su opinión sobre la educación maternal se siguió el método de análisis del contenido temático con el apoyo del software ATLAS.ti. Resultados: El foco de preocupación de las mujeres va cambiando con el tiempo. Pasaba de la necesidad de confirmar que «todo va bien» a necesitar más apoyo emocional y confianza para enfrentarse a sus miedos al parto y al cuidado de los hijos. Necesitaban mayor acompañamiento en el puerperio y menos presión con la lactancia materna. En cuanto a la educación maternal, demandaban un programa de educación perinatal en lugar de solo prenatal, más actualizado, con mayor participación de su pareja, más interactivo y flexible. Conclusión: Las mujeres de nuestro entorno perciben necesidades similares a las de los países anglosajones, independientemente de las diferencias culturales. Parece claro la necesidad de rediseñar un programa de educación perinatal extenso, personalizado, dinámico, que empodere a las mujeres para gestionar su propia salud y la de su famili

Development and evaluation of the psychometric properties of a digital questionnaire for the evaluation of perinatal psychosocial needs

Abstract Background If the purpose of maternal education is for women to take control of their own health and that of their family in the process, it is essential to have a simple instrument that allows them to self-assess, globally, how prepared they are to face future childbirth and maternity. As there is nothing similar in our area, the objective of this study was to design a complete, specific measurement questionnaire, with good metric quality and in digital format, for the assessment of perinatal psychosocial needs. Methods A cross-sectional study was carried out, to evaluate the psychometric properties of a digital measurement questionnaire. The questionnaire was developed in 4 steps following the recommendations of the International Test Commission. The participants were 263 pregnant women who were recruited in primary health care appointments in the Basque Healthcare Service (Osakidetza); they completed the newly created questionnaire and all the test selected as gold standard. Their mean age was 33.55 (SD = 4.73). The analysis of the psychometric characteristics was based on mixed expert judgment procedures (focus group of healthcare professionals, item assessment questionnaire and interviews with users) and quantitative procedures (EFA, CFA, association with the gold standard and classification agreement index, ordinal alpha and McDonald's omega). Results The final version of the questionnaire was made up of 55 items that evaluate 8 aspects related to perinatal psychosocial well-being (anxious-depressive symptoms, pregnancy acceptance, partner support, coping, internal locus of control, childbirth self-efficacy, perception of childbirth as a medicalized event, and fear of childbirth). Various tests were made of the validity and reliability of the scores, providing metric guarantees for their use in our context. Conclusions The use of this complete, quick-to-use tool with good psychometric properties will allow pregnant women to take stock of their situation, assess whether they have the necessary resources in the psychological and social sphere, and work together with midwives and other health professionals in the areas that are lacking

Development and evaluation of the psychometric properties of a digital questionnaire for the self-management of health and well-being in the postpartum period

Abstract Background Despite the fact that the Global Strategy for Women’s, Children’s and Adolescents’ Health (2016–2030) recognises the special importance of care for women during the postpartum period, thus highlighting the need to identify and measure any condition that may affect the welfare of pregnant women in any way, this is one of the most neglected stages in the health system. Given the absence in our area of global, efficient instruments, the objective of this study was to design a complete, specific measurement tool with good metric qualities in digital format for the evaluation of self-reported health and well-being during the puerperium, to conform to what was proposed by the ICHOM. Methods A cross-sectional study was carried out to evaluate the psychometric characteristics of a digital measurement tool. The development of the tool was carried out in 4 steps, following the recommendations of the International Test Commission. It was tested on 280 puerperas attending primary healthcare appointments in the Basque Healthcare System (Osakidetza), and they did the newly created survey, answering all the questions that had been selected as the gold standard. The average age of the women was 34.93 (SD = 4.80). The analysis of the psychometric characteristics was based on mixed procedures of expert judgment (a focus group of healthcare professionals, an item evaluation questionnaire and interviews with users) and quantitative evaluations (EFA, CFA, and correlation with gold standard, ordinal alpha and McDonald’s omega). Results The final version of the tool comprised 99 items that evaluate functional state, incontinence, sexuality, breastfeeding, adaptation to the role of mother and mental health, and all of these questions can be used globally or partially. It was found that the scores were valid and reliable, which gives metric guarantees for using the tool in our area. Conclusions The use of this comprehensive concise tool with good psychometric properties will allow women to take stock of their situation, assess if they have the necessary resources, in psychological and social terms, and work together with midwives and other healthcare professionals on the most deficient areas