Predictors associated with low-risk women's pre-labour intention for intrapartum pain relief: a cross-sectional study

Background: Pregnant women have preferences about how they intend to manage labour pain. Unmet intentions can result in negative emotions and/or birth experiences. Objective: To examine the antenatal level of intention for intrapartum pain relief and the factors that might predict this intention. Design: A cross-sectional online survey-based study. Setting and participants: 414 healthy pregnant women in the Netherlands, predominantly receiving antenatal care from the community-based midwife who were recruited via maternity healthcare professionals and social media platforms. Methods: The attitude towards intrapartum pain relief was measured with the Labour Pain Relief Attitude Questionnaire for pregnant women. Personality traits with the HEXACO-60 questionnaire, general psychological health with the Mental Health Inventory-5 and labour and birth anxiety with the Tilburg Pregnancy Distress Scale. Multiple linear regression was performed with the intention for pain relief as the dependant variable. Results: The obstetrician as birth companion (p<.001), the perception that because of the impact of pregnancy on the woman’s body, using pain relief during labour is self-evident (p<.001), feeling convinced that pain relief contributes to self-confidence during labour (p=.023), and fear of the forthcoming birth (p=.003) predicted women were more likely to use pain relief. The midwife as birth companion (p=.047) and considering the partner in requesting pain relief (p=.045) predicted women were less likely to use pain relief. Conclusion: Understanding the reasons predicting women’s intention of pain management during labour, provides insight in low-risk women’s supportive needs prior to labour and are worth paying attention to during the antenatal perio.

The intervening effect of the What Being the Parent of a New Baby is Like-Revised questionnaire on maternal affect

The 'What Being the Parent of a New Baby is Like-Revised' (WPL-R) is an instrument designed to measure adaptation to parenthood. In the process of pilot testing and validating the WPL-R in a postpartum Dutch population, we became aware of the potentially sensitive nature of the measure. Despite the ethics committee waiving the invasive nature of the measure, we conducted a survey to explore its possible effect on women's thoughts and emotions by using the Positive And Negative Affect Schedule (PANAS) to measure changes associated with completion of the WPL-R. Two hundred and fifteen questionnaires were returned. Our findings indicated a change in PANAS scores, implying an intervening effect when using the WPL-R, in research. This raises the question of whether it is acceptable to use a questionnaire with postpartum women without any knowledge of the possible effect it may have, even though the ethics committee has approved the study and considers the measure to be non-invasive

The impact of motherhood on the course of women's psychological wellbeing

BackgroundHaving children or being childless is associated with differences in women's psychological wellbeing during the reproductive age period.MethodsAn individually matched case-control cohort study, measuring psychological wellbeing with the 5-item Mental Health Inventory (MHI-5) was conducted. Repeated measures analysis of variance and chi-square tests were used to measure the across time changes of MHI-5 scores. ANCOVA and Cochran's Q examined the differences between MHI-5 scores of women with children (cases) and of childless women (controls) at three timepoints. Timepoints were determined by the cases’ pre-pregnancy (T1), post-birth (T2), longer-term (T3) moments.ResultsMotherhood status has a significant medium effect on psychological wellbeing [F(1.112) 20.99, p<.001, d.47). Psychological wellbeing of cases declines significantly from T2 to T3 (p<.001) and from T1 to T3 (p<.001), while psychological wellbeing of controls remains the same. Cases have significantly more often MHI-5 scores below the cut-off value at T2 compared to T3 (p.05) and at T1 compared to T3 (p<.001). Controls have significantly more often MHI-5 scores below the cut-off value at T1 compared to T2 (p<.001) and at T1 compared to T3 (p<.001).LimitationsWe depended on an existing data set with few predetermined variables. There was insufficient information about the full context of women’s lives such as (in)voluntary childlessness, life-events affecting happiness, or age of children, affecting a comprehensive representation of possible confounders or mediating factors.ConclusionPsychological wellbeing of mothers declines over time, while childless women’s wellbeing remains stable. Overall, both groups show evidence of good mental health

The ACCOMPLISH study. A cluster randomised trial on the cost-effectiveness of a multicomponent intervention to improve hand hygiene compliance and reduce healthcare associated infections

Contains fulltext : 97410.pdf (publisher's version ) (Open Access)BACKGROUND: Public health authorities have recognized lack of hand hygiene in hospitals as one of the important causes of preventable mortality and morbidity at population level. The implementation strategy ACCOMPLISH (Actively Creating COMPLIance Saving Health) targets both individual and environmental determinants of hand hygiene. This study aims to evaluate the cost-effectiveness of a multicomponent implementation strategy aimed at the reduction of healthcare associated infections in Dutch hospital care, by promotion of hand hygiene. METHODS/DESIGN: The ACCOMPLISH package will be evaluated in a two-arm cluster randomised trial in 16 hospitals in the Netherlands, in one intensive care unit and one surgical ward per hospital. INTERVENTION: A multicomponent package, including e-learning, team training, introduction of electronic alcohol based hand rub dispensers and performance feedback. VARIABLES: The primary outcome measure will be the observed hand hygiene compliance rate, measured at baseline and after 6, 12 and 18 months; as a secondary outcome measure the prevalence of healthcare associated infections will be measured at the same time points. Process indicators of the intervention will be collected pre and post intervention. An ex-post economic evaluation of the ACCOMPLISH package from a healthcare perspective will be performed. STATISTICAL ANALYSIS: Multilevel analysis, using mixed linear modelling techniques will be conducted to assess the effect of the intervention strategy on the overall compliance rate among healthcare workers and on prevalence of healthcare associated infections. Questionnaires on process indicators will be analysed with multivariable linear regression, and will include both behavioural determinants and determinants of innovation. Cost-effectiveness will be assessed by calculating the incremental cost-effectiveness ratio, defined here as the costs for the intervention divided by the difference in prevalence of healthcare associated infections between the intervention and control group. DISCUSSION: This study is the first RCT to investigate the effects of a hand hygiene intervention programme on the number of healthcare associated infections, and the first to investigate the cost-effectiveness of such an intervention. In addition, if the ACCOMPLISH package proves successful in improving hand hygiene compliance and lowering the prevalence of healthcare associated infections, the package could be disseminated at (inter)national level. TRIAL REGISTRATION: NTR2448

Systematic Review of the Content Validity of Patient Reported Outcome Measures of Transition to Parenthood

This review aims to identify self-report instruments examining aspects of transition to parenthood for use in practice and research. After performing a literature search in Embase, Medline, Web of Science, Cochrane, PsycINFO and Google Scholar, the Patient Reported Outcome Measures (PROMs) measuring (aspects of) transition to parenthood during pregnancy or up to 1-year postpartum were identified. Following COSMIN guidelines for systematic reviews on PROMs, the quality of the PROM development and PROM content validity was evaluated. From the 129 included studies, 39 PROMs assessed aspects of transition to parenthood. A total of 32 PROMs were included in the evaluation. The development quality of 30/32 PROMS was mostly rated as inadequate and the quality of 15 content validity studies was mostly rated as doubtful. All PROMs received inadequate or doubtful ratings on content validity. Most of the PROMs measuring aspects of the transition to parenthood didn't include parents' points of view when developing them. Many PROMs are being used for a long time without reassessing relevance, comprehensiveness, and comprehensibility among parents and/or practitioners. It is recommended that researchers and healthcare professionals assess content validity of the PROM before use with the target population

The comparison of the interpersonal action component of woman-centred care reported by healthy pregnant women in different sized practices in the Netherlands: A cross-sectional study

Background: The number of interventions is lower, and the level of satisfaction is higher among women who receive midwife-led primary care from one or two midwives, compared to more midwives. This suggests that midwives in small-sized practices practice more women-centred. This has yet to be explored.Objective: To examine pregnant women’s perceptions, of the interpersonal action component of woman-centred care by primary care midwives, working in different sized practices.Methods: A cross-sectional study using the Client Centred Care Questionnaire (CCCQ), administered during the third trimester of pregnancy among Dutch women receiving midwife-led primary care from midwives organised in small-sized practices (1-2 midwives), medium-sized (3-4 midwives) and large-sized practices (≥5 midwives). A Welch ANOVA with post hoc Bonferroni correction was performed to examine the differences.Results: 553 completed questionnaires were received from 91 small-sized practices/104 women, 98 medium-sized practices/258 women and 65 large-sized practices/191 women. The overall sum scores varied between 57–72 on a minimum/maximum scoring range of 15-75. Women reported significantly higher woman-centred care scores of midwives in small-sized practices (score 70.7) compared with midwives in medium-sized practices (score 63.6) (p<.001) and large-sized practices (score 57.9) (p<.001), showing a large effect (d .88; d 1.56). Women reported statistically significant higher woman-centred care scores of midwives in medium-sized practices compared with large-sized practices (p<.001), showing a medium effect (d .69).Conclusion: There is a significant variance in woman-centred care based on women’s perceptions of woman-midwife interactions in primary care midwifery, with highest scores reported by womenreceiving care from a maximum of two midwives. Although the CCCQ scores of all practices are relatively high, the significant differences in favour of small-sized practices may contribute to moving woman centred care practice from ‘good’ to ‘excellent’ practice

A multimodal regional intervention strategy framed as friendly competition to improve hand hygiene compliance

Objective: To investigate the effects of friendly competition on hand hygiene compliance as part of a multimodal intervention programDesign: Prospective observational study in which the primary outcome was hand hygiene compliance. Differences were analyzed using the Pearson χ2 test. Odds ratios (ORs) with 95% confidence interval were calculated using multilevel logistic regression. Setting: Observations were performed in 9 public hospitals and 1 rehabilitation center in Rotterdam, Netherlands. Participants: From 2014 to 2016, at 5 time points (at 6-month intervals) in 120 hospital wards, 20,286 hand hygiene opportunities were observed among physicians, nurses, and other healthcare workers (HCWs). Intervention: The multimodal, friendly competition intervention consisted of mandatory interventions: monitoring and feedback of hand hygiene compliance and optional interventions (ie, e-learning, kick-off workshop, observer training, and team training). Hand hygiene opportunities, as formulated by the World Health Organization (WHO), were unobtrusively observed at 5 time points by trained observers. Compliance data were presented to the healthcare organizations as a ranking. Results: The overall mean hand hygiene compliance at time point 1 was 42.9% (95% confidence interval [CI], 41.4–44.4), which increased to 51.4% (95% CI, 49.8–53.0) at time point 5 (P<.001). Nurses showed a significant improvement between time points 1 and 5 (P< .001), whereas the compliance of physicians and other HCWs remained unchanged. In the multilevel logistic regressions, time points, type of ward, and type of HCW showed a significant association with compliance. Conclusion: Between the start and the end of the multimodal intervention program in a friendly competition setting, overall hand hygiene compliance increased significantly

A hand hygiene intervention to reduce infections in child daycare: A randomized controlled trial

Copyrigh