Creating an Optimality Index – Netherlands: a validation study

Abstract Background At present, the maternity care system in the Netherlands is being reorganized into an integrated model of care, shifting the focus of midwives to include increasing numbers of births in hospital settings and clients with medium risk profiles. In light of these changes, it is useful for midwives to have a tool which may help them in reflecting upon care practices that promote physiological childbirth practices. The Optimality Index-US is an evidence based tool, designed to measure optimal perinatal care processes and outcomes. It has been validated for use in the United States (OI-US), United Kingdom (OI-UK) and Turkey (OI-TR). The objective of this study was to adapt the OI-US for the Dutch maternity care setting (OI-NL). Methods Translation and back translation were applied to create the OI-NL. A panel of maternity care experts (n = 10) provided input for face validation items in the OI-NL. Assessment of inter-rater reliability and ease of use was also conducted. Following this, the OI-NL was used prospectively to collect data on 266 women who commenced intrapartum care under the responsibility of a midwife. Twice groups were compared, based on parity and on care-setting at birth. Mean scores between these groups, corrected for perinatal background factors were assessed for discriminant validity. Results Face validity was established for OI-NL on the basis of expert input. Discriminant validity was confirmed by conducting multiple regressions analyses for parity (β = 6.21, P = 0.00) and for care-setting (β = 12.1, p = 0.00). Inter-rater reliability was 98%, with one item (Apgar score) sensitive to scoring differences. Conclusion OI-NL is a valid and reliable tool for use in the Dutch maternity care setting. In addition to its value for assessing evidence-based maternity care processes and outcomes, there is potential for use for learning and reflection. Against the backdrop of a changing maternity care system, and due to the specificity of its items OI-NL may be of value as a tool for detecting subtle changes indicative of escalating medicalization of childbirth in the Netherlands.https://deepblue.lib.umich.edu/bitstream/2027.42/143165/1/12884_2018_Article_1735.pd

door

On the improvement of students ’ conceptual understanding in statistics educatio

A simple formula for the calculation of sample size in pilot studies

One of the goals of a pilot study is to identify unforeseen problems, such as ambiguous inclusion or exclusion criteria or misinterpretations of questionnaire items. Although sample size calculation methods for pilot studies have been proposed, none of them are directed at the goal of problem detection. In this article, we present a simple formula to calculate the sample size needed to be able to identify, with a chosen level of confidence, problems that may arise with a given probability. If a problem exists with 5% probability in a potential study participant, the problem will almost certainly be identified (with 95% confidence) in a pilot study including 59 participants.publisher: Elsevier articletitle: A simple formula for the calculation of sample size in pilot studies journaltitle: Journal of Clinical Epidemiology articlelink: http://dx.doi.org/10.1016/j.jclinepi.2015.04.014 content_type: article copyright: Copyright © 2015 Elsevier Inc. All rights reserved.status: publishe

Evaluating the effect of an educational intervention on student midwife self-efficacy for their role as physiological childbirth advocates

Introduction: Midwifery education that strengthens self-efficacy can support student midwives in their role as advocates for a physiological approach to childbirth. Methods: To assess the effect of an educational intervention on self-efficacy, a pre- and post-intervention survey was administered to a control group and an intervention group of third year student midwives. The General Self-Efficacy Scale (GSES) was supplemented with midwifery-related self-efficacy questions related to behaviour in home and hospital settings, the communication of evidence, and ability to challenge practice. Results: Student midwives exposed to midwifery education designed to strengthen self-efficacy demonstrated significantly higher levels of general self-efficacy (p = .001) when contrasted to a control cohort. These students also showed significantly higher levels of self-efficacy in advocating for physiological childbirth (p = .029). There was a non-significant increase in self-efficacy in the hospital setting in the intervention group, a finding that suggests that education may ameliorate the effect of hospital settings on midwifery practice. Discussion: In spite of the small size of the study population, education that focuses on strengthening student midwife self-efficacy shows promise

Dutch Midwives' Behavior and Determinants in Promoting Healthy Gestational Weight Gain, Phase 2: A Quantitative Approach

Unhealthy gestational weight gain (GWG) contributes to long-term obesity in women and their offspring. The aim of this study is to quantify midwives’ behavior in promoting healthy GWG and to identify the most important determinants related to this behavior

Dutch Midwives' Behavior and Determinants in Promoting Healthy Gestational Weight Gain, Phase 1: A Qualitative Approach

A significant contributor to the global threat of obesity is excessive gestational weight gain (GWG). The aim of this article is to explore Dutch primary care midwives’ behaviors in promoting healthy GWG

Impact of maternal height on birthweight classification in singleton births at term: a cohort study in The Netherlands:a cohort study in the Netherlands

Objective: To assess the association between maternal height and birthweight in a healthy population and to study the effect of maternal height on the classification of birthweight as small for gestational age (SGA) and large for gestational age (LGA). Methods: A descriptive, observational retrospective study was conducted in a low risk population in the Netherlands. The study included term singleton healthy nonsmoking pregnant women with normal body mass index (n = 9291). We calculated the impact of maternal height on birthweight using multiple linear regression analyses with adjustment for gestational age, gender, and parity. We calculated the number of newborns classified as SGA and LGA using the cutoff point of the Dutch Birthweight chart, which does not customize for maternal height. Subsequently, we calculated the changes in classification from SGA and LGA to appropriate for gestational age (AGA) in case of customization for maternal height. Results: A significant association was found between maternal height and birthweight; 15.0 g higher birthweight per extra cm maternal height (95% confidence interval 13.8–16.1; p173 cm) women previously LGA were classified as AGA when controlling for maternal height. Conclusions: Maternal height is significantly associated with birthweight. Birthweight charts customized for maternal height change classification in one out of six SGA or LGA newborns at term

Development of the Conversational Health Literacy Assessment Tool for maternity care (CHAT-maternity-care): participatory action research

Abstract Background Limited health literacy in (expectant) parents is associated with adverse health outcomes. Maternity care providers often experience difficulties assessing (expectant) parents’ level of health literacy. The aim was to develop, evaluate, and iteratively adapt a conversational tool that supports maternity care providers in estimating (expectant) parents’ health literacy. Methods In this participatory action research study, we developed a conversational tool for estimating the health literacy of (expectant) parents based on the Conversational Health Literacy Assessment Tool for general care, which in turn was based on the Health Literacy Questionnaire. We used a thorough iterative process including different maternity care providers, (expectant) parents, and a panel of experts. This expert panel comprised representatives from knowledge institutions, professional associations, and care providers with whom midwives and maternity care assistants work closely. Testing, evaluation and adjustment took place in consecutive rounds and was conducted in the Netherlands between 2019 and 2022. Results The conversational tool ‘CHAT-maternity-care’ covers four key domains: (1) supportive relationship with care providers; (2) supportive relationship within parents’ personal network; (3) health information access and comprehension; (4) current health behaviour and health promotion. Each domain contains multiple example questions and example observations. Participants contributed to make the example questions and example observations accessible and usable for daily practice. The CHAT-maternity-care supports maternity care providers in estimating (expectant) parents’ health literacy during routine conversations with them, increased maternity care providers’ awareness of health literacy and helped them to identify where attention is necessary regarding (expectant) parents’ health literacy. Conclusions The CHAT-maternity-care is a promising conversational tool to estimate (expectant) parents’ health literacy. It covers the relevant constructs of health literacy from both the Conversational Health Literacy Assessment Tool and Health Literacy Questionnaire, applied to maternity care. A preliminary evaluation of the use revealed positive feedback. Further testing and evaluation of the CHAT-maternity-care is required with a larger and more diverse population, including more (expectant) parents, to determine the effectiveness, perceived barriers, and perceived facilitators for implementation