Using Intervention Mapping for Systematic Development of a Midwife-Delivered Intervention for Prevention and Reduction of Maternal Distress during Pregnancy

The authors describe how Intervention Mapping was used to develop a midwife-led intervention to prevent or reduce maternal distress during pregnancy. An extensive needs assessment showed that both pregnant women and midwives needed to be taught to recognise the vulnerability for developing maternal distress during pregnancy and how to identify maternal distress when it occurs. In addition to these mutual learning needs, women needed to learn to disclose their problems, how to handle maternal distress in their daily lives, and the value of seeking help when necessary. Midwives needed to prepare themselves to provide (collaborative) care for maternal distress. Screening and psycho-education were pathways to support self-disclosure, self-management, mobilizing support and treatment of maternal distress. Theory-based methods - such as tailoring, communicative support, individualization, advance organisers, cultural similarity, consciousness raising, elaboration, and cue altering - were built into a web-based tailored program for women. Information processing, intergroup dialogue training, verbal persuasion, providing cues, facilitation of means, and structural organization were the theory-based methods that were built into a training program and a toolbox for the midwife-delivered program. The program was introduced by means of the training given to midwives from 17 midwife-led practices in the Netherlands and proved to be effective. Finally, process and effect evaluations were planned

Vitalum study design: RCT evaluating the efficacy of tailored print communication and telephone motivational interviewing on multiple health behaviors

Abstract Background A large proportion of adults fail to meet public health guidelines for physical activity as well as fruit, vegetable and fat intake. Interventions are needed to improve these health behaviors. Both computer tailoring and motivational interviewing have shown themselves to be promising techniques for health behavior change. The Vitalum project aims to compare the efficacy of these techniques in improving the health behaviors of adults aged 45–70. This paper describes the design of the Vitalum study. Methods/Design Dutch general medical practices (N = 23) were recruited via a registration network or by personal invitation. The participants were then enrolled through these general practices using an invitational letter. They (n = 2,881) received a written baseline questionnaire to assess health behaviors, and potential psychosocial and socio-demographic behavioral determinants. A power analysis indicated that 1,600 participants who were failing to meet the guidelines for physical activity and either fruit or vegetable consumption were needed. Eligible participants were stratified based on hypertension status and randomized into one of four intervention groups: tailored print communication, telephone motivational interviewing, combined, and control. The first two groups either received four letters or took part in four interviews, whereas the combined group received two letters and took part in two interviews in turns at 5, 13, 30 and 43 weeks after returning the baseline questionnaire. Each letter and interview focused on physical activity or nutrition behavior. The participants also took part in a telephone survey 25 weeks after baseline to gather new information for tailoring. There were two follow-up questionnaires, at 47 and 73 weeks after baseline, to measure short- and long-term effects. The control group received a tailored letter after the last posttest. The process, efficacy and cost-effectiveness of the interventions will be examined by means of multilevel mixed regression, cost-effectiveness analyses and process evaluation. Discussion The Vitalum study simultaneously evaluates the efficacy of tailored print communication and telephone motivational interviewing, and their combined use for multiple behaviors and people with different motivational stages and education levels. The results can be used by policymakers to contribute to evidence-based prevention of chronic diseases. Trial Registration Dutch Trial Register NTR1068http://deepblue.lib.umich.edu/bitstream/2027.42/112919/1/12889_2008_Article_1186.pd

Tailored Print Communication and Telephone Motivational Interviewing Are Equally Successful in Improving Multiple Lifestyle Behaviors in a Randomized Controlled Trial

Background: Computer tailoring and motivational interviewing show promise in promoting lifestyle change, despite few head-to-head comparative studies. Purpose: Vitalum is a randomized controlled trial in which the efficacy of these methods was compared in changing physical activity and fruit and vegetable consumption in middle-aged Dutch adults. Methods: Participants (n?=?1,629) were recruited via 23 general practices and randomly received either four tailored print letters, four motivational telephone calls, two of each type of intervention, or no information. The primary outcomes were absolute change in self-reported physical activity and fruit and vegetable consumption. Results: All three intervention groups (i.e., the tailored letters, the motivational calls, and the combined version) were equally and significantly more effective than the control group in increasing physical activity (hours/day), intake of fruit (servings/day), and consumption of vegetables (grams/day) from baseline to the intermediate measurement (week 25), follow-up 1 (week 47) and 2 (week 73). Effect sizes (Cohen's d) ranged from 0.15 to 0.18. Participants rated the interventions positively; interviews were more positively evaluated than letters. Conclusions: Tailored print communication and telephone motivational interviewing or their combination are equally successful in changing multiple behaviors. © 2010 The Author(s)

Come On! Using intervention mapping to help healthy pregnant women achieve healthy weight gain

Objective: Gaining too much or too little weight in pregnancy (according to Institute of Medicine (IOM) guidelines) negatively affects both mother and child, but many women find it difficult to manage their gestational weight gain (GWG). Here we describe the use of the intervention mapping protocol to design ‘Come On!’, an intervention to promote adequate GWG among healthy pregnant women. Design: We used the six steps of intervention mapping: (i) needs assessment; (ii) formulation of change objectives; (iii) selection of theory-based methods and practical strategies; (iv) development of the intervention programme; (v) development of an adoption and implementation plan; and (vi) development of an evaluation plan. A consortium of users and related professionals guided the process of development. Results: As a result of the needs assessment, two goals for the intervention were formulated: (i) helping healthy pregnant women to stay within the IOM guidelines for GWG; and (ii) getting midwives to adequately support the efforts of healthy pregnant women to gain weight within the IOM guidelines. To reach these goals, change objectives and determinants influencing the change objectives were formulated. Theories used were the Transtheoretical Model, Social Cognitive Theory and the Elaboration Likelihood Model. Practical strategies to use the theories were the foundation for the development of ‘Come On!’, a comprehensive programme that included a tailored Internet programme for pregnant women, training for midwives, an information card for midwives, and a scheduled discussion between the midwife and the pregnant woman during pregnancy. The programme was pre-tested and evaluated in an effect study

Factors affecting perceived change in physical activity in pregnancy

Objective reduction of physical activity (PA) during pregnancy is common but undesirable, as it is associated with negative outcomes, including excessive gestational weight gain. Our objective was to explore changes in five types of activity that occurred during pregnancy and the behavioural determinants of the reported changes in PA. Design we performed a secondary analysis of a cross sectional survey that was constructed using the ASE-Model – an approach to identifying the factors that drive behaviour change that focuses on Attitude, Social influence, and self-Efficacy. Participants 455 healthy pregnant women of all gestational ages, receiving prenatal care from midwifery practices in the Netherlands. Findings more than half of our respondents reported a reduction in their PA during pregnancy. The largest reduction occurred in sports and brief rigorous activities, but other types of PA were reduced as well. Reduction of PA was more likely in women who considered themselves as active before pregnancy, women who experienced pregnancy-related barriers, women who were advised to reduce their PA, and multiparous women. Fewer than 5% increased their PA. Motivation to engage in PA was positively associated with enjoying PA. Key conclusions and implications for practice all pregnant women should be informed about the positive effects of staying active and should be encouraged to engage in, or to continue, moderately intensive activities like walking, biking or swimming. Our findings concerning the predictors of PA reduction can be used to develop an evidence-based intervention aimed at encouraging healthy PA during pregnancy

The effect of Wazzup Mama?! An antenatal intervention to prevent or reduce maternal distress in pregnancy

We evaluated the effect of the intervention WazzUp Mama?! on antenatal maternal distress in a non-randomized pre-post study including healthy women in 17 Dutch midwifery practices. The control group (n = 215) received antenatal care-as-usual. The experimental group (n = 218) received the intervention. Data were collected at the first and third trimester of pregnancy. Maternal Distress (MD) was measured with the Edinburgh Depression Scale (EDS), State-Trait Anxiety Inventory (STAI), and Pregnancy-Related Anxiety Questionnaire (PRAQ). We used multivariate repeated measure analysis to examine the across time changes and ANCOVA was used to examine the differences between the two groups. In the control group, mean EDS, STAI, and MD scores significantly increased from first to third trimester of pregnancy, mean PRAQ scores increased, but not significantly, the proportion of scores above cut-off level of EDS, STAI, and PRAQ significantly increased from first to third trimester, and the proportion of MD scores above cut-off level increased, but not significantly. Within the experimental group, the mean STAI, PRAQ, and MD scores significantly decreased from first to third trimester, the EDS mean scores decreased but not significantly, proportions of scores above cut-off level for PRAQ and MD significantly decreased from first to third trimester of pregnancy, the proportions of EDS and STAI scores above cut-off level decreased but not significantly. There was a moderate significant positive effect of WazzUP Mama?! on the MD scores (F(1.43) = 27.05, p < 0.001,d = 0.5). The results provide support for the effectiveness of the intervention WazzUp Mama?

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' behavioural intentions of antenatal management of maternal distress and factors influencing these intentions: An exploratory survey

Objective: to explore midwives' behavioural intentions and the determinants of these intentions with regard to the management of antenatal care of women with maternal distress.Design: an exploratory survey using a questionnaire. Descriptive statistics calculated expanded TPB constructs, demographic information, personal characteristics and work related details. Multiple linear regression analyses were used to examine which factors influence midwives' intention to provide antenatal care of maternal distress.Setting: midwives working in Dutch primary care.Participants: 112 midwives completed the survey.Results: midwives did not report a clear intention to screen for maternal distress (3.4671.8). On average, midwives expressed a positive intention to support women with maternal distress (4.6371.57) and to collaborate with other health-care professionals (4.6371.57). Finding maternal distress an interesting topic was a positive predictor for the intention to screen (B¼0.383; p¼0.005), to support (B¼0.637; p= <0.000) and to collaborate (B=0.455; p=0.002). Other positive predictors for the intention to screen for maternal distress were years of work experience (B=0.035; p=0.028), attitude about the value of screening (B=0.326; p=0.002), and self-efficacy (B=0.248; p=0.004). A positive attitude toward support for women with maternal distress (B=0.523; p=0.017) predicted the intention to support these women. Number of years of work experience (B=0.042; p¼0.017) was a positive predictor for the intention to collaborate with other health-care professionals.Key conclusions: the intention to screen for maternal distress was less evident than the intention to support women with maternal distress and the intention to collaborate with other health-careprofessionals. Important factors predicting the midwife's intention to screen, support and collaborate were finding maternal distress an interesting topic, years of work experience, attitude about the value of screening and support and self-efficacy about screening.Implications for practice: to provide care involving all three components of antenatal management of maternal distress implies efforts to influence the factors that predict the intention to screen, to support women with maternal distress and the intention to collaborate with other health-care professionals

Factors influencing maternal distress among Dutch women with a healthy pregnancy

Background: Maternal distress is a public health concern. Assessment of emotional wellbeing is not integrated in Dutch antenatal care. Midwives need to understand the influencing factors in order toidentify women who are more vulnerable to experience maternal distress.Objective: To examine levels of maternal distress during pregnancy and to determine the relationship between maternal distress and aetiological factors.Methods: A cross-sectional study including 458 Dutch-speaking women with uncomplicated pregnancies during all trimesters of pregnancy. Data were collected with questionnaires between 10 September and 6 November 2012. Demographic characteristics and personal details were obtained. Maternal distress was measured with the Edinburgh Depression Scale (EDS), State-Trait Anxiety Inventory (STAI), and Pregnancy-Related Anxiety Questionnaire (PRAQ). Behaviour was measured with Coping Operations Preference Enquiry-Easy (COPE-Easy). Descriptive statistics and multiple linear regression analysis were used.Results: Just over 20 percent of the women in our sample (21.8%) had a heightened score on one or more of the EDS, STAI or PRAQ. History of psychological problems (B = 1.071; p = .001), having young children(B = 2.998; p = .001), daily stressors (B = 1.304; p = <.001), avoidant coping (B = 1.047, p = <.001), somatisation (B = .484; p = .004), and negative feelings towards the forthcoming birth (B = .636; p = <.001) showed a significant positive relationship with maternal distress. Self-disclosure (B = .863; p = .004) and acceptance of the situation (B = .542; p = .008) showed a significant negative relationship with maternal distress.Conclusion: Maternal distress occurs among women with a healthy pregnancy and is significantly influenced by a variety of factors. Midwives need to recognise the factors that make women morevulnerable to develop and experience maternal distress in order to give adequate advice about how to best cope with this conditio

Responding to maternal distress: from needs assessment to effective intervention

Objectives To perform a needs assessment of maternal distress to plan the development of an intervention for the prevention and reduction of antenatal maternal distress.Methods We searched PubMed, OVID and EBSCO and applied the PRECEDE logic model to select the data. Experts in the field validated the findings.Results We identified 45 studies. Maternal distress was associated with diminished maternal and child’s quality of life. Aetiological factors of maternal distress included past and present circumstances related to obstetric factors and to a woman’s context of living, coping behaviour, and support mechanisms. Lacking knowledge of coping with (maternal) distress was identified as a predisposing factor. Reinforcing factors were relaxation, partner support, counsellingexperiences and positive interaction with the midwife. Enabling factors were the availability of a support network.Conclusions When planning the development of an antenatal intervention for maternal distress, it is advisable to focus on assessment of antenatal emotional wellbeing, the context of the woman’s past and present circumstances, her coping behaviour and her environment. The identified predisposing factors, enabling and reinforcing factors should also be taken into consideration