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Siddhpuria S, Breau G, Lackie ME, Lavery BM, Ryan D, Shulman B, Kennedy AL, Brotto LA. Women’s Preferences and Design Recommendations for a Postpartum Depression Psychoeducation Intervention: A User Involvement Study (Preprint). JMIR Form Res 2021; 6:e33411. [PMID: 35737435 PMCID: PMC9264129 DOI: 10.2196/33411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 04/24/2022] [Accepted: 04/30/2022] [Indexed: 11/13/2022] Open
Abstract
Background Objective Methods Results Conclusions
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Affiliation(s)
- Shailee Siddhpuria
- Department of Undergraduate Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Genevieve Breau
- School of Human Sciences, University of Greenwich, London, United Kingdom
| | - Madison E Lackie
- Department of Undergraduate Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Brynn M Lavery
- Department of Obstetrics & Gynaecology, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Deirdre Ryan
- Reproductive Mental Health Program, British Columbia Women's Hospital and Health Centre, Vancouver, BC, Canada
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Barbara Shulman
- Reproductive Mental Health Program, British Columbia Women's Hospital and Health Centre, Vancouver, BC, Canada
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Andrea L Kennedy
- Reproductive Mental Health Program, British Columbia Women's Hospital and Health Centre, Vancouver, BC, Canada
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Lori A Brotto
- Department of Obstetrics & Gynaecology, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- Women's Health Research Institute, British Columbia Women's Hospital and Health Centre, Vancouver, BC, Canada
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102
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Ackerman M, Greenwald E, Noulas P, Ahn C. Patient Satisfaction with and Use of Telemental Health Services in the Perinatal Period: a Survey Study. Psychiatr Q 2021; 92:925-933. [PMID: 33389477 PMCID: PMC7778562 DOI: 10.1007/s11126-020-09874-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/06/2020] [Indexed: 11/30/2022]
Abstract
We aimed to assess patients' utilization of and satisfaction with telemental health (TMH) in the perinatal period. We hypothesized that satisfaction with TMH would be at least equal to, if not greater than, with in-person appointments. We conducted a cross-sectional survey between March 2018-June 2019 to evaluate patient satisfaction with and use of TMH services in the perinatal period. Participants used TMH services across the second and third trimester of pregnancy and the first year post-partum. Nearly half of the patients (8/19, 42%) used TMH to see their provider within the first two weeks post-partum. Participants were most commonly in treatment for anxiety (14/19, 74%) and/or depression (9/19, 47%). Most participants agreed or strongly agreed (13/19, 69%) that TMH improved their access to healthcare and that they could see the clinician as well as if they met in person (14/19, 74%). TMH was a highly accepted and appreciated method of mental health care delivery for perinatal women when offered as an alternative to in-person or telephone sessions.
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Affiliation(s)
- Marra Ackerman
- Department of Psychiatry, NYU Grossman School of Medicine, New York, NY, USA.
| | - Elizabeth Greenwald
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Paraskevi Noulas
- Department of Psychiatry, NYU Grossman School of Medicine, New York, NY, USA
| | - Christina Ahn
- Department of Psychiatry, NYU Grossman School of Medicine, New York, NY, USA
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103
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Quinn LM, Olajide O, Green M, Sayed H, Ansar H. Patient and Professional Experiences With Virtual Antenatal Clinics During the COVID-19 Pandemic in a UK Tertiary Obstetric Hospital: Questionnaire Study. J Med Internet Res 2021; 23:e25549. [PMID: 34254940 PMCID: PMC8409501 DOI: 10.2196/25549] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 01/31/2021] [Accepted: 04/14/2021] [Indexed: 01/25/2023] Open
Abstract
Background The COVID-19 pandemic required rapid implementation of virtual antenatal care to keep pregnant women safe. This transition from face-to-face usual care had to be embraced by patients and professionals alike. Objective We evaluated patients’ and professionals’ experiences with virtual antenatal clinic appointments during the COVID-19 pandemic to determine satisfaction and inquire into the safety and quality of care received. Methods A total of 148 women who attended a virtual antenatal clinic appointment at our UK tertiary obstetric care center over a 2-week period provided feedback (n=92, 62% response rate). A further 37 health care professionals (HCPs) delivering care in the virtual antenatal clinics participated in another questionnaire study (37/45, 82% response rate). Results We showed that women were highly satisfied with the virtual clinics, with 86% (127/148) rating their experience as good or very good, and this was not associated with any statistically significant differences in age (P=.23), ethnicity (P=.95), number of previous births (P=.65), or pregnancy losses (P=.94). Even though 56% (83/148) preferred face-to-face appointments, 44% (65/148) either expressed no preference or preferred virtual, and these preferences were not associated with significant differences in patient demographics. For HCPs, 67% (18/27) rated their experience of virtual clinics as good or very good, 78% (21/27) described their experience as the same or better than face-to-face clinics, 15% (4/27) preferred virtual clinics, and 44% (12/27) had no preference. Importantly, 67% (18/27) found it easy or very easy to adapt to virtual clinics. Over 90% of HCPs agreed virtual clinics should be implemented long-term. Conclusions Our study demonstrates high satisfaction with telephone antenatal clinics during the pandemic, which supports the transition toward widespread digitalization of antenatal care suited to 21st-century patients and professionals.
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Affiliation(s)
| | - Oluwafumbi Olajide
- Department of Obstetrics, University Hospitals of Leicester, Leicester, United Kingdom
| | - Marsha Green
- Department of Obstetrics, University Hospitals of Leicester, Leicester, United Kingdom
| | - Hazem Sayed
- Department of Obstetrics, University Hospitals of Leicester, Leicester, United Kingdom
| | - Humera Ansar
- Department of Obstetrics, University Hospitals of Leicester, Leicester, United Kingdom
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104
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Alipour J, Hayavi-Haghighi MH. Opportunities and Challenges of Telehealth in Disease Management during COVID-19 Pandemic: A Scoping Review. Appl Clin Inform 2021; 12:864-876. [PMID: 34528234 PMCID: PMC8443403 DOI: 10.1055/s-0041-1735181] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 07/15/2021] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE The novel coronavirus disease 2019 (COVID-19) pandemic is an unexpected universal problem that has changed health care access across the world. Telehealth is an effective solution for health care delivery during disasters and public health emergencies. This study was conducted to summarize the opportunities and challenges of using telehealth in health care delivery during the COVID-19 pandemic. METHODS A structured search was performed in the Web of Science, PubMed, Science Direct, and Scopus databases, as well as the Google Scholar search engine, for studies published until November 4, 2020. The reviewers analyzed 112 studies and identified opportunities and challenges. This review followed the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) protocols. Quality appraisal was done according to the Mixed Methods Appraisal Tool (MMAT) version 2018. Thematic analysis was applied for data analysis. RESULTS A total of 112 unique opportunities of telehealth application during the pandemic were categorized into 4 key themes, such as (1) clinical, (2) organizational, (3) technical, and (4) social, which were further divided into 11 initial themes and 26 unique concepts. Furthermore, 106 unique challenges were categorized into 6 key themes, such as (1) legal, (2) clinical, (3) organizational, (40 technical, (5) socioeconomic, and (6) data quality, which were divided into 16 initial themes and 37 unique concepts altogether. The clinical opportunities and legal challenges were the most frequent opportunities and challenges, respectively. CONCLUSION The COVID-19 pandemic significantly accelerated the use of telehealth. This study could offer useful information to policymakers about the opportunities and challenges of implementing telehealth for providing accessible, safe, and efficient health care delivery to the patient population during and after COVID-19. Furthermore, it can assist policymakers to make informed decisions on implementing telehealth in response to the COVID-19 pandemic by addressing the obstacles ahead.
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Affiliation(s)
- Jahanpour Alipour
- Health Information Management, Health Information Technology Department, Health Promotion Research Center, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Mohammad Hosein Hayavi-Haghighi
- Department of Health Information Technology, Faculty of Para-Medicine, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
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105
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Accuracy, Clinical Utility, and Usability of a Wireless Self-Guided Fetal Heart Rate Monitor. Obstet Gynecol 2021; 137:673-681. [PMID: 33706351 PMCID: PMC7984751 DOI: 10.1097/aog.0000000000004322] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 01/07/2021] [Indexed: 11/28/2022]
Abstract
Evaluation of a wireless fetal heart rate monitor demonstrates high agreement with heart rate, as assessed by cardiotocography, and is feasible for use at home. To evaluate the accuracy, clinical utility, and usability of a wireless fetal and maternal heartbeat monitor to monitor fetal heart rate (FHR).
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106
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Sikka V, Somma SD, Galwankar SC, Sinha S, Garg N, Talwalkar N, Garg S, Mahajan P, Chauhan V, Moreno-Walton L, Dubhashi S, Dutta V, Saddikuti V, B. Nanayakkara PW, Grover J, Paranjape K, Singh S, Sharma P, Bhoi S, Sinha T, Stawicki SP, Garg M, Sardesai I. The World Health Organization Collaborating Center for Emergency and Trauma (WHO-CCET) in South East Asia, The World Academic Council of Emergency Medicine (WACEM), and The American College of Academic International Medicine (ACAIM) 2021 Framework for using Telemedicine Technology at Healthcare Institutions. J Emerg Trauma Shock 2021; 14:173-179. [PMID: 34759635 PMCID: PMC8527056 DOI: 10.4103/jets.jets_105_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 07/31/2021] [Indexed: 02/07/2023] Open
Abstract
The coronavirus disease 2019 crisis has forced the world to integrate telemedicine into health delivery systems in an unprecedented way. To deliver essential care, lawmakers, physicians, patients, payers, and health systems have all adopted telemedicine and redesigned delivery processes with accelerated speed and coordination in a fragmented way without a long-term vision or uniformed standards. There is an opportunity to learn from the experiences gained by this pandemic to help shape a better health-care system that standardizes telemedicine to optimize the overall efficiency of remote health-care delivery. This collaboration focuses on four pillars of telemedicine that will serve as a framework to enable a uniformed, standardized process that allows for remote data capture and quality, aiming to improve ongoing management outside the hospital. In this collaboration, we recommend learning from this experience by proposing a telemedicine framework built on the following four pillars-patient safety and confidentiality; metrics, analytics, and reform; recording of audio-visual data as a health record; and reimbursement and accountability.
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Affiliation(s)
- Veronica Sikka
- Clinical Contact Center, VA Sunshine Healthcare Network 8, St. Petersburg, Florida, USA
- Address for correspondence: Dr. Veronica Sikka, 140 Fountain Parkway, Suite 600, St. Petersburg, Florida 33716, USA. E-mail:
| | - Salvatore Di Somma
- Department of Medical-Surgical Sciences and Translational Medicine, University of Rome “Sapienza”, Rome, Italy
| | - Sagar C. Galwankar
- Department of Emergency Medicine, Sarasota Memorial Hospital, Florida State University, Sarasota, Florida, USA
| | - Sagar Sinha
- Department of Emergency Medicine and Critical Care, MGM Medical College and Hospital, MGMIHS, Mumbai, India
| | - Nidhi Garg
- Director of Emergency Medicine Research, South Shore University Hospital/Northwell Health; Donald and Barbara Zucker School of Medicine at Hofstra/ Northwell, Bay Shore, New York, USA
| | - Neilesh Talwalkar
- Bombay Hospital and Medical Research Center, Breach Candy Hospital, Mumbai, India
| | - Sona Garg
- Chief Medical Officer,S Holistic Family Medicine, US
| | - Prashant Mahajan
- Department of Emergency Medicine, CS Mott Children's Hospital of Michigan, Ann Arbor, Michigan, USA
| | - Vivek Chauhan
- Department of Medicine, IGMC, Shimla, Himachal Pradesh, India
| | - Lisa Moreno-Walton
- Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
| | - Siddharth Dubhashi
- Department of Surgery, All India Institute of Medical Sciences, Nagpur, Maharashtra, India
| | - Vibha Dutta
- Department of Director and CEO, All India Institute of Medical Sciences, Nagpur, Maharashtra, India
| | | | - Prabath W. B. Nanayakkara
- Location VU University Medical Center, General Internal Medicine, Acute Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC, Amsterdam, The Netherlands
| | - Joydeep Grover
- Department of Emergency Medicine, Southmead Hospital, Bristol, England, United Kingdom
| | - Ketan Paranjape
- Location VU University Medical Center, General Internal Medicine, Acute Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC, Amsterdam, The Netherlands
| | - Sarman Singh
- Director, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Pushpa Sharma
- Department of Anaesthesiology, Uniformed Services University of Health Sciences, Bethesda, Maryland, USA
| | - Sanjeev Bhoi
- Department of Emergency Medicine, WHO Collaborating Center for Emergency and Trauma, AIIMS, New Delhi, India
| | - Tejprakash Sinha
- Department of Emergency Medicine, JPN Apex Trauma Center, WHO Collaborating Center for Emergency and Trauma AIIMS, New Delhi, India
| | - Stanislaw P. Stawicki
- Department of Research an Innovation, St. Luke's University Health Network, Bethlehem, Pennsylvania, USA
| | - Manish Garg
- Departments of Emergency Medicine, New York Presbyterian, Weill Cornell Medicine and Columbia University Vagelos College of Physicians and Surgeons, New York, USA
| | - Indrani Sardesai
- Department of Emergency Medicine, Queen Elizabeth Hospital, Gateshead, England, United Kingdom
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107
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Barbosa W, Zhou K, Waddell E, Myers T, Dorsey ER. Improving Access to Care: Telemedicine Across Medical Domains. Annu Rev Public Health 2021; 42:463-481. [PMID: 33798406 DOI: 10.1146/annurev-publhealth-090519-093711] [Citation(s) in RCA: 76] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Over the past 20 years, the use of telemedicine has increased exponentially. Its fundamental aim is to improve access to care. In this review, we assess the extent to which telemedicine has fulfilled this promise across medical domains. Additionally, we assess whether telemedicine has improved related health outcomes. Finally, we determine who has benefited from this novel form of health care delivery. A review of the literature indicates that (a) telemedicine has improved access to care for a wide range of clinical conditions ranging from stroke to pregnancy; (b) telemedicine in select circumstances has demonstrated improved health outcomes; and (c) telemedicine has addressed geographical, but less so social, barriers to care. For telemedicine to fulfill its promise, additional evidence needs to be gathered on health outcomes and cost savings, the digital divide needs to be bridged, and policy changes that support telemedicine reimbursement need to be enacted.
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Affiliation(s)
- William Barbosa
- Department of Neurology, University of Rochester Medical Center, Rochester, New York 14642, USA;
| | - Kina Zhou
- School of Medicine and Dentistry, University of Rochester, Rochester, New York 14642, USA
| | - Emma Waddell
- Center for Health + Technology, University of Rochester Medical Center, Rochester, New York 14642, USA
| | - Taylor Myers
- Center for Health + Technology, University of Rochester Medical Center, Rochester, New York 14642, USA
| | - E Ray Dorsey
- Department of Neurology, University of Rochester Medical Center, Rochester, New York 14642, USA; .,Center for Health + Technology, University of Rochester Medical Center, Rochester, New York 14642, USA
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108
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van Manen ELM, Hollander M, Feijen-de Jong E, de Jonge A, Verhoeven C, Gitsels J. Experiences of Dutch maternity care professionals during the first wave of COVID-19 in a community based maternity care system. PLoS One 2021; 16:e0252735. [PMID: 34138877 PMCID: PMC8211230 DOI: 10.1371/journal.pone.0252735] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 05/21/2021] [Indexed: 11/19/2022] Open
Abstract
Background and objective During the COVID-19 pandemic the organization of maternity care changed drastically; this study into the experiences of maternity care professionals with these changes provides suggestions for the organization of care during and after pandemics. Design An online survey among Dutch midwives, obstetricians and obstetric residents. Multinomial logistic regression analyses were used to investigate associations between the respondents’ characteristics and answers. Results Reported advantages of the changes were fewer prenatal and postpartum consultations (50.1%). The necessity and safety of medical interventions and ultrasounds were considered more critically (75.9%); 14.8% of community midwives stated they referred fewer women to the hospital for decreased fetal movements, whereas 64.2% of the respondents working in hospital-based care experienced fewer consultations for this indication. Respondents felt that women had more confidence in giving birth at home (57.5%). Homebirths seemed to have increased according to 38.5% of the community midwives and 65.3% of the respondents working in hospital-based care. Respondents appreciated the shift to more digital consultations rather than face-to-face consultations. Mentioned disadvantages were that women had appointments alone, (71.1%) and that the community midwife was not allowed to join a woman to obstetric-led care during labour and subsequently stay with her (56.8%). Fewer postpartum visits by family and friends led to more tranquility (59.8%). Overall, however, 48.0% of the respondents felt that the safety of maternity care was compromised due to policy changes. Conclusions Maternity care professionals were positive about the decrease in routine care and the increased confidence of women in home birth, but also felt that safety in maternity care was sometimes compromised. According to the respondents in a future crisis situation it should be possible for community midwives to continue to deliver a personal handover after the referral of women to the hospital, and to stay with them.
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Affiliation(s)
- Eline L. M. van Manen
- Department of Obstetrics, Amalia Children’s Hospital, Radboud University Medical Center, Nijmegen, The Netherlands
- * E-mail:
| | - Martine Hollander
- Department of Obstetrics, Amalia Children’s Hospital, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Esther Feijen-de Jong
- Midwifery Science, AVAG (Academy Midwifery Amsterdam and Groningen), Amsterdam Public Health Research Institute, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of General Practice & Elderly Medicine, AVAG (Academy Midwifery Amsterdam and Groningen), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Ank de Jonge
- Midwifery Science, AVAG (Academy Midwifery Amsterdam and Groningen), Amsterdam Public Health Research Institute, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Corine Verhoeven
- Midwifery Science, AVAG (Academy Midwifery Amsterdam and Groningen), Amsterdam Public Health Research Institute, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Obstetrics and Gynecology, Maxima Medical Centre, Veldhoven, The Netherlands
- Division of Midwifery, School of Health Sciences, University of Nottingham, Nottingham, United Kingdom
| | - Janneke Gitsels
- Midwifery Science, AVAG (Academy Midwifery Amsterdam and Groningen), Amsterdam Public Health Research Institute, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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109
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Martin-Key NA, Spadaro B, Schei TS, Bahn S. Proof-of-Concept Support for the Development and Implementation of a Digital Assessment for Perinatal Mental Health: Mixed Methods Study. J Med Internet Res 2021; 23:e27132. [PMID: 34033582 PMCID: PMC8183599 DOI: 10.2196/27132] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 03/11/2021] [Accepted: 04/16/2021] [Indexed: 12/28/2022] Open
Abstract
Background Perinatal mental health symptoms commonly remain underdiagnosed and undertreated in maternity care settings in the United Kingdom, with outbreaks of disease, like the COVID-19 pandemic, further disrupting access to adequate mental health support. Digital technologies may offer an innovative way to support the mental health needs of women and their families throughout the perinatal period, as well as assist midwives in the recognition of perinatal mental health concerns. However, little is known about the acceptability and perceived benefits and barriers to using such technologies. Objective The aim of this study was to conduct a mixed methods evaluation of the current state of perinatal mental health care provision in the United Kingdom, as well as users’ (women and partners) and midwives’ interest in using a digital mental health assessment throughout the perinatal period. Methods Women, partners, and midwives were recruited to participate in the study, which entailed completing an online survey. Quantitative data were explored using descriptive statistics. Open-ended response data were first investigated using thematic analysis. Resultant themes were then mapped onto the components of the Capability, Opportunity, and Motivation Behavior model and summarized using descriptive statistics. Results A total of 829 women, 103 partners, and 90 midwives participated in the study. The provision of adequate perinatal mental health care support was limited, with experiences varying significantly across respondents. There was a strong interest in using a digital mental health assessment to screen, diagnose, and triage perinatal mental health concerns, particularly among women and midwives. The majority of respondents (n=781, 76.42%) expressed that they would feel comfortable or very comfortable using or recommending a digital mental health assessment. The majority of women and partners showed a preference for in-person consultations (n=417, 44.74%), followed by a blended care approach (ie, both in-person and online consultations) (n=362, 38.84%), with fewer participants preferring online-only consultations (n=120, 12.88%). Identified benefits and barriers mainly related to physical opportunity (eg, accessibility), psychological capability (eg, cognitive skills), and automatic motivation (eg, emotions). Conclusions This study provides proof-of-concept support for the development and implementation of a digital mental health assessment to inform clinical decision making in the assessment of perinatal mental health concerns in the United Kingdom.
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Affiliation(s)
- Nayra Anna Martin-Key
- Cambridge Centre for Neuropsychiatric Research, Department of Chemical Engineering and Biotechnology, University of Cambridge, Cambridge, United Kingdom
| | - Benedetta Spadaro
- Cambridge Centre for Neuropsychiatric Research, Department of Chemical Engineering and Biotechnology, University of Cambridge, Cambridge, United Kingdom
| | | | - Sabine Bahn
- Cambridge Centre for Neuropsychiatric Research, Department of Chemical Engineering and Biotechnology, University of Cambridge, Cambridge, United Kingdom
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110
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Dixon-Shambley K, Gabbe PT. Using Telehealth Approaches to Address Social Determinants of Health and Improve Pregnancy and Postpartum Outcomes. Clin Obstet Gynecol 2021; 64:333-344. [PMID: 33882522 DOI: 10.1097/grf.0000000000000611] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Telehealth has expanded its reach significantly since its inception due to the advances in technology over the last few decades. Social determinants of health (SDOH) negatively impact the health of pregnant and postpartum women and need to be considered when deploying telehealth strategies. In this article, we describe telehealth modalities and their application to improve the SDOH that impact pregnancy and postpartum outcomes. Physicians and patients alike report satisfaction with telehealth as it improves access to education, disease monitoring, specialty care, prenatal and postpartum care. Ten years ago, we developed a program, Moms2B, to eliminate disparities in pregnancy outcomes for underserved women. Using a case study, we describe how Moms2B, devoted to improve the SDOH for pregnant women, transitioned from an in-person to a virtual format. Telehealth benefited women before the recent coronavirus disease 2019 pandemic and increasingly after emergency authorizations has allowed telehealth to flourish.
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Affiliation(s)
| | - Patricia T Gabbe
- Departments of Obstetrics and Gynecology
- Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio
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111
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van Dijk W, Oosterman M, Jansen I, de Vente W, Huizink A. Stress- and smoke free pregnancy study protocol: a randomized controlled trial of a personalized eHealth intervention including heart rate variability-biofeedback to support pregnant women quit smoking via stress reduction. BMC Public Health 2021; 21:905. [PMID: 33980201 PMCID: PMC8115871 DOI: 10.1186/s12889-021-10910-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 04/26/2021] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Maternal smoking and stress during pregnancy are associated with adverse health effects for women themselves and are risk factors for adverse developmental outcomes of the unborn child. Smoking and stress seem to be intertwined in various ways. First, the majority of smoking pregnant women is of lower socio-economic status, which is associated with higher levels of perceived stress. Second, smoking women often report to smoke because they feel stressed. Third, quitting smoking often increases perceived stress levels initially. Therefore, effective interventions are needed to support women with smoking cessation by reducing stress. The aim of this study is to test the effectiveness of an eHealth intervention on stress reduction and smoking cessation. METHODS/DESIGN The Stress- and Smoke Free Start of Life (SSFSL) study is a randomized controlled trial (RCT) comparing a personalized eHealth intervention with a control condition. Inclusion criteria for the women are: (1) > 18 years of age, (2) < 28 weeks pregnant at recruitment, (3) currently smoking. Consenting participants will be randomly assigned to the intervention or control group. Participants allocated to the intervention group will receive an 8-week intervention delivered on their smartphone. The application includes psycho-education on pregnancy, stress, and smoking (cessation); stress-management training consisting of Heart Rate Variability-biofeedback; and a personalized stop-smoking-plan. Participants in the control condition will be invited to visit a webpage with information on pregnancy, stress, and smoking (cessation). Study outcomes will be collected via online questionnaires, at four timepoints: pre-intervention (baseline; t0), post-intervention (8 weeks + 1 day after t0; t1), follow up at two weeks after birth (t2), and follow up at three months after birth (t3). The primary outcome measure is self-reported smoking cessation. Secondary outcomes include daily self-reported number of cigarettes smoked, perceived stress, pregnancy experience, birth outcomes, and negative affectivity scores of the baby. Moreover, the mediating effect of stress reduction on smoking cessation will be examined, and possible moderators will be tested. DISCUSSION If the eHealth intervention is effective in smoking cessation among pregnant smoking women, it can be implemented as a tool into the health care in the Netherlands. TRIAL REGISTRATION Netherlands Trial Register, ID: NL8156 . Registered on 11 November 2019.
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Affiliation(s)
- Willeke van Dijk
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, 1081, BT, Amsterdam, the Netherlands.
| | - Mirjam Oosterman
- Department of Clinical Child and Family Studies, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Imke Jansen
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, 1081, BT, Amsterdam, the Netherlands
| | - Wieke de Vente
- Research Institute of Child Development and Education, University of Amsterdam, Amsterdam, the Netherlands
| | - Anja Huizink
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, 1081, BT, Amsterdam, the Netherlands
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112
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Oelmeier K, Schmitz R, Braun J, Möllers M, Klockenbusch W, Juhra C. Telemedizin in der Pränataldiagnostik in Zeiten der COVID-19-Pandemie: erste Erkenntnisse aus dem oVID-Projekt. Geburtshilfe Frauenheilkd 2021. [DOI: 10.1055/a-1389-9576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Affiliation(s)
- Kathrin Oelmeier
- Bereich Geburtshilfe und Pränatalmedizin, Klinik für Frauenheilkunde und Geburtshilfe am Universitätsklinikum Münster, Münster
| | - Ralf Schmitz
- Bereich Geburtshilfe und Pränatalmedizin, Klinik für Frauenheilkunde und Geburtshilfe am Universitätsklinikum Münster, Münster
| | - Janina Braun
- Bereich Geburtshilfe und Pränatalmedizin, Klinik für Frauenheilkunde und Geburtshilfe am Universitätsklinikum Münster, Münster
| | - Mareike Möllers
- Bereich Geburtshilfe und Pränatalmedizin, Klinik für Frauenheilkunde und Geburtshilfe am Universitätsklinikum Münster, Münster
| | - Walter Klockenbusch
- Bereich Geburtshilfe und Pränatalmedizin, Klinik für Frauenheilkunde und Geburtshilfe am Universitätsklinikum Münster, Münster
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Lawrie C, Highfield MEF, Mendelson S. Quiet Time to Increase Breastfeeding Rates and Enhance Women's Hospital Experiences in the Postpartum Period. Nurs Womens Health 2021; 25:170-178. [PMID: 33933423 DOI: 10.1016/j.nwh.2021.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 11/06/2020] [Accepted: 01/01/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To facilitate optimal hospital experiences and breastfeeding clinical outcomes among women by reducing interruptions during their first 24 hours in the postpartum period. DESIGN Evidence-based practice change initiated by a registered nurse staff member. SETTING/LOCAL PROBLEM There was concern that numerous visitor and staff interruptions to women during their early postpartum hours were interfering with establishing breastfeeding and maintaining a restful environment on our 21-bed postpartum unit within a 377-bed, Magnet-recognized, religiously affiliated hospital in suburban southern California. PARTICIPANTS Medically stable women with uncomplicated childbirth during the previous 24 hours and women in the postpartum period whose responses were recorded in facility databases maintained by the departments of Lactation Services and Nursing Research. INTERVENTION/MEASUREMENTS A daily quiet time from 1:00 p.m. to 3:00 p.m. was instituted on the postpartum unit. Measurements before and after implementing quiet time included data on (a) interruptions, as the number of times someone opened or entered women's room doors; (b) exclusive breastfeeding rates; and (c) women's postdischarge reports of their hospital experiences. RESULTS After quiet time was implemented, interruptions fell from an average of 74 to an average of 37 per day (n = 21, p = .02), and the percentage of women breastfeeding rose from 34% to 48% (n = 193, p = .39). Women's ratings of unit quietness improved significantly (n = 169, p = .008) to above the benchmark, and their overall facility rating and willingness to recommend the facility remained above the benchmark on surveys from the Hospital Consumer Assessment of Healthcare Providers and Systems. CONCLUSION A daily afternoon quiet time for women hospitalized in the postpartum period may reduce interruptions to women and thereby potentially increase breastfeeding rates and improve women's perceptions of their hospital experiences. Unsolicited reports from staff suggested that quiet time was well received by nurses providing postpartum care.
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Bogale B, Mørkrid K, Abbas E, Abu Ward I, Anaya F, Ghanem B, Hijaz T, Isbeih M, Issawi S, A. S. Nazzal Z, E. Qaddomi S, Frøen JF. The effect of a digital targeted client communication intervention on pregnant women's worries and satisfaction with antenatal care in Palestine-A cluster randomized controlled trial. PLoS One 2021; 16:e0249713. [PMID: 33891597 PMCID: PMC8064599 DOI: 10.1371/journal.pone.0249713] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 03/22/2021] [Indexed: 11/29/2022] Open
Abstract
Background The eRegCom cluster randomized controlled trial assesses the effectiveness of targeted client communication (TCC) via short message service (SMS) to pregnant women, from a digital maternal and child health registry (eRegistry) in Palestine, on improving attendance and quality of care. In this paper, we assess whether this TCC intervention could also have unintended consequences on pregnant women’s worries, and their satisfaction with antenatal care (ANC). Methods We interviewed a sub-sample of Arabic-speaking women attending ANC at public primary healthcare clinics, randomized to either the TCC intervention or no TCC (control) in the eRegCom trial, who were in 38 weeks of gestation and had a phone number registered in the eRegistry. Trained female data collectors interviewed women by phone from 67 intervention and 64 control clusters, after securing informed oral consent. The Arabic interview guide, pilot-tested prior to the data collection, included close-ended questions to capture the woman’s socio-demographic status, agreement questions about their satisfaction with ANC services, and the 13-item Cambridge Worry Scale (CWS). We employed a non-inferiority study design and an intention-to-treat analysis approach. Results A total of 454 women, 239 from the TCC intervention and 215 from the control arm participated in this sub-study. The mean and standard deviation of the CWS were 1.8 (1.9) for the intervention and 2.0 (1.9) for the control arm. The difference in mean between the intervention and control arms was -0.16 (95% CI: -0.31 to -0.01) after adjusting for clustering, which was below the predefined non-inferiority margin of 0.3. Women in both groups were equally satisfied with the ANC services they received. Conclusion The TCC intervention via SMS did not increase pregnancy-related worries among recipients. There was no difference in women’s satisfaction with the ANC services between intervention and control arms.
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Affiliation(s)
- Binyam Bogale
- Division for Health Services, Global Health Cluster, Norwegian Institute of Public Health, Oslo, Norway
- Center for Intervention Science in Maternal and Child Health, University of Bergen, Bergen, Norway
| | - Kjersti Mørkrid
- Division for Health Services, Global Health Cluster, Norwegian Institute of Public Health, Oslo, Norway
| | - Eatimad Abbas
- The Palestinian National Institute of Public Health, Irbid, Palestine
| | - Itimad Abu Ward
- The Palestinian National Institute of Public Health, Irbid, Palestine
| | - Firas Anaya
- Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Buthaina Ghanem
- The Palestinian National Institute of Public Health, Irbid, Palestine
| | | | - Mervett Isbeih
- The Palestinian National Institute of Public Health, Irbid, Palestine
| | - Sally Issawi
- The Palestinian National Institute of Public Health, Irbid, Palestine
| | - Zaher A. S. Nazzal
- Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Sharif E. Qaddomi
- The Palestinian National Institute of Public Health, Irbid, Palestine
| | - J. Frederik Frøen
- Division for Health Services, Global Health Cluster, Norwegian Institute of Public Health, Oslo, Norway
- Center for Intervention Science in Maternal and Child Health, University of Bergen, Bergen, Norway
- * E-mail:
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115
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Lobo EH, Frølich A, Rasmussen LJ, Livingston PM, Grundy J, Abdelrazek M, Kensing F. Understanding the Methodological Issues and Solutions in the Research Design of Stroke Caregiving Technology. Front Public Health 2021; 9:647249. [PMID: 33937175 PMCID: PMC8085388 DOI: 10.3389/fpubh.2021.647249] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 03/15/2021] [Indexed: 11/25/2022] Open
Abstract
The rise in the number of cases of stroke has resulted in a significant burden on the healthcare system. As a result, the majority of care for the person living with stroke occurs within the community, resulting in caregivers being a central and challenged agent in care. To better support caregivers during the recovery trajectory poststroke, we investigated the role of health technologies to promote education and offer various kinds of support. However, the introduction of any new technology comes with challenges due to the growing need for more user-centric systems. The integration of user-centric systems in stroke caregiving has the potential to ensure long-term acceptance, success, and engagement with the technology, thereby ensuring better care for the person living with stroke. We first briefly characterize the affordances of available technologies for stroke caregiving. We then discuss key methodological issues related to the acceptance to such technologies. Finally, we suggest user-centered design strategies for mitigating such challenges.
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Affiliation(s)
- Elton H Lobo
- School of Information Technology, Faculty of Science, Engineering and Built Environment, Deakin University, Geelong, VIC, Australia.,Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Anne Frølich
- Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.,Innovation and Research Centre for Multimorbidity, Slagelse Hospital, Region Zealand, Denmark
| | - Lene J Rasmussen
- Department of Cellular and Molecular Medicine, University of Copenhagen, Copenhagen, Denmark.,Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | | | - John Grundy
- Faculty of Information Technology, Monash University, Clayton, VIC, Australia
| | - Mohamed Abdelrazek
- School of Information Technology, Faculty of Science, Engineering and Built Environment, Deakin University, Geelong, VIC, Australia
| | - Finn Kensing
- Department of Computer Science, University of Copenhagen, Copenhagen, Denmark
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Hayman M, Alfrey KL, Cannon S, Alley S, Rebar AL, Williams S, Short CE, Altazan A, Comardelle N, Currie S, Denton C, Harrison CL, Lamerton T, Mena GP, Moran L, Mottola M, Nagpal TS, Vincze L, Schoeppe S. Quality, Features, and Presence of Behavior Change Techniques in Mobile Apps Designed to Improve Physical Activity in Pregnant Women: Systematic Search and Content Analysis. JMIR Mhealth Uhealth 2021; 9:e23649. [PMID: 33825693 PMCID: PMC8060865 DOI: 10.2196/23649] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 10/21/2020] [Accepted: 01/17/2021] [Indexed: 12/18/2022] Open
Abstract
Background Physical activity during pregnancy is associated with several health benefits for the mother and child. However, very few women participate in regular physical activity during pregnancy. eHealth platforms (internet and mobile apps) have become an important information source for pregnant women. Although the use of pregnancy-related apps has significantly increased among pregnant women, very little is known about their theoretical underpinnings, including their utilization of behavior change techniques (BCTs). This is despite research suggesting that inclusion of BCTs in eHealth interventions are important for promoting healthy behaviors, including physical activity. Objective The aim of this study was to conduct a systematic search and content analysis of app quality, features, and the presence of BCTs in apps designed to promote physical activity among pregnant women. Methods A systematic search in the Australian App Store and Google Play store using search terms relating to exercise and pregnancy was performed. App quality and features were assessed using the 19-item Mobile App Rating Scale (MARS), and a taxonomy of BCTs was used to determine the presence of BCTs (26 items). BCTs previously demonstrating efficacy in behavior changes during pregnancy were also identified from a literature review. Spearman correlations were used to investigate the relationships between app quality, app features, and number of BCTs identified. Results Nineteen exercise apps were deemed eligible for this review and they were accessed via Google Play (n=13) or App Store (n=6). The MARS overall quality scores indicated moderate app quality (mean 3.5 [SD 0.52]). Functionality was the highest scoring MARS domain (mean 4.2 [SD 0.5]), followed by aesthetics (mean 3.7 [SD 0.6]) and information quality (mean 3.16 [SD 0.42]). Subjective app quality (mean 2.54 [SD 0.64]) and likelihood for behavioral impact (mean 2.5 [SD 0.6]) were the lowest scoring MARS domains. All 19 apps were found to incorporate at least two BCTs (mean 4.74, SD 2.51; range 2-10). However, only 11 apps included BCTs that previously demonstrated efficacy for behavior change during pregnancy, the most common being provide opportunities for social comparison (n=8) and prompt self-monitoring of behavior (n=7). There was a significant positive correlation between the number of BCTs with engagement and aesthetics scores, but the number of BCTs was not significantly correlated with functionality, information quality, total MARS quality, or subjective quality. Conclusions Our findings showed that apps designed to promote physical activity among pregnant women were functional and aesthetically pleasing, with overall moderate quality. However, the incorporation of BCTs was low, with limited prevalence of BCTs previously demonstrating efficacy in behavior change during pregnancy. Future app development should identify and adopt factors that enhance and encourage user engagement, including the use of BCTs, especially those that have demonstrated efficacy for promoting physical activity behavior change among pregnant women.
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Affiliation(s)
- Melanie Hayman
- School of Health, Medical and Applied Sciences, CQUniversity, Rockhampton, Australia
| | - Kristie-Lee Alfrey
- School of Health, Medical and Applied Sciences, CQUniversity, Rockhampton, Australia
| | - Summer Cannon
- School of Health, Medical and Applied Sciences, CQUniversity, Rockhampton, Australia
| | - Stephanie Alley
- School of Health, Medical and Applied Sciences, CQUniversity, Rockhampton, Australia
| | - Amanda L Rebar
- School of Health, Medical and Applied Sciences, CQUniversity, Rockhampton, Australia
| | - Susan Williams
- School of Health, Medical and Applied Sciences, CQUniversity, Rockhampton, Australia
| | - Camille E Short
- School of Psychological Sciences, University of Melbourne, Melbourne, Australia
| | - Abby Altazan
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA, United States
| | - Natalie Comardelle
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA, United States
| | - Sinead Currie
- Division of Psychology, Stirling University, Scotland, United Kingdom
| | - Caitlin Denton
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA, United States
| | - Cheryce L Harrison
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Tayla Lamerton
- School of Human Movement and Nutrition Sciences, University of Queensland, Brisbane, Australia
| | - Gabriela P Mena
- School of Human Movement and Nutrition Sciences, University of Queensland, Brisbane, Australia
| | - Lisa Moran
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Michelle Mottola
- Faculty of Health Sciences in Kinesiology, University of Western Ontario, London, ON, Canada
| | - Taniya S Nagpal
- School of Human Kinetics, University of Ottawa, Ottawa, ON, Canada
| | - Lisa Vincze
- School of Allied Health Sciences - Nutrition and Dietetics, Griffith University, Gold Coast, Australia
| | - Stephanie Schoeppe
- School of Health, Medical and Applied Sciences, CQUniversity, Rockhampton, Australia
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Farsi D. Social Media and Health Care, Part I: Literature Review of Social Media Use by Health Care Providers. J Med Internet Res 2021; 23:e23205. [PMID: 33664014 PMCID: PMC8056296 DOI: 10.2196/23205] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 11/05/2020] [Accepted: 03/04/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND As the world continues to advance technologically, social media (SM) is becoming an essential part of billions of people's lives worldwide and is affecting almost every industry imaginable. As the world is becoming more digitally oriented, the health care industry is increasingly visualizing SM as an important channel for health care promotion, employment, recruiting new patients, marketing for health care providers (HCPs), building a better brand name, etc. HCPs are bound to ethical principles toward their colleagues, patients, and the public in the digital world as much as in the real world. OBJECTIVE This review aims to shed light on SM use worldwide and to discuss how it has been used as an essential tool in the health care industry from the perspective of HCPs. METHODS A literature review was conducted between March and April 2020 using MEDLINE, PubMed, Google Scholar, and Web of Science for all English-language medical studies that were published since 2007 and discussed SM use in any form for health care. Studies that were not in English, whose full text was not accessible, or that investigated patients' perspectives were excluded from this part, as were reviews pertaining to ethical and legal considerations in SM use. RESULTS The initial search yielded 83 studies. More studies were included from article references, and a total of 158 studies were reviewed. SM uses were best categorized as health promotion, career development or practice promotion, recruitment, professional networking or destressing, medical education, telemedicine, scientific research, influencing health behavior, and public health care issues. CONCLUSIONS Multidimensional health care, including the pairing of health care with SM and other forms of communication, has been shown to be very successful. Striking the right balance between digital and traditional health care is important.
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Affiliation(s)
- Deema Farsi
- Department of Pediatric Dentistry, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia
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118
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Dol J, Aston M, McMillan D, Tomblin Murphy G, Campbell-Yeo M. Effectiveness of a Postpartum Text Message Program (Essential Coaching for Every Mother) on Maternal Psychosocial Outcomes: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2021; 10:e27138. [PMID: 33764309 PMCID: PMC8088838 DOI: 10.2196/27138] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 02/22/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Women experience changes both physically and psychologically during their transition to motherhood. The postnatal period is a critical time for women to develop maternal self-efficacy. Mobile health interventions may offer a way to reach women during this critical period to offer support and information. Essential Coaching for Every Mother is a text message program that seeks to educate and support women during the first 6 weeks postpartum. OBJECTIVE The primary effectiveness objective is to compare the effectiveness of the Essential Coaching for Every Mother program on maternal psychosocial outcomes (self-efficacy, social support, postpartum depression, and postpartum anxiety) immediately after the intervention and 6 months postpartum, collectively as well as stratified by parity. The primary implementation objective is to evaluate the implementation extent and quality of the Essential Coaching for Every Mother program. METHODS This will be a hybrid type 1 effectiveness-implementation randomized controlled trial. A total of 140 mothers-to-be or new mothers from Nova Scotia will be recruited and randomized to the intervention or control arm, stratified by parity. The intervention arm will receive the Essential Coaching for Every Mother program, which consists of 53 messages sent twice a day for the first 2 weeks and daily for weeks 3 through 6. The control group will receive usual care. Messages are personalized based on the infant's age and the woman's self-selected preference for breastfeeding or formula feeding and tailored with the infant's name and gender. Women can enroll in the program if they are ≥37 weeks pregnant or within 10 days postpartum, with the first message designed to be sent on the second evening after birth. The actual number of messages received will vary based on the timing of enrollment and the infant's date of birth. Participants will complete questionnaires assessing self-efficacy, social support, and postpartum depression and anxiety at baseline (enrollment after birth) and 6 weeks (postintervention) and 6 months postpartum. Implementation data will be collected throughout the trial, and evaluation feedback will be collected at 6 weeks from women who received the intervention. RESULTS Recruitment for this study started on January 5, 2021, and is currently ongoing, with an anticipated date of recruitment completion of January 2022. CONCLUSIONS This study will assess the effectiveness of a postpartum text message program to improve maternal self-efficacy and social support while decreasing postpartum depression and anxiety. It will also shed light on the implementation effectiveness of the program. TRIAL REGISTRATION ClinicalTrials.gov NCT04730570; https://clinicaltrials.gov/ct2/show/NCT04730570. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/27138.
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Affiliation(s)
- Justine Dol
- Faculty of Health, Dalhousie University, Halifax, NS, Canada
| | - Megan Aston
- School of Nursing, Faculty of Health, Dalhousie University, Halifax, NS, Canada
| | - Douglas McMillan
- Department of Pediatrics, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | | | - Marsha Campbell-Yeo
- School of Nursing, Faculty of Health, Dalhousie University, Halifax, NS, Canada
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The Lègami/Legàmi Service-An Experience of Psychological Intervention in Maternal and Child Care during COVID-19. Pediatr Rep 2021; 13:142-161. [PMID: 33810190 PMCID: PMC8006011 DOI: 10.3390/pediatric13010021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 12/29/2020] [Accepted: 03/16/2021] [Indexed: 11/24/2022] Open
Abstract
This study provides a descriptive analysis of the Lègami/Legàmi service, a free psychological support service in maternal and childcare, offered through the internet and by telephone that was initiated by the Italian Society of Pediatric Psychology (S.I.P.Ped.) during the COVID-19 medical emergency as an act of solidarity, first independently, and then in collaboration with the Italian Ministry of Health. This paper presents findings related to the "universe" of people who called the toll-free service, from the sociocultural characteristics of the users to the information collected by the professionals during the psychological pathways until human satisfaction was achieved. We provide a retrospective description of an experience that took place between April and June 2020, and which involved users of the maternal-infant area calling from the whole Italy. (1) Methods: The aims of this study were to investigate the configuration of the indicators identified and to detect the possible correlations between them in the sample. There were 193 users who took advantage of the Service, 160 of whom continued beyond the reception service; it is this group that we report the findings from here. The tool used was a form reporting access to care and interventions, and the resulting data underwent a content analysis and the indicators were subject to non-parametric statistical analysis to analyze differences and relationships. (2) Results: There were many correlations among the indicators that revealed a high prevalence of calls due to personal motivations and requests for support, which later allowed users to gain a greater understanding of the underlying problems they were facing. The professionals running the service noticed a prevalence of weaknesses attributable to the negative emotions of its users, alongside a presence of cognitive and relational resources. The professionals' interventions, which can be characterized by a prevalence of social support, psychological rehabilitation, and psychoeducation, achieved outcomes of redefining users' relationships with themselves and others. All of the service's users have expressed a high level of satisfaction with it. (3) Discussion: Our results revealed the protective and transformative effects of the service for its users and the underlying importance of having an easily accessible psychological support system in place during emergencies, like the recent pandemic. In conditions like these, the great value of a remote support service should be noted, and despite its limitations, assures its own efficacy when a medical emergency precludes closer in-person forms of psychological assistance.
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van den Heuvel JFM, van Lieshout C, Franx A, Frederix G, Bekker MN. SAFE@HOME: Cost analysis of a new care pathway including a digital health platform for women at increased risk of preeclampsia. Pregnancy Hypertens 2021; 24:118-123. [PMID: 33813364 DOI: 10.1016/j.preghy.2021.03.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 03/09/2021] [Accepted: 03/15/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To perform a cost analysis of the use of a new care pathway with a digital health platform for blood pressure telemonitoring for women at risk of preeclampsia. STUDY DESIGN This is a cost analysis of a case-control study with women with chronic hypertension, history of preeclampsia, maternal cardiac or kidney disease at intake of pregnancy. Antenatal care with a reduced visit schedule and a digital health platform (SAFE@HOME, n = 97) was compared to a retrospective control group (n = 133) with usual care without self-monitoring. MAIN OUTCOME MEASURES Costs per pregnancy (€) of healthcare consumption of antenatal clinic visits, ultrasound assessments, antenatal admissions, laboratory and other diagnostic tests, and societal costs such as traveling and work absence. RESULTS Baseline characteristics and perinatal outcomes were similar between both groups. A significant reduction of antenatal visits, ultrasounds and hypertension-related admissions was associated with use of the digital platform. In the SAFE@HOME group, costs of antenatal care, including the costs of the digital platform, were 19.7% lower compared to the control group (median €3616 [IQR 3071 - 5329] vs €4504 [IQR 3515-6923], p = 0.001). Total costs per pregnancy, including societal costs, were also reduced (€7485 [IQR 6338-10,173] vs €9150, [IQR 7546-12,286] p < 0.001). Each euro invested in the platform saved on average €8 of antenatal care resources. CONCLUSION The use of a digital platform for blood pressure and symptom monitoring in antenatal care for high-risk women is associated with lower costs compared to conventional care, while observed maternal and neonatal outcomes are similar.
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Affiliation(s)
- Josephus F M van den Heuvel
- Department of Obstetrics and Gynaecology, University Medical Center Utrecht, Utrecht University, Lundlaan 6, 3508 AB Utrecht, the Netherlands
| | - Christiaan van Lieshout
- Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Arie Franx
- Department of Obstetrics and Gynaecology, University Medical Center Utrecht, Utrecht University, Lundlaan 6, 3508 AB Utrecht, the Netherlands; Department of Obstetrics and Gynaecology, Erasmus Medical Center, Erasmus University, Dr. Molewaterplein 40, 3015 GD Rotterdam, the Netherlands
| | - Geert Frederix
- Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Mireille N Bekker
- Department of Obstetrics and Gynaecology, University Medical Center Utrecht, Utrecht University, Lundlaan 6, 3508 AB Utrecht, the Netherlands.
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Ørtenblad L, Høtoft D, Krogh RH, Lynggaard V, Juel Christiansen J, Vinther Nielsen C, Hedeager Momsen AM. Women's perspectives on motivational factors for lifestyle changes after gestational diabetes and implications for diabetes prevention interventions. ENDOCRINOLOGY DIABETES & METABOLISM 2021; 4:e00248. [PMID: 34277972 PMCID: PMC8279634 DOI: 10.1002/edm2.248] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 02/02/2021] [Accepted: 02/27/2021] [Indexed: 12/12/2022]
Abstract
Introduction Gestational diabetes mellitus (GDM) is a common complication in pregnancy and constitutes a public health problem due to the risk of developing diabetes and other diseases. Most women face barriers in complying with preventive programs. This study aimed to explore motivational factors for lifestyle changes among women with a history of GDM and their suggestions for preventive programs. Methods This study used a qualitative approach in six focus group interviews with a total of 32 women. The selection criteria were time since onset of GDM, including women diagnosed with GDM, six months and five years after GDM, diagnosed and not diagnosed with diabetes. Inductive analysis was performed. Results The women reacted with anxiety about their GDM diagnosis and experienced persistent concerns about the consequences of GDM. They were highly motivated to take preventive initiatives, but faced major adherence challenges. The demotivating factors were lack of time and resources, too little family involvement, lack of knowledge and social norms that may obstruct healthy eating. A powerful motivational factor for complying with preventive strategies was the well-being of their children and partners. Conclusions Preventive initiatives should be rooted in the women's perception of GDM/diabetes and based on their experiences with barriers and motivational factors. The well-being and the quality of life within the family are dominant motivational factors which offer powerful potentials for supporting the women's coping capability. Further, there is a need to be responsiveness to the women and their families even a long time after the onset of GDM.
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Affiliation(s)
- Lisbeth Ørtenblad
- DEFACTUM - Public Health and Rehabilitation Research Central Denmark Region Aarhus Denmark.,Department of Public Health Aarhus University Aarhus Denmark
| | - Diana Høtoft
- DEFACTUM - Public Health and Rehabilitation Research Central Denmark Region Aarhus Denmark
| | - Rubab H Krogh
- Department of Gynaecology and Obstetrics Gødstrup Hospital Herning Denmark
| | - Vibeke Lynggaard
- Steno Diabetes Center Aarhus Health Promotion Research Aarhus Denmark.,Cardiovascular Research Unit Department of Cardiology Gødstrup Hospital Aarhus Denmark
| | - Jens Juel Christiansen
- Steno Diabetes Center Aarhus Health Promotion Research Aarhus Denmark.,Department of Medicine Gødstrup Hospital Aarhus Denmark
| | - Claus Vinther Nielsen
- DEFACTUM - Public Health and Rehabilitation Research Central Denmark Region Aarhus Denmark.,Department of Public Health Aarhus University Aarhus Denmark.,Section for Clinical Social Medicine and Rehabilitation Gødstrup Hospital Aarhus Denmark
| | - Anne-Mette Hedeager Momsen
- DEFACTUM - Public Health and Rehabilitation Research Central Denmark Region Aarhus Denmark.,Department of Public Health Aarhus University Aarhus Denmark
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Hadar E, Wolff L, Tenenbaum-Gavish K, Eisner M, Shmueli A, Barbash-Hazan S, Bergel R, Shmuel E, Houri O, Dollinger S, Brzezinski-Sinai NA, Sukenik S, Pardo A, Navon I, Wilk Y, Zafrir-Danieli H, Wiznitzer A. Mobile Self-Operated Home Ultrasound System for Remote Fetal Assessment During Pregnancy. Telemed J E Health 2021; 28:93-101. [PMID: 33729014 DOI: 10.1089/tmj.2020.0541] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Background: Mobile medical devices for self-patient use are a rapidly evolving section of telehealth. We examined the INSTINCT® ultrasound system, a portable, self-operated ultrasound device attached to a commercial smartphone for remote fetal assessment. We aimed to evaluate whether it is feasible to use remote fetal assessment during pregnancy. Materials and Methods: This is an observational noninterventional trial. We included women with a singleton fetus at 14 + 0 to 39 + 6 gestational weeks. Each participant received the device for a self-use period of 7-14 days and was instructed to perform one to three scans a day. Participants completed a self-assessment questionnaire to evaluate safety and usability (i.e., user experience and satisfaction). Each scan was evaluated for fetal heart activity, amniotic fluid volume, fetal tone, fetal body, and breathing movements. Results: One hundred women, completing 1,360 self scans, used the device for 8.1 ± 1.5 days, performing an average of 13.6 ± 6.2 scans each. There were no device-related serious adverse events. Success in detection was 95.3% for fetal heart activity, 88.3% for body movements, 69.4% for tone, 92.2% for normal amniotic fluid volume, and 23.8% for breathing movements. Interobserver agreement was 94.4% for fetal heart rate activity, 85.9% for body movements, 69.5% for fetal tone, 86.9% for amniotic fluid volume, and 94.0% for breathing movements. Self-assessed user experience was rated at 4.4/5, whereas device satisfaction was rated at 3.9/5. Conclusion: The INSTINCT ultrasound system is a feasible solution for remote sonographic fetal assessment. Further studies are needed to assess its role and impact in telehealth antenatal care and fetal surveillance.
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Affiliation(s)
- Eran Hadar
- Helen Schneider Hospital for Women, Rabin Medical Center, Petach-Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Leor Wolff
- Translational Innovation and eHealth Wing, Clalit Health Services, Tel-Aviv, Israel
| | - Kinneret Tenenbaum-Gavish
- Helen Schneider Hospital for Women, Rabin Medical Center, Petach-Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Michal Eisner
- Helen Schneider Hospital for Women, Rabin Medical Center, Petach-Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Anat Shmueli
- Helen Schneider Hospital for Women, Rabin Medical Center, Petach-Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Shiri Barbash-Hazan
- Helen Schneider Hospital for Women, Rabin Medical Center, Petach-Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Riki Bergel
- Helen Schneider Hospital for Women, Rabin Medical Center, Petach-Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Elyasaf Shmuel
- Helen Schneider Hospital for Women, Rabin Medical Center, Petach-Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Ohad Houri
- Helen Schneider Hospital for Women, Rabin Medical Center, Petach-Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Sarah Dollinger
- Helen Schneider Hospital for Women, Rabin Medical Center, Petach-Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Noa A Brzezinski-Sinai
- Helen Schneider Hospital for Women, Rabin Medical Center, Petach-Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Shay Sukenik
- Helen Schneider Hospital for Women, Rabin Medical Center, Petach-Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Anat Pardo
- Helen Schneider Hospital for Women, Rabin Medical Center, Petach-Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Inbal Navon
- Helen Schneider Hospital for Women, Rabin Medical Center, Petach-Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Yulia Wilk
- Helen Schneider Hospital for Women, Rabin Medical Center, Petach-Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Hadas Zafrir-Danieli
- Helen Schneider Hospital for Women, Rabin Medical Center, Petach-Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Arnon Wiznitzer
- Helen Schneider Hospital for Women, Rabin Medical Center, Petach-Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
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Saarikko J, Niela-Vilén H, Rahmani AM, Axelin A. Identifying target behaviors for weight management interventions for women who are overweight during pregnancy and the postpartum period: a qualitative study informed by the Behaviour Change Wheel. BMC Pregnancy Childbirth 2021; 21:200. [PMID: 33706722 PMCID: PMC7953784 DOI: 10.1186/s12884-021-03689-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 02/24/2021] [Indexed: 01/22/2023] Open
Abstract
Background Maternal overweight is increasing, and it is associated with several risk factors for both the mother and child. Healthy lifestyle behaviors adopted during pregnancy are likely to impact women’s health positively after pregnancy. The study’s aim was to identify and describe weight management behaviors in terms of the Capability, Opportunity and Motivation Behaviour (COM-B) -model to target weight management interventions from both the perspectives of women who are overweight and maternity care professionals. Methods This qualitative, descriptive study was conducted between 2019 and 2020. Individual interviews with pregnant and postpartum women who were overweight (n = 11) and focus group interviews with public health nurses (n = 5) were undertaken in two public maternity clinics in Southwest Finland. The data were analyzed using deductive content analysis consistent with the COM-B model. Results In the capability category, the women and the public health nurses thought that there was a need to find consistent ways to approach overweight, as it had often become a feature of the women’s identities. The use of health technology was considered to be an element of antenatal care that could be used to approach the subject of weight and weight management. Smart wearables could also support an evaluation of the women’s lifestyles. The opportunity category highlighted the lack of resources for support during perinatal care, especially after birth. Both groups felt that support from the family was the most important facilitating factor besides motivation. The women also expressed a conflict between pregnancy as an excuse to engage in unhealthy habits and pregnancy as a motivational period for a change of lifestyle. Furthermore, the women wanted to be offered a more robust stance on weight management and discreet counseling. Conclusions Our findings offer a theoretical basis on which future research can define intervention and implementation strategies. Such interventions may offer clear advice and non-judgmental support during pregnancy and after delivery by targeting women’s capabilities, opportunities, and motivation. Health technology could be a valuable component of intervention, as well as an implementation strategy, as they provide ways during maternity care to approach this topic and support women.
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Affiliation(s)
- Johanna Saarikko
- Department of Nursing Science, University of Turku, Turku, Finland.
| | - Hannakaisa Niela-Vilén
- Department of Nursing Science, University of Turku, Turku, Finland.,Department of Obstetrics and Gynaecology, Turku University Hospital and Faculty of Medicine, University of Turku, Turku, Finland
| | - Amir M Rahmani
- School of Nursing, University of California, Irvine, USA.,Department of Computer Science, University of California, Irvine, USA
| | - Anna Axelin
- Department of Nursing Science, University of Turku, Turku, Finland.,Department of Obstetrics and Gynaecology, Turku University Hospital and Faculty of Medicine, University of Turku, Turku, Finland
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124
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Militello L, Sezgin E, Huang Y, Lin S. Delivering Perinatal Health Information via a Voice Interactive App (SMILE): Mixed Methods Feasibility Study. JMIR Form Res 2021; 5:e18240. [PMID: 33646136 PMCID: PMC7961402 DOI: 10.2196/18240] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 06/10/2020] [Accepted: 01/17/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Perinatal health care is critically important for maternal health outcomes in infants. The United States fares considerably worse than comparable countries for maternal and infant mortality rates. As such, alternative models of care or engagement are warranted. Ubiquitous digital devices and increased use of digital health tools have the potential to extend the reach to women and infants in their everyday lives and make a positive impact on their health outcomes. As voice technology becomes more mainstream, research is prudent to establish evidence-based practice on how to best leverage voice technology to promote maternal-infant health. OBJECTIVE The aim of this study is to assess the feasibility of using voice technology to support perinatal health and infant care practices. METHODS Perinatal women were recruited from a large Midwest Children's Hospital via hospital email announcements and word of mouth. Owing to the technical aspects of the intervention, participants were required to speak English and use an iPhone. Demographics, patterns of technology use, and technology use specific to perinatal health or self-care practices were assessed at baseline. Next, participants were onboarded and asked to use the intervention, Self-Management Intervention-Life Essentials (SMILE), over the course of 2 weeks. SMILE provided users with perinatal health content delivered through mini podcasts (ranging from 3 to 8 minutes in duration). After each podcast, SMILE prompted users to provide immediate verbal feedback to the content. An exit interview was conducted with participants to gather feedback on the intervention and further explore participants' perceptions of voice technology as a means to support perinatal health in the future. RESULTS In total, 19 pregnant women (17 to 36 weeks pregnant) were consented. Themes identified as important for perinatal health information include establishing routines, expected norms, and realistic expectations and providing key takeaways. Themes identified as important for voice interaction include customization and user preferences, privacy, family and friends, and context and convenience. Qualitative analysis suggested that perinatal health promotion content delivered by voice should be accurate and succinctly delivered and highlight key takeaways. Perinatal health interventions that use voice should provide users with the ability to customize the intervention but also provide opportunities to engage family members, particularly spouses. As a number of women multitasked while the intervention was being deployed, future interventions should leverage the convenience of voice technology while also balancing the influence of user context (eg, timing or ability to listen or talk versus nonvoice interaction with the system). CONCLUSIONS Our findings demonstrate the short-term feasibility of disseminating evidence-based perinatal support via podcasts and curate voice-captured data from perinatal women. However, key areas of improvement have been identified specifically for perinatal interventions leveraging voice technology. Findings contribute to future content, design, and delivery considerations of perinatal digital health interventions.
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Affiliation(s)
- Lisa Militello
- Martha S Pitzer Center for Women, Children & Youth, College of Nursing, The Ohio State University, Columbus, OH, United States
| | - Emre Sezgin
- Research Information Solutions and Innovation, The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH, United States
| | - Yungui Huang
- Research Information Solutions and Innovation, The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH, United States
| | - Simon Lin
- Research Information Solutions and Innovation, The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH, United States
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Donelle L, Hall J, Hiebert B, Jackson K, Stoyanovich E, LaChance J, Facca D. Investigation of Digital Technology Use in the Transition to Parenting: Qualitative Study. JMIR Pediatr Parent 2021; 4:e25388. [PMID: 33595440 PMCID: PMC8078692 DOI: 10.2196/25388] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 12/23/2020] [Accepted: 12/29/2020] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The transition to parenting-that is, the journey from preconception through pregnancy and postpartum periods-is one of the most emotionally charged and information-intense times for individuals and families. While there is a developing body of literature on the use and impact of digital technology on the information behaviors of children, adolescents, and young adults, personal use of digital technology during the transition to parenting and in support of infants to 2 years of age is relatively understudied. OBJECTIVE The purpose of this study was to enhance our understanding of the ways digital technologies contribute to the experience of the transition to parenting, particularly the role these technologies play in organizing and structuring emerging pregnancy and early parenting practices. METHODS A qualitative descriptive study was conducted to understand new parents' experiences with and uses of digital technology during 4 stages-prenatal, pregnancy, labor, and postpartum-of their transition to becoming a new parent. A purposive sampling strategy was implemented using snowball sampling techniques to recruit participants who had become a parent within the previous 24 months. Focus groups and follow-up interviews were conducted using semistructured interview guides that inquired about parents' type and use of technologies for self and family health. Transcribed audio recordings were thematically analyzed. RESULTS A total of 10 focus groups and 3 individual interviews were completed with 26 participants. While recruitment efforts targeted parents of all genders and sexual orientations, all participants identified as heterosexual women. Participants reported prolific use of digital technologies to direct fertility (eg, ovulation timing), for information seeking regarding development of their fetus, to prepare for labor and delivery, and in searching for a sense of community during postpartum. Participants expressed their need for these technologies to assist them in the day-to-day demands of preparing for and undertaking parenting, yet expressed concerns about their personal patterns of use and the potential negative impacts of their use. The 3 themes generated from the data included: "Is this normal; is this happening to you?!", "Am I having a heart attack; what is this?", and "Anyone can put anything on Wikipedia": Managing the Negative Impacts of Digital Information. CONCLUSIONS Digital technologies were used by mothers to track menstrual cycles during preconception; monitor, document, and announce a pregnancy during the prenatal stage; prepare for delivery during labor/birth stage; and to help babies sleep, document/announce their birth, and connect to parenting resources during the postpartum stage. Mothers used digital technologies to reassure themselves that their experiences were normal or to seek help when they were abnormal. Digital technologies provided mothers with convenient means to access health information from a range of sources, yet mothers were apprehensive about the credibility and trustworthiness of the information they retrieved. Further research should seek to understand how men and fathers use digital technologies during their transition to parenting. Additionally, further research should critically examine how constant access to information affects mothers' perceived need to self-monitor and further understand the unintended health consequences of constant surveillance on new parents.
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Affiliation(s)
- Lorie Donelle
- Arthur Labatt Family School of Nursing, Faculty of Health Science, Western University, London, ON, Canada
| | - Jodi Hall
- Faculty of Health, Community Studies and Public Safety, Fanshawe College, London, ON, Canada
| | - Bradley Hiebert
- Arthur Labatt Family School of Nursing, Faculty of Health Science, Western University, London, ON, Canada
| | - Kimberley Jackson
- Arthur Labatt Family School of Nursing, Faculty of Health Science, Western University, London, ON, Canada
| | - Ewelina Stoyanovich
- Arthur Labatt Family School of Nursing, Faculty of Health Science, Western University, London, ON, Canada
| | - Jessica LaChance
- Arthur Labatt Family School of Nursing, Faculty of Health Science, Western University, London, ON, Canada
| | - Danica Facca
- Faculties of Health Science and Information and Media Studies, Western University, London, ON, Canada
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126
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Vickery M, van Teijlingen E, Hundley V, Smith GB, Way S, Westwood G. Midwives' views towards women using mHealth and eHealth to self-monitor their pregnancy: A systematic review of the literature. Eur J Midwifery 2021; 4:36. [PMID: 33537637 PMCID: PMC7839093 DOI: 10.18332/ejm/126625] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 07/27/2020] [Accepted: 08/21/2020] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION There are many mobile telephone apps to help women self-monitor aspects of pregnancy and maternal health. This literature review aims to understand midwives’ perspectives on women self-monitoring their pregnancy using eHealth and mHealth, and establish gaps in research. METHODS MEDLINE, PubMed, Scopus, CINAHL and PsycINFO were systematically searched on midwifery, eHealth/mHealth and perspectives. Qualitative, quantitative and mixed-methods studies published in English were considered for inclusion in the review, without geographical limitations. Relevant articles were critically appraised and narrative synthesis was conducted. RESULTS Twelve relevant papers covering midwives’ perspectives of the use of eHealth and mHealth by pregnant women were obtained for inclusion in this review. Seven of these publications focused on midwives’ views of eHealth, and five on their perspectives of mHealth interventions. The studies included demonstrate that midwives generally hold ambivalent views towards the use of eHealth and mHealth technologies in antenatal care. Often, midwives acknowledged the potential benefits of such technologies, such as their ability to modernise antenatal care and to help women make more informed decisions about their pregnancy. However, midwives were quick to point out the risks and limitations of these, such as the accuracy of conveyed information, and negative impacts on the patient-professional relationship. CONCLUSIONS Post-COVID-19, where technology is continuously developing, there is a compelling need for studies that investigate the role of eHealth and mHealth in self-monitoring pregnancy, and the consequences this has for pregnant women, health professionals and organisations, as well as midwifery curricula.
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Affiliation(s)
- Michelle Vickery
- Department of Midwifery & Health Sciences, Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, United Kingdom
| | - Edwin van Teijlingen
- Department of Midwifery & Health Sciences, Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, United Kingdom
| | - Vanora Hundley
- Department of Midwifery & Health Sciences, Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, United Kingdom
| | - Gary B Smith
- Department of Midwifery & Health Sciences, Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, United Kingdom
| | - Susan Way
- Department of Midwifery & Health Sciences, Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, United Kingdom
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Hedeager Momsen AM, Høtoft D, Ørtenblad L, Friis Lauszus F, Krogh RHA, Lynggaard V, Juel Christiansen J, Terkildsen Maindal H, Vinther Nielsen C. Diabetes prevention interventions for women after gestational diabetes mellitus: an overview of reviews. ENDOCRINOLOGY DIABETES & METABOLISM 2021; 4:e00230. [PMID: 34277958 PMCID: PMC8279604 DOI: 10.1002/edm2.230] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 12/04/2020] [Accepted: 12/07/2020] [Indexed: 12/21/2022]
Abstract
Aims To present an overview of reviews of interventions for the prevention of diabetes in women after gestational diabetes mellitus (GDM) with the overall aim of gaining information in order to establish local interventions. Methods Six databases were searched for quantitative, qualitative or mixed‐methods systematic reviews. All types of interventions or screening programmes were eligible. The outcomes were effectiveness of reducing diabetes incidence, encouraging healthy behavioural changes and enhancing women's perceptions of their increased risks of developing type 2 diabetes following GDM. Results Eighteen reviews were included: three on screening programmes and seven on participation and risk perceptions. Interventions promoting physical activity, healthy diet, breastfeeding and antidiabetic medicine reported significantly decreased incidence of postpartum diabetes, up to 34% reduction after any breastfeeding compared to none. Effects were larger if the intervention began early after birth and lasted longer. Participation in screening rose up to 40% with face‐to‐face recruitment in a GDM healthcare setting. Interventions were mainly based in healthcare settings and involved up to nine health professions, councillors and peer educators, mostly dieticians. Women reported a lack of postpartum care and demonstrated a low knowledge of risk factors for developing type 2 diabetes. Typical barriers to participation were lack of awareness of increased risk and low levels of support from family. Conclusions Lifestyle interventions or pharmacological treatment postpartum was effective in decreasing diabetes incidence following GDM. Women's knowledge of the risk of diabetes and importance of physical activity was insufficient. Early face‐to‐face recruitment increased participation in screening. Programmes aimed at women following a diagnosis of GDM ought to provide professional and social support, promote screening, breastfeeding, knowledge of risk factors, be long‐lasting and offered early after birth, preferably by face‐to‐face recruitment.
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Affiliation(s)
- Anne-Mette Hedeager Momsen
- Section for Clinical Social Medicine and Rehabilitation Gødstrup Hospital Herning Denmark.,DEFACTUM - Social & Health Services and Labour Market Corporate Quality, Central Denmark Region Aarhus Denmark
| | - Diana Høtoft
- DEFACTUM - Social & Health Services and Labour Market Corporate Quality, Central Denmark Region Aarhus Denmark
| | - Lisbeth Ørtenblad
- DEFACTUM - Social & Health Services and Labour Market Corporate Quality, Central Denmark Region Aarhus Denmark.,Department of Public Health Aarhus University Aarhus Denmark
| | - Finn Friis Lauszus
- Department of Gynaecology and Obstetrics Gødstrup Hospital Gødstrup Denmark
| | | | - Vibeke Lynggaard
- Steno Partner Collaboration between Gødstrup Hospital and Steno Diabetes Center Aarhus Herning Denmark.,Cardiovascular Research Unit Department of Cardiology Gødstrup Hospital Herning Denmark
| | - Jens Juel Christiansen
- Steno Partner Collaboration between Gødstrup Hospital and Steno Diabetes Center Aarhus Herning Denmark.,Department of Medicine Gødstrup Hospital Herning Denmark
| | - Helle Terkildsen Maindal
- Department of Public Health Aarhus University Aarhus Denmark.,Steno Diabetes Center Copenhagen Health Promotion Research Gentofte Denmark
| | - Claus Vinther Nielsen
- Section for Clinical Social Medicine and Rehabilitation Gødstrup Hospital Herning Denmark.,DEFACTUM - Social & Health Services and Labour Market Corporate Quality, Central Denmark Region Aarhus Denmark.,Department of Public Health Aarhus University Aarhus Denmark
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128
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Ferorelli D, Nardelli L, Spagnolo L, Corradi S, Silvestre M, Misceo F, Marrone M, Zotti F, Mandarelli G, Solarino B, Dell'Erba A. Medical Legal Aspects of Telemedicine in Italy: Application Fields, Professional Liability and Focus on Care Services During the COVID-19 Health Emergency. J Prim Care Community Health 2021; 11:2150132720985055. [PMID: 33372570 PMCID: PMC7780315 DOI: 10.1177/2150132720985055] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Telemedicine services can be classified into the macro-categories of specialist Telemedicine, Tele-health and Tele-assistance. From a regulatory perspective, in Italy, the first provision dedicated to the implementation of Telemedicine services is represented by the Agreement between the Government and the Regions on the document bearing “Telemedicine—National guidelines,” approved by the General Assembly of the Superior Health Council in the session of 10th July 2012 and by the State Regions Conference in the session of 20th February 2014. Scientifically, several studies in the literature state that information and communication technologies have great potential to reduce the costs of health care services in terms of planning and making appropriate decisions that provide timely tools to patients. Another clear benefit is the equity of access to health care. The evolution of telemedicine poses a series of legal problems ranging from the profiles on the subject of authorization and accreditation to those concerning the protection of patient confidentiality, the definition and solution of which, in the absence of specific regulatory provisions, is mainly left to the assessment of compatibility of the practices adopted so far, with the general regulatory framework. In terms of professional liability, it is necessary to first clarify that the telemedicine service is comparable to any diagnostic-therapeutic health service considering that the telemedicine service does not replace the traditional health service, but integrates the latter to improve its effectiveness, efficiency and appropriateness.
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Affiliation(s)
- D Ferorelli
- University of Bari-Section of Legal Medicine, Policlinico di Bari Hospital. Bari, Italy
| | - L Nardelli
- University of Bari-Section of Legal Medicine, Policlinico di Bari Hospital. Bari, Italy
| | - L Spagnolo
- University of Bari-Section of Legal Medicine, Policlinico di Bari Hospital. Bari, Italy
| | - S Corradi
- University of Bari-Section of Legal Medicine, Policlinico di Bari Hospital. Bari, Italy
| | - M Silvestre
- University of Bari-Section of Legal Medicine, Policlinico di Bari Hospital. Bari, Italy
| | - F Misceo
- University of Bari-Section of Legal Medicine, Policlinico di Bari Hospital. Bari, Italy
| | - M Marrone
- University of Bari-Section of Legal Medicine, Policlinico di Bari Hospital. Bari, Italy
| | - F Zotti
- University of Bari-Section of Legal Medicine, Policlinico di Bari Hospital. Bari, Italy
| | - G Mandarelli
- University of Bari-Section of Legal Medicine, Policlinico di Bari Hospital. Bari, Italy
| | - B Solarino
- University of Bari-Section of Legal Medicine, Policlinico di Bari Hospital. Bari, Italy
| | - A Dell'Erba
- University of Bari-Section of Legal Medicine, Policlinico di Bari Hospital. Bari, Italy
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129
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Namatovu HK, Oyana TJ, Sol HG. Barriers to eHealth adoption in routine antenatal care practices: Perspectives of expectant mothers in Uganda - A qualitative study using the unified theory of acceptance and use of technology model. Digit Health 2021; 7:20552076211064406. [PMID: 34900326 PMCID: PMC8664308 DOI: 10.1177/20552076211064406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Current empirical evidence suggests that successful adoption of eHealth systems improves maternal health outcomes, yet there are still existing gaps in adopting such systems in Uganda. Service delivery in maternal health is operating in a spectrum of inadequacy, hence eHealth adoption cannot ensue. This study set out to explore the challenges that impede eHealth adoption in women's routine antenatal care practices in Uganda. A qualitative approach using semi-structured interviews was employed to document challenges. These challenges were classified based on a unified theory of acceptance and use of technology constructs. One hundred and fifteen expectant mothers, aged between 18 and 49 years, who spoke either English or Luganda were included in the study that took place between January to May 2019. Thematic analysis using template analysis was adopted to analyse qualitative responses. Challenges were categorised based on five principal unified theories of acceptance and use of technology constructs namely: performance expectancy, effort expectancy, social influence, facilitating conditions and behavioural intention. Facilitating conditions had more influence on technology acceptance and adoption than the other four constructs. Specifically, the lack of training prior to using the system, technical support, computers and smart phones had a downhill effect on adoption. Subsequently, the cost of data services, internet intermittency, and the lack of systems that bridge the gap between mothers and health providers further hindered technology uptake. In conclusion, strategies such as co-development, training end-users, garnering support at the national and hospital levels should be advocated to improve user acceptance of technology.
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Affiliation(s)
- Hasifah Kasujja Namatovu
- Department of Information Systems, School of Computing and Informatics Technology, Makerere University Kampala, Uganda
| | - Tonny Justus Oyana
- Geospatial Data and Computational Intelligence Lab, School of Computing and Informatics Technology, Makerere University Kampala, Uganda
| | - Henk Gerard Sol
- Faculty of Economics and Business, University of Groningen, the Netherlands
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130
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Designing an IT Ecosystem for Pregnancy Care Management Based on Pervasive Technologies. Healthcare (Basel) 2020; 9:healthcare9010012. [PMID: 33374164 PMCID: PMC7824737 DOI: 10.3390/healthcare9010012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 12/13/2020] [Accepted: 12/18/2020] [Indexed: 11/17/2022] Open
Abstract
Pregnancy care is a topic of interest for both academia and practitioners. Novel pervasive technologies and applications, such as mobile technologies, wearables and IoT, open a wide corpus of possibilities for fostering pregnancy care management, and reducing risks and problems, improving communication among stakeholders and society development. This article introduces a model of a pregnancy care IT ecosystem based on the integration of various services in a semantically enriched e-health ecosystem. As proof of concept, both the web and mobile applications that aim to help pregnant women and gynaecologists were designed and employed in a real environment. An evaluation of the developed ecosystem was performed on a sample of 500 pregnant women and 100 doctors. After pilot usage, a survey was used to collect the data from participants, and assess the acceptance of the developed system. Results show that quality, usability and usefulness are on a high level, and that both pregnant women and doctors are ready for more extensive use of the system. In addition, research findings imply that employing pervasive technologies could bring significant benefits to all the parties in pregnancy care systems.
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131
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Mieso B, Neudecker M, Furman L. Mobile Phone Applications to Support Breastfeeding Among African-American Women: a Scoping Review. J Racial Ethn Health Disparities 2020; 9:32-51. [PMID: 33219430 DOI: 10.1007/s40615-020-00927-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 11/06/2020] [Accepted: 11/09/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Racial disparities persist with respect to breastfeeding. The use of health e-technology is increasing, with promise for a role in improving breastfeeding outcomes. OBJECTIVE We undertook a scoping review of both individual breastfeeding apps and the literature on breastfeeding apps to map the available evidence on app-based breastfeeding support for African-American mothers. DESIGN A systematic search of online databases identified 241 English language papers published on or before June 2020 that included e-technology in support of breastfeeding. We included those that (1) described individual human subjects research studies utilizing any research design, (2) described app-based breastfeeding support, and (3) could be pertinent for African-American mothers, and assessed for inclusion and relevance for this population. We also searched app stores for breastfeeding apps, and evaluated features with a rubric. Our aim was to identify if gaps exist relative to breastfeeding support for African-Americans. RESULTS Of the 15 publications meeting inclusion criteria, 9 focused on app development, 4 examined user experience, and 3 examined breastfeeding outcomes with use of an app (one study overlapped categories). The percentage of African-American participants ranged from 100% (2 studies) to none (7 studies); 3 studies (20%) focused on African-American mothers' breastfeeding experience. Of 77 apps that met inclusion criteria, just one was both breastfeeding-focused by content and targeted for African-Americans by picture predominance. CONCLUSIONS The quality of studies was generally high and many included African-American participants, but research focused on breastfeeding apps specifically for African-American mothers/parents is limited, creating a meaningful gap in the literature.
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Affiliation(s)
- Bethel Mieso
- Case Western Reserve University School of Medicine, Cleveland, OH, 44106, USA
| | - Mandy Neudecker
- Department of Pediatrics, Division of General Academic Pediatrics, University Hospitals Rainbow Babies and Children's Hospital, 11000 Euclid Avenue, Cleveland, OH, 44106, USA
| | - Lydia Furman
- Case Western Reserve University School of Medicine, Cleveland, OH, 44106, USA. .,Department of Pediatrics, Division of General Academic Pediatrics, University Hospitals Rainbow Babies and Children's Hospital, 11000 Euclid Avenue, Cleveland, OH, 44106, USA.
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132
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Smoke and Alcohol Free with EHealth and Rewards (SAFER) pregnancy study: a before-after study protocol. NPJ Prim Care Respir Med 2020; 30:51. [PMID: 33208752 PMCID: PMC7674488 DOI: 10.1038/s41533-020-00209-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 09/23/2020] [Indexed: 11/24/2022] Open
Abstract
Despite existing interventions, tobacco smoking and alcohol consumption during pregnancy are common. The Smoke and Alcohol Free with EHealth and Rewards (SAFER) pregnancy intervention combines monthly group sessions, access to a web-based platform and incentives upon biochemically validated cessation for a maximum duration of 6 months to promote cessation of smoking and alcohol use before and during pregnancy. To inform development of the SAFER pregnancy intervention, two focus groups with the target population were held beforehand, with results reported here alongside the final SAFER pregnancy study protocol. In a before−after study we aim to include 66 women who are pregnant or have a wish to become pregnant and who smoke and/or consume alcohol (i.e. target population of the SAFER pregnancy intervention). The primary outcome measure is cessation of smoking and/or alcohol use at 34−38 weeks of gestation, or after six group sessions if women did not become pregnant during the study period. Secondary outcomes focus on the barriers and facilitators for implementation of the SAFER pregnancy intervention.
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133
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van den Heuvel JFM, Ayubi S, Franx A, Bekker MN. Home-Based Monitoring and Telemonitoring of Complicated Pregnancies: Nationwide Cross-Sectional Survey of Current Practice in the Netherlands. JMIR Mhealth Uhealth 2020; 8:e18966. [PMID: 33112250 PMCID: PMC7657725 DOI: 10.2196/18966] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 05/29/2020] [Accepted: 09/03/2020] [Indexed: 01/18/2023] Open
Abstract
Background Daily monitoring of fetal and maternal conditions in complicated pregnancies leads to recurrent outpatient visits or (prolonged) hospitalization. Alternatives for hospital admissions include home-based monitoring with home visits by professionals or telemonitoring with self-measurements performed by pregnant women and uploaded for in-clinic assessment. For both alternatives, cardiotocography and blood pressure measurement can be performed at home. It is unknown to what extent, for which reasons, and for which pregnancy complications these strategies are used. Objective This study aims to assess the current practice and attitudes concerning home-based monitoring (with daily home visits by professionals) and telemonitoring (using devices and the internet for daily self-recorded measurements) in high-risk pregnancies requiring maternal and fetal monitoring in the Netherlands. Methods This nationwide cross-sectional study involved sending a web-based survey to the obstetrics departments of all 73 hospitals in the Netherlands to be answered by 1 representative dedicated to pregnancy monitoring per hospital. The primary outcome was the provision of home-based monitoring or telemonitoring using cardiotocography between 1995 and 2018. The survey further addressed perspectives regarding the use of home-based monitoring and telemonitoring, including (contra)indications, advantages, and disadvantages for pregnant women and clinicians. Results The response rate for the provision of either home-based monitoring or telemonitoring was 100%. In 2018, 38% (28/73) of centers in the Netherlands offered either home-based monitoring or telemonitoring or both to pregnant women with complications. Home-based monitoring was offered in 26% (19/73) of the centers; telemonitoring, in 23% (17/73); and both in 11% (8/73). Telemonitoring was first offered in 2009, increasing from 4% (3/73) of hospitals in 2014 to 23% (17/73) in 2018. Responses were received from 78% (57/73) of the invited hospitals and analyzed. Of all 17 centers using telemonitoring, 59% (10/17) did not investigate perinatal outcomes, safety, and patient satisfaction prior to implementation. Other (6/17, 35%) telemonitoring centers are participating in an ongoing multicenter randomized clinical trial comparing patient safety, satisfaction, and costs of telemonitoring with standard hospital admission. Home-based monitoring and telemonitoring are provided for a wide range of complications, such as fetal growth restriction, pre-eclampsia, and preterm rupture of membranes. The respondents reported advantages of monitoring from home, such as reduced stress and increased rest for patients, and reduction of admission and possible reduction of costs. The stated barriers included lack of insurance reimbursement and possible technical issues. Conclusions Home-based monitoring is provided in 26% (19/73) and telemonitoring, in 23% (17/73) of hospitals in the Netherlands to women with pregnancy complications. Altogether, 38% (28/73) of hospitals offer either home-based monitoring or telemonitoring or both as an alternative to hospital admission. Future research is warranted to assess safety and reimbursement issues before more widespread implementation of this practice.
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Affiliation(s)
| | - Samira Ayubi
- Department of Obstetrics, University Medical Center, Utrecht University, Utrecht, Netherlands
| | - Arie Franx
- Department of Obstetrics, University Medical Center, Utrecht University, Utrecht, Netherlands.,Department of Obstetrics and Gynaecology, Erasmus Medical Center, Erasmus University, Rotterdam, Netherlands
| | - Mireille N Bekker
- Department of Obstetrics, University Medical Center, Utrecht University, Utrecht, Netherlands
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134
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Torres Silva EA, Uribe S, Smith J, Luna Gomez IF, Florez-Arango JF. XML Data and Knowledge-Encoding Structure for a Web-Based and Mobile Antenatal Clinical Decision Support System: Development Study. JMIR Form Res 2020; 4:e17512. [PMID: 33064087 PMCID: PMC7600017 DOI: 10.2196/17512] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 06/24/2020] [Accepted: 08/16/2020] [Indexed: 01/30/2023] Open
Abstract
Background Displeasure with the functionality of clinical decision support systems (CDSSs) is considered the primary challenge in CDSS development. A major difficulty in CDSS design is matching the functionality to the desired and actual clinical workflow. Computer-interpretable guidelines (CIGs) are used to formalize medical knowledge in clinical practice guidelines (CPGs) in a computable language. However, existing CIG frameworks require a specific interpreter for each CIG language, hindering the ease of implementation and interoperability. Objective This paper aims to describe a different approach to the representation of clinical knowledge and data. We intended to change the clinician’s perception of a CDSS with sufficient expressivity of the representation while maintaining a small communication and software footprint for both a web application and a mobile app. This approach was originally intended to create a readable and minimal syntax for a web CDSS and future mobile app for antenatal care guidelines with improved human-computer interaction and enhanced usability by aligning the system behavior with clinical workflow. Methods We designed and implemented an architecture design for our CDSS, which uses the model-view-controller (MVC) architecture and a knowledge engine in the MVC architecture based on XML. The knowledge engine design also integrated the requirement of matching clinical care workflow that was desired in the CDSS. For this component of the design task, we used a work ontology analysis of the CPGs for antenatal care in our particular target clinical settings. Results In comparison to other common CIGs used for CDSSs, our XML approach can be used to take advantage of the flexible format of XML to facilitate the electronic sharing of structured data. More importantly, we can take advantage of its flexibility to standardize CIG structure design in a low-level specification language that is ubiquitous, universal, computationally efficient, integrable with web technologies, and human readable. Conclusions Our knowledge representation framework incorporates fundamental elements of other CIGs used in CDSSs in medicine and proved adequate to encode a number of antenatal health care CPGs and their associated clinical workflows. The framework appears general enough to be used with other CPGs in medicine. XML proved to be a language expressive enough to describe planning problems in a computable form and restrictive and expressive enough to implement in a clinical system. It can also be effective for mobile apps, where intermittent communication requires a small footprint and an autonomous app. This approach can be used to incorporate overlapping capabilities of more specialized CIGs in medicine.
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Affiliation(s)
| | - Sebastian Uribe
- Bioengineering Research Group, Universidad Pontificia Bolivariana, Medellin, Colombia
| | - Jack Smith
- Department of Microbial Pathogenesis and Immunology, Texas A&M Unversity, College Station, TX, United States
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135
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Brusniak K, Arndt HM, Feisst M, Haßdenteufel K, Matthies LM, Deutsch TM, Hudalla H, Abele H, Wallwiener M, Wallwiener S. Challenges in Acceptance and Compliance in Digital Health Assessments During Pregnancy: Prospective Cohort Study. JMIR Mhealth Uhealth 2020; 8:e17377. [PMID: 33052134 PMCID: PMC7593860 DOI: 10.2196/17377] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 07/30/2020] [Accepted: 08/10/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Pregnant women are increasingly using mobile apps to access health information during the antenatal period. Therefore, digital health solutions can potentially be used as monitoring instruments during pregnancy. However, a main factor of success is high user engagement. OBJECTIVE The aim of this study was to analyze engagement and factors influencing compliance in a longitudinal study targeting pregnant women using a digital health app with self-tracking. METHODS Digitally collected data concerning demographics, medical history, technical aspects, and mental health from 585 pregnant women were analyzed. Patients filling out ≥80% of items at every study visit were considered to be highly compliant. Factors associated with high compliance were identified using logistic regression. The effect of a change in mental and physical well-being on compliance was assessed using a one-sample t test. RESULTS Only 25% of patients could be considered compliant. Overall, 63% left at least one visit blank. Influential variables for higher engagement included higher education, higher income, private health insurance, nonsmoking, and German origin. There was no relationship between a change in the number of physical complaints or depressive symptoms and study dropout. CONCLUSIONS Maintaining high engagement with digital monitoring devices over a long time remains challenging. As cultural and socioeconomic background factors had the strongest influence, more effort needs to be directed toward understanding the needs of patients from different demographic backgrounds to ensure high-quality care for all patients. More studies need to report on compliance to disclose potential demographic bias.
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Affiliation(s)
- Katharina Brusniak
- Department of Gynecology and Obstetrics, University Hospital Heidelberg, Heidelberg, Germany
| | - Hannah Maria Arndt
- Department of Gynecology and Obstetrics, University Hospital Heidelberg, Heidelberg, Germany
| | - Manuel Feisst
- Institute of Medical Biometry and Informatics, Heidelberg University, Heidelberg, Germany
| | - Kathrin Haßdenteufel
- Department of Gynecology and Obstetrics, University Hospital Heidelberg, Heidelberg, Germany
| | - Lina Maria Matthies
- Department of Gynecology and Obstetrics, University Hospital Heidelberg, Heidelberg, Germany
| | | | - Hannes Hudalla
- Department of Neonatology, University Hospital Heidelberg, Heidelberg, Germany
| | - Harald Abele
- Department of Women's Health, University Hospital Tübingen, Tübingen, Germany.,Section of Midwifery Science, Institute for Health Sciences, University Hospital Tübingen, Tübingen, Germany
| | - Markus Wallwiener
- Department of Gynecology and Obstetrics, University Hospital Heidelberg, Heidelberg, Germany
| | - Stephanie Wallwiener
- Department of Gynecology and Obstetrics, University Hospital Heidelberg, Heidelberg, Germany
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136
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Patient Preferences for Prenatal and Postpartum Care Delivery: A Survey of Postpartum Women. Obstet Gynecol 2020; 135:1038-1046. [PMID: 32282598 DOI: 10.1097/aog.0000000000003731] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To describe patients' preferences for prenatal and postpartum care delivery. METHODS We conducted a cross-sectional survey of postpartum patients admitted for childbirth and recovery at an academic institution. We assessed patient preferences for prenatal and postpartum care delivery, including visit number, between-visit contact (eg, phone and electronic medical record portal communication), acceptability of remote monitoring (eg, weight, blood pressure, fetal heart tones), and alternative care models (eg, telemedicine and home visits). We compared preferences for prenatal care visit number to current American College of Obstetricians and Gynecologists' recommendations (12-14 prenatal visits). RESULTS Of the 332 women eligible for the study, 300 (90%) completed the survey. Women desired a median number of 10 prenatal visits (interquartile range 9-12), with most desiring fewer visits than currently recommended (fewer than 12: 63% [n=189]; 12-14: 22% [n=65]; more than 14: 15% [n=46]). Women who had private insurance or were white were more likely to prefer fewer prenatal visits. The majority of patients desired contact with their care team between visits (84%). Most patients reported comfort with home monitoring skills, including measuring weight (91%), blood pressure (82%), and fetal heart tones (68%). Patients reported that they would be most likely to use individual care models (94%), followed by pregnancy medical homes (72%) and home visits (69%). The majority of patients desired at least two postpartum visits (91%), with the first visit within 3 weeks after discharge (81%). CONCLUSION Current prenatal and postpartum care delivery does not match patients' preferences for visit number or between-visit contact, and patients are open to alternative models of prenatal care, including remote monitoring. Future prenatal care redesign will need to consider diverse patients' preferences and flexible models of care that are tailored to work with patients in the context of their lives and communities.
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137
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Abstract
In the current COVID-19 pandemic, a move towards virtual appointments has been vital. This article discusses the implementation of virtual antenatal clinics and the associated challenges
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Affiliation(s)
- Lauren Quinn
- Department of Obstetrics, University Hospitals of Leicester, Leicester
| | | | - Eamonn Breslin
- Consultant, Department of Obstetrics, University Hospitals of Leicester, Leicester
| | - Bee Tan
- Consultant, Department of Obstetrics, University Hospitals of Leicester, Leicester
| | - Humera Ansar
- Consultant, Department of Obstetrics, University Hospitals of Leicester, Leicester
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138
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Depla AL, Ernst‐Smelt HE, Poels M, Crombag NM, Franx A, Bekker MN. A feasibility study of implementing a patient-centered outcome set for pregnancy and childbirth. Health Sci Rep 2020; 3:e168. [PMID: 32607452 PMCID: PMC7317300 DOI: 10.1002/hsr2.168] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 04/30/2020] [Accepted: 05/09/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND AND AIMS Patient-reported outcome and experience measures (PROM and PREM) can facilitate shared decision making and hold potential to improve healthcare quality. However, their adoption in perinatal care is still limited. The International Consortium for Health Outcomes Measurement (ICHOM) developed a Pregnancy and Childbirth (PCB) outcome set, including PROM and PREM questionnaires. We studied the feasibility to use these PROMs/PREMs in Dutch perinatal care, addressing both women's and professionals' perspective. METHODS Patients and professionals in primary and hospital care participated. Women under care at one of five timepoints for PROM/PREM collection of the PCB set (2 during pregnancy, 3 postpartum) were e-mailed a questionnaire and discussed their answers with their obstetric professional the next regular visit. Compliance was recorded. After discussing the PROMs/PREMs, usability and experience were assessed with separate surveys amongst women and professionals. RESULTS Of 26 women approached, 21 completed and discussed their PROM/PREM questionnaire. Mean questionnaire completion rate was 97%. Average reported time completing the questionnaires was 10 minutes; most women (90%) stated this was acceptable. Women preferred completing questionnaires digitally and discuss their answers with an obstetric professional rather than other care professionals, also 6 months postpartum. Over half of women agreed PROMs/PREMs supported shared decision making (58%), ability to raise issues (60%), and patient-clinician relationship (52%). Six professionals participated: two obstetricians, two clinical midwives, and two community midwives. Most professionals experienced sufficient time to discuss the responses, except at 6 months postpartum. They knew what items to discuss but did not always feel responsible to act upon them. Professionals agreed PROMs/PREMs supported symptom detection and personalized care. CONCLUSIONS Patients and obstetric professionals consider the PCB set a feasible instrument for PROM/PREM assessment, with good compliance, acceptability and usability. Important determinants of successful implementation are a well-equipped ICT-tool, agreements regarding professionals' responsibilities and how outcomes are discussed or acted upon.
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Affiliation(s)
- Anne L. Depla
- Department of Obstetrics and Gynecology, Wilhelmina Children's HospitalUniversity Medical Center UtrechtUtrechtthe Netherlands
| | - Hiske E. Ernst‐Smelt
- Department of Obstetrics and Gynecology, Erasmus MC – Sophia Children's HospitalUniversity Medical Center RotterdamRotterdamthe Netherlands
| | - Marjolein Poels
- Department of Obstetrics and Gynecology, Wilhelmina Children's HospitalUniversity Medical Center UtrechtUtrechtthe Netherlands
| | - Neeltje M. Crombag
- Department of Development and RegenerationKU Leuven UniversityLeuvenBelgium
| | - Arie Franx
- Department of Obstetrics and Gynecology, Erasmus MC – Sophia Children's HospitalUniversity Medical Center RotterdamRotterdamthe Netherlands
| | - Mireille N. Bekker
- Department of Obstetrics and Gynecology, Wilhelmina Children's HospitalUniversity Medical Center UtrechtUtrechtthe Netherlands
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139
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Jongsma KR, van den Heuvel JFM, Rake J, Bredenoord AL, Bekker MN. User Experiences With and Recommendations for Mobile Health Technology for Hypertensive Disorders of Pregnancy: Mixed Methods Study. JMIR Mhealth Uhealth 2020; 8:e17271. [PMID: 32749225 PMCID: PMC7435610 DOI: 10.2196/17271] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 05/05/2020] [Accepted: 05/13/2020] [Indexed: 01/13/2023] Open
Abstract
Background Hypertensive disorders of pregnancy (HDP) are a primary cause of adverse maternal and neonatal outcomes worldwide. For women at risk of hypertensive complications, guidelines recommend frequent surveillance of blood pressure and signs of preeclampsia. Clinic visits range from every 2 weeks to several times a week. Given the wide ubiquity of smartphones and computers in most countries and a growing attention for self-management, digital technologies, including mobile health (mHealth), constitute a promising component of monitoring (self-measured) blood pressure during pregnancy. Currently, little is known about the experiences of women using such platforms and how mHealth can be aligned with their needs and preferences. Objective The objectives were twofold: (1) to explore the experiences of Dutch women who had an increased risk of HDP with a blended care approach (mHealth combined with face-to-face care) for remote self-monitoring of blood pressure and preeclampsia symptoms and (2) to formulate recommendations for the use and integration of mHealth in clinical care. Methods Alongside a prospective blended care study (SAFE@home study) that monitors pregnant women at increased risk of HPD with mHealth technology, a mixed methods study was conducted, including questionnaires (n=52) and interviews (n=11). Results were analyzed thematically. Results Of the 4 themes, 2 themes were related to the technologies themselves (expectations, usability), and 2 themes were related to the interaction and use of mHealth (autonomy and responsibilities of patients, responsibilities of health care professionals). First, the digital platform met the expectations of patients, which contributed to user satisfaction. Second, the platform was considered user-friendly, and patients favored different moments and frequencies for measuring their blood pressure. Third, patient autonomy was mentioned in terms of increased insight about their own condition and being able to influence clinical decision making. Fourth, clinical expertise of health care professionals was considered essential to interpret the data, which translates to subsequent responsibilities for clinical management. Data from the questionnaires and interviews corresponded. Conclusions Blended care using an mHealth tool to monitor blood pressure in pregnancy was positively evaluated by its users. Insights from participants led to 7 recommendations for designing and implementing similar interventions and to enhance future, morally sound use of digital technologies in clinical care.
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Affiliation(s)
- Karin Rolanda Jongsma
- Department of Medical Humanities, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | | | - Jasmijn Rake
- Obstetrics and Gynaecology, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Annelien L Bredenoord
- Department of Medical Humanities, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Mireille N Bekker
- Obstetrics and Gynaecology, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
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140
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Saarikko J, Niela-Vilen H, Ekholm E, Hamari L, Azimi I, Liljeberg P, Rahmani AM, Löyttyniemi E, Axelin A. Continuous 7-Month Internet of Things-Based Monitoring of Health Parameters of Pregnant and Postpartum Women: Prospective Observational Feasibility Study. JMIR Form Res 2020; 4:e12417. [PMID: 32706696 PMCID: PMC7414406 DOI: 10.2196/12417] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 02/03/2020] [Accepted: 05/14/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Monitoring during pregnancy is vital to ensure the mother's and infant's health. Remote continuous monitoring provides health care professionals with significant opportunities to observe health-related parameters in their patients and to detect any pathological signs at an early stage of pregnancy, and may thus partially replace traditional appointments. OBJECTIVE This study aimed to evaluate the feasibility of continuously monitoring the health parameters (physical activity, sleep, and heart rate) of nulliparous women throughout pregnancy and until 1 month postpartum, with a smart wristband and an Internet of Things (IoT)-based monitoring system. METHODS This prospective observational feasibility study used a convenience sample of 20 nulliparous women from the Hospital District of Southwest Finland. Continuous monitoring of physical activity/step counts, sleep, and heart rate was performed with a smart wristband for 24 hours a day, 7 days a week over 7 months (6 months during pregnancy and 1 month postpartum). The smart wristband was connected to a cloud server. The total number of possible monitoring days during pregnancy weeks 13 to 42 was 203 days and 28 days in the postpartum period. RESULTS Valid physical activity data were available for a median of 144 (range 13-188) days (75% of possible monitoring days), and valid sleep data were available for a median of 137 (range 0-184) days (72% of possible monitoring days) per participant during pregnancy. During the postpartum period, a median of 15 (range 0-25) days (54% of possible monitoring days) of valid physical activity data and 16 (range 0-27) days (57% of possible monitoring days) of valid sleep data were available. Physical activity decreased from the second trimester to the third trimester by a mean of 1793 (95% CI 1039-2548) steps per day (P<.001). The decrease continued by a mean of 1339 (95% CI 474-2205) steps to the postpartum period (P=.004). Sleep during pregnancy also decreased from the second trimester to the third trimester by a mean of 20 minutes (95% CI -0.7 to 42 minutes; P=.06) and sleep time shortened an additional 1 hour (95% CI 39 minutes to 1.5 hours) after delivery (P<.001). The mean resting heart rate increased toward the third trimester and returned to the early pregnancy level during the postpartum period. CONCLUSIONS The smart wristband with IoT technology was a feasible system for collecting representative data on continuous variables of health parameters during pregnancy. Continuous monitoring provides real-time information between scheduled appointments and thus may help target and tailor pregnancy follow-up.
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Affiliation(s)
- Johanna Saarikko
- Department of Nursing Science, University of Turku, Turku, Finland
| | | | - Eeva Ekholm
- Department of Obstetrics and Gynecology, Turku University Hospital, Turku, Finland.,Faculty of Medicine, University of Turku, Turku, Finland
| | - Lotta Hamari
- Department of Nursing Science, University of Turku, Turku, Finland.,Faculty of Communication Sciences, University of Tampere, Tampere, Finland
| | - Iman Azimi
- Department of Future Technologies, University of Turku, Turku, Finland
| | - Pasi Liljeberg
- Department of Future Technologies, University of Turku, Turku, Finland
| | - Amir M Rahmani
- School of Nursing and Department of Computer Science, University of California, Irvine, CA, United States
| | | | - Anna Axelin
- Department of Nursing Science, University of Turku, Turku, Finland
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141
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Kroenke K. Two Birds with One Stone: Joint Screening for Perinatal Depression and Anxiety. J Womens Health (Larchmt) 2020; 30:455-456. [PMID: 32721235 DOI: 10.1089/jwh.2020.8643] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Affiliation(s)
- Kurt Kroenke
- Indiana University School of Medicine and Regenstrief Institute, Indianapolis, Indiana, USA
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142
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Nakagawa K, Umazume T, Mayama M, Chiba K, Saito Y, Kawaguchi S, Morikawa M, Yoshino M, Watari H. Feasibility and safety of urgently initiated maternal telemedicine in response to the spread of COVID-19: A 1-month report. J Obstet Gynaecol Res 2020; 46:1967-1971. [PMID: 32691488 PMCID: PMC7405031 DOI: 10.1111/jog.14378] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 05/31/2020] [Accepted: 06/12/2020] [Indexed: 12/21/2022]
Abstract
Aim In Hokkaido, Japan, the number of people suffering from coronavirus disease 2019 (COVID‐19) is rapidly increased, and by the end of February 2020, there were already 70 confirmed cases of the disease. We investigated the safety of urgently initiated maternal telemedicine in preventing the spread of the coronavirus infection. Methods This retrospective, single‐institution study examined maternal telemedicine at the department of obstetrics of the Hokkaido University Hospital from March 4 to April 2, 2020. The physicians remotely examined the pregnant women from their homes using a visual communication system which kept communication confidential, performed prenatal checkup and administered medical care according to their various blood pressures, weights and cardiotocograms. Results Forty‐four pregnant women received a total of 67 telemedicine interventions. Thirty‐two pregnant women (73%) had complications, and 22 were primiparas (50%). Telemedicine interventions were provided 19 times at less than 26 weeks of gestation, 43 times between 26 and 36 weeks of gestation and 5 times after 37 weeks of gestation. There was one case with an abnormality diagnosed during the remote prenatal checkups, and the patient was hospitalized on the same day. However, there were no abnormal findings observed in mothers and children during the other 66 remote prenatal checkups and medical care. Conclusion Maternal telemedicine can be safely conducted in pregnant women who are at risk of having an underlying disorder or fetal abnormality 1 month following the start of the attempt. It should be considered as a form of maternal medical care to prevent the spread of COVID‐19.
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Affiliation(s)
- Kinuko Nakagawa
- Department of Obstetrics and Gynecology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Takeshi Umazume
- Department of Obstetrics and Gynecology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Michinori Mayama
- Department of Obstetrics and Gynecology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Kentaro Chiba
- Department of Obstetrics and Gynecology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Yoshihiro Saito
- Department of Obstetrics and Gynecology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Satoshi Kawaguchi
- Department of Obstetrics and Gynecology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Mamoru Morikawa
- Department of Obstetrics and Gynecology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Masanori Yoshino
- Center for Intellectual Property and Innovation, Hokkaido University, Sapporo, Japan
| | - Hidemichi Watari
- Department of Obstetrics and Gynecology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
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van den Heuvel JFM, Lely AT, Huisman JJ, Trappenburg JCA, Franx A, Bekker MN. SAFE@HOME: Digital health platform facilitating a new care path for women at increased risk of preeclampsia - A case-control study. Pregnancy Hypertens 2020; 22:30-36. [PMID: 32717653 DOI: 10.1016/j.preghy.2020.07.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 06/27/2020] [Accepted: 07/10/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVE In women at risk of developing preeclampsia, we evaluated the use of a digital health platform for telemonitoring blood pressure and symptoms combined with a minimal antenatal visit schedule. STUDY DESIGN A case-control study for women with chronic hypertension, history of preeclampsia, or maternal cardiac or kidney disease. A care path was designed with reduced visits enhanced with a digital platform (SAFE@HOME) for daily blood pressure and symptom monitoring starting from 16 weeks of gestation. Home-measurements were monitored in-hospital by obstetric professionals, taking actions upon alarming results. This prospective SAFE@HOME group was compared to a retrospective control group managed without self-monitoring. MAIN OUTCOME MEASURES Primary: healthcare consumption (number of antenatal visits, ultrasounds, admissions and diagnostics), user experiences of the platform. Secondary: maternal and perinatal outcomes. RESULTS Baseline characteristics of the SAFE@HOME (n = 103) and control group (n = 133) were comparable. In the SAFE@HOME group, antenatal visits (mean 13.7 vs 16.0, p < 0.001) and ultrasounds (6.3 vs 7.4, p = 0.005) were lower compared to the control group. Admissions for hypertension or suspected preeclampsia were significantly fewer in the SAFE@HOME group (2.9% versus 13.5%, p = 0.004). Telemonitoring participants were highly satisfied using the platform. No differences were observed for maternal and perinatal outcomes. CONCLUSIONS Our care path including blood pressure telemonitoring for women at risk of preeclampsia allows fewer antenatal visits, ultrasounds and hypertension-related admissions. We observed no differences in perinatal outcomes. These results suggest that telemonitoring of blood pressure is feasible in a high-risk pregnant population and has the potential to profoundly change antenatal care.
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Affiliation(s)
- Josephus F M van den Heuvel
- Department of Obstetrics and Gynaecology, University Medical Center Utrecht, Utrecht University, Lundlaan 6, 3508 AB Utrecht, the Netherlands.
| | - A Titia Lely
- Department of Obstetrics and Gynaecology, University Medical Center Utrecht, Utrecht University, Lundlaan 6, 3508 AB Utrecht, the Netherlands.
| | - Jolijn J Huisman
- Department of Obstetrics and Gynaecology, Diakonessenhuis, Bosboomstraat 1, 3582 KE Utrecht, the Netherlands.
| | - Jaap C A Trappenburg
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands.
| | - Arie Franx
- Department of Obstetrics and Gynaecology, University Medical Center Utrecht, Utrecht University, Lundlaan 6, 3508 AB Utrecht, the Netherlands; Department of Obstetrics and Gynaecology, Erasmus Medical Center, Erasmus University, Dr. Molewaterplein 40, 3015 GD Rotterdam, the Netherlands.
| | - Mireille N Bekker
- Department of Obstetrics and Gynaecology, University Medical Center Utrecht, Utrecht University, Lundlaan 6, 3508 AB Utrecht, the Netherlands.
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144
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Schramm K, Nees J, Hoffmann J, Bruckner T, Haun MW, Maatouk I, Stepan H, Schott S. Emergency consultations in obstetrics: identification of decisive, contributing and associated factors. Arch Gynecol Obstet 2020; 302:821-828. [PMID: 32607806 DOI: 10.1007/s00404-020-05662-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 06/18/2020] [Indexed: 12/01/2022]
Abstract
PURPOSE Psychosocial and biological factors influence the perception of physical changes during pregnancy. Some pregnant women present to the obstetric emergency department (ED) with diverse symptoms not requiring urgent medical action. These visits result in over-consultation, tying up resources and inflating health care expenses. This study outlines factors associated with multiple ED visits during pregnancy, measures the prevalence of anxiety and depression, and explores the choice of maternity clinic for delivery aiming to elucidate options for care strategies. METHODS This prospective, cross-sectional, questionnaire-based bicentric study was performed in the obstetric outpatient departments of two university hospitals in Germany and recruited pregnant women between 12/2016 and 11/2017. The questionnaire included socio-demographics, obstetric history, anxiety (GAD-7), depression (PHQ-9), and health status (WHO-5, SF-12). RESULTS This analysis included 496 women and showed that women with numerous ED visits were significantly younger (p < 0.0001), less educated (p = 0.0002), and more likely to be unemployed and single. Different prevalences for anxiety and depression were detected correlating with the number of ED visits although each showing only low effect sizes (0.024 resp. 0.015). CONCLUSIONS Pregnant women attending the ED more often might benefit from health education, psychosomatic interventions, and social support to overcome their depression and anxiety to avoid non-urgent ED consultations. Further prospective studies are needed to support these findings.
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Affiliation(s)
- Katharina Schramm
- Department of Gynecology and Obstetrics, University Hospital Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany.,Children's Hospital Heilbronn, SLK-Klinikum am Gesundbrunnen, Heilbronn, Germany
| | - Juliane Nees
- Department of Gynecology and Obstetrics, University Hospital Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany.
| | - Janine Hoffmann
- Department of Obstetrics, University Hospital Halle (Saale), Halle (Saale), Germany
| | - Thomas Bruckner
- Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - Markus W Haun
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg, Germany
| | - Imad Maatouk
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg, Germany
| | - Holger Stepan
- Department of Obstetrics, University Hospital Leipzig, Leipzig, Germany
| | - Sarah Schott
- Department of Gynecology and Obstetrics, University Hospital Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
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145
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Monteiro F, Pereira M, Canavarro MC, Fonseca A. Be a Mom's Efficacy in Enhancing Positive Mental Health among Postpartum Women Presenting Low Risk for Postpartum Depression: Results from a Pilot Randomized Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17134679. [PMID: 32610640 PMCID: PMC7370106 DOI: 10.3390/ijerph17134679] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 06/25/2020] [Accepted: 06/28/2020] [Indexed: 01/02/2023]
Abstract
In this study, we conducted a preliminary investigation of the efficacy of Be a Mom, a web-based self-guided intervention, in enhancing positive mental health among postpartum women at low risk for postpartum depression. Additionally, we examined Be a Mom’s efficacy regarding secondary outcomes as well as its acceptability and adherence. A total of 367 participants were randomly assigned to the Be a Mom group (n = 191) or to the waiting-list control group (n = 176) and completed baseline (T1) and postintervention (T2) assessments. The intervention group reported significant increases in positive mental health between T1 and T2 compared to the control group. Additionally, group effects were found for depressive and anxiety symptoms. A significantly higher proportion of participants in the Be a Mom group had an improvement trajectory (from not flourishing at T1 to flourishing at T2). A total of 62 (32.5%) women completed Be a Mom, and most would use it again if needed (n = 82/113; 72.6%). This study provides preliminary evidence of Be a Mom’s efficacy in increasing positive mental health among low-risk postpartum women. Our findings support mental health promotion strategies in the postpartum period and highlight the important role of web-based CBT interventions.
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146
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Li P, Luo Y, Yu X, Wen J, Mason E, Li W, Jalali MS. Patients' Perceptions of Barriers and Facilitators to the Adoption of E-Hospitals: Cross-Sectional Study in Western China. J Med Internet Res 2020; 22:e17221. [PMID: 32525483 PMCID: PMC7317627 DOI: 10.2196/17221] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 03/11/2020] [Accepted: 04/12/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND As an innovative approach to providing web-based health care services from physical hospitals to patients at a distance, e-hospitals (ie, extended care hospitals through the internet) have been extensively developed in China. This closed health care delivery chain was developed by combining e-hospitals with physical hospitals; treatment begins with web-based consultation and registration, and then, patients are diagnosed and treated in a physical hospital. This approach is promising in its ability to improve accessibility, efficiency, and quality of health care. However, there is limited research on end users' acceptance of e-hospitals and the effectiveness of strategies aimed to prompt the adoption of e-hospitals in China. OBJECTIVE This study aimed to provide insights regarding the adoption of e-hospitals by investigating patients' willingness to use e-hospitals and analyzing the barriers and facilitators to the adoption of this technology. METHODS We used a pretested self-administered questionnaire and performed a cross-sectional analysis in 1032 patients across three hierarchical hospitals in West China from June to August 2019. Patients' sociodemographic characteristics, medical history, current disease status, proficiency with electronic devices, previous experience with web-based health services, willingness to use e-hospitals, and perceived facilitators and barriers were surveyed. Multiple significance tests were employed to examine disparities across four age groups, as well as those between patients who were willing to use e-hospitals and those who were not. Multivariate logistic regression was also performed to identify the potential predictors of willingness to use e-hospitals. RESULTS Overall, it was found that 65.6% (677/1032) of participants were willing to use e-hospitals. The significant predictors of willingness to use e-hospitals were employment status (P=.02), living with children (P<.001), education level (P=.046), information technology skills (P<.001), and prior experience with web-based health care services (P<.001), whereas age, income, medical insurance, and familiarity with e-hospitals were not predictors. Additionally, the prominent facilitators of e-hospitals were convenience (641/677, 94.7%) and accessibility to skilled medical experts (489/677, 72.2%). The most frequently perceived barrier varied among age groups; seniors most often reported their inability to operate technological devices as a barrier (144/166, 86.7%), whereas young participants most often reported that they avoided e-hospital services because they were accustomed to face-to-face consultation (39/52, 75%). CONCLUSIONS We identified the variables, facilitators, and barriers that play essential roles in the adoption of e-hospitals. Based on our findings, we suggest that efforts to increase the adoption of e-hospitals should focus on making target populations accustomed to web-based health care services while maximizing ease of use and providing assistance for technological inquiries.
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Affiliation(s)
- Peiyi Li
- Institute of Hospital Management, West China Hospital of Sichuan University, Chengdu, China
| | - Yunmei Luo
- Institute of Hospital Management, West China Hospital of Sichuan University, Chengdu, China
| | - Xuexin Yu
- Biomedical Big Data Center, West China Hospital of Sichuan University, Chengdu, China
| | - Jin Wen
- Institute of Hospital Management, West China Hospital of Sichuan University, Chengdu, China
| | - Elizabeth Mason
- Massachusetts General Hospital's Institute for Technology Assessment, Harvard Medical School, Boston, MA, United States
| | - Weimin Li
- Department of Respiratory Medicine, West China Hospital of Sichuan University, Chengdu, China
| | - Mohammad S Jalali
- Massachusetts General Hospital's Institute for Technology Assessment, Harvard Medical School, Boston, MA, United States
- MIT Sloan School of Management, Massachusetts Institute of Technology, Cambridge, MA, United States
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147
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Payakachat N, Rhoads S, McCoy H, Dajani N, Eswaran H, Lowery C. Using mHealth in postpartum women with pre-eclampsia: Lessons learned from a qualitative study. Int J Gynaecol Obstet 2020; 149:339-346. [PMID: 32119129 PMCID: PMC7239748 DOI: 10.1002/ijgo.13134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 01/03/2020] [Accepted: 02/27/2020] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To explore perceptions and attitudes of postpartum women with pre-eclampsia towards remote monitoring (mHealth) and communication with the call center. METHODS A non-randomized cohort study was conducted in postpartum hypertensive women, recruited from a tertiary hospital between October 2015 and February 2016. Participants were categorized into users (using mHealth) and non-users (not using mHealth) to monitor vital signs at home over a 2-week period after discharge. Non-users were informed about functionality of mHealth. Both groups participated in a 30-minute phone interview at the end of the study. Directed content analysis of interview transcripts was conducted. RESULTS In total, 21 users and 16 non-users participated in the interview. Both groups perceived that mHealth helped manage their condition. However, non-users were concerned about the challenge of incorporating mHealth into their routine, whereas users mentioned that they liked using mHealth on a daily basis. They also stated that communication with nurses in the call center was helpful. Barriers identified by users included size of the blood pressure cuffs, size of the equipment set, wireless connection, and stress associated with mHealth monitoring. Users stated that they would have preferred using mHealth during pregnancy. CONCLUSION The findings provide useful insights to inform a successful remote monitoring program among perinatal and postpartum women.
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Affiliation(s)
- Nalin Payakachat
- Division of Pharmaceutical Evaluation and Policy, College of Pharmacy, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Sarah Rhoads
- Department of Health Promotion and Disease Prevention, College of Nursing, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Hannah McCoy
- Institute for digital Health & Innovation, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Nafisa Dajani
- Department of Obstetrics & Gynecology, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Hari Eswaran
- Institute for digital Health & Innovation, University of Arkansas for Medical Sciences, Little Rock, AR, USA
- Department of Obstetrics & Gynecology, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Curtis Lowery
- Institute for digital Health & Innovation, University of Arkansas for Medical Sciences, Little Rock, AR, USA
- Department of Obstetrics & Gynecology, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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Dol J, Tomblin Murphy G, Aston M, McMillan D, Campbell-Yeo M. Design, development and usability testing of Essential Coaching for Every Mother: A postnatal text message educational intervention. Women Birth 2020; 34:e228-e236. [PMID: 32475782 DOI: 10.1016/j.wombi.2020.05.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 04/10/2020] [Accepted: 05/18/2020] [Indexed: 01/15/2023]
Abstract
BACKGROUND The transition to motherhood is an exciting yet challenging period that requires physical, emotional, and social adjustment. During the postpartum period, mothers require support and information to ensure a smooth transition and adjustment to motherhood. One innovative strategy to provide mothers with this information is mobile health (mHealth), and specifically, text messaging. OBJECTIVE To describe the design, development and usability testing of a postnatal text message intervention called Essential Coaching for Every Mother. METHODS First time mothers (n=11) and postpartum healthcare providers (n=18) were involved in iterative interviewing in Halifax, Canada. Adaption of content occurred through three rounds of user testing using semi-structured interviews. The Information Assessment Method (IAM) Parents survey was also completed by mothers. RESULTS Three cycles of iterative testing were conducted with eight participants (3 mothers, 5 healthcare providers), thirteen participants (8 mothers, 5 healthcare providers) and 8 participants (8 healthcare providers), respectively. Messages evolved from risk-focused to prevention and education focused. Mothers felt the messages addressed their needs and healthcare providers ensured the content was consistent with the messaging currently provided to postpartum mothers. CONCLUSION Essential Coaching for Every Mother is the first postnatal educational text message intervention developed for mothers in Halifax, Canada. We sought to involve first time mothers (end-users) and postpartum healthcare providers (experts) in the development and usability evaluation to ensure the intervention adequately met needs and was consistent with current practices related to postpartum education.
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Affiliation(s)
- Justine Dol
- Faculty of Health, Dalhousie University, Halifax, NS, Canada.
| | | | - Megan Aston
- School of Nursing, Faculty of Health, Dalhousie University, Halifax, NS, Canada
| | - Douglas McMillan
- Division of Neonatal Perinatal Medicine, Department of Pediatrics, Faculty of Medicine, Dalhousie University and IWK Health Centre, Halifax, NS, Canada
| | - Marsha Campbell-Yeo
- School of Nursing, Faculty of Health, Dalhousie University, Halifax, NS, Canada; Division of Neonatal Perinatal Medicine, Department of Pediatrics, Faculty of Medicine, Dalhousie University and IWK Health Centre, Halifax, NS, Canada
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149
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Laureij LT, Breunis LJ, Steegers-Theunissen RPM, Rosman AN. Identifying the Needs for a Web-Based Postpartum Platform Among Parents of Newborns and Health Care Professionals: Qualitative Focus Group Study. JMIR Form Res 2020; 4:e16202. [PMID: 32452805 PMCID: PMC7284398 DOI: 10.2196/16202] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 02/03/2020] [Accepted: 02/24/2020] [Indexed: 01/01/2023] Open
Abstract
Background During the turbulent postpartum period, there is an urgent need by parents for support and information regarding the care for their infant. In the Netherlands, professional support is provided during the first 8 days postpartum and for a maximum of 8 hours a day. This care is delivered by maternity care assistants (MCAs). Despite the availability of this extensive care, a majority of women prefer to make use of a lesser amount of postpartum care. After this period, access to care is less obvious. Where parents are automatically offered care in the first 8 days after birth, they must request care in the period thereafter. To compensate for a possible gap in information transfer, electronic health (eHealth) can be a valuable, easily accessible addition to regular care. Objective We explored the needs and preferred content by new parents and health care professionals of a web-based platform dedicated to the postpartum period and identified barriers and facilitators for using such a platform. Methods We conducted 3 semistructured focus groups among (1) parents of newborns, (2) MCAs, and (3) clinicians and administrators in maternity care. A topic list based on a framework designed for innovation processes was used. Thematic content analysis was applied. Results In the focus group for parents, 5 mothers and 1 male partner participated. A total of 6 MCAs participated in the second focus group. A total of 5 clinicians and 2 administrators—a member of a stakeholder party and a manager of a maternity care organization—participated in the third focus group. All user groups underlined that a platform focusing on the postpartum period was missing in current care, especially by parents experiencing a gap following the intensive care ending after the first week of childbirth. Parents indicated that they would perceive a postpartum platform as a proper source of reliable information on topics regarding breastfeeding, growth, and developmental milestones, but also as a tool to support them in seeking care with appropriate professionals. They also emphasized the need to receive personalized information and the opportunity to ask questions via the platform. MCAs acknowledged added value of providing additional information on topics that they address during the early postpartum period. MCAs as well as clinicians and administrators would guide parents to such a platform for additional support. All user groups experienced disadvantages of using an authentication procedure and filling out extra questionnaires to receive tailored information. Conclusions Our research shows that parents of newborns, MCAs, and clinicians and administrators foresee the additional value of a web-based postpartum platform for at least the whole postpartum period. The platform should be easily accessible and personalized. Content on the platform should contain information regarding breastfeeding, growth, and developmental milestones. A chat function with professionals could be considered as an option.
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Affiliation(s)
- Lyzette T Laureij
- Department of Obstetrics and Gynecology, Sophia Children's Hospital, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Leonieke J Breunis
- Department of Obstetrics and Gynecology, Sophia Children's Hospital, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Regine P M Steegers-Theunissen
- Department of Obstetrics and Gynecology, Sophia Children's Hospital, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Ageeth N Rosman
- Department of Obstetrics and Gynecology, Sophia Children's Hospital, Erasmus University Medical Center, Rotterdam, Netherlands.,Department of Health Care Studies, Rotterdam University of Applied Sciences, Rotterdam, Netherlands
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Mhajna M, Schwartz N, Levit-Rosen L, Warsof S, Lipschuetz M, Jakobs M, Rychik J, Sohn C, Yagel S. Wireless, remote solution for home fetal and maternal heart rate monitoring. Am J Obstet Gynecol MFM 2020; 2:100101. [DOI: 10.1016/j.ajogmf.2020.100101] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 02/19/2020] [Accepted: 03/07/2020] [Indexed: 12/11/2022]
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