Intervention among new parents followed up by an interview study exploring their experiences of telemedicine after early postnatal discharge

The effect of telecounseling on depression in primiparous mothers during the postpartum period: A randomized controlled trial

Postpartum depression is one of the most common mental health disorders in women after giving birth. This study was conducted to examine the effect of telecounseling support on depression in primiparous mothers. This study was conducted as a randomized controlled trial with a parallel group pretest-posttest design. The study comprised 50 participants each in the intervention and control groups. Face-to-face interviews were conducted with all participants, and the Maternal Information Form and the Edinburgh Postpartum Depression Scale (EPDS) were administered. The intervention group received telecounseling for 6 weeks, while the control group received routine postnatal care. After the 6-week period, EPDS was re-administered to both groups. In the intervention group, the EPDS mean score decreased from 7.12 ± 3.96 to 6.34 ± 3.73 after telecounseling (p < 0.001). Conversely, in the control group, the EPDS mean score increased from 6.62 ± 3.55 to 7.90 ± 4.65 without any intervention (p = 0.002). The results indicate that telecounseling is an effective method for reducing the risk of depression among mothers during the postpartum period. It is recommended that healthcare professionals extend their support by providing telecounseling for mothers.

Examining the Perceptions of mHealth on Racial and Ethnic Disparities in Postpartum Health for Black Women: A Scoping Review

Background. Several disparities exist for Black mothers during the postpartum period, including but not limited to increased maternal mortality and morbidity rates, decreased access to care, and limited access to resources. Given the racial discrepancies in attention to postpartum care, coupled with the critical importance of the postpartum period for preventing adverse maternal health outcomes, research is warranted to explore how mobile health (mHealth) applications may help to alleviate maternal health disparities by optimizing postpartum care and addressing barriers to care for postpartum Black women. Thus, this review examines the perceptions of mHealth applications and their utility in health outcomes among postpartum Black women. Methods. We undertook a comprehensive literature search using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. We included peer-reviewed articles published between 2010 and 2022 that were written in English, utilized mHealth as a primary intervention, and focused on postpartum health and access to resources, primarily among Black women in the United States. Results. A total of eight articles were included in our synthesis, encompassing mobile phone-based interventions for Black women. Cultural tailoring was included in five studies. Interventions that incorporated tailored content and fostered interactions reported high rates of follow-up. Conclusions. Tailored mHealth interventions can effectively promote behavior change and improve health care outcomes for Black women. However, there is a critical need for more research to assess user engagement and retention and whether these improvements indicate long-term sustainability.

Patient Perspectives on Communication Pathways After Orthopedic Surgery and Discharge and Evaluation of Team-Based Digital Communication: Qualitative Exploratory Study

BACKGROUND

The transition from hospital to home after orthopedic surgery requires smooth communication and coordination between patients and their team of care to avoid fragmented care pathways. Digital communication is increasingly being used to facilitate easy and accessible asynchronous communication between patients and health care professionals across settings. A team-based approach to digital communication may provide optimized quality of care in the postoperative period following orthopedic surgery and hospital discharge.

OBJECTIVE

This study was divided into two phases that aimed to (1) explore the perspectives of patients undergoing orthopedic surgery on current communication pathways at a tertiary hospital in Denmark and (2) test and explore patients' experiences and use of team-based digital communication following hospital discharge (eDialogue).

METHODS

A triangulation of qualitative data collection techniques was applied: document analysis, participant observations (n=16 hours), semistructured interviews with patients before (n=31) and after (n=24) their access to eDialogue, and exploration of use data.

RESULTS

Findings show that patients experience difficult communication pathways after hospital discharge and a lack of information due to inadequate coordination of care. eDialogue was used by 84% (26/31) of the patients, and they suggested that it provided a sense of security, coherence, and proximity in the aftercare rearranging communication pathways for the better. Specific drivers and barriers to use were identified, and these call for further exploration of eDialogue.

CONCLUSIONS

In conclusion, patients evaluated eDialogue positively and suggested that it could support them after returning home following orthopedic surgery.

Health Care Professionals' Perspectives Before and After Use of eDialogue for Team-Based Digital Communication Across Settings: Qualitative Study

BACKGROUND

Orthopedic surgical treatment is a transversal task that requires the active involvement of patients, relatives, and health care professionals (HCPs) across various settings. However, after hospital discharge, communication is challenged and undertaken primarily by phone. New digital communication solutions have the potential to create a space for seamless and patient-centered dialogue across discipline and sector boundaries. When evaluating new communication solutions, knowledge about HCPs' needs and perspectives of use must be explored, as it is they who are responsible for implementing changes in practice.

OBJECTIVE

This study aimed to (1) investigate HCPs' perceptions of current communication pathways (phase 1) and (2) explore their experiences of using a simple messenger-like solution (eDialogue) for team-based digital communication across settings (phase 2).

METHODS

We used a triangulation of qualitative data collection techniques, including document analysis, observations, focus groups, and individual interviews of HCPs before (n=28) and after (n=12) their use of eDialogue. Data collection and analysis were inspired by the Consolidated Framework for Implementation Research (CFIR) to specifically understand facilitators and barriers to implementation as perceived by HCPs.

RESULTS

HCPs perceive current communication pathways as insufficient for both patients and themselves. Phone calls are disruptive, and there is a lack of direct communication modalities when communication crosses sector boundaries. HCPs experienced the use of eDialogue as a quick and easy way for timely interdisciplinary interaction with patients and other HCPs across settings; however, concerns were raised about time consumption.

CONCLUSIONS

eDialogue can provide needed support for interdisciplinary and cross-sectoral patient-centered communication. However, future studies of this solution should address its impact and the use of resources.

Postnatal Care: A Comparative Review of Guidelines

Importance

Postnatal care refers to the ongoing health care provision of both the mother and her offspring and contributes to the timely identification and effective management of complications in the postpartum period, to secure maternal and infant short- and long-term well-being.

Objective

The aim of this study was to review and compare the most recently published influential guidelines on postnatal care practices.

Evidence Acquisition

A comparative review of guidelines from the American College of Obstetricians and Gynecologists, the World Health Organization, the National Institute for Health and Care Excellence, and the Public Health Agency of Canada regarding postnatal care was conducted.

Results

There is a consensus among the reviewed guidelines regarding the importance of health care provision in the postpartum period, including home visits and midwifery services, the use of telemedicine for the facilitation of communication with the patient, and the appropriate preparation for discharge, as well as the discharge criteria. All medical societies also agree on the clinical aspects that should be evaluated at each postnatal visit, although discrepancies exist with regard to the contact schedule. In addition, there is consistency regarding the management of postpartum infections, perineal pain, fecal and urinary incontinence, and physical activity guidance. Mental health issues should be addressed at each postnatal visit, according to all guidelines, but there is disagreement regarding routine screening for depression. As for the optimal interpregnancy interval, the American College of Obstetricians and Gynecologists recommends avoiding pregnancy for at least 6 months postpartum, whereas the National Institute for Health and Care Excellence recommends a 12-month interval. There is no common pathway regarding the recommended contraceptive methods, the nutrition guidance, and the postpartum management of pregnancy complications. Of note, the World Health Organization alone provides recommendations concerning the prevention of specific infections during the postnatal period.

Conclusions

Postnatal care remains a relatively underserved aspect of maternity care, although the puerperium is a critical period for the establishment of motherhood and the transition to primary care. Thus, the development of consistent international protocols for the optimal care and support of women during the postnatal period seems of insurmountable importance to safely guide clinical practice and subsequently reduce maternal and neonatal morbidity.

Parental satisfaction with paediatric care with and without the support of an eHealth device: a quasi-experimental study in Sweden

BACKGROUND

The period after a child is discharged from hospital is generally described as challenging for the parents. Their satisfaction with the health services received is an important indicator of the quality of care. eHealth devices are increasingly used in health care to support communication with parents. Differences in levels of parental satisfaction by modality of provided care or by parental background are largely unknown. This study aimed to describe satisfaction with health care between sociodemographic groups of parents, who either received or did not receive an eHealth device for communication between parents and hospital staff as a supplement to routine care after a child's discharge from neonatal or paediatric surgery departments.

METHODS

Data from a quasi-experimental study was collected in the south of Sweden, between 2019 and 2021. The Pediatric Quality of Life Inventory™ (PedsQL) Healthcare Satisfaction Generic Module was used to assess the parents' satisfaction with different dimensions of health care. Seventy parents of children hospitalized in a neonatal or a paediatric surgery department were enrolled in intervention (eHealth device, n = 36) and control (no eHealth device, n = 34) groups.

RESULTS

The parents reported high overall satisfaction with the health care provided and were also highly satisfied within different dimensions of care. Moreover, they reported high satisfaction with using an eHealth device, although having support from the eHealth device was related to neither higher nor lower levels of satisfaction with care. There was a significant difference between fathers and mothers in the multivariate sub-analysis in certain instances regarding satisfaction with communication and the level of inclusion.

CONCLUSIONS

Parents were very satisfied with the health care provided, whether or not they received eHealth. Further research looking at groups with and without the support of an eHealth device is required to further develop future paediatric and neonatal care interventions. Communication and support through eHealth can be a tool to alleviate the distress parents experience after their child's hospital admission, accommodate the family's transfer to home, and increase satisfaction with care, but it needs to be evaluated before being implemented.

TRIAL REGISTRATION

Clinical Trials NCT04150120, first registration 4/11/2019.

Effectiveness of a breastfeeding promotion intervention model based on Society ecosystems Theory for maternal women: a study protocol of randomized controlled trial

BACKGROUND

Breastfeeding is recognized internationally as the most scientific and effective way to feed infants and young children. According to the World Health Organization in 2022, the exclusive breastfeeding rate within 6 months is 34.1% in China, which is still far from the goal of "more than 60% exclusive breastfeeding rate of infants within 6 months" by 2030 required by China's State Council. It is necessary to promote breastfeeding and provide maternal breastfeeding guidance to increase exclusive breastfeeding. Factors influencing breastfeeding can be explained by the society ecosystems theory, distributed in macro, mezzo and micro systems. The interventions focused on breastfeeding promotion are mainly carried out in the health systems and services, home and family environment, community environment, work environment, policy environment or a combination of these facilities. But there is sparse research on integrating resources in the macro, mezzo and micro systems of maternal breastfeeding processes to promote breastfeeding behavior. A randomized controlled trial will test the effect of a breastfeeding promotion intervention model based on the society ecosystems theory versus usual prenatal and postnatal care on maternal and infant health and the exclusive breastfeeding rate at 6 months.

METHODS/DESIGN

The study is a single-blind, parallel design, randomized controlled trial with an intervention group (n = 109) and a control group (n = 109) that compares the effect of a breastfeeding promotion intervention model based on the society ecosystems theory with usual prenatal and postnatal care. The intervention covers macro- (policy, culture), mezzo- (family-hospital-community) and micro- (biological, psychological and social) systems of the maternal breastfeeding process. Infant feeding patterns, neonatal morbidity and physical and mental health of antenatal and postpartum women will be collected at baseline (28 to 35 weeks of gestation), 1-, 4-, and 6-month postpartum.

DISCUSSION

This is a multifaceted, multifactorial, and multi-environmental breastfeeding promotion strategy to help mothers and their families learn breastfeeding knowledge and skills. The study provides a new modality for adding breastfeeding interventions to prenatal and postnatal care for healthcare providers in the hospital and the community.

TRIAL REGISTRATION

Chinese Clinical Trial Registry at www.chictr.org.cn , ChiCTR2300075795.

Strategies to improve interpersonal communication along the continuum of maternal and newborn care: A scoping review and narrative synthesis

Effective interpersonal communication is essential to provide respectful and quality maternal and newborn care (MNC). This scoping review mapped, categorized, and analysed strategies implemented to improve interpersonal communication within MNC up to 42 days after birth. Twelve bibliographic databases were searched for quantitative and qualitative studies that evaluated interventions to improve interpersonal communication between health workers and women, their partners or newborns' families. Eligible studies were published in English between January 1st 2000 and July 1st 2020. In addition, communication studies in reproduction related domains in sexual and reproductive health and rights were included. Data extracted included study design, study population, and details of the communication intervention. Communication strategies were analysed and categorized based on existing conceptualizations of communication goals and interpersonal communication processes. A total of 138 articles were included. These reported on 128 strategies to improve interpersonal communication and were conducted in Europe and North America (n = 85), Sub-Saharan Africa (n = 12), Australia and New Zealand (n = 10), Central and Southern Asia (n = 9), Latin America and the Caribbean (n = 6), Northern Africa and Western Asia (n = 4) and Eastern and South-Eastern Asia (n = 2). Strategies addressed three communication goals: facilitating exchange of information (n = 97), creating a good interpersonal relationship (n = 57), and/or enabling the inclusion of women and partners in the decision making (n = 41). Two main approaches to strengthen interpersonal communication were identified: training health workers (n = 74) and using tools (n = 63). Narrative analysis of these interventions led to an update of an existing communication framework. The categorization of different forms of interpersonal communication strategy can inform the design, implementation and evaluation of communication improvement strategies. While most interventions focused on information provision, incorporating other communication goals (building a relationship, inclusion of women and partners in decision making) could further improve the experience of care for women, their partners and the families of newborns.

Digital solutions to follow up on discharged new parents-A systematic literature review

New parents and their newborns are followed up after discharge either through home visits from midwives/nurses or using information and communication technology. This follow-up focuses on individual needs related to breastfeeding and infant feeding, practical advice on caring for babies, supporting and strengthening the new mother's knowledge and self-confidence concerning child development and parenting skills, and supporting the relationship between parents and baby. This systematic review aims to integrate available research results that describe new parents' experiences when health and care providers used telemedicine as a platform for follow-up after discharge from the childbirth department. This literature review was conducted following the PRISMA statement and was prospectively registered in PROSPERO CRD42021236912. The studies were identified through the following databases: AMED, Academic, EMBASE, Google Scholar, Ovid MEDLINE via PubMed, Cochrane database, and CINAHL. Results from these studies were compiled using thematic analysis. A total of 886 studies were identified. Screening resulted in eight studies that met the inclusion criteria. Thematic analysis produced the following themes: a) Flexibility and convenience of digital support, b) Digital literacy, c) Parents feeling safe with digital support, and d) Adequate substitute for physical meetings. New parents who live in a home environment with a relaxed atmosphere and around-the-clock digital support experience a sense of control, security, full attention, and encouragement. Digital follow up at home has proven effective because it can meet the support needs of new parents when necessary.

Factors that influence the uptake of postnatal care from the perspective of fathers, partners and other family members: a qualitative evidence synthesis

BACKGROUND

Postnatal care (PNC) is a key component of maternity provision and presents opportunities for healthcare providers to optimise the health and well-being of women and newborns. However, PNC is often undervalued by parents, family members and healthcare providers. As part of a larger qualitative review exploring the factors that influence PNC uptake by relevant stakeholders, we examined a subset of studies highlighting the views of fathers, partners and family members of postpartum women.

METHODS

We undertook a qualitative evidence synthesis using a framework synthesis approach. We searched multiple databases and included studies with extractable qualitative data focusing on PNC utilisation. We identified and labelled a subset of articles reflecting the views of fathers, partners and other family members. Data abstraction and quality assessment were carried out using a bespoke data extraction form and established quality assessment tools. The framework was developed a priori based on previous research on the topic and adapted accordingly. Findings were assessed for confidence using the GRADE-CERQual approach and are presented by country income group.

RESULTS

Of 12 678 papers identified from the original search, 109 were tagged as 'family members views' and, of these, 30 were eligible for this review. Twenty-nine incorporated fathers' views, 7 included the views of grandmothers or mothers-in-law, 4 incorporated other family member views and 1 included comothers. Four themes emerged: access and availability; adapting to fatherhood; sociocultural influences and experiences of care. These findings highlight the significant role played by fathers and family members on the uptake of PNC by women as well as the distinct concerns and needs of fathers during the early postnatal period.

CONCLUSION

To optimise access to postnatal care, health providers should adopt a more inclusive approach incorporating flexible contact opportunities, the availability of more 'family-friendly' information and access to psychosocial support services for both parents.

Impact of Mobile Technology-Enhanced Follow-Up Program for Mothers with New-Born Babies on Mothers' Anxiety, Self-Efficacy, and Infant Health

To explore the effects of mobile technology-enhanced interventions on mothers' self-efficacy, anxiety, and infant health. Quasi-experimental study. The intervention group (n=30) received mobile technology-enhanced nursing care, whereas the control group (n=30) used the hospital's routine maintenance services. Mothers' self-efficacy significantly improved, and anxiety and infant health problems (poor sucking, umbilical cord infection, and skin lesions) significantly decreased (p<0.05) in the intervention group. Mobile technology-enhanced nursing care improved self-efficacy, decreased mothers' anxiety levels, and reduced infant health problems. Mobile technology-enhanced nursing care can be integrated into clinical practice to improve maternal and infant health.

Discharge time after birth is associated with parity - A retrospective cohort study

Background

All healthy mothers with uncomplicated births are recommended to be discharged directly from the labour ward a few hours after birth as a change in practice in three hospitals in Denmark. However, despite this practice, there is limited knowledge about when mothers leave the hospital after birth in clinical practice.

Objective

The aim of this study is to examine 1) when mothers are discharged from hospital after birth, 2) if discharge time from the hospital after birth is associated with parity, and 3) which factors are associated with discharge time.

Methods

This retrospective study is based on data from the North Denmark Regional Hospital and included mothers giving vaginal birth from March 25, 2019 to April 10, 2021.

Results

A total of 1990 mothers were included. Nearly 50% of the new mothers stayed at the hospital less than 6 h after birth (26% of primiparous women vs 64% of multiparous women). Primiparous women had an adjusted RR 0.44 (95% CI 0.39-0.49) for discharge ≤6 h, RR 1.71 (95% CI 1.15-2.54) for discharge >6-12 h, and RR 3.76 (95% CI 3.03-4.67) for discharge >48 h after birth compared to multiparous women. Multiparous women's adjusted RR for discharge >6-12 h was 0.15 (95% CI 0.12-0.20) and for discharge >48 h 0.16 (95% CI 0.14-0.20) compared to discharge less than 6 h after birth. Furthermore, smoking, low education level, and younger age were associated with early discharge.

Conclusion

There is a significant association with parity and discharge time after birth and factors related to discharge time which healthcare professionals should be aware of when planning inpatient and outpatient care. In addition, healthcare professionals should be aware of mothers discharged early who are smoking, of younger age, lower education level or multiparity.

Society for Maternal-Fetal Medicine Special Statement: Telemedicine in obstetrics-quality and safety considerations

The frequency of telemedicine encounters has increased dramatically in recent years. This review summarizes the literature regarding the safety and quality of telemedicine for pregnancy-related services, including prenatal care, postpartum care, diabetes mellitus management, medication abortion, lactation support, hypertension management, genetic counseling, ultrasound examination, contraception, and mental health services. For many of these, telemedicine has several potential or proven benefits, including expanded patient access, improved patient satisfaction, decreased disparities in care delivery, and health outcomes at least comparable to those of traditional in-person encounters. Considering these benefits, it is suggested that payers should reimburse providers at least as much for telemedicine as for in-person services. Areas for future research are considered.

Policy measures to expand home visiting programs in the postpartum period

The postpartum period is characterized by a myriad of changes-emotional, physical, and spiritual; whilst the psychosocial health of new parents is also at risk. More alarmingly, the majority of pregnancy-related deaths in the U.S. occur during this critical period. The higher maternal mortality rate is further stratified by dramatic racial and ethnic variations: Black, brown, and American Indian/Alaska Native indigenous people have 3-4x higher rates of pregnancy-related deaths and severe morbidity than their White, non-Hispanic, and Asian/Pacific Islander counterparts. This policy brief explores how expanding evidence based home visiting programs (HVPs) and strengthening reimbursement policies that invest in such programs can be pivoted to optimize the scope of care in the postpartum period.

The effect of the Ebe Evimde application on the self-efficacy and anxiety levels of mothers: Randomized controlled trial

Objective

Family health can be improved by making home visits with mobile applications. This study was carried out to evaluate the effect of a mobile application and web-based software called Ebe Evimde (My Home Midwife), which was designed by the researchers for use in the postpartum period, on mothers' self-efficacy and anxiety levels.

Methods

Home visits to 60 mothers in the intervention group, who are over 18 years of age, who have given birth at term, who have no complications in mother and baby, and who are in the second to fifth postpartum days, were made with the online home visits mobile support application Midwifery Home software and their self-efficacy and anxiety levels were evaluated. Mothers were divided into two groups as intervention (60) and control group (60) using a random number table.

Results

While there was a significant difference between the pretest and posttest self-efficacy levels of the intervention group, there was no difference between the pretest and posttest self-efficacy levels of the control group. When the groups obtained from the Postpartum Specific Anxiety Scale were examined, it was seen that there was a negative and very strong significant relationship between the pretest and posttest scores of the mothers in the intervention group, while when the relationship between the pretest and posttest scores of the mothers in the control group was examined; no significant relationship was observed.

Conclusion

The practice of Ebe Evimde (My Home Midwife) had a positive effect on mothers' self-efficacy and postpartum anxiety levels.

Scoping review protocol to map the use of text-based two-way communication between patients and healthcare professionals after hospital discharge and identify facilitators and barriers to implementation

INTRODUCTION

After discharge, patients face multiple risks where timely communication with healthcare professionals is required. eHealth has proposed new possibilities for asynchronous text-based two-way communication between patients and healthcare professionals during this time, and studies show positive effects on clinical outcomes, care coordination and patient satisfaction. However, there are challenges to the adoption of text-based two-way communication, potentially undermining the positive effects in clinical practice. Knowledge of these factors may inform future research and implementations. No reviews have provided an overview of the use of text-based two-way communication after discharge and the identified facilitators and barriers. Therefore, the objective of this scoping review is to systematically identify and map available research that assess the use of text-based two-way communication between patients and healthcare professionals after hospital discharge, including facilitators and barriers to implementation.

METHODS AND ANALYSIS

We will include all studies describing the use of text-based two-way communication between patients and healthcare professionals after discharge from hospital. A preliminary search of PubMed (PubMed.gov), EMBASE (Elsevier), CINAHL (EBSCO), PsycINFO (Ovid), Cochrane Library (Wiley), Web of Science (Clarivate) and Scopus (Elsevier) was undertaken on 9 November 2021. The search will be updated for the full scoping review, and reference lists of relevant papers reviewed. Two reviewers will independently screen the literature for inclusion. Data will be extracted and charted in accordance with a data extraction form developed from the research questions and inspired by Consolidated Framework Implementation Research. Findings will be presented in tabular format and a descriptive summary, and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews checklist.

ETHICS AND DISSEMINATION

This scoping review will not require ethics approval. The dissemination strategy involves peer review publication and presentation at conferences.

Views and needs of people who at high-risk of gestational diabetes mellitus for the development of mobile health applications: A descriptive qualitative research (Preprint)

Background

Early prevention of gestational diabetes mellitus (GDM) can reduce the incidence of not only GDM, but also adverse perinatal pregnancy outcomes. Moreover, it is of great significance to prevent or reduce the occurrence of type 2 diabetes. Mobile health (mHealth) apps can help pregnant women effectively prevent GDM by providing risk prediction, lifestyle support, peer support, professional support, and other functions. Before designing mHealth apps, developers must understand the views and needs of pregnant women, and closely combine users’ needs to develop app functions, in order to better improve user experience and increase the usage rate of these apps in the future.

Objective

The objective of this study was to understand the views of the high-risk population of gestational diabetes mellitus on the development of mobile health apps and the demand for app functions, so as to provide a basis for the development of gestational diabetes mellitus prevention apps.

Methods

Fifteen pregnant women with at least one risk factor for gestational diabetes were recruited from July to September 2021, and were interviewed via a semistructured interview using the purpose sampling method. The transcribed data were analyzed by the traditional content analysis method, and themes were extracted.

Results

Respondents wanted to develop user-friendly and fully functional mobile apps for the prevention of gestational diabetes mellitus. Pregnant women's requirements for app function development include: personalized customization, accurate information support, interactive design, practical tool support, visual presentation, convenient professional support, peer support, reasonable reminder function, appropriate maternal and infant auxiliary function, and differentiated incentive function.These function settings can encourage pregnant women to improve or maintain healthy living habits during their use of the app

Conclusions

This study discusses the functional requirements of target users for gestational diabetes mellitus prevention apps, which can provide reference for the development of future applications.

Development of a Supportive Parenting App to Improve Parent and Infant Outcomes in the Perinatal Period: Development Study

Background

The transition to parenthood can be challenging, and parents are vulnerable to psychological disorders during the perinatal period. This may have adverse long-term consequences on a child’s development. Given the rise in technology and parents’ preferences for mobile health apps, a supportive mobile health intervention is optimal. However, there is a lack of a theoretical framework and technology-based perinatal educational intervention for couples with healthy infants.

Objective

The aim of this study is to describe the Supportive Parenting App (SPA) development procedure and highlight the challenges and lessons learned.

Methods

The SPA development procedure was guided by the information systems research framework, which emphasizes a nonlinear, iterative, and user-centered process involving 3 research cycles—the relevance cycle, design cycle, and rigor cycle. Treatment fidelity was ensured, and team cohesiveness was maintained using strategies from the Tuckman model of team development.

Results

In the relevance cycle, end-user requirements were identified through focus groups and interviews. In the rigor cycle, the user engagement pyramid and well-established theories (social cognitive theory proposed by Bandura and attachment theory proposed by Bowlby) were used to inform and justify the features of the artifact. In the design cycle, the admin portal was developed using Microsoft Visual Studio 2017, whereas the SPA, which ran on both iOS and Android, was developed using hybrid development tools. The SPA featured knowledge-based content, informational videos and audio clips, a discussion forum, chat groups, and a frequently asked questions and expert advice section. The intervention underwent iterative testing by a small group of new parents and research team members. Qualitative feedback was obtained for further app enhancements before official implementation. Testing revealed user and technological issues, such as web browser and app incompatibility, a lack of notifications for both administrators and users, and limited search engine capability.

Conclusions

The information systems research framework documented the technical details of the SPA but did not take into consideration the interpersonal and real-life challenges. Ineffective communication between the health care research team and the app developers, limited resources, and the COVID-19 pandemic were the main challenges faced during content development. Quick adaptability, team cohesion, and hindsight budgeting are crucial for intervention development. Although the effectiveness of the SPA in improving parental and infant outcomes is currently unknown, this detailed intervention development study highlights the key aspects that need to be considered for future app development.

Early discharge of first-time parents and their newborn: A scoping review

INTRODUCTION

This scoping review aims to identify the evidence and the factors influencing the outcomes of early discharge of both healthy first-time mothers and newborns.

METHODS

Systematic searches were conducted using four databases up to February 2021, and a search for grey literature was performed. A total of 2030 articles were identified and reduced to 13 articles, and one article was added through chain search in reference lists. The aims of the identified studies, the methodology, participants, inclusion and exclusion criteria, and the setting, context, and findings are summarized.

RESULTS

A total of 14 studies were included. A thematic analysis identified the following factors influencing the outcomes of discharge within 24 hours after birth: parental education in pregnancy, perinatal information before discharge, sources of support, and follow-up strategies after discharge. Also, the analysis identified outcomes such as breastfeeding, parents' experience and readmission of the newborn that may be influenced when first-time parents are discharged within 24 hours after birth. Findings in this review highlight the importance of identifying factors and outcomes related to early discharge. However, because of the heterogeneity in methodology, terminology and assessment procedures used in the retrieved articles, the generalization of study results is limited.

CONCLUSIONS

A gap in the literature about the outcomes of discharge within 24 hours after birth has been identified. Future studies with strong evidence are needed, defining criteria, context, and intervention.

A Nurse-Navigated, Postpartum Support Text Messaging Intervention: Satisfaction Among Primiparous Women

More than 50% of maternal deaths in the United States occur during the first year following childbirth. Nearly 40% of these deaths occur between days 1 and 41 of the postpartum period. Historically, women receive less attention from healthcare providers during the postpartum period when compared with the care provided during pregnancy and childbirth. Women may not return for scheduled follow-up care until 4 to 6 weeks after birth, if they return at all. The role of postpartum nurse navigator (PPNN) was developed to deliver a novel, text messaging intervention as part of a randomized controlled trial to 43 primiparous women who experienced an unplanned cesarean birth. Through daily, interactive text messaging, the PPNN assessed study participants' general well-being, assisted with symptom navigation, offered anticipatory guidance, and provided informational support until 4 weeks postpartum. Satisfaction with the intervention was evaluated using a survey that incorporated quantitative and qualitative responses. Overwhelmingly, 93% of participants rated their overall experience with the text messaging intervention as outstanding or good. At least 95% of the participants indicated that they would likely choose to receive daily text messaging from a PPNN following a subsequent birth. Convenient access to professional nurse support for women postbirth warrants further evaluation.

The development of the postpartum mobile support application and the effect of the application on mothers' anxiety and depression symptoms

OBJECTIVE

The study aimed to develop the postpartum mobile support application to support postpartum mothers and to examine the effects of the use of mobile app on mothers' anxiety level and depression symptoms.

RESEARCH DESIGN/SETTING

It is a parallel group pretest-posttest randomized controlled study carried out between July 2017 and February 2020. The mothers (62 in the experiment and 62 in the control group) who gave birth in full-term at a university hospital in Konya province in Turkey and who had healthy newborns constituted the study group. Data were collected using the Information Form, the STAI State and Continuity Anxiety Scale, and the Edinburgh Postpartum Depression Scale. Mixed pattern variance analysis (mixed anova), t test in dependent groups, t test and chi square analysis in independent groups were used to analyze the data.

FINDINGS

Most of the mothers who used the application fed their baby only with breast milk and felt more sufficient about breastfeeding. The depression symptoms of mothers using the postpartum mobile support application was lower than that of the mothers in the control group; however, it was found that the application was not adequate alone to decrease anxiety levels and depression symptoms (p > 0.05).

CONCLUSIONS

The postpartum mobile support application is an important and useful source in accessing reliable information; however, it was found to be insufficient to lower anxiety levels and prevent depression symptoms at the end of the six-week postpartum period.

Use of Telemedicine and Smart Technology in Obstetrics: Barriers and Privacy Issues

While telemedicine had been utilized in varying ways over the last several years, it has dramatically accelerated in the era of the COVID-19 pandemic. In this article we describe the privacy issues, in relation to the barriers to care for health care providers and barriers to the obstetric patient, licensing and payments for telehealth services, technological issues and language barriers. While there may be barriers to the use of telehealth services this type of care is feasible and the barriers are surmountable.

Optimizing mother-baby wellness during the 2019 coronavirus disease pandemic: A case for telemedicine

Background:

The 2019 coronavirus disease pandemic poses unique challenges to healthcare delivery. To limit the exposure of providers and patients to severe acute respiratory syndrome coronavirus 2, the Centers for Disease Control and Prevention encourages providers to use telehealth platforms whenever possible. Given the maternal mortality crisis in the United States and the compounding 2019 coronavirus disease public health emergency, continued access to quality preconception, prenatal, intrapartum, and postpartum care are essential to the health and well-being of mother and baby.

Objective:

This commentary explores unique opportunities to optimize virtual obstetric care for low-risk and high-risk mothers at each stage of pregnancy.

Methods:

In this review paper, we present evidence-based literature and tools from first-hand experience implementing telemedicine in obstetric care clinics during the pandemic.

Results:

Using the best evidence-based practices with telemedicine, health care providers can deliver care in the safest, most respectful, and appropriate way possible while providing the critical support necessary in pregnancy. In reviewing the literature, several studies endorse the implementation of specific tools outlined in this article, to facilitate the implementation of telemedicine. From a quality improvement standpoint, evidence-based telemedicine provides a solution for overburdened healthcare systems, greater confidentiality for obstetric services, and a personalized avenue for health care providers to meet maternal health needs in the pandemic.

Conclusion:

During the COVID-19 pandemic, continued access to quality prenatal, intrapartum, and postpartum care are essential to the health and well-being of mother and baby.

Developing eHealth in neonatal care to enhance parents' self-management

BACKGROUND

Discharge from a neonatal care unit is often experienced as a vulnerable time for parents. By communicating through digital technology, it may be possible to improve the support for parents and thereby make the transition from hospital to home less stressful.

AIM

To develop an eHealth device supporting the transition from hospital to home for parents with a preterm-born child in Sweden using participatory design.

METHOD

Employing a framework of complex interventions in health care using participatory design. Parents of preterm-born infants and professionals at a neonatal department identified specific technical requirements for an eHealth device to be developed in the context of neonatal care and neonatal home care. The prospective end-users - parents and professionals - were continuously involved in the process of designing solution prototypes through meetings, verbal and written feedback, and interviews. The interviews were analysed using thematic analysis.

RESULTS

Technical development was carried out with the perspectives of professionals and parents in mind, resulting in an eHealth application for computer tablets. The findings from the interviews with the parents and professionals revealed three categories: The tablets felt secure, easy to use and sometimes replaced visits to hospital and at home.

CONCLUSION

The use of participatory design to develop an eHealth device to support a safe transition from hospital to home can benefit parents, the child, the family, and professionals in neonatal care.

Knowledge of mothers and fathers' experiences of the early in-home care of premature infants supported by video consultations with a neonatal nurse

Aim

To gain in-depth knowledge of mothers’ and fathers’ experiences of the whole trajectory of an early in-home care programme supported by video consultations with a neonatal nurse.

Design

A qualitative interview study.

Methods

Data were collected through dyadic semi-structured interviews with mothers and fathers participating in virtual early in-home care programmes and were subjected to inductive content analysis.

Findings

The mothers and fathers were anxious about mastering the care of their premature infants at the start of the early in-home care phase but gradually developed confidence by the completion of the early in-home care programme. Being at home during the early in-home care programme gave the mothers and fathers an opportunity to test their decision making concerning the care of the infant while having the ability to obtain support from nurses when needed.

Conclusion

Our findings indicate that the trajectory of early in-home care programmes combined with video consultations contributes to parents’ increased confidence as mothers and fathers.

Trial registration

Clinical trial registration: REG-113-2014 and SJ-431.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12912-021-00572-9.

Synchronous and asynchronous tele-exercise during the coronavirus disease 2019 pandemic: Comparisons of implementation and training load in individuals with spinal cord injury

INTRODUCTION

Tele-exercise could represent an alternative for remote care in individuals with spinal cord injury at this time of the pandemic of coronavirus disease 2019. However, the differences regarding the training loads and implementation between synchronous and asynchronous types are not yet known. The purpose of this study was to compare the implementation and training load between synchronous and asynchronous tele-exercise programs in individuals with spinal cord injury.

METHODS

Forty individuals with spinal cord injury were recruited and stratified into tetraplegia and paraplegia groups. All subjects performed 3 weeks of both the synchronous and asynchronous tele-exercise programs, after two weeks of familiarization with the exercises, remote connection tools and methods to record information. The primary outcomes were training load (average daily workload and average and total weekly training load) and implementation (adherence and successful exercise recording). Demographic characteristics were obtained from participants' electronic medical records.

RESULTS

Weekly mean workload, total workload, adherence and successful exercise recording presented significantly higher values in the synchronous compared to asynchronous tele-exercises. Average daily workload did not present significant differences between the tele-exercises.

DISCUSSION

The training load for each training session presented no differences between synchronous and asynchronous tele-exercises. Both adherence and successful data recording showed more favourable implementation values for synchronous training, thus allowing greater weekly training loads (total and average).

How to improve emergency care to adults discharged within 24 hours? Acute Care planning in Emergency departments (The ACE study): a protocol of a participatory design study

INTRODUCTION

The development of acute symptoms or changes in diseases led to feelings of fear and vulnerability and the need for health professional support. Therefore, the care provided in the acute medical and surgical areas of the emergency department (ED) is highly important as it influences the confidence of patients and families in managing everyday life after discharge. There is an increase in short-episode (<24 hours) hospital admissions, related to demographic changes and a focus on outpatient care. Clear discharge information and inclusion in treatment decisions increase the patient's and family's ability to understand and manage health needs after discharge, reduces the risk of readmission. This study aims to identify the needs for ED care and develop a solution to improve outcomes of patients discharged within 24 hours of admission.

METHODS AND ANALYSIS

The study comprises the three phases of a participatory design (PD). Phase 1 aims to understand and identify patient and family needs when discharged within 24 hours of admission. A qualitative observational study will be conducted in two different EDs, followed by 20 joint interviews with patients and their families. Four focus group interviews with healthcare professionals will provide understanding of the short pathways. Findings from phase 1 will inform phase 2, which aims to develop a solution to improve patient outcomes. Three workshops gathering relevant stakeholders are arranged in the design plus development of a solution with specific outcomes. The solution will be implemented and tested in phase 3. Here we report the study protocol of phase 1 and 2.

ETHICS AND DISSEMINATION

The study is registered with the Danish Data Protection Agency (19/22672). Approval of the project has been granted by the Regional Committees on Health Research Ethics for Southern Denmark (S-20192000-111). Findings will be published in suitable international journals and disseminated through conferences.

Self-efficacy, support and sustainability - a qualitative study of the experience of establishing breastfeeding for first-time Australian mothers following early discharge

Background

Ensuring women receive optimal breastfeeding support is of key importance to the health of mothers and their infants. Early discharge within 24 h of birth is increasingly common across Australia, and the practice of postnatal home visiting varies between settings. The reduction in length of stay without expansion of home visits reduces midwives’ ability to support breastfeeding. The impact of early discharge on first-time mothers establishing breastfeeding was unknown. The study aim was to understand the experiences of first-time Australian mothers establishing breastfeeding when discharged from the hospital within 24 h of a normal vaginal birth.

Methods

A qualitative interpretive method was used. Semi-structured interviews with 12 women following early discharge were conducted. Data were audio recorded, professionally transcribed, and subjected to a thematic analysis.

Results

Three interconnected themes of ‘self-efficacy’, ‘support’ and ‘sustainability’ were identified. Self-efficacy influenced the women’s readiness and motivation to be discharged home early and played a role in how some of the mothers overcame breastfeeding challenges. Social, semi-professional and professional breastfeeding supports were key in women’s experiences. Sustainability referred to and describes what women valued in relation to continuation of their breastfeeding journey.

Conclusion

This study found accessible people-based breastfeeding services in the community are valued following early discharge. Furthermore, there is demand for more evidence-based breastfeeding educational resources, potentially in the form of interactive applications or websites. Additionally, a focus on holistic and individualised breastfeeding assessment and care plans prior to discharge that link women with ongoing breastfeeding services is paramount.

The Spanish version of the Mothers' Postnatal Sense of Security Scale: Psychometric properties and predictive utility

Postnatal sense of security is a relevant construct related to several variables of motherhood. However, it has not yet been studied in the Spanish context. The aims were: (a) To analyze the psychometric properties of a Spanish version of the Mothers' Postnatal Sense of Security Scale (PPSS-S); (b) analyze the factors related to mothers' sense of security during the first 2 weeks following childbirth (sociodemographic variables and factors related to maternity); and (c) examine the predictive utility that mothers' sense of security has on symptoms of postpartum depression 6-11 months after childbirth. This was a prospective longitudinal study performed in the first 6-11 months post-partum in four regions of Spain. A total of 928 mothers whose mean age was 33.67 years (standard deviation = 4.54) participated. The confirmatory factor analysis showed adequate adjustment to the original structure (χ²  = 17,272.79, df = 153, p < .001; Tucker-Lewis index = 0.98; comparative fit index = 0.98; root mean square error of approximation = 0.058 [0.053-0.063])and the overall internal consistency was 0.89. Direct relationships were shown between women' sense of security and already having had a child, the absence of postpartum health complications (either in the mother or the newborn) and receiving consistent information from healthcare professionals. Our results showed adequate evidence for the reliability and validity of the Spanish version of the PPSS-S. Understanding mothers' sense of security during the early months of motherhood, as well as related factors in the postpartum period, will allow health professionals to implement preventive measures to promote mental health and could help reduce symptoms of postpartum depression.

The Co-development and Feasibility-Testing of an Innovative Digital Animation Intervention (DAISI) to Reduce the Risk of Maternal Sepsis in the Postnatal Period

INTRODUCTION

Sepsis is one of the most common causes of mortality in postnatal women globally and many other women who develop sepsis are left with severe morbidity. Women's knowledge of postnatal sepsis and how it can be prevented by simple changes to behaviour is lacking.

METHODS

This paper describes the co-development and feasibility testing of a digital animation intervention called DAISI (digital animation in service improvement). This DAISI is designed to enhance postnatal women's awareness of sepsis and how to reduce their risk of developing the condition. We co-designed the digital animation over a six-month period underpinned by theory, best evidence and key stakeholders, translated it into Urdu then assessed its use, firstly in a focus group with women from different Black, Asian and Minority Ethnic (BAME) groups and secondly with 15 clinical midwives and 15 women (including BAME women). Following exposure to the intervention, midwives completed a questionnaire developed from the COM-B behaviour change model and women participated in individual and focus group interviews using similar questions.

RESULTS

The animation was considered acceptable, culturally sensitive and simple to implement and follow.

DISCUSSION

DAISI appears to be an innovative solution for use in maternity care to address difficulties with the postnatal hospital discharge process. We could find no evidence of digital animation being used in this context and recommend a study to test it in practice prior to adopting its use more widely. If effective, the DAISI principle could be used in other maternity contexts and other areas of the NHS to communicate health promotion information.

Identifying the Needs for a Web-Based Postpartum Platform Among Parents of Newborns and Health Care Professionals: Qualitative Focus Group Study

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.

Parenting Outcomes and Predictors of Parenting Satisfaction in the Early Postpartum Period

This study examined the relationships among parenting self-efficacy (PSE), social support, postnatal depression (PND), and predictors of parenting satisfaction in the early postpartum period using a cross-sectional exploratory quantitative design. The hypothetical model was tested among interrelated concepts of outcome variables among 250 parents (125 couples). The structural equation model revealed an adequate fit between the hypothesized model and the data. PSE and spousal support were found to be predictors of parenting satisfaction. PSE was also found to be a predictor of social support. PND was not found to be a predictor of parenting satisfaction. None of the obstetric and demographic factors predicted parenting satisfaction. This is the first study that tested interrelations among crucial parenting outcome variables among fathers and mothers in the early postpartum period. It is important to assess interrelated parenting outcomes among both parents so that support can be provided to ultimately influence parenting satisfaction.

Development of an individualized asynchronous sensor-based telerehabilitation program for patients undergoing total knee replacement: Participatory design

Telerehabilitation programs can be employed to establish communication between patients and healthcare professionals and empower patients performing their training remotely. This study aimed to identify patients’ requirements after a total knee replacement following a self-training rehabilitation program, leading to the design and development of a telerehabilitation program that can meet the stakeholders’ actual needs. System design, development, and testing were conducted in five iterations based on a participatory design approach. Data collection was performed using interviews, observations, prototyping, and questionnaires. It was found that the main barriers facing the existing rehabilitation program were a lack of clear communication, lack of relevant information, and healthcare professional’s feedback. The participants emphasized the main themes of communication, information, training, and motivation in the process of design and development. In using the telerehabilitation program, the patients reported a high level of user-friendliness, flexibility, and a sense of security. This study has identified obstacles in the current rehabilitation program and revealed the potential effectiveness of using asynchronous communication and sensor-based technologies by employing participatory design and development. A higher level of portability and flexibility were observed. However, future studies and development are required to investigate the overall usability and reliability of the telerehabilitation program.

Parents' experiences of early discharge after a planned caesarean section: A qualitative interpretive study

OBJECTIVE

The birth rate in Denmark is increasing, and the rate of births by caesarean section has increased to more than 20%. Thus, the obstetric departments have been put under pressure to identify new solutions to optimize the maternity care system, in which early discharge might be considered. The aim of this study was to explore parents' experiences of the postnatal care after planned caesarean section with focus on factors that support or hinder early discharge.

DESIGN

An interpretive, hermeneutic approach was chosen, using qualitative interviews with multiparous women and their partners. Data analysis was performed using thematic analysis.

PARTICIPANTS AND SETTING

Twelve women and partners were recruited from two hospital-based maternity units in Denmark. The inclusion criteria were low-risk Danish-speaking multiparous women having a planned caesarean section with a singleton pregnancy (gestational age between 37+0 and 41+6 weeks). Seven sets of parents were discharged before 28 h and five were discharged after 48 h.

FINDINGS

Three main themes were identified as important for timing of discharge: (1) Setting for recovery (2) Views on length of stay, and (3) Preparation and individual planning. All parents valued the safe and supportive environment at the hospital, but several preferred early discharge as they felt more comfortable in their home environment and wanted to be together as a family with all siblings. When considering appropriate time of discharge, the main issues were that pain was manageable, that breastfeeding was initiated successfully and that professional support was available after discharge. Finally, early discharge required preparation and planning and the parents stressed the importance of knowing that they would not be discharged unless they felt ready.

CONCLUSION AND IMPLICATION FOR PRACTICE

A clear link was observed between the care package the parents received and their views on the optimal time of discharge. Based on our findings it seems likely that a significant proportion of parents will accept and feel confident about early discharge if individual circumstances are taken into account in the antenatal planning of a caesarean section.

Factors Related to the Intra-Partner Postnatal Sense of Security in a Spanish Sample

BACKGROUND

The fathers' sense of security and their related factors during the process of parenthood remains largely unexplored. The objectives were to analyse: the psychometric properties of the Spanish version of the Parent's Postnatal Sense of Security scale used for fathers, and the factors related to fathers' sense of security during the postpartum period.

METHODS

A total of 583 fathers participated. The fathers' version of the questionnaire was adapted for Spanish speakers. The psychometric properties of the instrument and its relationship with the mother's sense of security were considered.

FINDINGS

The results showed that the data fit well with the original model (TLI = 0.98, CFI = 0.98, and RMSEA = 0.05). The fathers' sense of security was associated with previously having become a father (t = -2.39, p = .02), the level of state anxiety (r = -0.34; p < .01) and trait anxiety (r = -0.24; p < .01), as well as the sense of security of their partners (r = 0.55, p < .001). In the regression analysis, the mothers' sense of security construct provided the greatest explanation of the model.

DISCUSSION

The results of this study highlight the importance of considering the family unit in pre-, intra-, and postnatal education in order to increase the sense of security of both parents and reduce their anxiety levels.

APPLICATION TO PRACTICE

This study provides Spanish healthcare professionals with access to a scale for assessing fathers' sense of security in the immediate postpartum period and allows them to identify needs in the process of becoming parents, emphasising the inclusion of both parents in any intervention.

Working with patients and the public to design an electronic health record interface: a qualitative mixed-methods study

BACKGROUND

Enabling patients to be active users of their own medical records may promote the delivery of safe, efficient care across settings. Patients are rarely involved in designing digital health record systems which may make them unsuitable for patient use. We aimed to develop an evidence-based electronic health record (EHR) interface and participatory design process by involving patients and the public.

METHODS

Participants were recruited to multi-step workshops involving individual and group design activities. A mixture of quantitative and qualitative questionnaires and observational methods were used to collect participant perspectives on interface design and feedback on the workshop design process.

RESULTS

48 recruited participants identified several design principles and components of a patient-centred electronic medical record interface. Most participants indicated that an interactive timeline would be an appropriate way to depict a medical history. Several key principles and design components, including the use of specific colours and shapes for clinical events, were identified. Participants found the workshop design process utilised to be useful, interesting, enjoyable and beneficial to their understanding of the challenges of information exchange in healthcare.

CONCLUSION

Patients and the public should be involved in EHR interface design if these systems are to be suitable for use by patient-users. Workshops, as used in this study, can provide an engaging format for patient design input. Design principles and components highlighted in this study should be considered when patient-facing EHR design interfaces are being developed.

A home-video method to assess infant gross motor development: parent perspectives on feasibility

Background

Current use of smartphone cameras by parents create opportunities for longitudinal home-video-assessments to monitor infant development. We developed and validated a home-video method for parents, enabling Pediatric Physical Therapists to assess infants’ gross motor development with the Alberta Infant Motor Scale (AIMS). The objective of the present study was to investigate the feasibility of this home-video method from the parents’ perspective.

Methods

Parents of 59 typically developing infants (0–19 months) were recruited, 45 parents participated in the study. Information about dropout was collected. A sequential mixed methods design was used to examine feasibility, including questionnaires and semi-structured interviews. While the questionnaires inquired after the practical feasibility of the home-video method, the interviews also allowed parents to comment on their feelings and thoughts using the home-video method.

Results

Of 45 participating parents, 34 parents returned both questionnaires and eight parents agreed to an interview. Parent reported effort by the infants was very low: the home-video method is perceived as similar to the normal routine of playing. The parental effort level was acceptable. The main constraint parents reported was time planning. Parents noted it was sometimes difficult to find the right moment to record the infant’s motor behavior, that is, when parents were both at home and their baby was in the appropriate state. Technical problems with the web portal, reported by 28% of the parents were also experienced as a constraint. Positive factors mentioned by parents were: the belief that the home videos are valuable for family use, receiving feedback from a professional, the moments of one-on-one attention and interaction with their babies. Moreover, the process of recording the home videos resulted in an increased parental awareness of, and insight into, the gross motor development of their infant.

Conclusion

The AIMS home-video method is feasible for parents of typically developing children. Most constraints are of a practical nature that can be addressed in future applications. Future research is needed to show whether the home-video method is also applicable for parents with an infant at risk of motor development problems.

Women's successful transition to motherhood during the early postnatal period: A qualitative systematic review of postnatal and midwifery home care literature

OBJECTIVE

To undertake a systematic review of available qualitative research literature to determine what women need to successfully transition to motherhood during the early postnatal period and whether postnatal home care delivered by midwives supports this process.

DESIGN

The transition from woman to mother is a significant occurrence, one that requires adjustments on physical, psychological and social levels. A qualitative systematic review design was chosen to ensure both humanistic and interactive concepts related to what women need to successfully transition to motherhood during the early postnatal period were identified. The systematic and structured search uncovered 33 research articles for detailed review. Two team members, using the qualitative research checklist from the Critical Appraisal Skills Programme, appraised the quality of the research articles. A total of 19 articles met the quality criteria and were included in the data evaluation process.

SETTING AND PARTICIPANTS

Research teams from Asia-Pacific, Europe, Middle East and North America generated the 19 qualitative journal articles.

MEASUREMENTS AND FINDINGS

Data evaluation included identification of research aim, presence of a research question, type of methodology, data collection processes, sample information, data analysis techniques and study outcomes. Data was analysed using an inductive content analysis approach. Four themes were identified from the qualitative systematic review process including: women and midwives connecting, identification and meeting of women's individual needs, family and cultural influences and, education and support.

KEY CONCLUSIONS

The ability of women to connect with midwives during the early postnatal period assisted them overcome barriers and to successfully transitioning to motherhood. Although all four themes were determined to be key to effective postnatal transition, overwhelmingly the findings showed postnatal midwifery home care to be important in women's successful transition to motherhood in the early postnatal period.

IMPLICATIONS FOR PRACTICE

Strategies are needed ensure women have access to midwives in the early postnatal period.

Technology-assisted nursing for postpartum support: A randomized controlled trial

AIM

To determine if an electronic nursing intervention during the first 6 months postpartum was effective in improving mood and decreasing stress.

BACKGROUND

Unmet needs postpartum can have a negative impact on mood and parenting stress. Technology-assisted nursing care may provide needed support and reduce risk.

DESIGN

Randomized controlled trial (RCT) with three conditions.

METHODS

Enrollment began on 11 May 2017. Participants were randomized into one of three groups after completion of the baseline survey. Intervention I participants received standardized electronic messages four times/week for 6 months postpartum. Intervention II participants additionally received the option for nurse contact. Depression and parenting stress as measured using the Edinburgh Postnatal Depression Scale (EPDS) and Parenting Stress Index-Short form (PSI-SF) was obtained at 3 weeks, 3 months and 6 months postpartum and results compared with a usual care group. Patient satisfaction and nursing factors were measured.

RESULTS

Significantly higher satisfaction scores were found in both intervention groups as compared with control, but there were no significant changes in EPDS or PSI-SF.

CONCLUSION

The interventions were perceived as helpful and not burdensome. Better nurse-sensitive outcome measures are needed to adequately assess effectiveness.

IMPACT

Postpartum women report unmet needs for support and education. The interventions were perceived as being helpful but did not significantly reduce depressive symptoms or parenting stress. Nurses can use this research to inform development of innovative approaches to support postpartum women.

TRIAL REGISTRATION NUMBER

ClinicalTrials.gov NCT02843022.

User involvement in the development of a telehealth solution to improve the kidney transplantation process: A participatory design study

Kidney transplantation is the treatment of choice for patients with end-stage renal disease, and leads to everyday self-management of this chronic condition. This article aims to provide documentation for a participatory design study of a telehealth solution to improve the kidney transplantation process, and to identify the impact from the different participants in the participatory design study. Through a participatory design approach, a smartphone application (app) was developed for the entire kidney transplantation process together with a workflow for post-transplantation follow-up. A core element in participatory design is user involvement. By way of workshops and laboratory tests, the telehealth solution was developed in close cooperation with patients, their families, healthcare professionals, kidney association representatives, and Information Technology designers. The participatory design approach means that the telehealth solution was designed to be functional in a clinical setting, address patients' needs, and support their self-management.

Evaluation of Mothers' Perceptions of a Technology-Based Supportive Educational Parenting Program (Part 2): Qualitative Study

Background

Transitioning into parenthood can be stressful as parents struggle to cope with new parenting responsibilities. Although perinatal care in hospitals aims to improve parental outcomes, there is a general consensus that it is suboptimal and insufficient. Therefore, many studies have designed intervention methods to supplement support for parents during this stressful period. However, studies often focus on parental outcomes as indicators of their interventions’ success and effectiveness. Studies evaluating participants’ experiences and feedback are limited.

Objective

This study aimed to examine the experiences and perceptions of participants who participated in a supportive education parenting program intervention study.

Methods

A qualitative semistructured interview was conducted with 16 mothers (6 control and 10 intervention) from a randomized controlled trial. The supportive education parenting program received by the intervention group included 2 phone-based perinatal educational sessions, a phone-based educational session after childbirth, and a 1-month postpartum access to a mobile health app. The interviews were approximately 30- to 60-min long, audiotaped and transcribed verbatim, and analyzed using thematic analysis. Study findings were reported according to the Consolidated Criteria for Reporting Qualitative Research checklist.

Results

The 3 main themes evaluating mothers’ experiences and perceptions were generated: (1) changed perspective toward parenthood, (2) journey from pregnancy to after birth, and (3) a way forward. Mothers from the intervention group mostly had good perinatal experiences with sufficient support received, which elevated their emotional well-being and increased parenting involvement. Mothers in the control group, although satisfied with the hospital care received, were more stressed and shared a need for professional advice and extra support. Apart from technical enhancements, mothers also requested extended social support during early pregnancy up to 1 year postpartum, taking into consideration Asian cultural practices.

Conclusions

Mothers who received the intervention were overall satisfied with the support provided by the technology-based supportive educational parenting program. The success of the educational program in this study highlights the need to supplement standard care in hospitals with technology-based educational programs. Future research should include fathers’ perceptions to attain an in-depth understanding of overall participants’ experiences and needs in the future development of supportive and educational programs.

Effectiveness of a Technology-Based Supportive Educational Parenting Program on Parental Outcomes (Part 1): Randomized Controlled Trial

Background

Transitioning into parenthood can be stressful for new parents, especially with the lack of continuity of care from health care professionals during the postpartum period. Short hospital stays limit the availability of support and time parents need to be well equipped with parenting and infant care skills. Poor parental adjustment may, in turn, lead to negative parental outcomes and adversely affect the child’s development. For the family’s future well-being, and to facilitate a smoother transition into parenthood, there is a need for easily accessible, technology-based educational programs to support parents during the crucial perinatal period.

Objective

This study aimed to examine the effectiveness of a technology-based supportive educational parenting program (SEPP) on parenting outcomes during the perinatal period in couples.

Methods

A randomized, single-blinded, parallel-armed, controlled trial was conducted. The study recruited 236 parents (118 couples) from an antenatal clinic of a tertiary hospital in Singapore. Eligible parents were randomly assigned to the intervention group (n=118) or the control group (n=118). The SEPP is based on Bandura’s self-efficacy theory and Bowlby’s theory of attachment. Components of the intervention include 2 telephone-based educational sessions (1 antenatal and 1 immediately postnatal) and a mobile health app follow-up for 1 month. The control group only received routine perinatal care provided by the hospital. Outcome measures including parenting self-efficacy (PSE), parental bonding, perceived social support, parenting satisfaction, postnatal depression (PND), and anxiety were measured using reliable and valid instruments. Data were collected over 6 months at 4 time points: during pregnancy (third trimester), 2 days postpartum, 1 month postpartum, and 3 months postpartum. Outcomes were standardized using baseline means and SDs. Linear mixed models were used to compare the groups for postpartum changes in the outcome variables.

Results

The intervention group showed significantly better outcome scores than the control group from baseline to 3 months postpartum for PSE (mean difference, MD, 0.37; 95% CI 0.06 to 0.68; P=.02), parental bonding (MD −1.32; 95% CI −1.89 to −0.75; P<.001), self-perceived social support (MD 0.69; 95% CI 0.18 to 1.19; P=.01), parenting satisfaction (MD 1.40; 95% CI 0.86 to 1.93; P<.001), and PND (MD −0.91; 95% CI −1.34 to −0.49; P<.001). Postnatal anxiety (PNA) scores of the intervention group were only significantly better after adjusting for covariates (MD −0.82; 95% CI −1.15 to −0.49; P<.001).

Conclusions

The technology-based SEPP is effective in enhancing parental bonding, PSE, perceived social support and parental satisfaction, and in reducing PND and PNA. Health care professionals could incorporate it with existing hands-on infant care classes and routine care to better meet parents’ needs and create positive childbirth experiences, which may in turn encourage parents to have more children.

Trial Registration

ISRCTN Registry ISRCTN48536064; http://www.isrctn.com/ISRCTN48536064 (Archived by WebCite at http://www.webcitation.org/6wMuEysiO).

Effect of Lifestyle Coaching Including Telemonitoring and Telecoaching on Gestational Weight Gain and Postnatal Weight Loss: A Systematic Review

Background: Obesity during pregnancy, excessive gestational weight gain (GWG), and postpartum weight retention (PPWR) are associated with health risks for mothers and their offspring. Face-to-face lifestyle interventions can reduce GWG and PPWR, but they are resource-demanding and effects on long-term maternal and fetal outcomes are scarce. Objectives: To explore the existing literature about the effect of technology-supported lifestyle interventions including telemonitoring and-coaching on GWG and PPWR. Methods: PudMed, MEDLINE, CINAHL, EMBASE (incl. The Cochrane databases), and Web of Science databases were searched for relevant studies published since 2000. Inclusion criteria were: lifestyle interventions to optimize GWG or PPWR with at least mobile applications or websites, focusing on physical activity (PA), healthy eating (HE), and/or psychological well-being, including self-monitoring with telemonitoring and telecoaching. Results: The technology-supported interventions in seven study protocols and four pilot studies differed in terms of the used behavior change models, their focus on different lifestyle issues, and their intervention components for telemonitoring and telecoaching. Technology-supported interventions including telemonitoring and coaching can optimize GWG and PPWR, although not all results are significant. Effects on PA and HE are inconsistent. Conclusions: Technology-supported lifestyle interventions might affect GWG and PPWR, but more research is needed to examine the effectiveness, the usability, and the critical features of these interventions.

Fathers' experiences during the first postnatal week at home after early discharge of mother and baby from the maternity unit: A meta-synthesis

Aim: The aim of this study was to explore and describe fathers' experiences during the first postnatal week after early discharge of mother and baby from the maternity unit. Methods: A meta-synthesis. Inclusion criteria: peer-reviewed qualitative single studies of fathers' experiences during the first week after early discharge (defined as less than 72 hours postpartum) from hospital after the birth of a healthy singleton baby born between weeks 37 and 40. Databases: Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medline, Maternity and Infant Care, Joanna Briggs, SweMed+ and PsycInfo were searched in May 2015 and May 2018. Of the 940 titles scanned for eligibility, three articles met the inclusion criteria. The consolidated criteria for reporting qualitative research checklist was used. Findings: All included studies were conducted in Sweden during the period 2002-2012. The total sample of participants in the meta-synthesis comprised 35 fathers. Analysis of the included studies generated two themes: building confidence and coping with responsibility. Conclusions: The fathers' experiences were affected by the emotional support of midwives, which boosted their confidence. This seems to be a premise for taking and coping with responsibility during the first days at home. Good cooperation between hospitals and municipalities is vital, and midwives must be available and present in order to ensure continuity in maternity care.

The "Happy-Mums" website dedicated to the perinatal period: Evaluation of its acceptability by parents and professionals

OBJECTIVE

Pregnancy and childbirth are associated with new needs for mothers, especially an eagerness for information. The aim of this study was to evaluate whether the Happy-Mums.be website meets the expectations and needs of its future users.

DESIGN

After the development of the Happy-Mums.be website, it was submitted to parents and professionals and evaluated by an online survey, which consisted of the third round of an ongoing Delphi survey.

SETTING AND PARTICIPANTS

The panel involved in the survey included parents (both mothers and fathers) and professionals (health professionals and early childhood professionals, orbiting mothers of children aged 0-2 years).

FINDINGS

Twenty-eight parents and professionals participated in the third round of the Delphi survey. The participants indicated that Happy-Mums.be was useful and easy to use. They attributed a mean score of 8 out of 10 for the content, design and quality of the information on the Happy-Mums.be website. The majority of participants said that they would recommend the website both during pregnancy and the postnatal period.

CONCLUSIONS

Happy-Mums.be meets the needs and expectations of parents and professionals in terms of both content and design. More specifically, the quality of the information found on Happy-Mums.be was judged to be significantly better than the information found on other websites.

Informational interventions on paternal outcomes during the perinatal period: A systematic review

PROBLEM

The perinatal period is a stressful transition for new parents.

BACKGROUND

Various forms of educational interventions are available and are found to be efficacious in improving maternal and child outcomes. Such interventions for fathers were scarce and western-centric. Fathers should be educated as they have an impact on maternal and child outcomes.

AIM

This review aims to evaluate the efficacy of quantitatively-studied informational support-focused interventions for fathers using paternal outcomes only.

METHODS

The search was carried out in six databases: Cumulative Index to Nursing and Allied Health Literature, PubMed, Scopus, Embase, Psychological Information Database, and MedNar. Cochrane Collaboration's tools were used to assess the eligibility of the studies.

FINDINGS

A total of 17 studies with 18 interventions were identified and included in the narrative synthesis. Most interventions were delivered to the Western population during the antenatal or postpartum period. The method of delivery for these interventions was mainly face-to-face, with inconclusive findings on various paternal psychosocial outcomes.

DISCUSSION

Limited father-inclusive interventions were available. Technology-based longitudinal studies with interventions carried out across the perinatal period with longer follow-up periods were recommended for interventions providing informational support for fathers. Future studies can also examine paternal physical health and behavioural outcomes. Interventions in culturally-diverse populations should be designed and tested for their efficacies as fathers have different informational needs, especially in Asia.

CONCLUSION

Informational interventions for fathers were found to be lacking and recommendations for future studies on educational interventions for fathers were discussed.

Parent perspectives of neonatal tele-homecare: A qualitative study

INTRODUCTION

Neonatal homecare for preterm infants is a method of supporting families and monitoring infant growth in the home setting. Telehealth may be used to deliver specialist neonatal care remotely, using online communication methods. This study explored parental experiences with neonatal tele-homecare (NTH).

METHODS

Semi-structured interviews were conducted with 49 parents whose preterm infants had received NTH from a neonatal intensive care unit (NICU) in Denmark. Interview transcripts were analysed using Malterud's systematic text condensation.

RESULTS

Parents experienced NTH as a personalised method for linking to specialist staff in the NICU. NTH promoted the parent's role as the primary care provider, further strengthening the parent-infant relationship.

DISCUSSION

From the perspective of parents with preterm infants requiring specialist care, NTH is a useful method of supporting families in the home. Telehealth provides effective communication links with NICU specialists and encourages family-centred care.