Screening for trauma and anxiety recognition: knowledge, management and attitudes amongst gynecologists regarding women with fear of childbirth and postpartum posttraumatic stress disorder

Contribution of the abbreviated CAVE-st questionnaire in Spanish: the attitudes toward childbirth experiences

There are several factors that influence women's childbirth experience, and personal interactions with health professionals are of particular significance. The main objective of this study was to present the validation of an abbreviated form of an existing questionnaire on attitudes about childbirth in medical and nursing students. We used a sample of 512 perinatal medicine and nursing students who received the original 52-item CAVE-st questionnaire to obtain a shorter version with proper psychometric properties. We used Cronbach's alpha coefficient to evaluate the new version's internal consistency. The Kaiser- Meyer-Olkin test and the Barlett sphericity test were performed to assess the suitability of exploratory factor analysis (EFA). Subsequently, confirmatory factor analysis (CFA) was performed using structural equation models in a second sample of 139 medical students. We obtained a 15-item version with a Cronbach's alpha of 0.82. The EFA revealed a four-dimensional structure, similar to the full 52-item version. In the CFA the adjustment indexes showed good model fitness, RMSEA= 0.046 [CI 0.00-0.07]; CFI = 0.978. We can conclude that the 15-item version is a valid tool for evaluating the attitude of students toward childbirth, pointing out the matters that should be improved in their training to avoid obstetric trauma by the promotion of a positive experience in women during childbirth.

Childbirth-related posttraumatic stress disorder: definition, risk factors, pathophysiology, diagnosis, prevention, and treatment

Psychological birth trauma and childbirth-related posttraumatic stress disorder represent a substantial burden of disease with 6.6 million mothers and 1.7 million fathers or co-parents affected by childbirth-related posttraumatic stress disorder worldwide each year. There is mounting evidence to indicate that parents who develop childbirth-related posttraumatic stress disorder do so as a direct consequence of a traumatic childbirth experience. High-risk groups, such as those who experience preterm birth, stillbirth, or preeclampsia, have higher prevalence rates. The main risks include antenatal factors (eg, depression in pregnancy, fear of childbirth, poor health or complications in pregnancy, history of trauma or sexual abuse, or mental health problems), perinatal factors (eg, negative subjective birth experience, operative birth, obstetrical complications, and severe maternal morbidity, as well as maternal near misses, lack of support, dissociation), and postpartum factors (eg, depression, postpartum physical complications, and poor coping and stress). The link between birth events and childbirth-related posttraumatic stress disorder provides a valuable opportunity to prevent traumatic childbirths and childbirth-related posttraumatic stress disorder from occurring in the first place. Childbirth-related posttraumatic stress disorder is an extremely distressing mental disorder and has a substantial negative impact on those who give birth, fathers or co-parents, and, potentially, the whole family. Still, a traumatic childbirth experience and childbirth-related posttraumatic stress disorder remain largely unrecognized in maternity services and are not routinely screened for during pregnancy and the postpartum period. In fact, there are gaps in the evidence on how, when, and who to screen. Similarly, there is a lack of evidence on how best to treat those affected. Primary prevention efforts (eg, screening for antenatal risk factors, use of trauma-informed care) are aimed at preventing a traumatic childbirth experience and childbirth-related posttraumatic stress disorder in the first place by eliminating or reducing risk factors for childbirth-related posttraumatic stress disorder. Secondary prevention approaches (eg, trauma-focused psychological therapies, early psychological interventions) aim to identify those who have had a traumatic childbirth experience and to intervene to prevent the development of childbirth-related posttraumatic stress disorder. Tertiary prevention (eg, trauma-focused cognitive behavioural therapy and eye movement desensitization and reprocessing) seeks to ensure that people with childbirth-related posttraumatic stress disorder are identified and treated to recovery so that childbirth-related posttraumatic stress disorder does not become chronic. Adequate prevention, screening, and intervention could alleviate a considerable amount of suffering in affected families. In light of the available research on the impact of childbirth-related posttraumatic stress disorder on families, it is important to develop and evaluate assessment, prevention, and treatment interventions that target the birthing person, the couple dyad, the parent-infant dyad, and the family as a whole. Further research should focus on the inclusion of couples in different constellations and, more generally, on the inclusion of more diverse populations in diverse settings. The paucity of national and international policy guidance on the prevention, care, and treatment of psychological birth trauma and the lack of formal psychological birth trauma services and training, highlight the need to engage with service managers and policy makers.

Validating the use of the Wijma Delivery Expectancy/Experience Questionnaire in Mainland China: a descriptive, cross-sectional study

BACKGROUND

Fear of childbirth (FOC) is a common psychological problem in Chinese pregnant women. FOC can influence both maternal health and infants' wellness. Special assessment tools for FOC in Mandarin Chinese are currently lacking. The aim of this study was to evaluate the psychometric properties of the Mandarin Chinese of the Wijma Delivery Expectancy/Experience Questionnaire Version A (W-DEQ-A).

METHODS

We recruited 364 Chinese pregnant women from April 2021 to July 2021. Translation and cultural adaptation, as well as reliability and validity testing were conducted. Analyses included the content validity, structural validity, criterion-related validity, convergent validity and reliability. The content validity indices were used to assess the content validity of the tool. The structural validity was tested through exploratory factor analysis and confirmatory factor analysis. The Cronbach's alpha coefficient was used to evaluate the reliability of the W-DEQ-A Chinese version.

RESULTS

The Chinese translation showed excellent similarities and equivalence to the original version, with the satisfactory content validity. Factor analysis indicated 5 factors, accounting for 57% of the total variance. Both criterion-related validity and convergent validity proved to be acceptable. The reliability was tested with a Cronbach's alpha coefficient of 0.911 for the total scale.

CONCLUSION

The W-DEQ-A Chinese version is a reliable and valid tool to identify FOC in Mandarin Chinese-speaking populations.

Identifying women with fear of childbirth with the Dutch Fear of Birth Scale and its added value for consultations

OBJECTIVES

Determine whether the Fear of Birth Scale (FOBS) is a useful screening instrument for Fear of Childbirth (FoC) and examine the potential added value of screening by analyzing how often pregnant women discuss their FoC during consultation.

METHODS

This cross-sectional survey study included nulliparous pregnant women of all gestational ages, recruited via the internet, hospital and midwifery practices. The online questionnaires included the FOBS and Wijma Delivery Expectations Questionnaire version A (W-DEQ A). The latter was used as golden standard for assessing FoC (cutoff: ≥85).

RESULTS

Of the 364 included women, 67 (18.4%) had FoC according to the W-DEQ A. Using the FOBS with a cutoff score of ≥49, the sensitivity was 82.1% and the specificity 81.1%, with 111 (30.5%) women identified as having FoC. Positive predictive value was 49.5% and negative predictive value 95.3%. Of the women with FoC (FOBS ≥49), 68 (61.3%) did not discuss FoC with their caregiver.

CONCLUSION

The FOBS is a useful screening instrument for FoC. A positive score must be followed by further assessment, either by discussing it during consultation or additional evaluation with the W-DEQ A. The majority of pregnant women with FoC do not discuss their fears, underscoring the need for screening.

An educational programme based on salutogenesis theory on childbirth fear and delivery method among nulliparous women: A mixed methods research protocol

AIM

Designing, executing and testing a training intervention based on enhanced concepts of salutogenesis theory for managing fear of childbirth and choice of delivery method among nulliparous women.

DESIGN

A Sequential-Exploratory Mixed Methods Research.

METHODS

In the first phase (qualitative approach), the determinants of childbirth fear among nulliparous women will be explored. In the second phase (systematic review), the factors of childbirth fear among them will be summarized. In the third phase, the content of the educational intervention is developed based on the common factors of childbirth fear obtained from the previous two phases of the study. In the fourth phase (randomized controlled trial), two intervention and the control groups will be compared based on primary and secondary outcomes.

DISCUSSION

Using salutogenesis theory in a few interventional studies on various health areas has produced promising results. Based on the evidence, women had less sense of coherence with a strong childbirth fear. Therefore, developing an effective intervention based on this theory can probably help manage childbirth fear and reduce the costs of any potential consequences.

Factors of the childbirth fear among nulliparous women in Iran

BACKGROUND

Fear of childbirth is an anxiety associated with childbirth, which manifests itself in physical and concentration problems. It is often associated with requesting a cesarean section, and it is prevalent in nulliparous women. This is a study aimed to summarize the published research on the factors for fear of childbirth in nulliparous women in Iran.

METHODS

This study was conducted based on the PRISMA statement. A literature search was performed on nine electronic databases (Web of Sciences, Since Direct, Scopus, PubMed, Cochrane Library, ProQuest, and Persian databases including Scientific Information Database, Irandoc, and Magiran) using keywords related to fear of childbirth, factors, nulliparous, and Iran from 2000 to 2020. This study included cross-sectional studies with full-text in English or Persian in Iran. The quality of the selected studies was evaluated independently by two authors and via the STROBE checklist.

RESULTS

In this study, 93 articles were identified,13 duplicate articles were excluded, 80 articles were screened by title and abstract, 62 were excluded, and the full-text of 18 articles was assessed for analysis. Of these, 12 were excluded, and six articles were reviewed. Six studies were conducted in different provinces of Iran. Based on the study results, factors of the fear of childbirth in nulliparous women were: biological (the process of labor and childbirth and labor pain, concern for the baby (harm to the baby and baby infirmity), psychological (painful injections during labor and suturing in childbirth), and individual (loss of control during labor).

CONCLUSIONS

This study identified four main factors that affect fear of childbirth status in nulliparous women, and concern for the baby was a more common factor in this study. In conclusion, these factors can be reduced by increasing their assurance about child health, training during pregnancy, talking about positive experiences, and holding workshops.

Primiparous and Multiparous Women's Mode of Birth and Negative Emotions

Negative childbirth experiences may result in negative emotions that may lead to negative outcomes, such as post-traumatic stress disorder. We aimed to examine the differences in emotions between primiparous and multiparous women and mode of birth. We used a retrospective cross-sectional study design with three hundred and fifty women. Primiparous women reported higher levels of fear, lack of control, and dissociation emotions compared to multiparous women. The EmCs (emergency cesarean section) group experienced the most fear, lack of control, anger, and conflict emotions. It is important to conduct follow up work with women who underwent unplanned birth procedures since negative childbirth experiences may lead to further negative effects on women's psychosocial health and well-being.

Implementing an Eye Movement and Desensitization Reprocessing Treatment-Program for Women With Posttraumatic Stress Disorder After Childbirth

PURPOSE

The purpose of this study is to describe the implementation and outcomes of an Eye Movement and Desensitization Reprocessing (EMDR) treatment-program for women with posttraumatic stress disorder (PTSD) after childbirth.

METHODS

A prospective cohort-study with pre- and post-measurements was carried out in the setting of an academic hospital in the Netherland. Included were women who gave birth to a living child at least 4 weeks ago, with a diagnosis of PTSD, or severe symptoms of PTSD combined with another psychiatric diagnosis. All received up to 8 sessions of EMDR-therapy. The posttraumatic stress disorder Checklist for DSM-5 was administered before and after treatment. Trauma history was assessed before treatment with the Life Events Checklist for the DSM-5, the Childhood Trauma Questionnaire and the Childbirth Perception Scale. Descriptive statistics were used.

RESULTS

Forty-four women were referred, 26 met the inclusion criteria. After treatment, none of the women met the criteria for diagnosis of PTSD after on average 5 weekly sessions of EMDR- therapy. These outcomes are promising, as they were achieved in women with relatively high levels of psychiatric comorbidity (64%) and high rates of previous mental health treatment (80%).

CONCLUSION

Implementing an EMDR-treatment program for women with PTSD after childbirth in the setting of an academic hospital is feasible and effective. Key factors for success include a close collaboration between the relevant hospital departments and a thorough case conceptualization addressing the etiology of the PTSD.

Policy, service, and training provision for women following a traumatic birth: an international knowledge mapping exercise

Background

High numbers of women experience a traumatic birth, which can lead to childbirth-related post-traumatic stress disorder (CB-PTSD) onset, and negative and pervasive impacts for women, infants, and families. Policies, suitable service provision, and training are needed to identify and treat psychological morbidity following a traumatic birth experience, but currently there is little insight into whether and what is provided in different contexts. The aim of this knowledge mapping exercise was to map policy, service and training provision for women following a traumatic birth experience in different European countries.

Methods

A survey was distributed as part of the COST Action “Perinatal mental health and birth-related trauma: Maximizing best practice and optimal outcomes”. Questions were designed to capture country level data; care provision (i.e., national policies or guidelines for the screening, treatment and/or prevention of a traumatic birth, service provision), and nationally mandated pre-registration and post-registration training for maternity professionals.

Results

Eighteen countries participated. Only one country (the Netherlands) had national policies regarding the screening, treatment, and prevention of a traumatic birth experience/CB-PTSD. Service provision was provided formally in six countries (33%), and informally in the majority (78%). In almost all countries (89%), women could be referred to specialist perinatal or mental health services. Services tended to be provided by midwives, although some multidisciplinary practice was apparent. Seven (39%) of the countries offered ‘a few hours’ professional/pre-registration training, but none offered nationally mandated post-registration training.

Conclusions

A traumatic birth experience is a key public health concern. Evidence highlights important gaps regarding formalized care provision and training for care providers.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-021-07238-x.

Obstetric factors associated with postpartum post-traumatic stress disorder after spontaneous vaginal birth

BACKGROUND

This study aimed to determine whether there is an association between clinical practices carried out during spontaneous vaginal birth (SVB), or clinical situations that arise during vaginal birth, and the incidence of post-traumatic stress disorder (PTSD).

METHODS

A cross-sectional study with 839 puerperal women in Spain was conducted. The Perinatal Post-traumatic Stress Disorder Questionnaire (PPQ) was administered online. The relationship between the risk of postpartum PTSD and various intrapartum complications was studied in addition to practices or procedures performed during the intrapartum period.

RESULTS

PTSD (PPQ scores ≥19) was identified in 8.1% (68) of the women who participated. Among the risk factors for PTSD was a concerning intrapartum FHR tracing (adjusted OR: 2.24, 95% CI: 1.07-4.66). Other intrapartum practices also put women at risk of PTSD, including the administration of an enema (aOR: 7.01, 95% CI: 2.14-23.01), being required to stay lying down throughout the labor and birth (aOR: 5.75, 95% CI: 3.25-10.19), artificial amniorrhexis without consent (aOR: 2.28, 95% CI: 1.31-3.97), administration of synthetic oxytocin without consent (aOR: 2.18, 95% CI: 1.26-3.77), fundal pressure during pushing (aOR: 3.14, 95% CI: 1.72-5.73), repeated vaginal examinations performed by different people (aOR: 4.84, 95% CI: 2.77-8.47), and manual removal of the placenta without anesthesia (aOR: 3.45, 95% CI: 1.81-6.58).

CONCLUSIONS

Various intrapartum clinical practices, all related to dehumanized treatment, and intrapartum complications, were associated with an increased risk of PTSD. There is a need to eradicate obstetric mistreatment and to increase access to evidence-informed, respectful care in Spain. Care practitioners need to better appreciate their roles in preventing PTSD.

Simulation-based childbirth education for Chinese primiparas: A pilot randomized controlled trial

OBJECTIVE

To evaluate the effectiveness and feasibility of simulation-based childbirth education (SBCE) on reducing fear of childbirth (FOC) of Chinese primiparas.

METHODS

A total of 56 primiparas completed the trial including 26 in the intervention group and 30 in the control group. The intervention group received four sessions of SBCE while the control group received routine prenatal care. Chinese versions of the Wijma Delivery Expectancy/Experience Questionnaire (WDEQ-A) and Childbirth Self-Efficacy Inventory (CBSEI) were used to evaluate FOC and childbirth self-efficacy. Birth outcomes including delivery method, labor duration and Apgar scores were collected.

RESULTS

Scores on the WDEQ-A of the intervention group were statistically lower than those of the control group (P < 0.05). The CBSEI scores of the intervention group were significantly higher than those of the control group (P < 0.05). The cesarean birth rate of the intervention group was lower than that of the control group (34.61% vs 46.67%, P > 0.05).

CONCLUSION

Simulation-based childbirth education alleviates FOC, increases childbirth self-efficacy and improves birth outcomes, providing a new perspective to alleviate FOC of primiparas in the future.

PRACTICE IMPLICATIONS

Simulation-based childbirth education is an effective and feasible method to educate women about childbirth. Its integration into routine prenatal care of Chinese primiparas should be encouraged to reduce FOC.

Assessment of the attitude towards childbirth in health sciences students - development and validation of the questionnaire Cave-St

The purpose of this study is to report on the validation process of a questionnaire that explores health science students’ attitudes towards women’s childbirth experiences. This questionnaire can help inform education programs to enhance the quality of woman-professional interactions, and to improve women’s experiences of childbirth. A standardized procedure for the development and validation of the questionnaire included: item development and psychometric pre-validation, Cronbach’s Alpha coefficient calculation, test–retest and item-total correlation for the reliability analysis. Content validity was undertaken by Delphi method with sixteen panelists over two rounds. We determined the factor structure and refined and validated the questionnaire according to the responses of a cohort of 560 students using principal components factor analysis with varimax rotation. Confirmatory factor analysis was undertaken. A 52-items questionnaire CAVE-st: (acronym for cuestionario de actitudes sobre vivencias y experiencias en el parto) was developed and validated. The results of the factor analysis finally revealed four latent dimensions. The questionnaire CAVE-st is a valid and reliable tool to assess health science students’ attitude towards women’s childbirth experiences. Further work to translate and adapt the instrument in other cultures and languages will be undertaken.

Educating future professionals in perinatal medicine: the attitude of medical and nursing students towards childbirth

OBJECTIVES

The main objective of the present study was to evaluate what educational needs were being neglected in current perinatal educational program in the University of Malaga.

METHODS

We performed a cross-sectional study using the Students' questionnaire on attitudes towards childbirth (CAVE-st) in a sample of 378 students who were finishing their undergraduate or postgraduate academic perinatal program, including medical and nursing students.

RESULTS

The Cronbach's alpha reliability coefficient was 0.895. The mean score of CAVE-st in the sample was 200.34 (DT 21.0). The scores were below the median value in more than 53% of the students, especially in medical students. Female students scored systematically higher in the overall scale and its subscales, even after adjusting for study groups. On the other hand, the students with children scored significantly lower in the subscale that explored their attitudes towards unexpected results. A huge margin for improvement was recognizable in those subscales related with childbirth medicalization, respect to women decisions, and health-care prioritization.

CONCLUSIONS

Students' attitude towards childbirth need to be improved as a means to improve women's childbirth experience and prevent birth-related trauma. The current undergraduate and postgraduate training in perinatal care lacks a comprehensive and biopsychosocial perspective that would improve the quality of clinical practice during childbirth.

Factors Associated with Postpartum Post-Traumatic Stress Disorder (PTSD) Following Obstetric Violence: A Cross-Sectional Study

To determine the association between experiencing obstetric violence and the incidence of postpartum post-traumatic stress disorder (PTSD). A cross-sectional study with puerperal women was conducted in Spain following ethical approval. The Perinatal Posttraumatic Stress Disorder Questionnaire (PPQ) was administered online. Sociodemographic, clinical, and obstetric violence variables and the risk of dichotomized PTSD (low/high) were studied by bivariate and multivariate analysis with binary logistic regression. 955 women were invited to participate. 53 women refused to participate, three did not complete all survey questions and, finally, 899 women were included. The risk of PTSD (score ≥ 19) using the PPQ was 12.7% (114). The mean score was 9.10 points (SD = 8.52). Risk factors identified were having a delivery plan that was not respected (aOR: 2.85, 95% CI 1.56–5.21), elective caesarean delivery (aOR: 2.53, 95% CI 1.02–2.26), emergency caesarean section (aOR: 3.58, 95% CI 1.83–6.99), admission of the newborn to the neonatal intermediate care unit (aOR: 4.95, 95% CI 2.36–10.36), admission to the intensive care unit (aOR: 2.25, 95% CI 1.02–4.97), formula feeding on discharge (aOR: 3.57, 95% CI 1.32–9.62), verbal obstetric violence (aOR: 5.07, 95% CI 2.98–8.63), and psycho-affective obstetric violence (aOR: 2.61, 95% CI 1.45–4.67). Various clinical practices were identified with the risk of PTSD, highlighting various types of obstetric violence. Partner support and early breastfeeding were identified as protective factors. Sensitizing professionals is essential to prevent the risk of PTSD.

Long-Term High Risk of Postpartum Post-Traumatic Stress Disorder (PTSD) and Associated Factors

Postpartum post-traumatic stress disorder (PTSD) is not a specific process but can last for months and may manifest itself during any subsequent pregnancies or even become chronic. This study aimed to determine the factors associated with long-term PTSD symptoms one year after delivery. A cross-sectional study was conducted on 1301 Spanish puerperal women. Data were collected on sociodemographic, obstetric, and neonatal variables. The Perinatal Post-Traumatic Stress Disorder Questionnaire (PPQ) was administered online through midwives' associations across Spain. Crude odds ratio (OR) and adjusted odds ratio (aOR) and their 95% confidence intervals were calculated. A PPQ score ≥ 19 (high-risk) was recorded for 13.1% (171) of the participants. Identified risk factors were not respecting a birth plan (aOR = 1.89 (95% CI 1.21-2.94)), formula-feeding of the baby at discharge (aOR = 2.50 (95% CI 1.20-5.17)), postpartum surgical intervention (aOR = 2.23 (95% CI 1.02-4.85)), hospital readmission (aOR = 3.45 (95% CI 1.21-9.84)), as well as verbal obstetric violence (aOR = 3.73 (95% CI 2.52-5.53)) and psycho-affective obstetric violence (aOR = 3.98 (95% CI 2.48-6.39)). During childbirth, some clinical practices, such as formula-feeding of the newborn at discharge or types of obstetric violence towards the mother, were associated with a higher risk of PTSD symptoms one year after delivery.

Women's experiences of fear of childbirth: a metasynthesis of qualitative studies

Purpose: Women’s experiences of pregnancy, labour and birth are for some pregnant women negative and they develop a fear of childbirth, which can have consequences for their wellbeing and health. The aim was to synthesize qualitative literature to deepen the understanding of women’s experiences of fear of childbirth.

Methods: A systematic literature search and a meta-synthesis that included 14 qualitative papers.

Results: The main results demonstrate a deepened understanding of women’s experiences of fear of childbirth interpreted through the metaphor “being at a point of no return”. Being at this point meant that the women thought there was no turning back from their situation, further described in the three themes: To suffer consequences from traumatic births, To lack warranty and understanding, and To face the fear.

Conclusions: Women with fear of childbirth are need of support that can meet their existential issues about being at this point of no return, allowing them to express and integrate their feelings, experiences and expectations during pregnancy, childbirth and after birth.

Women with fear after birth, i.e., after an earlier negative birth experience, need support that enables them to regain trust in maternity care professionals and their willingness to provide them with good care that offers the support that individual women require. Women pregnant for the first time require similar support to reassure them that other’s experiences will not happen to them.

Screening for Mental Health and Substance Use Disorders in Obstetric Settings

PURPOSE OF REVIEW

The objective of this review is to describe the extent to which (1) obstetric settings are currently screening for mental health and substance use disorders and social determinants of health (SDoH), and (2) screening is followed by systematic approaches for ensuring an adequate response to positive screens. Additionally, clinical and policy implications of current screening practices and recommendations are discussed.

RECENT FINDINGS

Screening for perinatal depression in obstetric settings has increased. Despite their prevalence and negative impact, screening for other mental health and substance use disorders and SDoH is much less common and professional society recommendations are either nonexistent, less consistent, or less prescriptive. To truly address maternal mental health, we need to move beyond focusing solely on depression and address other mental health and substance use disorders and the contextual social determinants in which they occur.

Communication and patient safety in gynecology and obstetrics - study protocol of an intervention study

BACKGROUND

Patient safety is a key target in public health, health services and medicine. Communication between all parties involved in gynecology and obstetrics (clinical staff/professionals, expectant mothers/patients and their partners, close relatives or friends providing social support) should be improved to ensure patient safety, including the avoidance of preventable adverse events (pAEs). Therefore, interventions including an app will be developed in this project through a participatory approach integrating two theoretical models. The interventions will be designed to support participants in their communication with each other and to overcome difficulties in everyday hospital life. The aim is to foster effective communication in order to reduce the frequency of pAEs. If communication is improved, clinical staff should show an increase in work satisfaction and patients should show an increase in patient satisfaction.

METHODS

The study will take place in two maternity clinics in Germany. In line with previous studies of complex interventions, it is divided into three interdependent phases. Each phase provides its own methods and data. Phase 1: Needs assessment and a training for staff (n = 140) tested in a pre-experimental study with a pre/post-design. Phase 2: Assessment of communication training for patients and their social support providers (n = 423) in a randomized controlled study. Phase 3: Assessment of an app supporting the communication between staff, patients, and their social support providers (n = 423) in a case-control study. The primary outcome is improvement of communication competencies. A range of other implementation outcomes will also be assessed (i.e. pAEs, patient/treatment satisfaction, work satisfaction, safety culture, training-related outcomes).

DISCUSSION

This is the first large intervention study on communication and patient safety in gynecology and obstetrics integrating two theoretical models that have not been applied to this setting. It is expected that the interventions, including the app, will improve communication practice which is linked to a lower probability of pAEs. The app will offer an effective and inexpensive way to promote effective communication independent of users' motivation. Insights gained from this study can inform other patient safety interventions and health policy developments.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT03855735; date of registration: February 27, 2019.