Public health education for midwives and midwifery students: a mixed methods study

The role of midwives and obstetrical nurses in the promotion of healthy lifestyle during pregnancy

Women with maternal obesity, an unhealthy lifestyle before and during pregnancy and excess gestational weight gain have an increased risk of adverse pregnancy and birth outcomes that can also increase the risk of long-term poor health for them and their children. Pregnant women have frequent medical appointments and are highly receptive to health advice. Healthcare professionals who interact with women during pregnancy are in a privileged position to support women to make lasting healthy lifestyle changes that can improve gestational weight gain and pregnancy outcomes and halt the intergenerational nature of obesity. Midwives and obstetrical nurses are key healthcare professionals responsible for providing antenatal care in most countries. Therefore, it is crucial for them to build and enhance their ability to promote healthy lifestyles in pregnant women. Undergraduate midwifery curricula usually lack sufficient lifestyle content to provide emerging midwives and obstetrical nurses with the knowledge, skills, and confidence to effectively assess and support healthy lifestyle behaviours in pregnant women. Consequently, registered midwives and obstetrical nurses may not recognise their role in healthy lifestyle promotion specific to healthy eating and physical activity in practice. In addition, practising midwives and obstetrical nurses do not consistently have access to healthy lifestyle promotion training in the workplace. Therefore, many midwives and obstetrical nurses may not have the confidence and/or skills to support pregnant women to improve their lifestyles. This narrative review summarises the role of midwives and obstetrical nurses in the promotion of healthy lifestyles relating to healthy eating and physical activity and optimising weight in pregnancy, the barriers that they face to deliver optimal care and an overview of what we know works when supporting midwives and obstetrical nurses in their role to support women in achieving a healthy lifestyle.

Inequalities in the education of midwives in Europe

Although midwifery in Serbia has a long tradition, in the last decades, and especially in the last years since the Republic of Serbia is in the process of joining the European Union, this profession faces numerous challenges both in the context of formal education and the role that in the 21st century midwife has in practice. The midwife profession is faced with numerous challenges related to demographic trends and demands and expectations of a contemporary woman. The aim of the paper was to examine the difference in standards in the education of midwives in Serbia, and the neighbouring countries and Europe. Professional publications related to education and practice of midwives, published in Serbia, the neighbouring countries and Europe have been used. According to the presentation of standards and competencies of midwives in Serbia and education standards under Directive 2005/36/EZ and 2013/55/EU as well as the role and tasks midwives have in our country and European countries, there is a need for harmonization of standards in the education of midwife nurses and accreditation of joint study programs of professional master studies for nurses and midwives within the educational system of Serbia, all in the context of new paradigm of health care, which implies a holistic approach to women's health, a personalized approach and a self-protection concept. It is necessary to reform the education system of midwives in Serbia in accordance with the requirements of Directive2005/36/EZ, 2013/55/EU.

Midwives' and obstetricians' level of knowledge of appropriate gestational weight gain recommendations for pregnancy: A systematic review

BACKGROUND

Excessive gestational weight gain (GWG) is a modifiable risk factor associated with maternal and infant health, and pregnancy outcomes. However, several factors influence the provision of health promotion advice including professional knowledge. This review aims to summarize published evidence relating to midwives' and obstetricians' knowledge of GWG guidelines.

METHODS

Electronic database searches were carried out using EMBASE, CINAHL, PubMed, Web of Science, and Cochrane Database. English-language studies and quantitative results were included. Identified studies were screened by two authors independently. Disagreements were discussed with a third reviewer. A review protocol was submitted for registration with PROSPERO in May 2019.

RESULTS

From 10 960 records identified in preliminary searches, 12 studies reporting on 2652 midwives and obstetricians collectively were included. All studies were conducted in high-income countries. Synthesis of data was difficult as guidelines and methods for assessing knowledge varied. Midwives were mainly reported as the leading participant, with limited data available on obstetrician knowledge. Both groups demonstrated insufficient knowledge of GWG guidelines. Self-reported knowledge was significantly higher than those assessed by direct knowledge.

CONCLUSIONS

This review highlights a substantial gap in health care professionals' knowledge of GWG guideline content which needs to be addressed. Differences between professionals' direct knowledge and self-reported knowledge are important for clinical practice as it may inhibit the provision of evidence-based advice. It is important to accurately assess knowledge in this area to develop further training for midwives and obstetricians to improve health promotion during pregnancy.

A cross-sectional study of domestic violence instruction in nursing and midwifery programs: Out of step with community and student expectations

BACKGROUND

Domestic violence is a global health concern. Nurses and midwives must respond to those who experience domestic violence, although many are not prepared to do this. The World Health Organization recommend that domestic violence content be included in all pre-registration training as a matter of urgency.

OBJECTIVES

To examine self-reported undergraduate student perceptions of domestic violence content in their programs of study and student attitudes and beliefs about domestic violence.

DESIGN

A cross-sectional research design with online survey was employed from June to October 2017.

METHODS

Using convenience sampling, 1076 students were recruited to the study from a total population sample of just over 6000 undergraduate nursing and midwifery students; a response rate of 17.9%. Survey data reported the nature and frequency of teaching and learning along with student attitudes and beliefs about domestic violence. Open ended responses were examined via thematic analysis.

SETTINGS

Nine Australian universities offering undergraduate nursing and midwifery degrees.

PARTICIPANTS

Undergraduate university nursing and midwifery students.

RESULTS

Over half of students surveyed (53.7%, n = 578) reported that domestic violence was not addressed in their program of study. A direct correlation was found between students' perceived preparedness to assess and respond to domestic violence, and the amount of taught content in their program of study.

CONCLUSION

This major gap in curricula has significant implications for professional practice preparedness. Further research should focus on examining the reasons why quality domestic violence content is lacking in undergraduate nursing and midwifery programs and how prioritisation of domestic violence content can be improved.

Knowledge and Attitude of Midwifery Students on Oral Health Care

Midwifery students can have an important role in transferring oral health care information to expecting mothers. The aim of this study was to assess the effect of an educational intervention on knowledge and attitudes of midwifery students on oral health in pregnancy. Study population consisted of 60 midwifery students in a Midwifery School in Iran who were randomly allocated into case and control groups. Self-administered questionnaires were distributed before, immediately after the intervention and also three months later. The validity and reliability of the questionnaire was confirmed at the beginning. Mean total pre-test knowledge scores from total 10 in the interventional and control groups were 4.63 ± 0.25 (Standard Error, SE) and 4.79 ± 0.31 (SE) respectively. After three months scores reached to 8.87 ± 0.15 (SE) in the interventional and 5.57 ± 0.29 (SE) in the control groups. Mean attitude pre-test scores in the interventional group was 27.23 ± 0.75 (SE) and after the intervention reached to 31.13 ± 0.25 (SE). Lecture-based educational intervention improved the knowledge and attitudes of midwifery students on oral health care in pregnancy. Incorporating courses on oral health in pregnancy into the curricula of midwifery programs can be effective in promoting oral health care in pregnant women.

Investigating midwives' barriers and facilitators to multiple health promotion practice behaviours: a qualitative study using the theoretical domains framework

Background

In addition to their more traditional clinical role, midwives are expected to perform various health promotion practice behaviours (HePPBes) such as informing pregnant women about the benefits of physical activity during pregnancy and asking women about their alcohol consumption. There is evidence to suggest several barriers exist to performing HePPBes. The aim of the study was to investigate the barriers and facilitators midwives perceive to undertaking HePPBes.

Methods

The research compromised of two studies.

Study 1: midwives based in a community setting (N = 11) took part in semi-structured interviews underpinned by the theoretical domains framework (TDF). Interviews were analysed using a direct content analysis approach to identify important barriers or facilitators to undertaking HePPBes.

Study 2: midwives (N = 505) completed an online questionnaire assessing views on their HePPBes including free text responses (n = 61) which were coded into TDF domains. Study 2 confirmed and supplemented the barriers and facilitators identified in study 1.

Results

Midwives’ perceived a multitude of barriers and facilitators to carrying out HePPBes. Key barriers were requirements to perform an increasing amount of HePPBes on top of existing clinical work load, midwives’ cognitive resources, the quality of relationships with pregnant women, a lack of continuity of care and difficulty accessing appropriate training. Key facilitators included midwives’ motivation to support pregnant women to address their health. Study 1 highlighted strategies that midwives use to overcome the barriers they face in carrying out their HePPBes.

Conclusions

Despite high levels of motivation to carry out their health promotion practice, midwives perceive numerous barriers to carrying out these tasks in a timely and effective manner. Interventions that support midwives by addressing key barriers and facilitators to help pregnant women address their health behaviours are urgently needed.

Electronic supplementary material

The online version of this article (10.1186/s13012-019-0913-3) contains supplementary material, which is available to authorized users.

A Healthy Eating Education Program for Midwives to Investigate and Explore Their Knowledge, Understanding, and Confidence to Support Pregnant Women to Eat Healthily: Protocol for a Mixed-Methods Study

Background

Nutrition and healthy eating behaviors during pregnancy are vitally important for the health of a mother and her developing baby. However, some midwives have reported a lack of evidence-based nutrition knowledge for providing information about healthy eating to women during pregnancy.

Objective

In this study, the aim is to design and evaluate a healthy eating education program to enhance midwives’ knowledge, understanding, and confidence to support pregnant women in South Australia to make healthy eating choices.

Methods

This mixed-methods study consists of two phases. The first phase, Phase 1, consists of an education program for midwives, “Healthy Eating in Pregnancy,” to be delivered through a workshop or webinar. Each midwife will attend one workshop or webinar, which will be approximately two hours in length. This program will be evaluated through pre-, immediate-, and post-educational questionnaires utilizing a website specifically designed for this study. The participants will be midwives who are members of the Australian College of Midwives and the Australian Nursing and Midwives Federation, and users of social media (eg, Facebook and Twitter) residing and employed in South Australia. Phase 2 will consist of semistructured interviews with a purposive sample of midwives. These interviews will be undertaken to gain an in-depth understanding of midwives’ views and how confident they feel educating pregnant women after receiving the healthy eating education. Interviews will be face-to-face or conducted by telephone with midwives who have participated in the healthy eating educational program.

Results

A systematic review has previously been undertaken to inform this study protocol. This paper describes and discusses the protocol for this mixed-methods study, which will be completed in April 2019.

Conclusions

The results from the systematic review suggest that there is clear justification to undertake this mixed-methods study to investigate and explore midwives’ knowledge, understanding and confidence to support healthy eating in pregnant women. The results and conclusions from the systematic review provided some guidance for the design and development of this study protocol. This mixed-methods study will address a gap in the literature. The results from quantitative and qualitative data sources in this proposed study will help to draw conclusions to address the research topic.

Registered Report Identifier

RR1-10.2196/9861

Pregnancy nutrition knowledge and experiences of pregnant women and antenatal care clinicians: A mixed methods approach

BACKGROUND

Dietary intake of pregnant women do not appear to meet the dietary recommendations. Nutrition knowledge and practices of pregnant women and their antenatal care clinicians are factors that may be influential on dietary intakes of pregnant women.

AIM

To assess and compare pregnancy nutrition recommendation knowledge and to explore how nutrition knowledge impacts on food choices in pregnant women and nutrition education practices of antenatal care providers.

METHODS

An explanatory sequential research mixed methods study design was applied. All participants were recruited from a metropolitan maternity hospital in Melbourne, Australia. The first phase assessed pregnancy nutrition knowledge and sources of nutrition information using a questionnaire (n=202) then followed semi-structured interviews with women and clinicians (n=31).

FINDINGS

The clinicians obtained significantly higher nutrition scores than compared to women, however, nutrition knowledge gaps were highlighted for both women and clinicians. Women reported receiving limited nutrition advice, a reflection of the clinicians reporting they provided limited nutrition advice.

CONCLUSION

A key challenge for women adhering to dietary recommendations was having inadequate knowledge of the dietary recommendations and receiving limited information from their care providers. Similarly, as well as time constraints, limited nutrition knowledge and a lack of nutrition training impacted on the capacity of clinicians to provide adequate nutrition education.

Self-Reported Nutrition Education Received by Australian Midwives before and after Registration

Educating midwives to provide nutrition advice is essential. Limited research focuses on midwives' nutrition education. This paper explores self-reported nutrition education received by Australian midwives before and after registration. It draws on quantitative and qualitative data from a larger online survey conducted with the members of the Australian College of Midwives (response rate = 6.9%, n = 329). Descriptive and content analyses were used. Of the midwives, 79.3% (n = 261) reported receiving some nutrition education during, before, and/or after registration. However, some described this coverage as limited. It lacked sufficient focus on topics such as weight management, nutrition assessment, and nutrition for vulnerable groups. Continuing education often occurred through personal initiatives, such as the midwife enrolling in external courses or exploring issues on the Internet and with colleagues. The majority of participants indicated a need for increased nutrition education (94.2%, n = 310) and guidelines tailored for them to provide nutrition advice (87.8%, n = 289). Australian midwives may not be receiving adequate nutrition education to provide nutrition advice. Inclusion of evidence-based nutrition components in midwifery education and regular updates for practising midwives focusing on challenging nutrition issues is required to ensure that they are supported in this important role.

'Asking the hard questions': Improving midwifery students' confidence with domestic violence screening in pregnancy

Domestic violence is a global public health issue. Midwives are ideally placed to screen for, and respond to, disclosure of domestic violence. Qualified midwives and midwifery students report a lack of preparedness and low levels of confidence in working with women who disclose domestic violence. This paper reports the findings from an education intervention designed to increase midwifery students' confidence in working with pregnant women who disclose domestic violence. An authentic practice video and associated interactive workshop was developed to bring the 'woman' into the classroom and to provide role-modelling of exemplary midwifery practice in screening for and responding to disclosure of domestic violence. The findings demonstrated that students' confidence increased in a number of target areas, such as responding appropriately to disclosure and assisting women with access to support. Students' confidence increased in areas where responses needed to be individualised as opposed to being able to be scripted. Students appreciated visual demonstration (video of authentic practice) and having the opportunity to practise responding to disclosures through experiential learning. Given the general lack of confidence reported by both midwives and students of midwifery in this area of practice, this strategy may be useful in supporting midwives, students and other health professionals in increasing confidence in working with women who are experiencing domestic violence.

A wall of information? Exploring the public health component of maternity care in England

BACKGROUND

midwives have traditionally had an important role in providing public health messages to women. The range and diversity of the public health remit within maternity services has expanded rapidly over the past decade and maternity support workers as well as midwives are now engaged in public health work in many areas. Given these changes a review of current practice was indicated.

OBJECTIVE

to identify student midwives׳, midwives׳ and midwifery support workers׳ current knowledge of and involvement in the public health agenda in England.

DESIGN

descriptive qualitative study using online discussion forums.

SETTING

England, United Kingdom

PARTICIPANTS

undergraduate student midwives, midwives and maternity support workers employed by the National Health Service in England and University employed Leads for Midwifery Education.

FINDINGS

key themes identified were: the scope of the midwives׳ public health role, training and support for public health role, barriers and facilitators, specific client groups, specialist referral services. Student midwives, midwives and maternity support workers view engagement with, and delivery of, public health initiatives as an integral component of their roles, but are on occasions frustrated by constraints of time, training and public engagement.

KEY CONCLUSIONS

the National Health Service in England aims to engage pregnant women and new mothers in a diverse range of population based and individualised, public health initiatives. Currently, there are high levels of involvement in the public health agenda from the maternity workforce across a wide range of activities. However, midwives and maternity support workers are restricted by barriers of time, training and resources. These barriers will need addressing for optimal maternity care engagement in public health to be realised.

IMPLICATIONS FOR PRACTICE

policy makers, commissioners and National Health Service providers need to provide clear guidance on the expectations of the public health remit of midwives and maternity support workers and ensure that such expectations are appropriately resourced to provide effective delivery.

Midwives' perceptions and experiences of health promotion practice in Ghana

INTRODUCTION

This research explores midwives' perceptions and experiences of health promotion practice in Ghana.

METHODS

A qualitative descriptive exploratory design was used in order to gain better insight into midwives' perceptions and experiences of health promotion practice. A total of 21 midwives took part in the study. Data were collected by individual in-depth semi-structured interviews. Thematic analysis was used to analyse the transcript.

RESULTS

Five dominant themes emerged from the interview transcripts, namely: health promotion as education, health promotion activities, the value of health promotion, client participation, and midwives' barriers to promoting health. Although midwives underscored the importance of health promotion to their work, their reports indicated that, in practice, midwives mostly delivered health education and behaviour change communication rather than health promotion. The midwives expressed the view that by way of their close association with women, they were in a better position to influence women's health. Health promotion activities engaged by the midwives included weight management, healthy eating, infection prevention, personal hygiene, counselling on family planning, and screening for hazardous and harmful substance use such as alcohol and smoking. All the midwives mentioned that clients participated in their health promotion activities. Factors that were identified by the midwives to enhance client participation were trust, attitude of the midwife, building rapport, creating enabling environment, listening and paying attention to clients and using simple language. The barriers to health promotion identified by the midwives included time, stress, culture, lack of training and inadequate health educational materials.

DISCUSSION

Midwives in this study had limited knowledge about health promotion, yet could play a significant role in influencing health; thus there is a need for on-going in-service training for midwives to focus on health promotion.

Eating for 1, Healthy and Active for 2; feasibility of delivering novel, compact training for midwives to build knowledge and confidence in giving nutrition, physical activity and weight management advice during pregnancy

Background

Women in Wales are more likely to be obese in pregnancy than in any other United Kingdom (UK) country. Midwives are ideally placed to explore nutrition, physical activity and weight management concerns however qualitative studies indicate they lack confidence in raising the sensitive issue of weight. Acknowledging this and the reality of finite time and resources, this study aimed to deliver compact training on nutrition, physical activity and weight management during pregnancy to increase the knowledge and confidence of midwives in this subject.

Methods

A compact training package for midwives was developed comprising of evidence based nutrition, physical activity and weight management guidance for pregnancy. Training was promoted via midwifery leads and delivered within the Health Board. Questionnaires based on statements from national public health guidance were used to assess changes in self-reported knowledge and confidence pre and post training. Descriptive statistics were applied and 95% confidence intervals were calculated.

Results

43 midwives registered for training, 32 (74%) attended and completed the questionnaires. Although, pre training knowledge and confidence varied between participants, statistically significant improvements in self-reported knowledge and confidence were observed post training. 97% indicated knowledge of pregnancy specific food and nutrition messages as ‘better’ (95% CI 85 to 100), as opposed to 3% stating ‘stayed the same’ – 60% stated ‘much better’. 83% indicated confidence to explain the risks of raised BMI in pregnancy was either ‘much’ or ‘somewhat better’ (95% CI 66 to 93), as opposed to 17% stating ‘stayed the same’. 89% indicated confidence to discuss eating habits and physical activity was ‘much’ or ‘somewhat better’ (95% CI 73 to 97) as opposed to 11% stating ‘stayed the same’. Emergent themes highlighted that training was positively received and relevant to midwifery practice.

Conclusions

This study provides early indications that a compact nutrition, physical activity and weight management training package improves midwives self-reported knowledge and confidence. Cascading training across the midwifery service in the Health Board and conducting further studies to elicit longer term impact on midwifery practice and patient outcomes are recommended.