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Cummins L, Dawson K, Bayes S, Wilson V, Meedya S. Using the principles of practice development to address challenges in recruitment and data collection when face-to-face methods are unavailable. Nurse Res 2024; 32:22-30. [PMID: 38419422 DOI: 10.7748/nr.2024.e1898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND Researchers conducting studies involving pregnant women often find recruitment challenging. The COVID-19 pandemic added further complexity to studies requiring face-to-face participation. AIM To demonstrate how to maintain the principles of practice development (PD) when a study must switch from face-to-face to remote methods of collecting data. DISCUSSION The number of participants in the authors' study increased when they moved from face-to-face to telephone engagement during the COVID-19 pandemic. They continued using PD principles when they changed method and the quality of the data they collected remained constant, even once lockdown restrictions were in place. CONCLUSION PD principles can offer ways for nurse researchers to engage, collaborate with and reflect with people for research projects, including when constraints compete with participation. They can also assist researchers in optimising and maintaining recruitment and data collection when face-to-face research methods are impossible. IMPLICATIONS FOR PRACTICE The telephone can be a valuable alternative medium for recruiting participants and collecting data when face-to-face methods are impossible to use. PD principles can be maintained and response rates and participation may even be greater when using it.
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Affiliation(s)
- Leanne Cummins
- Australian Catholic University, Blacktown, NSW Australia
| | - Kate Dawson
- Faculty of Health Science/School of Nursing, Midwifery, Australian Catholic University, Melbourne, Victoria
| | - Sara Bayes
- Australian Catholic University, Melbourne, Victoria
| | - Valerie Wilson
- person-centred healthcare, Ingham Institute, Liverpool, NSW Australia
| | - Shahla Meedya
- Australian Catholic University, Blacktown, NSW Australia
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O'Leary BD, Keane DP. Validation of online delivery of the Australian Pelvic Floor Questionnaire in an Irish obstetric population. Int Urogynecol J 2023; 34:2133-2139. [PMID: 37004518 PMCID: PMC10066939 DOI: 10.1007/s00192-023-05529-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 03/13/2023] [Indexed: 04/04/2023]
Abstract
INTRODUCTION AND HYPOTHESIS Childbirth remains an important risk factor for the development of pelvic floor disorders, regardless of the mode of delivery. To accurately assess these symptoms, accurate, woman-centric assessments are needed. Online versions of these assessments may be especially useful in the COVID-19 era. Women may potentially answer questions differently in an online format, and this study aimed to validate an online version of the paper-based self-administered Australian Pelvic Floor Questionnaire (APFQ). METHODS The questionnaire was completed antenatally and at 3 months postpartum by 647 and 481 women respectively. Test- validity was assessed in subgroups of 61 and 57 women in each period, using intraclass correlation coefficients and Cohen's kappa. Sensitivity to change was assessed by comparing responses during pregnancy to those at 3 months postpartum. Internal consistency was assessed using Cronbach's alpha. Construct validity was assessed by comparing women with and without subjective bothersomeness. RESULTS Intraclass correlation coefficients were above 0.9 for all domains and the overall questionnaire. Cohen's kappa for individual questions ranged from 0.71-1.00 across the antenatal and postnatal questionnaires. Cronbach's alpha was acceptable for all domains except the prolapse domain. The APFQ was sensitive to changes occurring between antenatal recruitment and 3 months postpartum. Effect sizes ranged from 0.83-7.99. CONCLUSIONS This online version of the APFQ is valid for assessing pelvic floor disorders in an Irish obstetric population. The APFQ is reproducible and responsive to change occurring with childbirth, and can be used to research longitudinal changes in pelvic floor disorders. As an online tool, this questionnaire may be useful in increasing response rates to clinical research.
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Affiliation(s)
- Bobby D O'Leary
- Department of Urogynaecology, National Maternity Hospital, Holles Street, Dublin 2, Ireland.
- UCD Perinatal Research Centre, National Maternity Hospital, Holles Street, Dublin 2, Ireland.
| | - Declan P Keane
- Department of Urogynaecology, National Maternity Hospital, Holles Street, Dublin 2, Ireland
- Royal College of Surgeons in Ireland, National Maternity Hospital, Holles Street, Dublin 2, Ireland
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Lovell H, Silverio SA, Story L, Skelton E, Matthew J. Factors which influence ethnic minority women's participation in maternity research: A systematic review of quantitative and qualitative studies. PLoS One 2023; 18:e0282088. [PMID: 36827386 PMCID: PMC9956875 DOI: 10.1371/journal.pone.0282088] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 02/07/2023] [Indexed: 02/26/2023] Open
Abstract
BACKGROUND Women from Black, Asian and mixed ethnicity backgrounds in the UK experience higher rates of maternal and neonatal mortality and morbidity, and report poorer experiences of maternity care. Research is required to understand how to reduce these disparities, however, it is acknowledged these groups of women are under-represented in clinical research. AIM To investigate factors which influence participation in maternity research for women from an ethnic minority background. METHODS A systematic review was conducted to examine influencing factors for research participation. MEDLINE/CINHAL/PsycInfo/EMBASE databases were systematically searched in March 2021 and updated in March 2022. Papers were eligible if they explored maternal research participation and identified a woman's ethnicity in the results. No restrictions were placed on methodology. A convergent integrated approach was used to synthesise findings. FINDINGS A total of 14 papers met the inclusion criteria. Results were divided into eight overarching themes. A personalised approach to recruitment and incorporating culturally sensitive communication and considerations enhanced research participation. Distrust around sharing data, a perception of risk to research participation, and research lacking in personal relevance adversely affected the decision to participate. Large variation existed in the quality of the studies reviewed. CONCLUSIONS Consideration of a woman's culture and background in the design and the delivery of a maternity research study may facilitate participation, particularly when sampling from a specific population. Further research, informed by women from ethnic minority backgrounds is warranted to develop women-centred recommendations for conducting inclusive maternity research. Prospero registration: www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42021261686.
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Affiliation(s)
- Holly Lovell
- Maternity Services, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Sergio A. Silverio
- Department of Women & Children’s Health, School of Life Course & Population Sciences, King’s College London, London, United Kingdom
| | - Lisa Story
- Maternity Services, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
- Department of Women & Children’s Health, School of Life Course & Population Sciences, King’s College London, London, United Kingdom
| | - Emily Skelton
- Division of Radiography and Midwifery, City University of London, London, United Kingdom
| | - Jacqueline Matthew
- Maternity Services, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
- Department of Perinatal Imaging and Health, School of Biomedical Engineering & Imaging Sciences, King’s College London, London, United Kingdom
- * E-mail:
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Cozzi GD, Jauk VC, Szychowski JM, Tita AT, Battarbee AN, Subramaniam A. Participation in obstetrical studies is associated with improved pregnancy outcomes. Am J Obstet Gynecol MFM 2022; 4:100729. [PMID: 35995368 PMCID: PMC10577523 DOI: 10.1016/j.ajogmf.2022.100729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 08/04/2022] [Accepted: 08/15/2022] [Indexed: 10/31/2022]
Abstract
BACKGROUND The association between pregnant patients participating in obstetrical studies and pregnancy outcomes is understudied. OBJECTIVE This study aimed to evaluate the association between participation in obstetrical studies and maternal and neonatal outcomes. STUDY DESIGN This was a retrospective cohort study of all patients delivering at a single center from 2013 to 2018. Patients with pregnancy loss at <13 weeks of gestation or major fetal anomalies were excluded. Patients who enrolled in one or more obstetrical studies were categorized as "study participants" and were compared with patients who did not enroll in an obstetrical study, that is, "study nonparticipants." The primary outcome was a composite of maternal morbidity diagnosed up to 6 weeks after delivery. The secondary outcomes included composite neonatal morbidity and other perinatal outcomes. Bivariate analyses compared baseline demographics and outcomes between groups. Multivariable logistic regression was used to estimate adjusted odds ratios with 95% confidence intervals. Subgroup analyses by study design (trial or observational) were planned. RESULTS Of 19,569 patients included in this analysis, 3848 (19.7%) were study participants, and 15,721 (80.3%) were study nonparticipants. Among study participants, 3023 (78.6%) enrolled in a trial, and 825 (21.4%) enrolled in an observational study. The study participants had higher body mass index and were more likely to be younger, non-Hispanic Black, publicly insured, nulliparous, and undergo cesarean delivery than study nonparticipants. Compared with study nonparticipants, the study participants had significantly lower odds of composite maternal morbidity (9.2% vs 8.7%; adjusted odds ratio, 0.83; 95% confidence interval, 0.73-0.95) and composite neonatal morbidity (27.5% vs 18.6%; adjusted odds ratio, 0.53; 95% confidence interval, 0.48-0.58). In addition, the odds of fetal death, 5-minute Apgar score of <5, neonatal death, maternal and neonatal intensive care unit admissions, and lengths of stay were lower for study participants than for study nonparticipants. In stratified analyses, maternal morbidity was only significantly decreased among trial participants; however, there was a significantly reduced odds of neonatal morbidity, regardless of study design (trial or observational vs no study). CONCLUSION Participation in obstetrical studies was associated with decreased maternal and neonatal morbidities after adjusting for potential confounders. This underscored the importance of pregnant patients enrolling in obstetrical clinical studies and potentially benefiting from the additional surveillance. Further study of how study participation exerts this effect on pregnancy outcomes is warranted.
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Affiliation(s)
- Gabriella D Cozzi
- Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, AL (Dr Cozzi, Ms Jauk, and Drs Szychowski, Tita, Battarbee, and Subramaniam); Departments of Obstetrics and Gynecology (Drs Cozzi, Szychowski, Tita, Battarbee, and Subramaniam).
| | - Victoria C Jauk
- Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, AL (Dr Cozzi, Ms Jauk, and Drs Szychowski, Tita, Battarbee, and Subramaniam)
| | - Jeff M Szychowski
- Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, AL (Dr Cozzi, Ms Jauk, and Drs Szychowski, Tita, Battarbee, and Subramaniam); Departments of Obstetrics and Gynecology (Drs Cozzi, Szychowski, Tita, Battarbee, and Subramaniam); Biostatistics (Dr Szychowski), University of Alabama at Birmingham, Birmingham, AL
| | - Alan T Tita
- Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, AL (Dr Cozzi, Ms Jauk, and Drs Szychowski, Tita, Battarbee, and Subramaniam); Departments of Obstetrics and Gynecology (Drs Cozzi, Szychowski, Tita, Battarbee, and Subramaniam)
| | - Ashley N Battarbee
- Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, AL (Dr Cozzi, Ms Jauk, and Drs Szychowski, Tita, Battarbee, and Subramaniam); Departments of Obstetrics and Gynecology (Drs Cozzi, Szychowski, Tita, Battarbee, and Subramaniam)
| | - Akila Subramaniam
- Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, AL (Dr Cozzi, Ms Jauk, and Drs Szychowski, Tita, Battarbee, and Subramaniam); Departments of Obstetrics and Gynecology (Drs Cozzi, Szychowski, Tita, Battarbee, and Subramaniam)
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5
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Goldstein E, Bakhireva LN, Nervik K, Hagen S, Turnquist A, Zgierska AE, Marquez LE, McDonald R, Lo J, Chambers C. Recruitment and retention of pregnant women in prospective birth cohort studies: A scoping review and content analysis of the literature. Neurotoxicol Teratol 2021; 85:106974. [PMID: 33766723 PMCID: PMC8137666 DOI: 10.1016/j.ntt.2021.106974] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 03/16/2021] [Accepted: 03/16/2021] [Indexed: 11/20/2022]
Abstract
Longitudinal cohort studies present unique methodological challenges, especially when they focus on vulnerable populations, such as pregnant women. The purpose of this review is to synthesize the existing knowledge on recruitment and retention (RR) of pregnant women in birth cohort studies and to make recommendations for researchers to improve research engagement of this population. A scoping review and content analysis were conducted to identify facilitators and barriers to the RR of pregnant women in cohort studies. The search retrieved 574 articles, with 38 meeting eligibility criteria and focused on RR among English-speaking, adult women, who are pregnant or in early postpartum period, enrolled in birth cohort studies. Selected studies were birth cohort (including longitudinal) (n = 20), feasibility (n = 14), and other (n = 4) non-interventional study designs. The majority were from low-risk populations. Abstracted data were coded according to emergent theme clusters. The majority of abstracted data (79%) focused on recruitment practices, with only 21% addressing retention strategies. Overall, facilitators were reported more often (75%) than barriers (25%). Building trusting relationships and employing diverse recruitment methods emerged as major recruitment facilitators; major barriers included heterogeneous participant reasons for refusal and cultural factors. Key retention facilitators included flexibility with scheduling, frequent communication, and culturally sensitive practices, whereas participant factors such as loss of interest, pregnancy loss, relocation, multiple caregiver shifts, and substance use/psychiatric problems were cited as major barriers. Better understanding of facilitators and barriers of RR can help enhance the internal and external validity of future birth/pre-birth cohorts. Strategies presented in this review can help inform investigators and funding agencies of best practices for RR of pregnant women in longitudinal studies.
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Affiliation(s)
- Ellen Goldstein
- Department of Family Medicine and Community Health, University of Wisconsin, School of Medicine and Public Health, 1100 Delaplaine Ct, Madison, WI 53715, United States of America.
| | - Ludmila N Bakhireva
- College of Pharmacy Substance Use Research and Education (SURE) Center, United States of America; Department of Family and Community Medicine, United States of America; Division of Epidemiology, Biostatistics, and Preventive Medicine, Department of Internal Medicine, University of New Mexico Health Sciences Center, 1 University of New Mexico, MSC 09 5360, Albuquerque, NM 87131, United States of America.
| | - Kendra Nervik
- Department of Sociology, University of Wisconsin, 8128 William H. Sewell Social Sciences Building, 1180 Observatory Drive, Madison, WI 53706-1393, United States of America.
| | - Shelbey Hagen
- Department of Family Medicine and Community Health, University of Wisconsin, School of Medicine and Public Health, 1100 Delaplaine Ct, Madison, WI 53715, United States of America.
| | - Alyssa Turnquist
- Department of Family Medicine and Community Health, University of Wisconsin, School of Medicine and Public Health, 1100 Delaplaine Ct, Madison, WI 53715, United States of America.
| | - Aleksandra E Zgierska
- Department of Family and Community Medicine, Pennsylvania State University, College of Medicine, United States of America.
| | - Lidia Enriquez Marquez
- College of Pharmacy Substance Use Research and Education (SURE) Center, United States of America.
| | - Ryan McDonald
- Department of Obstetrics & Gynecology, University of Wisconsin School of Medicine and Public Health McConnell Hall, 1010 Mound Street, Madison, WI 53715, United States of America.
| | - Jamie Lo
- Department of Obstetrics & Gynecology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, L466, Portland, OR 97239, United States of America.
| | - Christina Chambers
- Departments of Pediatrics and Herbert Wertheim School of Public Health and Longevity Science, University of California San Diego, 9500 Gilman Drive, MC0828, La Jolla, CA 92093, United States of America.
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6
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Smith R, Alvarez C, Crixell S, Lane MA. The Food, Feelings, and Family Study: comparison of the efficacy of traditional methods, social media, and broadcast email to recruit pregnant women to an observational, longitudinal nutrition study. BMC Pregnancy Childbirth 2021; 21:203. [PMID: 33711946 PMCID: PMC7953646 DOI: 10.1186/s12884-021-03680-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 02/28/2021] [Indexed: 11/17/2022] Open
Abstract
Background It is well known that recruitment is a challenging aspect of any study involving human subjects. This challenge is exacerbated when the population sought is reticent to participate in research as is the case with pregnant women and individuals with depression. This paper compares recruitment methods used for the Food, Feelings, and Family Study, an observational, longitudinal pilot study concerning how diet and bisphenol A exposure affect maternal mood and cognitive function during and after pregnancy. Methods Pregnant women were recruited to this study over a period of 15 months using traditional methods, social media including paid and unpaid posts, and emails broadcast to the university community. Contingency analysis using the Pearson’s Chi-square test was used to determine if recruitment method was associated with likelihood of participation. T-tests were used to analyze Facebook advertisement success. ANOVAs and Fisher exact tests were used to determine if recruitment method was related to continuous and categorical demographics, respectively. Results Social media resulted in the largest number of recruits, followed by traditional methods and broadcast email. Women recruited through social media were less likely to participate. In contrast, use of broadcast email resulted in a smaller pool of recruits but these recruits were more likely to be eligible for and complete the study. Most women recruited via social media were the result of unpaid posts to the study’s Facebook page. Paid posts lasting at least 4 days were the most successful. Recruitment method was not associated with participant demographics. Conclusions Social media has the potential to recruit a large pool of potential subjects; however, when studies require a large time investment such as the case here, women recruited through social media are less likely to participate and complete the study than women recruited through other means. Trial registration N/A. This study does not describe a health care intervention. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-021-03680-1.
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Affiliation(s)
- Rebecca Smith
- Nutrition and Foods Program, School of Family and Consumer Sciences, Texas State University, 601 University Dr., San Marcos, TX, 78666, USA
| | - Crystal Alvarez
- Nutrition and Foods Program, School of Family and Consumer Sciences, Texas State University, 601 University Dr., San Marcos, TX, 78666, USA
| | - Sylvia Crixell
- Nutrition and Foods Program, School of Family and Consumer Sciences, Texas State University, 601 University Dr., San Marcos, TX, 78666, USA
| | - Michelle A Lane
- Nutrition and Foods Program, School of Family and Consumer Sciences, Texas State University, 601 University Dr., San Marcos, TX, 78666, USA.
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Rose J, Lynn K, Akister J, Maxton F, Redsell SA. Community midwives' and health visitors' experiences of research recruitment: a qualitative exploration using the Theoretical Domains Framework. Prim Health Care Res Dev 2021; 22:e5. [PMID: 33509327 PMCID: PMC8057511 DOI: 10.1017/s1463423621000050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 10/20/2020] [Accepted: 12/30/2020] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Successful research is frequently hampered by poor study recruitment, especially in community settings and with participants who are women and their children. Health visitors (HVs) and community midwives (CMs) are well placed to invite young families, and pregnant and postnatal women to take part in such research, but little is known about how best to support these health professionals to do this effectively. AIM This study uses the Theoretical Domains Framework (TDF) to explore the factors that influence whether HVs and CMs invite eligible patients to take part in research opportunities. METHOD HVs (n = 39) and CMs (n = 22) working in four NHS Trusts and one community partnership in England completed an anonymous, online survey with open-ended questions about their experiences of asking eligible patients to take part in the research. Qualitative data were analysed using directed content analysis and inductive coding to identify specific barriers and enablers to patient recruitment within each of the 14 theoretical domains. FINDINGS Six key TDF domains accounted for 81% of all coded responses. These were (a) environmental context and resources; (b) beliefs about capabilities; (c) social/professional role and identity; (d) social influences; (e) goals; (f) knowledge. Key barriers to approaching patients to participate in the research were time and resource constraints, perceived role conflict, conflicting priorities, and particularly for HVs, negative social influences from patients and researchers. Enablers included feeling confident to approach patients, positive influence from peers, managers and researchers, beliefs in the relevance of this behaviour to health care and practice and good knowledge about the study procedures, its rationale and the research topic. The findings suggest that to improve research recruitment involving HVs and CMs, a package of interventions is needed to address the barriers and leverage the enablers to participant approach.
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Affiliation(s)
- Jennie Rose
- Faculty of Health, Education, Medicine and Social Care, Anglia Ruskin University, Cambridge, UK
| | - Kieran Lynn
- Faculty of Health, Education, Medicine and Social Care, Anglia Ruskin University, Cambridge, UK
| | - Jane Akister
- Faculty of Health, Education, Medicine and Social Care, Anglia Ruskin University, Cambridge, UK
| | - Fiona Maxton
- Research Department, North West Anglia NHS Foundation Trust, Peterborough, UK
| | - Sarah A. Redsell
- School of Health Sciences, University of Nottingham, Nottingham, UK
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Shomaker LB, Gulley LD, Clark ELM, Hilkin AM, Pivarunas B, Tanofsky-Kraff M, Nadeau KJ, Barbour LA, Scott SM, Sheeder JL. Protocol for a pilot randomized controlled feasibility study of brief interpersonal psychotherapy for addressing social-emotional needs and preventing excess gestational weight gain in adolescents. Pilot Feasibility Stud 2020; 6:39. [PMID: 32206334 PMCID: PMC7082950 DOI: 10.1186/s40814-020-00578-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Accepted: 02/26/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Excess gestational weight gain (GWG) in pregnant adolescents is a major public health concern. Excess GWG increases risk of pregnancy complications as well as postpartum and offspring obesity and cardiometabolic disease. Prevention interventions for pregnant adults that target lifestyle modification (i.e., healthy eating/physical activity) show insufficient effectiveness. Pregnant adolescents have distinct social-emotional needs, which may contribute to excess GWG. From an interpersonal theoretical framework, conflict and low social support increase negative emotions, which in turn promote excess GWG through mechanisms such as overeating and physical inactivity. METHODS The current manuscript describes the design of a pilot randomized controlled feasibility trial of adolescent interpersonal psychotherapy (IPT) to address social-emotional needs and prevent excess GWG. Up to 50 pregnant, healthy adolescents 13-19y, 12-18 weeks gestation are recruited from an interdisciplinary adolescent maternity hospital clinic and randomized to IPT + usual care or usual care alone. IPT involves 6 individual 60-minute sessions delivered by a trained behavioral health clinician during 12-30 weeks gestation. Sessions include relationship psychoeducation, emotion identification and expression, and teaching/role-playing communication skills. Between sessions, adolescents are instructed to complete a daily journal and to have conversations to work on relationship goals. Outcomes are assessed at baseline, mid-program, post-program, and 3-months postpartum. Primary outcomes are feasibility and acceptability based upon rate of recruitment, session attendance, program acceptability ratings, and follow-up retention. Secondary outcomes are perinatal social functioning, stress, depression, and eating behaviors assessed with validated surveys and interviews; perinatal physical activity and sleep measured via accelerometer; GWG from measured weights; and at 3-months postpartum only, maternal adiposity by dual energy x-ray absorptiometry, maternal insulin sensitivity derived from 2-hour oral glucose tolerance testing, and infant adiposity by air displacement plethysmography. DISCUSSION This pilot trial will address a key gap in extant understanding of excess GWG prevention for a high-risk population of adolescents. If feasible and acceptable, brief psychotherapy to address social-emotional needs should be tested for its effectiveness to address excess GWG and postpartum maternal/infant health. If effective, such an approach has potential to interrupt an adverse, intergenerational cycle of social-emotional distress, obesity, and cardiometabolic disease among young mothers and their offspring. TRIAL REGISTRATION ClinicalTrials.gov NCT03086161, retrospectively registered.
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Affiliation(s)
- Lauren B. Shomaker
- Department of Human Development and Family Studies, Colorado State University, 1570 Campus Delivery, Fort Collins, CO 80523-1570 USA
- Department of Community and Behavioral Health, Colorado School of Public Health, Aurora, CO USA
- Department of Pediatrics, University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora, CO USA
| | - Lauren D. Gulley
- Department of Human Development and Family Studies, Colorado State University, 1570 Campus Delivery, Fort Collins, CO 80523-1570 USA
- Department of Pediatrics, University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora, CO USA
| | - Emma L. M. Clark
- Department of Human Development and Family Studies, Colorado State University, 1570 Campus Delivery, Fort Collins, CO 80523-1570 USA
- Department of Pediatrics, University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora, CO USA
| | - Allison M. Hilkin
- Department of Pediatrics, University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora, CO USA
| | - Bernadette Pivarunas
- Department of Human Development and Family Studies, Colorado State University, 1570 Campus Delivery, Fort Collins, CO 80523-1570 USA
| | - Marian Tanofsky-Kraff
- Department of Medical and Clinical Psychology and Department of Medicine, Uniformed Services University of the Health Sciences, Department of Defense, Bethesda, MD USA
| | - Kristen J. Nadeau
- Department of Pediatrics, University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora, CO USA
| | - Linda A. Barbour
- Department of Medicine, University of Colorado School of Medicine, Aurora, CO USA
- Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, CO USA
| | - Stephen M. Scott
- Department of Pediatrics, University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora, CO USA
- Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, CO USA
| | - Jeanelle L. Sheeder
- Department of Pediatrics, University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora, CO USA
- Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, CO USA
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9
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Stillbirth research: Recruitment barriers and participant feedback. Women Birth 2020; 33:153-160. [DOI: 10.1016/j.wombi.2019.03.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 03/12/2019] [Accepted: 03/15/2019] [Indexed: 11/22/2022]
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10
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van der Zande ISE, van der Graaf R, Oudijk MA, van Vliet-Lachotzki EH, van Delden JJM. A qualitative study on stakeholders' views on the participation of pregnant women in the APOSTEL VI study: a low-risk obstetrical RCT. BMC Pregnancy Childbirth 2019; 19:65. [PMID: 30744577 PMCID: PMC6371564 DOI: 10.1186/s12884-019-2209-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Accepted: 01/29/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Bioethicists argue that inclusion of pregnant women in clinical research should be more routine to increase the evidence-base for pregnant women and foetuses. Yet, it is unknown whether pregnant women and others directly involved are willing to be routinely included. Therefore, we first need to establish what these stakeholders think about research participation in regular pregnancy-related research. However, studies on their views are scarce. In our study, we piggy-backed on a relatively conventional RCT, the APOSTEL VI study, to identify the views of stakeholders on inclusion of pregnant women in this study. METHODS We conducted a prospective qualitative study using 35 in-depth semi-structured interviews and one focus group. We interviewed pregnant women (n = 14) recruited for the APOSTEL VI study, in addition to healthcare professionals (n = 14), Research Ethics Committee members (RECs) (n = 5) and regulators (n = 7) involved in clinical research in pregnant women. RESULTS Three themes characterise stakeholders' views on inclusion of pregnant women in the APOSTEL VI study. Additionally, one theme characterises stakeholders' interest in inclusion of pregnant women in clinical research in general. First, pregnant women participate in the APOSTEL VI study for potential individual benefit and secondarily for altruistic motives, contrary to hypothetical studies. Second, a gatekeeping tendency hampers recruitment of pregnant women who might be eligible and willing, and questions about pregnant women's decisional capacities surface. Third, healthcare professionals sometimes use the counselling conversation to steer pregnant women in a direction. Fourth, all stakeholders are hesitant about inclusion of pregnant women in clinical research in general due to a protective sentiment. CONCLUSIONS Pregnant women are willing to participate in the APOSTEL VI study for potential individual benefit and altruistic motives. However, an underlying protective sentiment, resulting in gatekeeping and directive counselling, sometimes hampers recruitment in the APOSTEL VI study as well as in clinical research in general. While bioethicists claim that inclusion of pregnant women should be customary, our study indicates that healthcare professionals, regulators, RECs and pregnant women themselves are not necessarily interested in inclusion. Advancing the situation and increasing the evidence-base for pregnant women and foetuses may require additional measures such as investing in the recruitment and feasibility of RCTs and stimulating pregnant women's decisional capacities.
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Affiliation(s)
- Indira S. E. van der Zande
- Department of Medical Humanities, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, P.O. box 85500, 3508 GA Utrecht, the Netherlands
| | - Rieke van der Graaf
- Department of Medical Humanities, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, P.O. box 85500, 3508 GA Utrecht, the Netherlands
| | - Martijn A. Oudijk
- Department of Obstetrics and Gynaecology, Academic Medical Center, Amsterdam, the Netherlands
| | | | - Johannes J. M. van Delden
- Department of Medical Humanities, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, P.O. box 85500, 3508 GA Utrecht, the Netherlands
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11
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Pihl S, Uustal E, Blomberg M. Anovaginal distance and obstetric anal sphincter injury: a prospective observational study. Int Urogynecol J 2018; 30:939-944. [PMID: 30535980 PMCID: PMC6511353 DOI: 10.1007/s00192-018-3838-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 11/21/2018] [Indexed: 02/06/2023]
Abstract
INTRODUCTION AND HYPOTHESIS No measurements are available for diagnosing the extent of obstetric lacerations. The primary aim of this study was to evaluate the relation between the anovaginal distance (AVD) measured with transperineal ultrasound immediately after delivery and external anal sphincter injury. A secondary aim was to assess whether the palpated perineal thickness was associated with the AVD. METHODS A prospective observational study of 150 primiparous women at the University Hospital, Linköping, Sweden. After vaginal delivery, initial inspection and palpation of the perineal thickness were performed by the midwife. The women were then divided into subgroups depending on the degree of the suspected perineal laceration. Transperineal ultrasound of the AVD was performed by a physician. Diagnostics of the perineal laceration were done according to standard care. RESULTS Women with an external sphincter injury had a shorter AVD and shorter palpatory perineal thickness compared with women without anal sphincter injury. No external sphincter injuries were diagnosed when the AVD and/or palpation height was > 20 mm. The mean AVD in the group with probable second-degree laceration (n = 85) was 18.8 mm (95% CI 17.8-19.8), in suspected third-degree laceration (n = 33) 15.7 mm (95% CI 13.7-17.7) and in probable third-degree laceration (n = 32) 11.8 mm (95% CI 9.7-13.9) (p < 0.001). CONCLUSIONS A short AVD could be a warning sign postpartum and should increase the awareness of possible external sphincter injury before suturing. An AVD of 20 mm seems to indicate a cutoff level of the occurrence of external sphincter injury, but this needs further evaluation.
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Affiliation(s)
- Sofia Pihl
- Department of Obstetrics and Gynecology, and Department of Clinical and Experimental Medicine, Linköping University, SE-581 85, Linköping, Sweden.
| | - Eva Uustal
- Department of Obstetrics and Gynecology, and Department of Clinical and Experimental Medicine, Linköping University, SE-581 85, Linköping, Sweden
| | - Marie Blomberg
- Department of Obstetrics and Gynecology, and Department of Clinical and Experimental Medicine, Linköping University, SE-581 85, Linköping, Sweden
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12
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van der Zande ISE, van der Graaf R, Hooft L, van Delden JJM. Facilitators and barriers to pregnant women's participation in research: A systematic review. Women Birth 2018; 31:350-361. [PMID: 29373261 DOI: 10.1016/j.wombi.2017.12.009] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Revised: 12/01/2017] [Accepted: 12/22/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND Although there is consensus among many that exclusion of pregnant women from clinical research should be justified, there is uncertainty as to whether and why pregnant women themselves would be willing to participate even if they were found to be eligible. The objective was to identify the reasons why pregnant women participate in clinical research and thereby to distinguish between facilitators and barriers. METHODS We conducted a systematic review of articles regarding pregnant women's reasons for participation in clinical research. We used the PubMed/MEDLINE, EMBASE, PsycINFO and CINAHL databases and retrieved additional articles through manually searching the reference lists. We included all articles that reported on pregnant women's reasons for participation in clinical research. We accumulated all reasons that were mentioned in the total of articles and collated them to themes, classifying these themes as a facilitator or a barrier. RESULTS The search identified thirty articles that met the inclusion criteria. Themes classified as facilitators: aspirational benefits, collateral benefits, direct benefits, third party influence and lack of inconvenience. Themes classified as barriers: inconveniences, risks, randomisation, lack of trust in research enterprise, medical reasons and third party influence. CONCLUSIONS Pregnant women report mostly altruistic and personal reasons for their willingness to participate in clinical research, while barriers primarily relate to inconveniences. It appears that pregnant women's described reasoning is similar to the described reasoning of non-pregnant research subjects. Enhancing the facilitators and overcoming the barriers is the next step to increase the evidence-base underlying maternal and foetal health.
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Affiliation(s)
- Indira S E van der Zande
- University Medical Center Utrecht, Julius Center for Health Sciences and Primary Care, Department of Medical Humanities, Utrecht, The Netherlands.
| | - Rieke van der Graaf
- University Medical Center Utrecht, Julius Center for Health Sciences and Primary Care, Department of Medical Humanities, Utrecht, The Netherlands.
| | - Lotty Hooft
- Cochrane Netherlands, University Medical Center Utrecht, Utrecht, The Netherlands; University Medical Center Utrecht, Julius Center for Health Sciences and Primary Care, Department of Epidemiology, Utrecht, The Netherlands.
| | - Johannes J M van Delden
- University Medical Center Utrecht, Julius Center for Health Sciences and Primary Care, Department of Medical Humanities, Utrecht, The Netherlands.
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13
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Ekambareshwar M, Mihrshahi S, Wen LM, Taki S, Bennett G, Baur LA, Rissel C. Facilitators and challenges in recruiting pregnant women to an infant obesity prevention programme delivered via telephone calls or text messages. Trials 2018; 19:494. [PMID: 30219067 PMCID: PMC6139132 DOI: 10.1186/s13063-018-2871-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Accepted: 08/23/2018] [Indexed: 11/10/2022] Open
Abstract
Background Recruitment of pregnant women into trials is a challenge exacerbated by a number of factors, including strict eligibility criteria. There has been little in-depth examination of the recruitment process to trials involving pregnant women. This paper presents the findings of a study conducted to identify facilitators and challenges in recruiting pregnant women to the Communicating Healthy Beginnings Advice by Telephone (CHAT) randomised controlled trial, which aims to reduce the prevalence of infant and childhood obesity. Methods Data were collected from (1) administration of a short questionnaire to women at the time of recruitment exploring women’s reasons for consent and non-consent; (2) interviews with recruiters to capture recruiters’ experiences of the recruitment process; and (3) analysis of field notes taken by recruiters on the number of women approached/recruited and reasons as to why they did not consent to participate. Data obtained were triangulated to gain insights into the process of recruiting pregnant women. Results A total of 1155 pregnant women (mean gestational age 31.5 weeks) were enrolled over 5 months. The main reasons for women consenting to participate in the study were convenience in programme delivery mode via telephone calls or text messages, altruism and because the programme was free of charge. The main reasons for women not consenting were lack of interest, language challenges/difficulty speaking English and some felt they did not need information and support due to prior experience as a mother. Facilitators included organisational support, rapport with recruiters and some women with no other children who needed advice. Despite the challenges, the mode of delivery of intervention via telephone calls or text messages, the minimal effort required of women to participate, organisational support from the lead site and recruiters’ knowledge of and commitment towards the trial contributed towards successful recruitment. Conclusion Despite some challenges in recruiting pregnant women to an infant obesity prevention programme, some of the facilitators in recruitment included mode of delivery of the intervention programme via telephone calls or text messages, the minimal effort required for women to participate, organisational support from the lead site, and recruiters’ knowledge of and commitment towards the trial. Trial registration The CHAT RCT is registered with the Australian Clinical Trial Registry (ACTRN12616001470482p); Ethics Review Committee of Sydney Local Health District (Protocol No. X16–0360 & LNR/16/RPAH/495).
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Affiliation(s)
- Mahalakshmi Ekambareshwar
- Sydney School of Public Health, Sydney Medical School, University of Sydney, Sydney, Australia. .,NHMRC Centre of Research Excellence in the Early Prevention of Obesity in Childhood, Sydney School of Public Health, University of Sydney, Sydney, Australia. .,Charles Perkins Centre, University of Sydney, Sydney, Australia.
| | - Seema Mihrshahi
- Sydney School of Public Health, Sydney Medical School, University of Sydney, Sydney, Australia.,NHMRC Centre of Research Excellence in the Early Prevention of Obesity in Childhood, Sydney School of Public Health, University of Sydney, Sydney, Australia.,Charles Perkins Centre, University of Sydney, Sydney, Australia
| | - Li Ming Wen
- Sydney School of Public Health, Sydney Medical School, University of Sydney, Sydney, Australia.,NHMRC Centre of Research Excellence in the Early Prevention of Obesity in Childhood, Sydney School of Public Health, University of Sydney, Sydney, Australia.,Charles Perkins Centre, University of Sydney, Sydney, Australia.,Health Promotion Unit, Sydney Local Health District, Sydney, Australia
| | - Sarah Taki
- NHMRC Centre of Research Excellence in the Early Prevention of Obesity in Childhood, Sydney School of Public Health, University of Sydney, Sydney, Australia.,Health Promotion Unit, Sydney Local Health District, Sydney, Australia
| | - Greer Bennett
- Health Promotion Unit, Sydney Local Health District, Sydney, Australia
| | - Louise A Baur
- Sydney School of Public Health, Sydney Medical School, University of Sydney, Sydney, Australia.,NHMRC Centre of Research Excellence in the Early Prevention of Obesity in Childhood, Sydney School of Public Health, University of Sydney, Sydney, Australia.,Charles Perkins Centre, University of Sydney, Sydney, Australia.,Discipline of Child & Adolescent Health, University of Sydney, Sydney, Australia
| | - Chris Rissel
- Sydney School of Public Health, Sydney Medical School, University of Sydney, Sydney, Australia.,NHMRC Centre of Research Excellence in the Early Prevention of Obesity in Childhood, Sydney School of Public Health, University of Sydney, Sydney, Australia.,Charles Perkins Centre, University of Sydney, Sydney, Australia.,New South Wales Office of Preventive Health, Ministry of Health, Sydney, Australia
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14
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Muggli E, Curd H, Nagle C, Forster D, Halliday J. Engaging pregnant women in observational research: a qualitative exploratory study. BMC Pregnancy Childbirth 2018; 18:334. [PMID: 30115019 PMCID: PMC6097433 DOI: 10.1186/s12884-018-1966-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 08/06/2018] [Indexed: 01/24/2023] Open
Abstract
Background Recruitment of pregnant women to population health research can be challenging, especially if the research topic is sensitive. While many pregnant women may be inherently interested in research about pregnancy, there is the possibility that the nature and timing of the project may give rise to anxiety in some women, especially if the topic is sensitive or it brings about new awareness of potential pregnancy complications. Research staff undertaking recruitment need to be skilled at strategies to manage the environment, and have well developed communication and interpersonal skills to explain and promote the study and facilitate each woman’s informed decision-making regarding participation. However, the skills needed by recruitment staff to successfully engage pregnant women with a research topic are not well understood. This study aimed to address this evidence gap by providing insight into the dynamics between a pregnant woman and recruitment staff at the time of the offer to participate in an observational study about alcohol use in pregnancy. Methods Naturalistic inquiry guided a qualitative exploratory descriptive approach. Experienced recruitment staff from the Asking Questions about Alcohol in Pregnancy (AQUA) study (Muggli et al., BMC Pregnancy Childbirth 14:302, 2014) participated in individual semi-structured interviews and were asked about their experiences and approaches to engaging pregnant women. Interviews were transcribed verbatim and analysed using inductive content analysis. Results Pregnant women brought with them an inherent interest or disinterest in alcohol research, or in research in general, which formed the basis for engagement. Women responded favourably to the invitation to participate being delivered without pressure, and as part of a two-way conversation. Engagement with a sensitive topic such as alcohol use in pregnancy was facilitated by a non-judgmental and non-targeted approach. Influences such as privacy, distractions, partner’s opinion, time factors and level of clinical support either facilitated or hindered a woman’s engagement with the research. Conclusions These results provide an in-depth explanation of barriers and enablers to recruitment of pregnant women in antenatal clinics to studies that may inform strategies and the training of recruitment staff.
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Affiliation(s)
- Evelyne Muggli
- Murdoch Childrens Research Institute, 50 Flemington Rd, Parkville, VIC, 3052, Australia.,Department of Paediatrics, The University of Melbourne, 50 Flemington Rd, Parkville, VIC, 3052, Australia
| | - Helen Curd
- Monash Health Genetics Department, Monash Medical Centre, 246 Clayton Rd, Clayton, VIC, 3168, Australia
| | - Cate Nagle
- Centre for Nursing and Midwifery Research, James Cook University, 1 James Cook Dr, Townsville, QLD, 4811, Australia. .,Townsville Hospital and Health Service, 100 Angus Smith Dr, Douglas, QLD, 4814, Australia.
| | - Della Forster
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Plenty Rd & Kingsbury Dr, Bundoora, VIC, 3086, Australia.,The Royal Women's Hospital, Grattan St, Parkville, VIC, 3052, Australia
| | - Jane Halliday
- Murdoch Childrens Research Institute, 50 Flemington Rd, Parkville, VIC, 3052, Australia.,Department of Paediatrics, The University of Melbourne, 50 Flemington Rd, Parkville, VIC, 3052, Australia
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15
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Abstract
OBJECTIVES The aim of this study was to establish the predictive role of obstetric variables for obstetric outcomes and birth related levator ani muscle (LAM) trauma. METHODS In this prospective study, women underwent 3-dimensional pelvic floor ultrasound at their first appointment at 36 weeks and also 3 months postpartum. The measurements included minimal levator hiatus circumference (MLHC) and the ratio of fetal head circumference to MLHC = head-induced stretch ratio (HISR) as an indicator of the discrepancy between passage and passing canal. To derive the true impact of baby's mass on the levator ani musculature, we devised the levator ani stretch ratio (LASR), which was calculated by multiplying the HISR and the baby's weight. RESULTS Data set of 173 women was available for analysis. Mean HISR and LASR values were statistically different across all binary outcome categories, with 1 exception for HISR and levator ani injury. The odds ratios for LASR indicated positive and statistically significant associations with all obstetric outcomes examined. The probability of the LASR correctly classifying those with the adverse obstetric outcome, as estimated by the area under the curve, ranged from 0.64 to 0.80 with the strongest discriminatory ability observed for severe LAM trauma. CONCLUSIONS Fetal head circumference/mother MLHC ratio (HISR) is associated with longer length of second stage of labor, assisted delivery, and increased severity of perineal trauma. Similar associations were observed for LASR, but in addition, LASR had good discriminatory ability to identify severe LAM trauma.
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16
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Nicklas JM, Skurnik G, Zera CA, Reforma LG, Levkoff SE, Seely EW. Employing a Multi-level Approach to Recruit a Representative Sample of Women with Recent Gestational Diabetes Mellitus into a Randomized Lifestyle Intervention Trial. Matern Child Health J 2016; 20:261-9. [PMID: 26520160 DOI: 10.1007/s10995-015-1825-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The postpartum period is a window of opportunity for diabetes prevention in women with recent gestational diabetes (GDM), but recruitment for clinical trials during this period of life is a major challenge. METHODS We adapted a social-ecologic model to develop a multi-level recruitment strategy at the macro (high or institutional level), meso (mid or provider level), and micro (individual) levels. Our goal was to recruit 100 women with recent GDM into the Balance after Baby randomized controlled trial over a 17-month period. Participants were asked to attend three in-person study visits at 6 weeks, 6, and 12 months postpartum. They were randomized into a control arm or a web-based intervention arm at the end of the baseline visit at six weeks postpartum. At the end of the recruitment period, we compared population characteristics of our enrolled subjects to the entire population of women with GDM delivering at Brigham and Women's Hospital (BWH). RESULTS We successfully recruited 107 of 156 (69 %) women assessed for eligibility, with the majority (92) recruited during pregnancy at a mean 30 (SD ± 5) weeks of gestation, and 15 recruited postpartum, at a mean 2 (SD ± 3) weeks postpartum. 78 subjects attended the initial baseline visit, and 75 subjects were randomized into the trial at a mean 7 (SD ± 2) weeks postpartum. The recruited subjects were similar in age and race/ethnicity to the total population of 538 GDM deliveries at BWH over the 17-month recruitment period. CONCLUSIONS Our multilevel approach allowed us to successfully meet our recruitment goal and recruit a representative sample of women with recent GDM. We believe that our most successful strategies included using a dedicated in-person recruiter, integrating recruitment into clinical flow, allowing for flexibility in recruitment, minimizing barriers to participation, and using an opt-out strategy with providers. Although the majority of women were recruited while pregnant, women recruited in the early postpartum period were more likely to present for the first study visit. Given the increased challenges of recruiting postpartum women with GDM into research studies, we believe our findings will be useful to other investigators seeking to study this population.
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Affiliation(s)
- Jacinda M Nicklas
- Division of General Internal Medicine, University of Colorado School of Medicine, Anschutz Health and Wellness Center, Mailstop C263, 12348 E. Montview Blvd., Aurora, CO, 80045, USA. .,Division of Diabetes, Hypertension and Endocrinology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | - Geraldine Skurnik
- Division of Diabetes, Hypertension and Endocrinology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Chloe A Zera
- Division of Maternal-Fetal Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Liberty G Reforma
- Division of Diabetes, Hypertension and Endocrinology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Sue E Levkoff
- College of Social Work, University of South Carolina, Columbia, SC, USA
| | - Ellen W Seely
- Division of Diabetes, Hypertension and Endocrinology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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17
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Volløyhaug I, van Gruting I, van Delft K, Sultan AH, Thakar R. Is bladder neck and urethral mobility associated with urinary incontinence and mode of delivery 4 years after childbirth? Neurourol Urodyn 2016; 36:1403-1410. [DOI: 10.1002/nau.23123] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 08/24/2016] [Indexed: 11/08/2022]
Affiliation(s)
- Ingrid Volløyhaug
- Department of Laboratory Medicine, Children's and Women's Health; Norwegian University of Science and Technology; Trondheim Norway
- Department of Obstetrics and Gynecology; Trondheim University Hospital; Trondheim Norway
| | | | - Kim van Delft
- Obstetrics and Gynaecology; Radboud University; Nijmegen The Netherlands
| | - Abdul H. Sultan
- Obstetrics and Gynaecology; Croydon University Hospital; Croydon United Kingdom
| | - Ranee Thakar
- Obstetrics and Gynaecology; Croydon University Hospital; Croydon United Kingdom
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18
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Carpenter RE, Emery SJ, Rassi D, Uzun O, Lewis MJ. Recruitment of pregnant women to an exercise-intervention study. J OBSTET GYNAECOL 2015; 36:200-7. [PMID: 26467417 DOI: 10.3109/01443615.2015.1049988] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
We share here our experience of recruiting pregnant women into an exercise intervention study. Recruitment challenges were anticipated owing to the study design, which required four hospital visits for cardiovascular assessment, a long-term (nine-month) commitment, and adherence to a 20-week exercise programme. Fifty-three women were assigned to one of three groups (no-exercise, land exercise or water exercise) using a 2 × 2 × 2 flexible randomisation design. Seven hundred forty-four women were screened at an antenatal clinic, of whom 501 were eligible to participate in the study. One hundred forty-five women were subsequently approached: 46 (32%) of whom agreed to participate, 42 (29%) were interested but then declined and 57 (39%) declined outright. Our study design helped recruit pregnant women as it allowed them some choice of group membership. We also noted that the participant-researcher relationship is important in reducing attrition. Our experience provides indications of likely recruitment and attrition rates for future randomised controlled trials of this type.
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Affiliation(s)
- R E Carpenter
- a College of Engineering, Swansea University , UK.,b Abertawe Bro Morgannwg University Health Board , Swansea , UK
| | - S J Emery
- b Abertawe Bro Morgannwg University Health Board , Swansea , UK
| | - D Rassi
- c College of Health and Human Sciences, Swansea University , UK
| | - O Uzun
- a College of Engineering, Swansea University , UK.,d University Hospital of Wales , Cardiff , UK
| | - M J Lewis
- a College of Engineering, Swansea University , UK.,b Abertawe Bro Morgannwg University Health Board , Swansea , UK
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19
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van Delft K, Thakar R, Sultan AH, Kluivers KB. Does the prevalence of levator ani muscle avulsion differ when assessed using tomographic ultrasound imaging at rest vs on maximum pelvic floor muscle contraction? ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2015; 46:99-103. [PMID: 25366807 DOI: 10.1002/uog.14719] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Revised: 10/02/2014] [Accepted: 10/22/2014] [Indexed: 06/04/2023]
Abstract
OBJECTIVE It has been suggested that transperineal ultrasound images obtained during maximum pelvic floor muscle contraction improve the diagnosis of levator ani muscle (LAM) avulsion by comparison with those obtained at rest. The objective of this study was to establish, using transperineal tomographic ultrasound imaging (TUI), the correlation between LAM avulsion diagnosed at rest and that on contraction. METHODS Primiparous women were examined 3 months postpartum by Pelvic Organ Prolapse Quantification (POP-Q) assessment and for LAM avulsion clinically by digital palpation and by transperineal TUI performed at rest and on pelvic floor muscle contraction. LAM avulsion was diagnosed on TUI when the three central slices were abnormal. A comparison was made between LAM avulsion diagnosed at rest and on maximum contraction. Two independent blinded investigators performed the analyses and a third investigator resolved discrepancies. RESULTS One hundred and ninety primiparae were analyzed providing 380 results for comparison, as right and left LAM were analyzed independently. LAM avulsion was found in 36 (9.5%) images obtained at rest and in 35 (9.2%) on contraction, revealing moderate correlation between the two (ICC, 0.58 (95% CI, 0.51-0.64)). Twenty-two cases of LAM avulsion were identified both at rest and on contraction. One woman had LAM avulsion on palpation, which was seen on TUI as LAM avulsion on contraction, but not at rest. More cases of anterior and posterior compartment prolapse were found in women with LAM avulsion diagnosed on contraction only compared to LAM avulsion observed at rest only (POP-Q assessment point Ba, -1.8 vs -2.5 (P = 0.075) and point Bp, -2.5 vs -2.8 (P = 0.072)). CONCLUSIONS Findings on transperineal TUI performed in women at rest and on contraction correlate reasonably well. However, given the trend towards an association with signs of pelvic floor dysfunction, diagnosis of LAM avulsion on contraction seems to be more reliable. Consistency in technique and interpretation should be maintained.
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Affiliation(s)
- K van Delft
- Departments of Obstetrics and Gynaecology and Urogynaecology, Croydon University Hospital, Croydon, UK
| | - R Thakar
- Departments of Obstetrics and Gynaecology and Urogynaecology, Croydon University Hospital, Croydon, UK
| | - A H Sultan
- Departments of Obstetrics and Gynaecology and Urogynaecology, Croydon University Hospital, Croydon, UK
| | - K B Kluivers
- Department of Obstetrics and Gynaecology, Radboud University Medical Center, Nijmegen, The Netherlands
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20
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van Delft K, Thakar R, Sultan AH. Pelvic floor muscle contractility: digital assessment vs transperineal ultrasound. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2015; 45:217-222. [PMID: 25044167 DOI: 10.1002/uog.13456] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Revised: 05/26/2014] [Accepted: 06/25/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVES A significant reduction in hiatal area and anteroposterior diameter can be induced by pelvic floor muscle contraction, and this has been demonstrated using three-dimensional/four-dimensional (3D/4D) transperineal ultrasound (TPS) in a small group of women. Our objective was to correlate pelvic floor muscle contractility using digital assessment with the change in TPS hiatus measurements during maximum pelvic floor muscle contraction. METHODS Nulliparous pregnant women were recruited from the antenatal clinic. Pelvic floor muscle contractility was assessed by digital palpation using the validated Modified Oxford Scale (MOS). Subsequently, women underwent 3D/4D TPS. Measurements of the hiatal area and anteroposterior diameter were taken from the rendered ultrasound images at rest and at maximum contraction, and differences in measurements were expressed as percentages. Spearman's rank (ρ) was used to assess the correlation. RESULTS Four hundred and fifty-nine assessments were performed, of which 268 were from women at around 36 weeks' gestation, and 191 were from women following delivery at 3 months postpartum. The overall correlation between MOS and TPS was found to be ρ = 0.47 for hiatal area (P < 0.001) and ρ = 0.51 for hiatal anteroposterior diameter (P < 0.001). CONCLUSIONS Digital palpation using MOS and TPS can both be used as tools to assess pelvic floor muscle contractility. Although MOS is a simple clinical tool without the need for any equipment, TPS can provide good visual biofeedback when training patients in pelvic floor muscle exercises. As TPS is non-intrusive, it may be the method of choice for some women.
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Affiliation(s)
- K van Delft
- Croydon University Hospital, Department of Obstetrics and Gynaecology, Division of Urogynaecology, Croydon, UK
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21
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van Delft KWM, Thakar R, Sultan AH, IntHout J, Kluivers KB. The natural history of levator avulsion one year following childbirth: a prospective study. BJOG 2014; 122:1266-73. [DOI: 10.1111/1471-0528.13223] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2014] [Indexed: 02/05/2023]
Affiliation(s)
- KWM van Delft
- Department of Obstetrics and Gynaecology, Urogynaecology; Croydon University Hospital; Croydon UK
| | - R Thakar
- Department of Obstetrics and Gynaecology, Urogynaecology; Croydon University Hospital; Croydon UK
| | - AH Sultan
- Department of Obstetrics and Gynaecology, Urogynaecology; Croydon University Hospital; Croydon UK
| | - J IntHout
- Radboud University Medical Centre; Department for Health Evidence; Section Biostatistics; Nijmegen the Netherlands
| | - KB Kluivers
- Radboud University Medical Centre; Department of Obstetrics and Gynaecology; Nijmegen the Netherlands
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22
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Frew PM, Saint-Victor DS, Isaacs MB, Kim S, Swamy GK, Sheffield JS, Edwards KM, Villafana T, Kamagate O, Ault K. Recruitment and retention of pregnant women into clinical research trials: an overview of challenges, facilitators, and best practices. Clin Infect Dis 2014; 59 Suppl 7:S400-7. [PMID: 25425718 PMCID: PMC4303058 DOI: 10.1093/cid/ciu726] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Pregnant women are a vulnerable group who are needed in clinical research studies to advance prevention and treatment options for this population. Yet, pregnant women remain underrepresented in clinical research. Through the lens of the socioecological model, we highlight reported barriers and facilitators to recruitment and retention of pregnant women in studies that sought their participation. We trace historical, policy-based reasons for the exclusion of pregnant women in clinical studies to present-day rationale for inclusion of this group. The findings highlight why it has been difficult to recruit and retain this population over time. A body of literature suggests that integrative sampling and recruitment methods that leverage the influence and reach of prenatal providers will overcome recruitment challenges. We argue that these strategies, in combination with building strong engagement with existing community-based organizations, will enable teams to more effectively promote and retain pregnant women in future longitudinal cohort studies.
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Affiliation(s)
- Paula M. Frew
- Emory University School of Medicine, Departmentof Medicine, Division of Infectious Diseases
- Emory Rollins School of Public Health, Department of Behavioral Sciences and Health Education, Emory University,Atlanta, Georgia
| | - Diane S. Saint-Victor
- Emory University School of Medicine, Departmentof Medicine, Division of Infectious Diseases
| | | | - Sonnie Kim
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | | | | | | | | | - Ouda Kamagate
- Emory University School of Medicine, Departmentof Medicine, Division of Infectious Diseases
| | - Kevin Ault
- Department of Obstetrics and Gynecology, University of Kansas Medical Center, Kansas City
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van Delft K, Thakar R, Sultan AH, Schwertner-Tiepelmann N, Kluivers K. Levator ani muscle avulsion during childbirth: a risk prediction model. BJOG 2014; 121:1155-63; discussion 1163. [DOI: 10.1111/1471-0528.12676] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/28/2013] [Indexed: 11/27/2022]
Affiliation(s)
- K van Delft
- Urogynaecology Unit; Department of Obstetrics and Gynaecology; Croydon University Hospital; Croydon UK
| | - R Thakar
- Urogynaecology Unit; Department of Obstetrics and Gynaecology; Croydon University Hospital; Croydon UK
| | - AH Sultan
- Urogynaecology Unit; Department of Obstetrics and Gynaecology; Croydon University Hospital; Croydon UK
| | - N Schwertner-Tiepelmann
- Urogynaecology Unit; Department of Obstetrics and Gynaecology; Croydon University Hospital; Croydon UK
| | - K Kluivers
- Department of Obstetrics and Gynaecology (791); Radboud University Medical Centre; Nijmegen the Netherlands
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van Delft K, Sultan AH, Thakar R, Schwertner-Tiepelmann N, Kluivers K. The relationship between postpartum levator ani muscle avulsion and signs and symptoms of pelvic floor dysfunction. BJOG 2014; 121:1164-71; discussion 1172. [DOI: 10.1111/1471-0528.12666] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2013] [Indexed: 01/05/2023]
Affiliation(s)
- K van Delft
- Department of Obstetrics and Gynaecology, Urogynaecology; Croydon University Hospital; Croydon UK
| | - AH Sultan
- Department of Obstetrics and Gynaecology, Urogynaecology; Croydon University Hospital; Croydon UK
| | - R Thakar
- Department of Obstetrics and Gynaecology, Urogynaecology; Croydon University Hospital; Croydon UK
| | - N Schwertner-Tiepelmann
- Department of Obstetrics and Gynaecology, Urogynaecology; Croydon University Hospital; Croydon UK
| | - K Kluivers
- Department of Obstetrics and Gynaecology (791); Radboud University Medical Centre; Nijmegen The Netherlands
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van Delft K, Thakar R, Shobeiri SA, Sultan AH. Levator hematoma at the attachment zone as an early marker for levator ani muscle avulsion. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2014; 43:210-217. [PMID: 23893754 DOI: 10.1002/uog.12571] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Revised: 07/08/2013] [Accepted: 07/19/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVES Childbirth causes overstretching of the levator ani muscle (LAM), predisposing to avulsion. LAM avulsion has not been evaluated early postpartum using endovaginal ultrasound (EVUS). The aim of this study was to evaluate the relationship between hematomas and LAM avulsion using EVUS and palpation early and late postpartum. METHODS Nulliparous women were studied prospectively at 36 weeks' gestation and within 4 days and 3 months postpartum. Palpation and high-frequency three-dimensional EVUS were performed. Two independent investigators reviewed the scans. RESULTS No antenatal LAM avulsions were found (n = 269). 114/199 (57.3%) women seen early postpartum agreed to examination. 27/114 (23.7%) had well delineated, hypoechoic areas consistent with hematomas (100% agreement), 26 following vaginal delivery, one following emergency Cesarean section. In total, 38 hematomas were found (11 bilateral, 16 unilateral). Hematomas away from the attachment zone of the LAM to the pubic bone (n = 22) resolved. Hematomas at the attachment zone (n = 16) manifested as pubococcygeus avulsions 3 months postpartum. In addition to these 16 avulsions, we found another 20 at 3 months postpartum. 13/20 were not scanned early postpartum and in seven no hematomas were seen, but avulsion was seen early postpartum. Overall, LAM avulsion was found in 23/191 (12.0%) women (13 bilateral, 10 unilateral) 3 months postpartum. Hematomas were significantly associated with episiotomy, instrumental delivery and increased hiatal measurements. Palpation was unreliable early postpartum as only seven avulsions were diagnosed. CONCLUSION Hematomas at the site of LAM attachment to the pubic bone always result in avulsion diagnosed 3 months postpartum. However, one third of avulsions are not preceded by a hematoma at the site of LAM attachment to the pubic bone.
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Affiliation(s)
- K van Delft
- Croydon University Hospital, Department of Obstetrics and Gynaecology, Urogynaecology and Pelvic Floor Reconstruction Unit, Croydon, UK
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