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Shared decision making in integrated maternity care: Systematic development of health literacy sensitive strategies for professionals and clients

Projectomschrijving

Shared Decision Making in de integrale geboortezorg

Vraagstuk

Dit project beoogt systematisch strategieën te ontwikkelen om Gedeelde Besluitvorming (Shared Decision Making) in de integrale geboortezorg te verbeteren. Hoewel Gedeelde Besluitvorming in opkomst is in de zorg, zijn er weinig echt goede voorbeelden van effectieve interventies in de geboortezorg, met name voor vrouwen met gebrekkige gezondheidsvaardigheden. Gebrekkige gezondheidsvaardigheden vormen een barrière in de communicatie met zorgverleners, maar ook in het zelfstandig verkrijgen, begrijpen en toepassen van informatie over de opties die je hebt als cliënt in de geboortezorg.

Onderzoek en verwachte uitkomst

In dit project ontwikkelen en evalueren we tools om cliënten te ondersteunen in een aantal essentiële keuzes rondom zwangerschap en geboorte, zoals 'omgaan met pijn tijdens de bevalling' en 'problemen met borst / flesvoeding'. Daarnaast ontwikkelen we hierbij passende trainingsmodules voor zorgverleners. Zowel de tools als de trainingsmodules worden ontwikkeld in co-creatie met de belangrijkste gebruikers, namelijk zwangere vrouwen, vrouwen die net bevallen zijn, en alle betrokken zorgverleners (bv. verloskundigen, gynaecologen, kraamverzorgenden en professionals in de jeugdgezondheidszorg). De effecten van zowel de tools als de training worden onderzocht in experimentele studies. 

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Samenvatting van de aanvraag

LOW HEALTH LITERACY CHALLENGE FOR SHARED DECISION-MAKING IN MATERNITY CARE While integrated maternity care increasingly aims at Shared Decision-making (SDM), it seems that clients with low health literacy (HL) do not optimally benefit. Low HL is a barrier in e.g. communication with health professionals, in obtaining/understanding information on options, and in evaluating the importance of pros and cons. Despite growing awareness that HL matters to SDM, intervention development is lagging behind. Current decision support strategies in maternity care tend to apply a ‘one size fits all’ approach, and have not been designed for or evaluated among clients with low HL. A lack of SDM may result in miscommunication during labour, suboptimal decision-making and low quality of care. SYSTEMATIC DEVELOPMENT OF HEALTH LITERACY-SENSITIVE STRATEGIES This project aims to systematically develop and evaluate strategies to improve SDM in integrated maternity care. Strategies for clients will focus on decision support tools sensitive to HL levels. Strategies for professionals will focus on skills development, following educational theories, innovative methods and existing Dutch training interventions. Strategies will be developed for decisions where more than one reasonable option exists. Two decisions function as central test cases throughout the project: ‘coping with pain during labour’ and ‘issues in breast/bottle feeding’. Other decisions (e.g., place and mode of birth) are explored and further investigated where appropriate. STAGE 1 NEEDS ASSESSMENT CLIENTS AND PROFESSIONALS (12 months) Study 1.1: In qualitative interviews with low HL (n=20 ) and higher HL (n=20) clients, we will examine relevant decision-making skills for SDM in maternity care and the support needed. The usability of available decision support tools will also be assessed in a test among clients, using think aloud protocols and interviews. Study 1.2: In simulated consultations with actor clients, we will observe the extent to which SDM is practiced by professionals (n=20) and their responsiveness to HL. Observed professionals will also participate in qualitative interviews, in which their SDM experiences and needs for support will be assessed, particularly regarding clients with low HL. STAGE 2 DEVELOPMENT SDM STRATEGIES (8 months) Studies 2.1&2.2: Based on Stage 1, we will systematically develop strategies to support SDM in integrated maternity care in brainstorm sessions with project members and advisory committee and in co-creation sessions with clients (N=12) and professionals (N=6). Examples of envisioned HL-sensitive elements are interactive visualizations of risk communication and values clarification methods (VCMs), and digital avatars that guide clients through information. Accessibility, acceptability, and usability of functional prototypes will be investigated in follow-up interviews among 10 clients and 10 professionals. Study 2.3: Training elements for professionals will be developed together with professional teachers in SDM and communication skills in AMC/VUMC and Midwifery Academies in Maastricht and Amsterdam/ Groningen. Best practices will be combined with innovative elements. STAGE 3 EVALUATION AMONG CLIENTS AND PROFESSIONALS (20 months) Study 3.1: The effect of the training on observed SDM and HL-sensitive communication will be assessed in simulated sessions with actors. Professionals will be randomly assigned to either an intervention group (training; N=20) or a waiting list control group (non-training; N=20). They will be observed before (T0) and after (T1) training. Each observation will be video-recorded and discussed with professionals and actors afterwards. Study 3.2: The effect of the combination of training and the decision support tool on perceived SDM among clients will be investigated in an evaluation in maternity care practice. Perceived SDM and HL will be assessed in an online survey among clients after consultations. The intervention group (n=80) will be recruited by professionals who participate in the training and who are encouraged to use the decision support tool. Control clients (n=80) will be recruited by professionals not participating in the training and providing usual care. Differences in outcomes between intervention and control groups in studies 3.1&3.2 will be analysed by linear and logistic regression analyses. HL differences in SDM and other outcomes among clients will also be investigated. Study 3.3: A process-evaluation will be performed based on several measures derived from studies 3.1&3.2, e.g., professionals’ perceived accessibility of the training and clients’ experiences in using the tool. STAGE 4 IMPLEMENTATION (2 months) The process of strategy development and the SDM strategies themselves will be incorporated in a SDM toolkit for integrated maternity care. Together with the Netwerk Geboortezorg and the GeboorteBeweging, an implementation plan will be developed for the toolkit and strategies.

Kenmerken

Projectnummer:
543003303
Looptijd: 100%
Looptijd: 100 %
2018
2022
Onderdeel van programma:
Gerelateerde subsidieronde:
Projectleider en penvoerder:
Dr. O.C. Damman
Verantwoordelijke organisatie:
Amsterdam UMC - locatie AMC