Development of dissemination and implementation strategies to promote wider uptake and usage of the ‘NietofWelZwanger (NWZ)’ Preconception Care intervention

NEED FOR PRECONCEPTION CARE FOR VULNERABLE FUTURE PARENTS Dutch perinatal mortality rate is relatively high: Pregnancy risks are higher among lower educated future parents. Preconception care (i.e., a healthy lifestyle and early risk detection before conception) increases the chance for healthy pregnancy and birth. Secondary vocational schools (MBO in Dutch) are an important setting to empower vulnerable future parents. EXISTING EVIDENCE BASED PRECONCEPTION CARE PROGRAM NietofWelZwanger (NWZ) is a recent school-based preconception care education program. NWZ consists of 1) a teaching module about sexually transmitted infections, contraception, preconception care and (teenage) pregnancy based on the Centering method, and 2) the website ‘nietofwelzwanger.nl’ that provides tailored feedback on the prevention of pregnancy and achieving healthy pregnancy. The NWZ program has shown to improve knowledge, intentions and informed decision making regarding preconception health and care among MBO students. NWZ was well received by students of different MBO-educational levels, and perceived as relevant by both students and teachers. Currently, the program is carried out by midwives: this ensures fidelity of implementation, but limits dissemination. RELEVANCE Wider delivery of NWZ would contribute to the overarching goal to increase awareness of preconception care and health, as well as, self-management opportunities among MBO students. Implementation of NWZ can be greatly improved when involving other intermediaries (i.e., MBO teachers and (sexual) health professionals (SHPs)). Previous studies on health promotion in the MBO setting have shown these intermediaries perceive the relevance of the topic of preconception care, and generally feel willing and capable to carry out a program like NWZ. Nevertheless, in order to ensure that NWZ is delivered as intended, we have to ensure that they are well-equipped. Our aim is to address both challenges: (1) increased dissemination and (2) quality of implementation of NWZ, by three types of implementation strategies: - Adaptation of NWZ for delivery by other intermediaries besides midwives (i.e. MBO teachers, SHPs of Municipal Health Services), and the development of a trainer module. - The development of a train-the-trainer module via which experienced, trained midwives will train new implementers. - Add a preconception care module to Testjeleefstijl.nu (TJL), a life style monitor that is regularly used among MBO schools. The chances for dissemination and implementation of are maximized, because our project (1) is embedded within the context of two consortia Pregnancy and Birth (i.e., Northern South Holland (NSH) and North Netherlands), (2) has a multidisciplinary project group (covering (implementation) researchers, midwifery, gynecologists, teachers, municipality), (2) involves stakeholders by means of a linkage group, and (3) ensures active participation of potential program users via user-centered design methods. PROJECT AIM The aim of this project is to promote preconception care among vulnerable future parents by developing strategies to systematically disseminate and implement NWZ among MBO students. Wider diffusion and fidelity of implementation of NWZ is promoted by the development of a train-de-trainer approach and training material for the implementation of NWZ by midwives and other intermediaries (e.g., teachers). Train-the-trainer activities will be part of a network diffusion approach, where already trained midwives will function as ambassadors, to disseminate NWZ. We will examine implementation fidelity by means of a pilot in two regions (NSH and North Netherlands). SUBGOALS 1) Understand requirements necessary to adapt NWZ for implementation; 2) Adapt and pretest NWZ for use by others besides midwives: development of a train-the-trainer to train implementers, and training material for implementers; 3) Pilot-implementation of NWZ in NSH and North Netherlands; 4) Examine the fidelity of implementation among implementers and its relation with determinants of preconception care among MBO-students. A specific goal will also be to explore differences between delivery modes (teacher+support; teacher only; professional). DESIGN A quasi-experimental design is used, where in both regions, differences in class and health outcomes (at the level of intermediaries and students) are compared based on the different implementation modes: (1) implementation by a teacher with support of a professional, (2) implementation by a teacher without support, or (3) implementation by professional. In addition, pre-posttest evaluations are carried out at the level of the intermediaries to examine improvements in determinants of adoption and use, and at student level on determinants of preconception health and care. PROJECT PHASES (42 MONTHS) A. Preproduction and implementation research (12 months) B. Design and pretesting (12 months) C. Pilot-implementation and evaluation (18 months)