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Samenvatting
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Het ZonMW project “Samen Stoppen, Samen Sterk!” richt zich op het roken van vrouwen in Noord-Nederland tijdens de zwangerschap. In het project werken we samen met zorgverleners van de Verloskundig Samenwerkings Verbanden in Noord-Nederland, verslavingszorg Noord Nederland, Zorgbelang Groningen en Stichting Mens en Maatschappij. Er zijn twee ervaringsdeskundigen Sterk uit Armoede bij het project betrokken die de stem van de vrouwen gedurende het hele project vertegenwoordigen. Het doel van het project is om de implementatie van de Trimbos-richtlijn addendum ‘Behandeling van tabaksverslaving en stoppen-met-roken ondersteuning bij zwangere vrouwen’ te verbeteren. Hiervoor worden eerst de ervaringen van de zorgverleners en zwangeren of net bevallen vrouwen met de begeleiding bij het stoppen met roken tijdens de zwangerschap onderzocht. Vervolgens wordt per Verloskundig Samenwerkings Verband in Noord-Nederland een verbeterplan opgesteld, met strategieën om de implementatie van de richtlijn te verbeteren. In het laatste jaar van het onderzoeksproject wordt het implementatieproces geëvalueerd.

 

Resultaten
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In de periode 2018-2019 hebben we interviews gehouden met eerstelijns verloskundigen, klinisch verloskundigen, en gynaecologen om hun ervaren belemmerende en faciliterende factoren bij de implementatie van het addendum van de Trimbos-richtlijn in de dagelijkse praktijk te inventariseren. Deze resultaten, gecombineerd met de input van de zorgprofessionals aangesloten bij Verloskundige Samenwerkings Verbanden, Verslavingszorg Noord Nederland, de ervaringsdeskundigen Sterk uit Armoede en Zorgbelang, hebben geleid tot acht verbeterplannen voor een betere implementatie van het addendum van de Trimbos-richtlijn. Een grote meerderheid van de Verloskundige Samenwerkings Verbanden geeft de voorkeur aan een doorverwijzing naar een Komend jaar zullen we deze trajecten implementeren en evalueren met kwalitatieve en kwantitatieve onderzoeksmethoden.

Samenvatting van de aanvraag

Samenvatting
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BACKGROUND Compared with other Dutch regions, women living in the North of the Netherlands are significantly more classified in the lowest socio-economic status (SES) quartile, and are more likely to have adverse lifestyle behaviors (e.g. smoking behavior). To support these women to quit smoking during and after pregnancy, healthcare professionals (e.g. midwives, gynecologist, general practitioners) can support women using the Trimbos Guideline Addendum Treatment of tobacco addiction and smoking cessation support to pregnant women (Trimbos Guideline). Previous research showed that the Trimbos Guideline showed poor adherence in daily midwifery care and consequently had a limited effect on the quit smoking rate in (low SES) pregnant women.

A successful implementation of the Trimbos Guideline in daily practice will lead to a more tailored support of low SES and with that, a decrease in the prevalence of smoking during pregnancy and after childbirth. Not smoking during or after pregnancy will reduce the risks of complications during pregnancy, and other future health problems of the baby. Quitting smoking will also benefit woman’s long-term health since risk factors will be reduced for e.g. cardiovascular diseases, cancer and respiratory diseases.

 

AIM The project aims to optimize the implementation of the Trimbos Guideline in daily practice of healthcare professionals regarding low SES pregnant women who smoke during and/or after pregnancy living in Groningen, Friesland and Drenthe and with that to reduce the number of low SES women that smoke during and after pregnancy.

 

METHODS We will conduct a mixed-method design to examine the implementation of the Trimbos Guideline in daily practice in Groningen, Friesland and Drenthe. In our project low SES women and healthcare professionals will actively participate. Low SES women will be represented by Experts by Experience in Poverty and Social Exclusion and by researchers of Zorgbelang. The involved healthcare professionals are from 11 obstetric cooperation units (VSVs), which include midwives, gynecologists, maternity care workers, and physicians from youth health care. Furthermore, general practitioners and addiction care physicians are participating in our project as well. Throughout all phases of the project, low SES women and healthcare professionals will be collaborating intensively to realize an optimal implementation of the Trimbos Guideline in daily practice with tailored strategies for 11 regional settings. The Action toolkit, which includes seven steps to implement the Trimbos Guideline in daily practice, will be used as a guidance instrument. Step 1 - 3 of the ACTion Toolkit which includes the problem-analyzing phase of the implementation process by e.g. identifying the factors that will facilitate or hinder the implementation of the Trimbos Guideline in daily practice. ACTion steps 4 and 5 will continue with the preparations for implementing the guideline based on the improvement plan. The final ACTion steps 6-7 concern evaluation and sustainability of the implementation of the guideline. Within these steps we will conduct qualitative research methods (e.g. in-depth interviews, focus groups, waiting room conversations) and quantitative research methods (e.g. analyzing questionnaires and population-based registry data.

 

DELIVERABLES An overall generic implementation plan of the Trimbos Guideline including tailored strategies for each VSV based on the (locally) experienced facilitators and barriers will be developed. This will lead to a sustainable implementation of the Trimbos Guideline in daily practice in each VSV located in the North of the Netherlands.

 

IMPLEMENTATION/DISSIMINATION The overall generic implementation plan with successful strategies of the VSVs will be shared with other Dutch VSVs. The generated knowledge is of great importance to be translated in educational curricula for healthcare professionals. Moreover, the results will be shared within multiple professional networks, the intervention database of the RIVM Centrum Gezond Leven, (social) media,

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