The development of an intervention to support midwives in addressing multiple health behaviours with pregnant women

Abstract

Background Midwives are expected to perform multiple health promotion practice behaviours (HePPBes) such as informing pregnant women about the benefits of physical activity during pregnancy and asking women about their alcohol consumption. However, no formal support appears to be available to midwives in carrying out these tasks. This thesis describes the systematic development of an evidence-based, theory-informed intervention to support midwives in addressing health behaviours with pregnant women. Methods This thesis consisted of four phases. Phase 1: review of the evidence including key documentation and a narrative review to identify interventions to support midwives’ HePPBes. Phase 2: semi-structured interviews with midwives (N= 11) based on the theoretical domains framework and an online questionnaire assessing midwives’ views on HePPBes (N= 505). Phase 3: systematic development of the HePPBe toolkit, integrating: i) target population, ii) target behaviours, ii) theory, iv) behaviour change techniques and v) format of delivery. User, patient and public involvement was carried out throughout phase 3. Phase 4: online questionnaire to assess midwives’ preliminary views (N= 108) on the acceptability of the newly developed HePPBe toolkit. Results and conclusions A review of existing evidence identified multiple policies and guidelines implicating midwives in performing HePPBes. However, no peer-reviewed literature reported interventions to support midwives in carrying out their HePPBes. New evidence found midwives perceived barriers to carrying out HePPBes, such as a requirement to perform an increasing amount of HePPBes on top of existing clinical workload. Facilitators, including strategies used by midwives to perform HePPBes, were also identified. Performance of HePPBes was predicted by psychological factors, including confidence, intrinsic drive, and feelings of being supported. These findings informed the development of a handheld HePPBe toolkit with evidence of preliminary acceptability. This thesis provides a practical example of how to systematically develop a multiple behaviour change intervention for, and in consultation with, healthcare professionals.