Co-designing a theory-informed intervention to increase shared decision-making in maternity care

Abstract

Background Shared decision-making (SDM) has been shown to improve healthcare outcomes and is a recognized right of patients. Policy requires health services to implement SDM. However, there is limited research into what interventions work and for what reasons. The aim of the study was to develop a series of interventions to increase the use of SDM in maternity care with stakeholders. Methods Interventions to increase the use of SDM in the setting of pregnancy care were developed using Behaviour Change Wheel and Theoretical Domains Framework and building on findings of an in-depth qualitative study which were inductively analysed. Intervention development workshops involved co-design, with patients, clinicians, health service administrators and decision-makers, and government policy makers. Workshops focused on identifying viable SDM opportunities and tailoring interventions to the local context (the Royal Women’s Hospital) and salient qualitative themes. Results Pain management options during labour were identified by participants as a high priority for application of SDM, and three interventions were developed including patient and clinician access to the Victorian Government’s maternity record via the patient portal and electronic medical records (EMR); a multi-layered persuasive communications campaign designed; and clinical champions and SDM simulation training. Factors identified by participants for successful implementation included having alignment with strategic direction of the service, support of leaders, using pre-standing resources and workflows, using clinical champions, and ensuring equity. Conclusion Three interventions co-designed to increase the use of SDM for pain management during labour address key barriers and facilitators to SDM in maternity care. This study exemplifies how health services can use behavioural science and co-design principles to increase the use of SDM. Insights into the co-design of interventions to implement SDM in routine practice provide a framework for other health services, policy makers and researchers.

Knowledge, attitude, and practice of atrial fibrillation in high altitude areas

“…Individuals with a more profound understanding of AF tend to demonstrate more favorable attitudes and adopt healthier practices. This intrinsic interdependence accentuates the imperative for interventions that address not only knowledge augmentation but also the transformation of attitudes and the modification of behaviors ( 29 , 30 ). The firmly established correlations among knowledge, attitudes, and practices serve to underscore the inseparable interplay within these realms.…”

Co-creation of a health literate-sensitive training and conversation aid to support shared decision-making in maternity care

“…To the best of our knowledge, only few studies have developed and evaluated decision aids targeting low HL clients, [ 9 ] or used co-creation to develop SDM training and decision support tools in maternity care. [ 41 ] Furthermore, this study adds to the scarce literature on partners' needs regarding SDM. [ 38 ] One unique aspect was the attention to partners' involvement in decision-making, especially by including partners in the co-creation sessions and user tests.…”

“…Including stakeholders in the development process who have knowledge of, and influence on, organizational level is also recommended for successful implementation of SDM interventions. [ 41 ] This approach including a user-centered design is known to enhance patient decision aid's quality and acceptability, and to improve the likelihood of successful implementation. [ 32 ]…”

“The Terminology Might Be Ahead of Practice”: Embedding Shared Decision Making in Practice—Barriers and Facilitators to Implementation of SDM in the Context of Maternity Care

“…The barriers and facilitators elicited subsequently informed intervention development at the Women's. 38 Health service administrators and decision makers reported using different ways to describe SDM without using the term to overcome the lack of or mixed understanding. This method allowed them to create a shared understanding of what SDM involved in practice.…”