Social-cognitive correlates of expectant mothers’ safe communication behaviour: Applying an adapted HAPA model
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Effective Communication Supported by an App for Pregnant Women: Quantitative Longitudinal Study
Background In the medical field of obstetrics, communication plays a crucial role, and pregnant women, in particular, can benefit from interventions improving their self-reported communication behavior. Effective communication behavior can be understood as the correct transmission of information without misunderstanding, confusion, or losses. Although effective communication can be trained by patient education, there is limited research testing this systematically with an app-based digital intervention. Thus, little is known about the success of such a digital intervention in the form of a web-app, potential behavioral barriers for engagement, as well as the processes by which such a web-app might improve self-reported communication behavior. Objective This study fills this research gap by applying a web-app aiming at improving pregnant women’s communication behavior in clinical care. The goals of this study were to (1) uncover the potential risk factors for early dropout from the web-app and (2) investigate the social-cognitive factors that predict self-reported communication behavior after having used the web-app. Methods In this study, 1187 pregnant women were recruited. They all started to use a theory-based web-app focusing on intention, planning, self-efficacy, and outcome expectancy to improve communication behavior. Mechanisms of behavior change as a result of exposure to the web-app were explored using stepwise regression and path analysis. Moreover, determinants of dropout were tested using logistic regression. Results We found that dropout was associated with younger age (P=.014). Mechanisms of behavior change were consistent with the predictions of the health action process approach. The stepwise regression analysis revealed that action planning was the best predictor for successful behavioral change over the course of the app-based digital intervention (β=.331; P<.001). The path analyses proved that self-efficacy beliefs affected the intention to communicate effectively, which in turn, elicited action planning and thereby improved communication behavior (β=.017; comparative fit index=0.994; Tucker–Lewis index=0.971; root mean square error of approximation=0.055). Conclusions Our findings can guide the development and improvement of apps addressing communication behavior in the following ways in obstetric care. First, such tools would enable action planning to improve communication behavior, as action planning is the key predictor of behavior change. Second, younger women need more attention to keep them from dropping out. However, future research should build upon the gained insights by conducting similar internet interventions in related fields of clinical care. The focus should be on processes of behavior change and strategies to minimize dropout rates, as well as replicating the findings with patient safety measures. Trial Registration ClinicalTrials.gov identifier: NCT03855735; https://classic.clinicaltrials.gov/ct2/show/NCT03855735
Effective Communication Supported by an App for Pregnant Women: Quantitative Longitudinal Study
Background In the medical field of obstetrics, communication plays a crucial role, and pregnant women, in particular, can benefit from interventions improving their self-reported communication behavior. Effective communication behavior can be understood as the correct transmission of information without misunderstanding, confusion, or losses. Although effective communication can be trained by patient education, there is limited research testing this systematically with an app-based digital intervention. Thus, little is known about the success of such a digital intervention in the form of a web-app, potential behavioral barriers for engagement, as well as the processes by which such a web-app might improve self-reported communication behavior. Objective This study fills this research gap by applying a web-app aiming at improving pregnant women’s communication behavior in clinical care. The goals of this study were to (1) uncover the potential risk factors for early dropout from the web-app and (2) investigate the social-cognitive factors that predict self-reported communication behavior after having used the web-app. Methods In this study, 1187 pregnant women were recruited. They all started to use a theory-based web-app focusing on intention, planning, self-efficacy, and outcome expectancy to improve communication behavior. Mechanisms of behavior change as a result of exposure to the web-app were explored using stepwise regression and path analysis. Moreover, determinants of dropout were tested using logistic regression. Results We found that dropout was associated with younger age (P=.014). Mechanisms of behavior change were consistent with the predictions of the health action process approach. The stepwise regression analysis revealed that action planning was the best predictor for successful behavioral change over the course of the app-based digital intervention (β=.331; P<.001). The path analyses proved that self-efficacy beliefs affected the intention to communicate effectively, which in turn, elicited action planning and thereby improved communication behavior (β=.017; comparative fit index=0.994; Tucker–Lewis index=0.971; root mean square error of approximation=0.055). Conclusions Our findings can guide the development and improvement of apps addressing communication behavior in the following ways in obstetric care. First, such tools would enable action planning to improve communication behavior, as action planning is the key predictor of behavior change. Second, younger women need more attention to keep them from dropping out. However, future research should build upon the gained insights by conducting similar internet interventions in related fields of clinical care. The focus should be on processes of behavior change and strategies to minimize dropout rates, as well as replicating the findings with patient safety measures. Trial Registration ClinicalTrials.gov identifier: NCT03855735; https://classic.clinicaltrials.gov/ct2/show/NCT03855735
BACKGROUND Research has shown an increase in patient education internet interventions, based in health communication tools via apps and mHealth applications to foster the relation and communication behaviour between physicians and patients and thereby improving clinical care. Specifically, in the medical field of obstetrics, safe communication behaviour plays a crucial role, and pregnant women in particular would benefit from digitally delivered interventions to improve their safe communication behaviour. However, research testing this is scarce. Thus, little is known about the success of such an endeavour, potential behavioural barriers for engagement, as well as the processes by which such an internet intervention might improve safe communication behaviour. OBJECTIVE The current study filled this research gap, by applying a web-app aimed to improve pregnant women’s safe communication behaviour in clinical care. METHODS Thereby the focus lay on investigating the processes behind safe communication behaviour while identifying potential barriers for engagement with the web-app´s content. RESULTS N= 1187 pregnant women were recruited and started participating in the web app. The ten lessons in the web app targeted participants intention, planning, self-efficacy, and outcome expectancy beliefs to improve safe communication behaviour. The intervention was based on the Health Action Process Approach (HAPA) model, that has proven fruitful in explaining safe communication behaviour within previous research. Firstly, a behavioural risk factor for early internet intervention dropout was identified: younger age at intervention start. Additionally, our analyses revealed that capacity for action planning was the best predictor for successful behavioural change over the course of the app. Lastly, sequential mediation analyses revealed a mechanism behind this change, whereby self-efficacy beliefs affected the intention to communicate safely which in turn elicited action planning and thereby improved safe communication behaviour. CONCLUSIONS Concluding, this research shows how internet supported interventions can be utilized to improve pregnant women´s safe communication behaviour in obstetrics care. Interventions improved safe communication behaviour along the constructs of the HAPA framework and thus similarly to a broad range of other health behaviours. Future research should build upon the gained insights conducting similar internet interventions in related fields of clinical care and/ or improve upon insights relating to processes of behaviour change, internet intervention success and minimizing dropout. CLINICALTRIAL ClinicalTrials.gov Identifier: NCT03855735
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