Study design of a stepped wedge cluster randomized controlled trial to evaluate the effect of a locally tailored approach for preconception care – the APROPOS-II study

BMC Pregnancy Childbirth

Poels

Kievit

et al. 2022

Self Cite

Background Unhealthy prenatal lifestyle behaviours are associated with adverse pregnancy outcomes, but little is known about what motivates women to comply with preconceptional lifestyle recommendations or consciously plan their pregnancy. Therefore, the objective of this study is to explore the associations between preconceptional lifestyle behaviours, health beliefs and pregnancy planning among Dutch pregnant women. Methods In this cross-sectional study based on the data of the APROPOS-II study, 1,077 low-risk pregnant women were eligible for inclusion. Preconception lifestyle behaviours and actively preparing for pregnancy were assessed in relation to planned pregnancies (based on the London Measure of Unplanned Pregnancies) and health beliefs (14 statements). The following preconceptional lifestyle behaviours were assessed through a self-administered questionnaire in the first trimester of pregnancy: fruit intake, vegetable intake, caffeine intake, (second-hand)smoking, alcohol intake, folic acid supplement use and exercise. Data were analysed using multivariate logistic regression analyses. Results A total of 921 (85.5%) women in our cohort had a planned pregnancy. However, of these women, 640 (69.5%) adequately used folic acid supplements and 465 (50.5%) women consumed alcohol at any point during pregnancy. Of the women considering themselves ‘healthy enough and not needing preconception care’, 48 (9.1%) women had an adequate vegetable intake, 294 (55.6%) women consumed alcohol at any point during pregnancy and 161 (30.4%) women were either over-or underweight. Conclusion Despite consciously planning their pregnancy, most women did not adhere to preconceptional lifestyle behaviour recommendations. Women’s health beliefs and overestimation of their health status seem to interfere with actively planning and preparing for pregnancy. Findings from our study may encourage the development of prospective health-promoting interventions that focus on health beliefs and actively preparing for pregnancy, to improve preconceptional lifestyle behaviours, thereby optimizing the health of future generations.

Section: Methodsmentioning

confidence: 99%

Planning is not equivalent to preparing, how Dutch women perceive their pregnancy planning in relation to preconceptional lifestyle behaviour change - a cross-sectional study

BMC Pregnancy Childbirth

Poels

Kievit

et al. 2022

Self Cite

“…Also, small-scaled verbal pre-testing of the materials took place amongst the target population using a bottom-up approach. The implementation and evaluation phase, in which the final products are being evaluated, is currently ongoing in a stepped-wedge randomised controlled trial (APROPOS-II), where the social marketing strategy is implemented in four municipalities in The Netherlands (Maas et al , 2020).…”

Section: Methodsmentioning

confidence: 99%

“…Finally, while pre-testing of our materials already showed some tentative positive results, the effect of our social marketing strategy on PCC behaviour change of prospective parents remains to be scientifically evaluated. The effect of the Woke Women strategy on PCC behaviour is currently studied in the ongoing APROPOS-II study, and the results of this study are expected by the end of 2021 (Maas et al, 2020).…”

Section: Use Of Local Ambassadors To Spread Our Messagementioning

confidence: 99%

A social marketing strategy to promote preconception care: development of the Woke Women strategy

Blanchette

Amstel³

et al. 2022

JSOCM

Self Cite

Purpose Exposure to unhealthy lifestyle behaviours before pregnancy affects the health of mothers and their (unborn) children. A social marketing strategy could empower prospective parents to actively prepare for pregnancy through preconception care (PCC). This study aims to describe the development of a PCC social marketing strategy based on the eight-point benchmark criteria for effective social marketing and to clarify the concept of using social marketing for health promotion purposes. Design/methodology/approach An extensive literature search was carried out regarding the needs of the target population and PCC behavioural goals, leading to the development of a bottom-up, ambassador-driven, communication concept. Findings In-depth insights of all benchmarks were analysed and incorporated during the development process of a new PCC social marketing strategy, with a special focus on the application of the “Health Belief Model” (Benchmark 3) and “the Four-P framework” (Benchmark 8). Evidence-based preconceptional health information is our product, for a low price as the information is freely attainable, promoting a message of overall women‘s health and online or through a consult with a health-care provider as the appropriate place. This formative research resulted in the development of the Woke Women® strategy, empowering women to actively prepare for pregnancy. Originality/value Developing a social marketing strategy to enhance actively preparing for pregnancy shows potential to encourage prospective parents to adopt healthier preconceptional lifestyle behaviours and can therefore improve the health of future generations.

“…A previous locally tailored PCC-intervention promoting preconceptional health was implemented and evaluated in a feasibility study (APROPOS-I) conducted by our group in 2017, which led to improved preconceptional lifestyle behaviours and increased use of PCC among prospective parents [ 32 ]. In the current study (APROPOS-II), we enhanced this previous PCC-intervention by including a social marketing strategy and a larger study population [ 33 , 34 ]. This study aims to assess the effectiveness of the APROPOS-II intervention in a hybrid-II effectiveness implementation design on (1) adequate preconceptional (lifestyle) behaviours among prospective parents and (2) provision of PCC and PCC-knowledge among healthcare providers.…”

Section: Introductionmentioning

confidence: 99%

The effect of a locally tailored intervention on the uptake of preconception care in the Netherlands: a stepped-wedge cluster randomized trial (APROPOS-II study)

Poels²,

Ista³

et al. 2022

BMC Public Health

Background The preconception period provides a window of opportunity for interventions aiming to reduce unhealthy lifestyle behaviours and their negative effect on pregnancy outcomes. This study aimed to assess the effectiveness of a locally tailored preconception care (PCC) intervention in a hybrid-II effectiveness implementation design. Methods A stepped-wedge cluster randomized controlled trial was performed in four Dutch municipalities. The intervention contained a social marketing strategy aiming to improve the uptake (prospective parents) and the provision (healthcare providers) of PCC. Prospective parents participated by administering a questionnaire in early pregnancy recalling their preconceptional behaviours. Experiences of healthcare providers were also evaluated through questionnaires. The composite primary outcome was adherence to at least three out of four preconceptional lifestyle recommendations (early initiation of folic acid supplements, healthy nutrition, no smoking or alcohol use). Secondary outcomes were preconceptional lifestyle behaviour change, (online) reach of the intervention and improved knowledge among healthcare providers. Results A total of 850 women and 154 men participated in the control phase and 213 women and 39 men in the intervention phase. The composite primary outcome significantly improved among women participating in the municipality where the reach of the intervention was highest (Relative Risk (RR) 1.57 (95% Confidence Interval (CI) 1.11–2.22). Among women, vegetable intake had significantly improved in the intervention phase (RR 1.82 (95%CI 1.14–2.91)). The aimed online reach- and engagement rate of the intervention was achieved most of the time. Also, after the intervention, more healthcare providers were aware of PCC-risk factors (54.5% vs. 47.7%; p = 0.040) and more healthcare providers considered it easier to start a conversation about PCC (75.0% vs. 47.9%; p = 0.030). Conclusion The intervention showed some tentative positive effects on lifestyle behaviours among prospective parents. Primarily on vegetable intake and the knowledge and competence of healthcare providers. The results of this study contribute to the evidence regarding successfully implementing PCC-interventions to optimize the health of prospective parents and future generations. Trial registration Dutch Trial Register: NL7784 (Registered 06/06/2019).