[MA 2024 11] Next-Gen Childbirth: User-Centered eHealth Module for Pain Relief in Digital Birth Plans
eHealth Living & Learning Lab Amsterdam, Department of Medical Informatics, AMC
Proposed by: Dr. Marloes Derksen [m.e.derksen@amsterdamumc.nl]
Introduction
Childbirth is a life changing and unique experience. For every woman—independent of her medical situation—being prepared, informed, feeling empowered and resilient, and having a birth plan (i.e., on being informed and prepared regarding labor pain) leads to a more positive childbirth experience and can prevent postnatal maternal distress(1-4). Nowadays, expectant mothers are increasingly preparing themselves through digital heath information (e.g. online childbirth courses)(5). Yet, finding, understanding, appraising reliability of, and using digital health information (i.e., digital health literacy) requires skills, which differ greatly between women (6). Additionally, while most pregnancies begin as low-risk, women may encounter unforeseen medical complications throughout pregnancy and childbirth. Furthermore, women may have a wish for pain relief and management during labour. At the beginning of pregnancy at least 88% of all women receive primary midwifery care, while at the beginning of labour up to 47% receive obstetric care and this rate increases to 87% at the end of labour. Moreover, over 63% of women giving birth to their first child are then caught off guard with a referral during labour to the hospital(7). Consequently, women may be suboptimally prepared for their birth (e.g. including inadequate informed decisions regarding pain relief options), most likely resulting in less positive birthing experiences (8,9). Additionally, labour pain relief is not only related to medical indications, obstetric interventions, and adverse neonatal outcome but may also stem from fear of childbirth known to be associated with prolonged labour and an increased risk of postnatal depression (10, 11). Yet, so far, adequate and effective preventive strategies and (e)Health education addressing fear of childbirth, labour pain intensity and childbirth experience are lacking. To the best of our knowledge, there is currently no evidence-based, interactive eHealth tool available, tailored to women’s digital health literacy needs and interoperable between childbirth healthcare systems, to foster optimal digital preparation for childbirth and consequently positive childbirth experiences.
Description of the SRP Project/Problem
This study will take a user-centered design approach, ensuring that end-users are engaged in every phase of the design process (12):
- Understanding the context of use; and specifying user requirements through literature research and qualitative interviews with end-users (i.e. pregnant women (n=10) and obstetricians/midwives (n=5) supported by the Amsterdam UMC/Childbirth Network).
- Creating design solutions with end-users (n=10+5)
- Evaluating the usability of the solution through means of a Think Aloud usability test combined with qualitative interviews with end-users (n=10+5).
- If possible in the time frame: Testing the deployment of the solution, for which we will also reach out to a small cohort of voluntary participants (n=50), who will be given access to the eHealth solution and fill in the PRAQ-R before and after use (13), to assess if their fear of childbirth has decreased after its use, combined with the ACTA User experience questionnaire to assess the potential adoption of the tool in practice combined with a measure of their digital health literacy (14).
Research questions
- This pilot study aims to develop and test an evidence-based, eHealth module on pain relief during childbirth tailored to women's digital health literacy needs, resulting in a digitalized, interactive (pain relief) birth plan for use in clinical practice of primary midwifery and obstetric care.
- What is the context of use for an evidence-based pain relief module?
- What are user requirements of a pain relief module?
- What design solution will be created for the pain relief module taking a user-centred design?
- What is the user experience of the pain relief module?
- How is the design pain relief module evaluated?
Expected results
- Novel insights into design and evaluation of eHealth modules to build a digital birth plan;
- An evidence-based, eHealth module on pain relief during childbirth tailored to women's digital health literacy needs, resulting in a digitalized, interactive (pain relief) birth plan. Expected stage of maturity: prototype-pilot (15).
Time period, please tick at least 1 time period
November – June
May – November
Both time periods are possible.
Allowance
Subject to the approval of a grant application, a modest internship allowance is available.
Contact
Dr. Marloes Derksen, eHealth Living & Learning Lab, Department of Medical Informatics, AMC
m.e.derksen@amsterdamumc.nl
References
1. Childbirth Network, Floor Meurs. 2023. Een geboorteplan. Onzin of wijsheid? Op 8 februari 2024 opgehaald van: https://www.childbirthnetwork.nl/publicaties/een-geboorteplan-onzin-of-wijsheid/
2. Bell CH, Muggleton S, Davis DL. Birth plans: A systematic, integrative review into their purpose, process, and impact. Midwifery. 2022 Aug;111:103388.
3. Handelzalts JE, Zacks A, Levy S. The association of birth model with resilience variables and birth experience: home versus hospital birth. Midwifery 36 (2016): 80-85.
4. Kuipers YJ, van Beek E. Predictors associated with low-risk women’s pre-labour intention for intrapartum pain relief: a cross-sectional study. International Journal of Nursing Studies Advances, 2022, 4: 100070.
5. Arbour MW, Stec MA. Mobile applications for women's health and midwifery care: a pocket reference for the 21st century. Journal of Midwifery & Women's Health, 2018, 63.3: 330-334.
6. Wolrd Health Organization. 2023. Digital health divide: only 1 in 2 countries in Europe and central Asia have policies to improve digital health literacy, leaving millions behind. Op 15 februari 2024 opgehaald van: https://www.who.int/europe/news/item/05-09-2023-digital-health-divide--only-1-in-2-countries-in-europe-and-central-asia-have-policies-to-improve-digital-health-literacy--leaving-millions-behind
7. Perined. Kerncijfers 2021. Op 15 februari 2024 opgehaald van: https://www.perined.nl/onderwerpen/publicaties-perined/kerncijfers-2021
8. Maclellan J. Vulnerability in birth: a negative capability. Journal of clinical nursing, 2020, 29.17-18: 3565-3574.
9. Hollander M, et al. Women’s motivations for choosing a high risk birth setting against medical advice in the Netherlands: a qualitative analysis. BMC Pregnancy and Childbirth, 2017, 17.1: 1-13.
10. Fear of childbirth and use of labor analgesia: A nationwide register-based analysis in Finland - Vaajala - 2023 - International Journal of Gynecology & Obstetrics - Wiley Online Library;
11. Psychosocial and peripartum determinants of postpartum depression: Findings from a prospective population-based cohort. The ABCD study - PubMed (nih.gov)
12. Holtzblatt K, Wendell JB, & Wood S. (2004).?Rapid contextual design: a how-to guide to key techniques for user-centered design. Elsevier: San Francisco.
13. Adaption of pregnancy anxiety questionnaire–revised for all pregnant women regardless of parity: PRAQ-R2 - PMC (nih.gov)
14. Front. Psychol., 28 May 2018; Sec. Human-Media Interaction;Volume 9 – 2018; https://doi.org/10.3389/fpsyg.2018.00797
15. World Health Organization. (2016). Monitoring and evaluating digital health interventions: a practical guide to conducting research and assessment. Retrieved on July 19, 2024 from https://www.who.int/publications/i/item/9789241511766