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BMC Pregnancy and Childbirth
Published in: BMC Pregnancy and Childbirth 1/2019

Open Access 01-12-2019 | Care | Study protocol

Client-tailored maternity care to increase maternal empowerment: cluster randomized controlled trial protocol; the healthy pregnancy 4 All-2 program

Authors: J. Lagendijk, J. V. Been, H. E. Ernst-Smelt, G. J. Bonsel, L. C. M. Bertens, E. A. P. Steegers

Published in: BMC Pregnancy and Childbirth | Issue 1/2019

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Abstract

Background

The postpartum period is an important period for preventive strategies as common maternal and child health risks may become manifest. Women with a lower socioeconomic status tend to have lower maternal empowerment. Increasing their risks of adverse maternal and child health outcomes. This study aims to assess the effectiveness of a primary care level intervention. Delivered to maternity care assistants, aiming to increase maternal empowerment postpartum.

Methods

This study is part of the Dutch nationwide “Healthy Pregnancy 4 All-2” (HP4All-2) program, which aims to identify vulnerable mothers and young children at risk of adverse health outcomes, and subsequently improve their care. This program targets women from deprived neighborhoods.
A pragmatic cluster randomized controlled trial will be undertaken in 12 maternity care organizations. Maternity care organizations in urban municipalities (i.e. the clusters) will be randomized to either a systematic risk assessment during pregnancy with emphasis on identification of non-medical risk factors for adverse maternal and neonatal health outcomes, and subsequent adaptation of care towards a client-tailored approach during pregnancy and the postpartum period, or solely the systematic risk assessment. The primary outcome is the prevalence of a low maternal empowerment score postpartum. Secondary maternal outcomes cover health-related quality of life, postnatal depression, smoking, alcohol consumption, illicit drug use. Finally, maternal and neonatal health care utilization postpartum are recorded. All outcomes will be analyzed according to the intention-to-treat principle, using multi-level mixed effects models.

Discussion

The study will contribute to evidence regarding the effectiveness of client-tailored, risk-based maternity care to increase maternal empowerment postpartum.

Trial registration

Netherlands Trial Registry (NTR) 6311, registered 03-27-2017.
Literature
1.
Data WLC-i-P: WHO recommendations on postnatal care of the mother and newborn. 2013.
2.
T.A. W. Adjusting to motherhood maternity care assistance during the postpartum period: how to help new mothers cope. J Neonatal Nurs. 2006;12(5):163–71.CrossRef
3.
Steegers EA, Been JV. Health inequalities: congenital or preventable? Ned Tijdschr Geneeskd. 2015;160(0):D83.PubMed
4.
Timmermans S, Bonsel GJ, Steegers-Theunissen RP, Mackenbach JP, Steyerberg EW, Raat H, Verbrugh HA, Tiemeier HW, Hofman A, Birnie E, et al. Individual accumulation of heterogeneous risks explains perinatal inequalities within deprived neighbourhoods. Eur J Epidemiol. 2011;26(2):165–80.CrossRef
5.
Mackenbach JP. The persistence of health inequalities in modern welfare states: the explanation of a paradox. Soc Sci Med. 2012;75(4):761–9.CrossRef
6.
Vos AA, Posthumus AG, Bonsel GJ, Steegers EA, Denktas S. Deprived neighborhoods and adverse perinatal outcome: a systematic review and meta-analysis. Acta Obstet Gynecol Scand. 2014;93(8):727–40.CrossRef
7.
Steegers EA, Barker ME, Steegers-Theunissen RP, Williams MA. Societal valorisation of new knowledge to improve perinatal health: time to act. Paediatr Perinat Epidemiol. 2016;30(2):201–4.CrossRef
8.
Ahmed S, Creanga AA, Gillespie DG, Tsui AO. Economic status, education and empowerment: implications for maternal health service utilization in developing countries. PLoS One. 2010;5(6):e11190.CrossRef
9.
(WHO) WHO: Health Promotion Glossary. WHO/HPR/HEP/981 1998.
10.
Carlson GJ, Kordas K, Murray-Kolb LE. Associations between women's autonomy and child nutritional status: a review of the literature. Matern Child Nutr. 2015;11(4):452–82.CrossRef
11.
Hou X, Ma N. The effect of women's decision-making power on maternal health services uptake: evidence from Pakistan. Health Policy Plan. 2013;28(2):176–84.CrossRef
12.
Bloom SS, Wypij D, Das Gupta M. Dimensions of women's autonomy and the influence on maternal health care utilization in a north Indian city. Demography. 2001;38(1):67–78.CrossRef
13.
Pratley P. Associations between quantitative measures of women's empowerment and access to care and health status for mothers and their children: a systematic review of evidence from the developing world. Soc Sci Med. 2016;169:119–31.CrossRef
14.
(KNOV) KNOvV: Instrument voor toekenning van kraamzorg: Partusassistentie en kraamzorg gedurende de kraamperiode.
15.
16.
Sado L, Spaho A, Hotchkiss DR. The influence of women's empowerment on maternal health care utilization: evidence from Albania. Soc Sci Med. 2014;114:169–77.CrossRef
17.
Waelput AJM, Sijpkens MK, Lagendijk J, van Minde MRC, Raat H, Ernst-Smelt HE, de Kroon MLA, Rosman AN, Been JV, LCM B, et al. Geographical differences in perinatal health and child welfare in the Netherlands: rationale for the healthy pregnancy 4 all-2 program. BMC Pregnancy Childbirth. 2017;17(1):254.CrossRef
18.
Chan AW, Tetzlaff JM, Altman DG, Laupacis A, Gotzsche PC, Krle AJK, Hrobjartsson A, Mann H, Dickersin K, Berlin JA, et al. SPIRIT 2013 statement: defining standard protocol items for clinical trials. Rev Panam Salud Publica. 2015;38(6):506–14.PubMedPubMedCentral
19.
Quispel C, Schneider TA, Bonsel GJ, Lambregtse-van den Berg MP. An innovative screen-and-advice model for psychopathology and psychosocial problems among urban pregnant women: an exploratory study. J Psychosom Obstet Gynaecol. 2012;33(1):7–14.CrossRef
20.
Scheerhagen M, van Stel HF, Tholhuijsen DJ, Birnie E, Franx A, Bonsel GJ. Applicability of the ReproQ client experiences questionnaire for quality improvement in maternity care. PeerJ. 2016;4:e2092.CrossRef
21.
Adams G, Gulliford MC, Ukoumunne OC, Eldridge S, Chinn S, Campbell MJ. Patterns of intra-cluster correlation from primary care research to inform study design and analysis. J Clin Epidemiol. 2004;57(8):785–94.CrossRef
22.
Donner A, Birkett N, Buck C. Randomization by cluster. Sample size requirements and analysis. Am J Epidemiol. 1981;114(6):906–14.CrossRef
Metadata
Title
Client-tailored maternity care to increase maternal empowerment: cluster randomized controlled trial protocol; the healthy pregnancy 4 All-2 program
Authors
J. Lagendijk
J. V. Been
H. E. Ernst-Smelt
G. J. Bonsel
L. C. M. Bertens
E. A. P. Steegers
Publication date
01-12-2019
Publisher
BioMed Central
Keyword
Care
Published in
BMC Pregnancy and Childbirth / Issue 1/2019
Electronic ISSN: 1471-2393
DOI
https://doi.org/10.1186/s12884-018-2155-9

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