What is the challenge your project is going to address and how does it connect to your chosen theme?
In the UK, the number of women requiring advanced level of antenatal care due to obesity during pregnancy has more than doubled over the last two decades. The special pathway for women who are obese and who develop gestational diabetes (GDM) mainly includes medical management in secondary care. An evaluation of the Implementation of Maternal Obesity Pathways of Care report found that the clinical management was viewed positively with good compliance. However, the prevention (public health management) was predominantly non-compliant, and it found that increased antenatal and postnatal weight management support was needed, mainly in the community.
Reviews have found that facilitators and barriers in counselling were “Counselling as a challenge”; “Counselling as walking the thin ice” and “Counselling as an opportunity”. It is perceived by midwives as a ‘complex and ambiguous’ task, and a fine balancing act with a high risk of being ‘rejected’ by the pregnant women.
What does your project aim to achieve?
This research will aim to explore whether the highly medicalised management of women with a raised BMI who develop gestational diabetes, throughout the current health pathway can be complemented with better lifestyle support in the community through supplementing of the role of community midviwes by means of mHealth technology. In particular, we want to co-develop an mHealth tool with community-based health professionals (HPs) that can be used to assit HPs to provide lifestyle advice to this group of patients. In particular, as most interventions in the past have focused on the patient-group rather than HPs. This type of intervention may reduce the need for some of the medical interventions, if such intervention was successful and was proven feasible.
How will the project be delivered?
Preparation work will include recruitment and focus groups with midwives to co-develop an mHealth tool to be used for weight management consultations during pregnancy.
-We propose to develop an mHealth tool that will incorporate the use of the GDm-health app (available on the nhs app library) to improve uptake to reduce deman for real-time consultations and face-to-face appointments for women with GDM.
-We propose to work together with health professionals and the local Reproductive Health Advisory PPI group to explore how and where the GDm-health app should be incorporated in the health pathway.
-Previous work with the GDm-health app found that patient satisfaction improved significantly, that there was better adherence to blood glucose monitoring, significant reduction in C- sections and preterm births.
What and how is your project going to share learning throughout?
This is potentially a new and innovative way that can better support pregnant obese women with GDM>
We propose to explore how this tool can be combined with a support tool for midwives as part of a digital health solutions to promote desired self-management lifestyle behaviours and dietetic adherence, and influence maternal and neonatal outcomes. Effective monitoring of blood glucose monitoring may address the growing burden of GDM on the NHS and reduce the number of outpatient appointments due to complications and poor self-monitoring.
We plan to conduct co-design sessions with a local reproductive health advisory group and health professionals to inform the development of an m-health tool that will support both HPs and patients to enable better self-management of the condition. New models of care provision will demand new skills, which will be explored during the co-design sessions.
How you can contribute
- It would be interesting to hear from others on their experience of co-design and their approach to achieve system-wide perspective in order to impact the wider pathway.
|18 Jul 2019|
|6 Jan 2020||Start of the project. Informing the already established PPI|
|1 Apr 2020||Review of previous work and establishing contact with Synerg|
|1 Jul 2020||Conduct focus group to inform the online tool.|
|1 Oct 2020||Input of information and development of relevant information|
|24 Nov 2020||Involvement with the Advisory PPI group and recruitment|
|25 Nov 2020||Evaluation. Collating Evidence|