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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?

We plan multiple co-design sessions all the stakeholders, recognising that  new models of care provision will demand new skills, which will be explored during the co-design sessions.

-We propose to work together with HPs and a Reproductive Health Advisory PPI group to explore how and where the GDm-health app should be incorporated in the health pathway. Preparation work will include recruitment and focus groups with midwives.  We will liase with Sensyne, a developer with a basic application which has been  approved for use in the NHS.

We want to explore whether and how an mHealth tool can improve compliance to health recommendations in order to reduce demand for real-time consultations and face-to-face appointments for women with GDM.

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 project has the potential to generate valuable learning about effective incorporation of technology into current practice.  We aim to explore incorporation of an mHealth tool within the current practice to promote desired self-management lifestyle behaviours and dietetic adherence, and influence maternal and neonatal outcomes. However, we aim to do this with recommendation from health professionals, which has not been previously done.  Effective monitoring of blood glucose 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 are liasing with Sensyne who have  an application in the NHS Digital Apps Library. We are also aiming to liase with a research team from a different institution who have initiated similar work in the past.

We will publish our findings in a peer-reviewed journal. We will also share our findings with the wider Q Community and other networks.

How you can contribute

  • We would like to hear from developers as well as anyone who is working on similar projects in a community-based setting. We would like to hear about your experience of co-design and your approach to achieve system-wide perspective in order to impact the wider pathway. In particular, we would want to know more about the specific challenges and barriers to implementation and translation from knowledge to action.
  • Community Midwives and Health Professionals
  • It would be extremely useful to receive feedback from community midwives about your challenges and barriers to delivering care to a population with high risk of complications. We would like to know more about your ideas about tools that can be improved or new tools that are needed and how technology can facilitate delivery of care.
  • Most importantly, we would like to receive input and feedback from maternity service users who have suggestions for improvement, in particular those who were diagnosed with gestational diabetes.

Plan timeline

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

Comments

  1. Dear Michaela, Cecily and team

    I am an ST7 O&G in North West London. Well done for putting this work through, indeed fits nicely with MTPs.

    I wanted to seek your attention that NHS long term plan is driving a paradigm shift towards prevention, hence this initiative should certainly flourish in the pre-conception period, where midwives can play a vital role.

    I am leading a local set up for pre-conception health and optimising BMI is a top priority, happy to discuss further if useful.

     

    Best,

     

     

    1. Dear Osama

       

      Thank you for taking time to read our proposal. Your comment and advice is much appreciated. We strongly believe that there is a lot of room for improvement atm. We would like to get in touch to discuss more if our project is successful.

       

      Best wishes

      Michaela

  2. Hi Michaela and team,  This looks very interesting and agree a community focused tech enabled approach will hopefully generate a lot of interesting learning away from a medicalised secondary care approach.  Hopefully connecting with voluntary sector input is deeply embedded in the proposed approach as with local council, transport etc if that is realistic in this phase.

    Will track your progress with interest.  Best Wishes for very important work!

     

    Mark

    1. Dear Mark

       

      Thank you for comments. They are much appreciated. Part of our research is to engage with  local council and health professionals to find out what is feasible. We will continue to work on this to figure out how to best engage with all relevant stakeholders.

      Best wishes

      Michaela

  3. Hi, this looks really interesting. Are you linked in with your Local Maternity System and your local Maternity Voices Partnership? I’m sure you are, but thought it worth checking as this fits in so brilliantly with “Better Births” and the Prevention workstream within the national maternity transformation programme.

    1. Dear Cecily

      Thank you for taking time to read about our project and make suggestions. Yes, our project fits perfectly in within the 9 work streams of the Maternity Transformation Programme. In particular, we are focusing on harnessing digital technology, improving prevention and increasing choice and personalisation. We believe it will all contribute to a safer, kinder and more family friendly service.

      Do you know if there are any Q members who are involved with the Maternity Transformation Programme on a local and/or national level? We would very much like to hear from them!

       

      We would also like to network with one of the Early Adopter sites to learn more from their experiences.

      Best wishes

      Michaela

  4. Hi Michaela

    Thanks for getting in touch and good luck with the proposal… Not sure if you have come across the baby buddy app …https://www.bestbeginnings.org.uk/baby-buddy – but I know Alison Baum who set it up and immediately thought she would be a potentially useful contact / source of information.

    It is one of my ongoing frustrations that so much public health information / messaging – which can have such a positive impact on pregnant women because they are usually very receptive to improving their health and wellbeing during this time – is not given the resource and support it needs.

    Unfortunately community midwives rarely have time in their busy, generally overflowing clinics to follow up such great initiatives – except where they provide continuity of carer in caseload teams and can disseminate information to the women they look after over the whole of the pregnancy – not try and cram it all into a 10 min app’t.

    If you are keen to explore the involvement of midwives they are the ones I would target… homebirth and caseload teams based in the community.

    Hope that is helpful, let me know if I can help more and if you would like to make contact with Alison.

    1. Dear Alison

      Thank you so much for valuable input.  This is very helpful. We are hoping to explore how some of the workload can be better managed as, it is not sustainable longterm. It is a pressing issue both for the wellbeing of staff as well as patients.

      Unfortunately, due to this overwhelming workload, patients are not receiving the best quality of care.

       

      I am familiar with the Babybuddy and would very much like to get in touch with Alison Baum.

      Best wishes

      Michaela

  5. Thank you. We aim to recruit maternity service users and health professionals from a local Reproductive Health Advisory group.

  6. This sounds like am excellent and much needed piece of research. I'd be interested in learning more how you will find out the views of HPs and pregnant women.

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