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.
|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|