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Co-designing a theory-informed intervention to increase shared decision-making in maternity care
Open accessAbstract
Background: Shared decision-making (SDM) has been shown to improve healthcare outcomes and is a recognized right of patients. Policy requires health services to implement SDM. However, there is limited research into what interventions work and for what reasons. The aim of the study was to develop a series of interventions to increase the use of SDM in maternity care with stakeholders. Methods: Interventions to increase the use of SDM in the setting of pregnancy care were developed using Behaviour Change Wheel and Theoretical Domains Framework and building on findings of an in-depth qualitative study which were inductively analysed. Intervention development workshops involved co-design, with patients, clinicians, health service administrators and decision-makers, and government policy makers. Workshops focused on identifying viable SDM opportunities and tailoring interventions to the local context (the Royal Women’s Hospital) and salient qualitative themes. Results: Pain management options during labour were identified by participants as a high priority for application of SDM, and three interventions were developed including patient and clinician access to the Victorian Government’s maternity record via the patient portal and electronic medical records (EMR); a multi-layered persuasive communications campaign designed; and clinical champions and SDM simulation training. Factors identified by participants for successful implementation included having alignment with strategic direction of the service, support of leaders, using pre-standing resources and workflows, using clinical champions, and ensuring equity. Conclusion: Three interventions co-designed to increase the use of SDM for pain management during labour address key barriers and facilitators to SDM in maternity care. This study exemplifies how health services can use behavioural science and co-design principles to increase the use of SDM. Insights into the co-design of interventions to implement SDM in routine practice provide a framework for other health services, policy makers and researchers.
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Although shared decision‐making is the preferred model in maternity care, the unexpected diagnosis of GDM can initially limit women's ability to participate fully until information has been provided and understanding has been developed.
“It is also important to recognise that although shared decision‐making is the preferred model in maternity care [38], the unexpected diagnosis of GDM can initially limit women's ability to participate fully until information has been provided and understanding has been developed.”
From Preconception Perceptions, Knowledge and Behaviours of Women With Gestational Diabetes Mellitus: A Qualitative Study (2026) · cites this paper as [38]
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Metadata
- Authors
- Waddell, A., Spassova, G., Sampson, L., Jungbluth, L., Dam, J., & Bragge, P.
- Affiliations
- Government of Victoria (AU)
- Monash University (AU)
- Royal Women's Hospital (AU)
- Corresponding author
- Waddell, Alex
- Venue
- Health Research Policy and Systems
- Published
- 2023-01-31
- Volume
- 21
- Issue
- 1
- Pages
- 15-15
- ISSN
- 1478-4505 (ISSN-L)
- PMC
- PMC9888748
- OpenAlex
- W4318700678
- Cited by
- 20
- References
- 54
- Citations by year
- 2026: 5 · 2025: 6 · 2024: 5 · 2023: 4
- FWCI
- 7.08
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- Health Research Policy and Systems (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Monash University Research Portal (Monash University) (acceptedVersion, other-oa)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- Australian Government Research Training Program
- Safer Care Victoria
- Topics
- Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
- Health Sciences › Health Professions › General Health Professions › Patient-Provider Communication in Healthcare
- Health Sciences › Health Professions › General Health Professions › Mental Health and Patient Involvement
- Keywords
- shared decision-making, obstetric care, labor analgesia, intervention development, co-design, Behaviour Change Wheel, Theoretical Domains Framework, patient portals, electronic health records, clinical champions, simulation-based training, implementation barriers and facilitators
- MeSH terms
- Administrative Personnel, Female, Humans, Maternal Health Services, Pregnancy, Prenatal Care, Problem Solving, Electronic Health Records
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