Development and testing of an online educational intervention in early labour care
Abstract
Background: Early labour is a challenging situation for many women, and reports of
dissatisfaction with care provided during early labour prior to hospital admission have
been made. A mismatch between the woman's perceived need to be cared for, and
midwives wanting to prevent unnecessary hospital admission may cause conflicts in early
labour. Easy access to relevant and reliable information could be a way of supporting and
strengthening women at home and create a common ground of understanding. Digital
media offers many advantages, allowing for up-to-date information to be presented in a
comprehensible way. Previous research has examined different types of interventions in
relation to the experiences of early labour. However, few have developed an online
educational intervention in early labour care and evaluated how it affects early labour
experience.
Aim: The main aim of this project was to develop an online educational resource for
women in early labour and test how it affected women’s experience of early labour and
subsequent labour characteristics. The aims of the three substudies are based on
different parts of the process. Substudy 1 aimed at exploring women’s experience with
information, and their information needs in pre-admission early labour. The second
substudy describes the development of a Norwegian website, Latens.no, and explores
users’ experiences with the website to increase its user-friendliness. In the third study,
first-time mothers’ experience of early labour and subsequent labour characteristics
before and after introducing Latens.no is compared, and the underlying structure of the
Swedish version of the Early Labour Experience Questionnaire for primiparous women
(SWE-ELEQ-PP) in a Norwegian setting is tested.
Materials and methods: Two qualitative studies and one quantitative study were
conducted to address the aims. Substudy 1 was a qualitative interview study involving
five focus group interviews with sixteen first-time mothers who all had experienced
staying at home during early labour. The study had an exploratory and descriptive
approach, and data was analysed using systematic text condensation. Using this
information, we developed a website with a multidisciplinary research team, health personnel, users, a graphic designer, and an expert in software development working
together in an iterative process. In substudy 2, the development-process was described,
and the website’s user-friendliness was examined. A total of eight participants verbalized
their experiences in semistructured individual interviews and completed tasks on
Latens.no in think-aloud interviews. Participants’ feedback on the website was analysed
using thematic analyses. In the third substudy, a prospective before-and-after-design was
used. Pre- and post-intervention cohorts were recruited (174 pre-intervention and 178
post-intervention). The SWE-ELEQ-PP was distributed among primiparous mothers in the
maternity ward at Oslo University Hospital. Data on obstetric outcomes were obtained
through the medical record system ‘CSAM Partus’. The relationship between cohorts and
demographic characteristics were analysed using chi-square statistics and t-tests.
Confirmatory factor analyses (CFA) were used to evaluate model fit, and the internal
consistency of the scale was measured by Cronbach’s α coefficient.
Main results: The most important theme in substudy 1 involved information. To the
women, having accessible trustworthy information at the appropriate time was crucial.
However, to have a positive impact in reassuring the women in early labour, information
had to be accompanied by acknowledgement and support from both midwives and
partners or other supporting persons. Overall, the participants in substudy 2 both
confirmed the user-friendliness of the website and at the same time provided
information for its improvement. In substudy 3, Latens.no did not improve early labour
experience as measured by the SWE-ELEQ-PP questionnaire. When assessing the labour
characteristics, however, we found that women in the post-intervention group presented
at the labour ward with greater cervical dilatation than those in the pre-intervention
group. Moreover, the post-intervention group received less oxytocin during labour. The
number of telephone consultations increased significantly after the intervention was
introduced. Despite poor fit of Question 9, the CFA of the SWE-ELEQ-PP is within an
acceptable fit.
Conclusion: Findings from the first study suggest that easy access to trustworthy online
information at the right time, together with acknowledgment and support from midwives, can reassure women in early labour. In the second study we demonstrate that
a multidisciplinary approach may be used to develop and test an online educational
resource, and that users may provide suggestions for improvements using the thinkaloud
method. In the third part of this thesis, we were unable to demonstrate that the
introduction of an online educational resource for women in early labour improved early
labour experience. However, women who had access to Latens.no presented to the
labour ward with greater cervical dilatation and received less oxytocin. The findings
demonstrate that participation and use of the think-aloud method is useful in the
development of online resources, and that a website may be a suitable way to convey
information on early labour. However, as this is a single study, more research about
women’s information needs in early labour is warranted, including studies that further
explore the format for information and assess the outcomes after implementation of
such information. This in order to make women feel more comfortable staying at home
during early labour.
Has parts
Paper 1: Myhre EL, Lukasse M, Reigstad MM, Holmstedt V, Dahl B. A qualitative study of Norwegian first-time mothers’ information needs in pre-admission early labour. Midwifery. 2021;100:103016Paper 2: Myhre EL, Garnweidner-Holme L, Dahl B, Reigstad MM, Lukasse M. Development of and Experiences With an Informational Website on Early Labor: Qualitative User Involvement Study. JMIR Form Res. 2021;5(9):e28698
Paper 3: Myhre EL, Lukasse M, Dahl B, Reigstad MM. Early labour experience and labour characteristics after introduction of an electronic early labour educational intervention. Sex Reprod Healthc. In review