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.