A protocol for a systematic review of behaviour change techniques used in the context of stillbirth prevention

Tamara Escañuela Sánchez,Sarah Meaney,Karen Matvienko-Sikar,Keelin O'Donoghue,Molly Byrne

doi:10.12688/hrbopenres.13375.1

Abstract

Background: Stillbirth is a devastating pregnancy outcome that affects approximately 3.5 per 1000 births in high-income countries. Previous research has highlighted the importance of focusing prevention efforts on targeting risk factors and vulnerable groups. A wide range of risk factors has been associated with stillbirth before, including maternal behaviours such as back sleep position, smoking, alcohol intake, illicit drug use, and inadequate attendance at antenatal care. Given the modifiable nature of these risk factors, there has been an increase in the design of behaviour change interventions targeting such behaviours to reduce the risk of stillbirth. Objectives: The aim of this study is to identify all behavioural interventions with a behavioural component designed and trialled for the prevention of stillbirth in high-income countries, and to identify the behaviour change techniques (BCTs) used in such interventions using the Behaviour Change Techniques Taxonomy V1 (BCTTv1). Inclusion criteria: Interventions will be included in this review if they (1) have the objective of reducing stillbirth rates with a focus on behavioural risk factors; (2) are implemented in high-income countries; (3) target pregnant women or women of childbearing age; and (4) are published in research articles. Methods: A systematic search of the literature will be conducted. The results of the search will be screened against our inclusion criteria by two authors. The following data items will be extracted from the selected papers: general information, study characteristics, participant and intervention/approach details. The Cochrane Effective Practice and Organization of Care (EPOC) risk of bias criteria will be used to assess the methodological quality of included studies. Intervention content will be coded for BCTs as present (+) or absent (-) by two authors using the BCTTv1, discrepancies will be discussed with a third author. A narrative synthesis approach will be used to present the results of this systematic review.

Highlights

Stillbirth is one of the most devastating outcomes of pregnancy that expectant parents can face
The stillbirth series published in the Lancet in 2016 highlighted the importance of focusing future stillbirth prevention efforts in high-income countries on targeting specific causes, risk factors, and vulnerable groups[5]
Previous research has shown that stillbirth is associated with a wide range of risk factors, including maternal medical factors, for example hypertensive disorders or diabetes[7,8,9]; factors associated with the woman’s obstetric history, for example having a history of previous pregnancy loss[10], primiparity[11] or multiple pregnancy[12]; pregnancy related complications such as placental insufficiency[13] or fetal growth restriction[14]; ethnic[15] and socioeconomic status[16]; maternal overweight and obesity[17,18,19]; and maternal age[20,21,22]