Midwives' survey of weight management practices before and after implementation of the GLOWING guideline: a pilot, cluster, randomised controlled trial

Abstract

BackgroundMaternal weight management increases risks for women and babies and is a public health priority. Interventions can substantially improve maternal diet and physical activity behaviours and pregnancy outcomes. Low self-efficacy is a core barrier to midwives' implementation of guidelines. GLOWING used social cognitive theory to address evidence-based barriers to practice, aiming to support midwives' guidelines implementation. MethodsThis study was a pilot cluster randomised controlled trial in four UK National Health Service Trusts (clusters) in England. Clusters were randomised to intervention (midwives received intervention) or control (no intervention). Guideline recommendations for midwives' practice were: first, communication-related behaviours (weight-communication and risk-communication); and second, support and intervention-related behaviours (diet and nutrition, physical activity, weight management, and referrals and signposting). Questionnaires were designed using social cognitive theory constructs (eg, self-efficacy, outcome expectancies, intentions, behaviours), higher scores being more positive. Following Consolidated Standards of Reporting Trials guidelines for pilot trials, descriptive statistics were used to compare arms, before and after the intervention. Findings100 midwives were randomised to complete questionnaires before and after the intervention. 74% consented, and 68% returned questionnaires. Pre-intervention, self-efficacy for support, and intervention-related behaviours scored lowest. In controls, the difference between pre-intervention and post-intervention scores were negligible. Post-intervention scores were consistently higher in midwives in the intervention group than the control group, particularly for support and intervention self-efficacy (mean 71·4 [SD 17·1] vs 58·4 [20·1]). Self-efficacy was higher after the intervention than before the intervention for all outcomes among intervention midwives: weight-communication (mean 76·3 [SD 16·7] vs 67·2 [21·1]), risk-communication (79·4 [16·4] vs 68·6 [14·9]), diet, nutrition, and physical activity (76·4 [16·0] vs 49·3 [16·5]), weight management (72·1 [18·3] vs 48·3 [19·8]), referrals and signposting (63·3 [26·0] vs 47·9 [17·3]), and consistently higher than controls. InterpretationResults support the theoretical models used to develop GLOWING: low self-efficacy is a core implementation barrier. Results suggest GLOWING successfully targets self-efficacy, potentially with positive implications for guideline implementation. A strength of this work is the rigorous evidence-based theoretical approach to intervention development, largely absent in maternity-based research. A limitation is that this is a pilot trial. A definitive trial is required to determine effectiveness. FundingNational Institute for Health Research Postdoctoral Fellowship (reference PDF-2011-04-034).