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Implementation of a novel shared decision-making intervention in women with chronic hypertension in pregnancy: multiple-site multiple-method investigation

Research output: Contribution to journalArticlepeer-review

Rebecca Whybrow, Jane Sandall, Joanna Girling, Heather Brown, Paul T Seed, Marcus Green, Sarah Findlay, Louise Webster, Lucy C Chappell

Original languageEnglish
Pages (from-to)137-144
Number of pages8
JournalPregnancy Hypertension
Volume30
Early online date20 Sep 2022
DOIs
E-pub ahead of print20 Sep 2022
PublishedDec 2022

Bibliographical note

Funding Information: This work was supported by the National Institute for Health Research (Research Professorship RP-2014-05-019 ) and by the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care South London (NIHR CLAHRC South London) at King’s College Hospital NHS Foundation Trust. Jane Sandall is an NIHR Senior Investigator and is supported by the National Institute for Health Research (NIHR) Applied Research Collaboration South London (NIHR ARC South London) at King’s College Hospital NHS Foundation Trust. Paul T Seed and Louise M Webster are partly funded by Tommy’s (Registered charity no. 1060508) and Paul T Seed was funded by CLAHRC South London (NIHR). Funding Information: This work was supported by the National Institute for Health Research (Research Professorship RP-2014-05-019) and by the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care South London (NIHR CLAHRC South London) at King's College Hospital NHS Foundation Trust. Jane Sandall is an NIHR Senior Investigator and is supported by the National Institute for Health Research (NIHR) Applied Research Collaboration South London (NIHR ARC South London) at King's College Hospital NHS Foundation Trust. Paul T Seed and Louise M Webster are partly funded by Tommy's (Registered charity no. 1060508) and Paul T Seed was funded by CLAHRC South London (NIHR). Publisher Copyright: © 2022 The Authors

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Abstract

BACKGROUND: Many women with chronic hypertension are conflicted about antihypertensive medication during pregnancy and some are non-adherent to prescribed medication.

OBJECTIVES: Codesign, implement and evaluate a novel shared decision-making (SDM) intervention for use with pregnant women with chronic hypertension.

SETTING AND PARTICIPANTS: Pregnant women with chronic hypertension and their principal healthcare professionals (obstetricians, midwives, and physicians), at three National Health Service hospital trusts with different models of care.

MAIN OUTCOME MEASURES: The RE-AIM framework guided the evaluation. Primary: Decisional conflict scale, medication intention survey and women's acceptability. Secondary: Healthcare professionals' acceptability and the barriers and facilitators to SDM implementation with pregnant women with chronic hypertension.

RESULTS: Fifty women participated. Nearly half (46 %; n = 23) of women were from Black and Asian backgrounds. The SDM intervention was effective at reducing decisional conflict (mean reduction from baseline 42 %, 95 % CI 35-49, p ≤ 0.05). In 36 women (72 %), the reduction was of clinical importance. 24 women (48 %) were uncertain about or planned not to take antihypertensives prior to the SDM intervention, compared to two women (4 %) after the intervention. The intervention was acceptable to women and healthcare professionals. 10 of 14 healthcare professionals felt that the in-consultation aid facilitated SDM in current antenatal contexts, a similar proportion (10/14) felt the length of consultations hindered SDM.

CONCLUSION: A novel codesigned SDM intervention reduced decisional conflict and increased women's intention to take antihypertensive agents during pregnancy. This intervention could be adopted into practice for women making pregnancy decisions where there is uncertainty around the medication management option.

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