Co-designing a theory-informed intervention to increase shared decision-making in maternity care

Area of Science:

• Healthcare policy and implementation science
• Patient-centered care and health outcomes research
• Behavioral science in healthcare interventions

Background:

• Shared decision-making (SDM) is a patient right and policy requirement, crucial for improving healthcare outcomes.
• Limited research exists on effective interventions and their underlying mechanisms for implementing SDM.
• This study aimed to develop targeted interventions to increase SDM use within maternity care settings.

Purpose of the Study:

• To develop and co-design interventions aimed at increasing the utilization of shared decision-making (SDM) in maternity care.
• To address barriers and facilitators for SDM implementation through stakeholder engagement.
• To focus intervention development on high-priority areas identified by patients and clinicians.

Main Methods:

• Utilized the Behaviour Change Wheel and Theoretical Domains Framework for intervention design.
• Employed inductive analysis of qualitative study findings to inform intervention development.
• Conducted co-design workshops with diverse stakeholders including patients, clinicians, administrators, and policymakers.

Main Results:

• Identified labor pain management as a key area for SDM application.
• Developed three interventions: enhanced access to maternity records (patient portal/EMR), a persuasive communications campaign, and clinical champions with simulation training.
• Key implementation factors included strategic alignment, leadership support, leveraging existing resources, and ensuring equity.

Conclusions:

• Co-designed interventions for labor pain management effectively address SDM barriers and facilitators in maternity care.
• Demonstrates the utility of behavioral science and co-design principles for implementing SDM in health services.
• Provides a framework for other health services, policymakers, and researchers to enhance SDM implementation.