Conversation cards for pregnancy: a protocol for a multi-method study

Conversations regarding health behaviours, mental health, and socioeconomic contexts are recommended during prenatal visits to optimize maternal and fetal health outcomes. This study was designed to develop and evaluate the acceptability of a clinical dialogue tool called Conversation Cards for Pregnancy (PregnancyCards for short). PregnancyCards are being designed as a practical, person-centered clinical dialogue tool to empower pregnant individuals to talk with their prenatal care providers about potentially sensitive topics regarding health behaviours that are important to them during their prenatal visits.

This two-step, 3-year, multi-method study, guided by the Obesity-Related Behavioural Interventions Trial (ORBIT) model, is grounded in the Capability, Opportunity, and Motivation (COM-B) framework for understanding behaviour. Pregnant individuals and prenatal care providers will be recruited by our partners from across Canada, in clinical and community settings. Step 1: Identify topics of interest related to health behaviours by conducting virtual semi-structured interviews with pregnant individuals (n ~ 20) and prenatal health care providers (n ~ 10-15) and by analyzing data using thematic analysis. Step 2: Topics generated in Step 1 will be used to create a prototype deck of PregnancyCards that will be evaluated in clinical settings with pregnant individuals (n ~ 40) to assess acceptability, appropriateness, and feasibility, and qualitative experiences of using the cards. Prenatal care providers (n ~ 15) will be recruited at one time point to capture their perceptions of usability, acceptability and likability of the prototype cards as well.

Currently, a total of 21 pregnant individuals and 14 prenatal care providers have already participated in Step 1 of this study. All participants (pregnant individuals and prenatal care providers) engaged in semi-structured interviews to determine the topics of interest related to health behaviours. Thematic analysis of interview data has been completed and the results informed the development of a prototype deck of PregnancyCards, which will be tested in Step 2.

We seek to gain a better understanding of pregnant individuals' perceived needs for conversations related to health behaviours and provide insight into the acceptability, appropriateness, and feasibility of PregnancyCards in clinical settings. PregnancyCards has the potential to serve as a practical clinical dialogue tool to help empower pregnant individuals and optimize discussions about health behaviours that matter to them during pregnancy. The two studies outlined in this protocol paper will inform future research to test the efficacy and effectiveness of PregnancyCards as a behavioural intervention aimed at improving health behaviours in pregnancy.