Abstract：
BACKGROUND: Maternal 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.
METHODS: This 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.
RESULTS: 100 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.
CONCLUSIONS: Results 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.
BACKGROUND: National Institute for Health Research Postdoctoral Fellowship (reference PDF-2011-04-034).
METHODS: This 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.
RESULTS: 100 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.
CONCLUSIONS: Results 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.
BACKGROUND: National Institute for Health Research Postdoctoral Fellowship (reference PDF-2011-04-034).
摘要：
背景：母亲体重管理增加了妇女和婴儿的风险，是公共卫生的优先事项。干预措施可以大大改善产妇的饮食和身体活动行为以及妊娠结局。低自我效能感是助产士实施指南的核心障碍。GLOWING使用社会认知理论来解决基于证据的实践障碍，旨在支持助产士指南的实施。
方法：本研究是在英国的四个英国国家健康服务信托（集群）中进行的一项前瞻性集群随机对照试验。群集被随机分为干预（助产士接受干预）或对照（无干预）。助产士实践的指导建议是：首先，与沟通相关的行为(体重沟通和风险沟通)；第二，支持和干预相关行为(饮食和营养，身体活动,体重管理,以及转介和路标)。问卷是使用社会认知理论结构设计的(例如，自我效能感,结果预期，意图,行为)，分数越高，越积极。遵循试点试验的综合报告标准指南，描述性统计用于比较武器，干预前后。
结果：100名助产士在干预前后随机完成问卷调查。74%同意，68%的人返回了问卷。干预前,支持的自我效能感，干预相关行为得分最低。在控件中，干预前和干预后评分之间的差异可以忽略不计.干预组助产士干预后得分始终高于对照组,特别是支持和干预自我效能感(平均71·4[SD17·1]vs58·4[20·1])。在干预助产士中，干预后的所有结果的自我效能均高于干预前：体重交流（平均76·3[SD16·7]vs67·2[21·1]），风险沟通（79·4[16·4]vs68·6[14·9]），饮食，营养,和身体活动（76·4[16·0]vs49·3[16·5]），体重管理（72·1[18·3]vs48·3[19·8]），推荐和路标（63·3[26·0]vs47·9[17·3]），并且始终高于控制。
结论：结果支持用于开发GLOWING的理论模型：低自我效能感是一个核心实施障碍。结果表明，GLOWING成功地针对自我效能感，可能对指导方针的实施有积极意义。这项工作的一个优势是对干预发展采取严格的循证理论方法，在以产妇为基础的研究中基本上没有。一个限制是，这是一个试点试验。需要进行明确的试验以确定有效性。
背景：国家健康研究所博士后奖学金（参考PDF-2011-04-034）。
方法：本研究是在英国的四个英国国家健康服务信托（集群）中进行的一项前瞻性集群随机对照试验。群集被随机分为干预（助产士接受干预）或对照（无干预）。助产士实践的指导建议是：首先，与沟通相关的行为(体重沟通和风险沟通)；第二，支持和干预相关行为(饮食和营养，身体活动,体重管理,以及转介和路标)。问卷是使用社会认知理论结构设计的(例如，自我效能感,结果预期，意图,行为)，分数越高，越积极。遵循试点试验的综合报告标准指南，描述性统计用于比较武器，干预前后。
结果：100名助产士在干预前后随机完成问卷调查。74%同意，68%的人返回了问卷。干预前,支持的自我效能感，干预相关行为得分最低。在控件中，干预前和干预后评分之间的差异可以忽略不计.干预组助产士干预后得分始终高于对照组,特别是支持和干预自我效能感(平均71·4[SD17·1]vs58·4[20·1])。在干预助产士中，干预后的所有结果的自我效能均高于干预前：体重交流（平均76·3[SD16·7]vs67·2[21·1]），风险沟通（79·4[16·4]vs68·6[14·9]），饮食，营养,和身体活动（76·4[16·0]vs49·3[16·5]），体重管理（72·1[18·3]vs48·3[19·8]），推荐和路标（63·3[26·0]vs47·9[17·3]），并且始终高于控制。
结论：结果支持用于开发GLOWING的理论模型：低自我效能感是一个核心实施障碍。结果表明，GLOWING成功地针对自我效能感，可能对指导方针的实施有积极意义。这项工作的一个优势是对干预发展采取严格的循证理论方法，在以产妇为基础的研究中基本上没有。一个限制是，这是一个试点试验。需要进行明确的试验以确定有效性。
背景：国家健康研究所博士后奖学金（参考PDF-2011-04-034）。
