[Project "FrühStart"--family midwives in Saxony-Anhalt. Their networking with other health care and child welfare professionals and subjective view of the families]

Evaluation of a Child-centred Psychosocial Healthcare Intervention (KIDPROTEKT) - Results of a Cluster Randomized Controlled Trial in Paediatric and Gynaecologic Practices

KID-PROTEKT is a child-centred psychosocial healthcare intervention which aims at improving the identification of psychosocial needs and navigation in the outpatient gynaecologic and paediatric setting. In this cluster randomized-controlled trail we examined the effect of KID-PROTEKT on the referrals (to support services) in comparison to the regular gynaecologic and paediatric outpatient healthcare . A variant based on the qualification of the healthcare providers (qualified treatment, QT) and a variant with social worker (supported treatment, ST) were compared to the regular healthcare (treatment as usual, TAU). Twenty-four gynaecologic and paediatric practices were randomized to one of three study arms. Therefore 8,458 pregnant women and families recruited in one of these practices were enrolled in the study. Participating patients reported on average 1.73 (SD = 1.34) psychosocial risks. In total 522 patients were linked to a support service. Compared to TAU, the probability of a referral was significantly higher in QT (OR = 10.70) and ST (OR = 11.28). Also, a higher number of psychosocial risks were linked to a referral (OR = 2.72). These findings support the importance of a psychosocial assessment in the gynaecologic and paediatric setting.

[Self-Efficacy as Outcome Measuring the Effectiveness of the Family Intervention "Babylotse ambulant" in Gynecologic Practices]

BACKGROUND

Psychosocial stress can have detrimental effects on the mother's health and the development of the child. The aim of the family intervention "Babylotse ambulant" in gynecologic practices is the systematic and early identification of psychosocially distressed families as well as consulting and connecting them to the regional health and social care system.

OBJECTIVES

The effectiveness of the family intervention in six gynecologic practices was investigated through a pre-post control group design using perceived self-efficacy as outcome. It was assumed that participation in the intervention would result in increased maternal self-efficacy as a measurement of faith in one's own abilities to solve problems.

METHODS

Self-efficacy of n=202 psychosocially distressed and n=262 non-distressed patients, who were screened in one of the six gynaecologic practices, was assessed using the Self-Efficacy Scale during the first trimester (T0) and one year after birth (T1).

RESULTS

Psychosocially distressed mothers, who all received counselling from social workers, showed a significantly higher self-efficacy at T1 compared to T0. After the intervention, no significant differences were found between distressed patients and the control group of non-distressed patients who received no intervention.

DISCUSSION

Increased self-efficacy in distressed mothers after giving birth and thus, more faith in their own problem-solving capabilities points to the positive effects of the intervention during pregnancy in an outpatient gynecologic setting.

CONCLUSION

Addressing psychosocial distress and strengthening self-efficacy is relevant in clinical interventions. As interface management, a pilot-based intervention like "Babylotse ambulant" can provide relief in the care of distressed patients during pregnancy and birth.

Experiences and wishes of women regarding systemic aspects of midwifery care in Germany: a qualitative study with focus groups

BACKGROUND

Knowledge of pregnant women's and mothers' viewpoints on midwifery care is crucial for its appropriate delivery and research. In Germany, comprehensive research to more fully understand women's needs in pregnancy, labour, birth and the postpartum period until weaning is lacking. International studies provide some knowledge of women's expectations, their choices, and subjective criteria indicating good midwifery care.

METHODS

This study explores pregnant women's and mothers' experiences, needs and wishes regarding systemic aspects of midwifery care (access, availability, choices, model of midwifery care; maternity care in the healthcare system). 50 women participated in 10 focus groups in 5 states of Germany. The groups were heterogeneous with regard to age, parity, model of maternity care used, and rating of satisfaction. Women with limited educational years (n = 9) were personally contacted by midwives and reached by social media. Also, mothers living in a mother-child home (n = 6) or attending a peer group for grieving parents (n = 5) were included. The digitally documented focus groups were systematically analysed in an itinerary hermeneutic manner.

RESULTS

Three themes were identified: (a) Knowledge or lack of awareness of midwifery care, (b) availability of and access to midwives, and (c) midwifery care in the healthcare system. Theme (a) entails the scope of midwifery care and the midwife's competence, but also a lack of information, inconsistent counselling, and difficulty identifying midwives. Theme (b) encompasses aspects such as the availability, accessibility and selection of a midwife, the effort involved in looking for a midwife, the challenge of transition points, and family midwives. Theme (c) relates interprofessional cooperation, gaps/inadequacies of care during latency phase, alternative models of care, and the importance of family and peer groups for women.

CONCLUSIONS

Midwifery care and research in Germany must address the issue of imparting relevant information about midwifery services. Interprofessional cooperation and management of transition points ought to be improved in the interests of the women concerned. Moreover, the quality of antenatal classes, support during latency phase, and intrapartum care in hospitals need to be addressed. Lastly, the special needs of vulnerable women in midwifery care must become a major focus in Germany.

Access to Difficult-to-reach Population Subgroups: A Family Midwife Based Home Visiting Service for Implementing Nutrition-related Preventive Activities - A Mixed Methods Explorative Study

Health and social inequality are tightly linked and still pose an important public health problem. However, vulnerable and disadvantaged populations are difficult to reach for health-related interventions. Given the long-lasting effects of an adverse, particular nutrition-related, intrauterine and neonatal environment on health development (perinatal programming), an early and easy access is essential for sustainable interventions. The goal of this explorative study was therefore to elucidate whether an existing access of family midwives (FMs) to families in need of support could be an option to implement effective public health and nutrition interventions. To that end three research objectives were formulated: (1) to determine whether a discernible impact of home visits by FMs can be described; (2) to identify subgroups among these families in need of more specific interventions; (3) to determine how relevant nutrition-related topics are for both FMs and the supported families. For addressing these objectives a mixed methods design was used: Routine documentation data from 295 families visited by a family midwife (FM) were analyzed (secondary analysis), and structured expert interviews with FMs were conducted and analyzed. Study reporting followed the STROBE (STrengthening the Reporting of OBservational studies in Epidemiology) statement. Based on the FMs reports, a significant improvement (p < 0.001) regarding psycho-social variables could be determined after the home visits. Single mothers, however, seemed to benefit less from the FMs service compared to their counterparts (p = 0.015). Nutritional counseling was demanded by 89% of the families during the home visits. In addition, nutrition-related topics were reported in the interviews to be of high interest to both families and the FMs. Based on the obtained results it is concluded that FMs home visits offer a promising access to vulnerable and disadvantaged families for implementing nutrition-related preventive activities.

The current state of midwifery and development of midwifery research in four European countries

OBJECTIVE

to describe the current state of midwifery and explore the development of midwifery research during the last two decades in four non-English speaking European countries in order to understand what factors influenced the course of establishing research as a professional activity.

DESIGN

qualitative collective case study.

SETTING

Germany, Austria, Switzerland and the Netherlands.

FINDINGS

with the ICM Workshop in Germany in 1989 as a central starting point for midwifery research in all four countries, different courses, in timing as well as content, characterised its development in the individual countries. Major factors contributing to this development during the last decades involved the history and character of midwifery, initiatives of individual midwifery researchers, alliances with other professions and the transition of midwifery programmes into higher education. Whereas midwifery research is currently established as a professional role in all countries, future challenges involve the creation of its own profile and identity, while building up its own academic workforce and strengthening the role of midwifery in multidisciplinary alliances.

KEY CONCLUSIONS AND IMPLICATIONS

although a common vision was shared between the four countries in 1989, midwifery research developed as a context-specific phenomenon related to the character of midwifery and education in each country. These factors have to be taken into account in the further development of midwifery as an academic discipline at a national as well as at an international level.

Key role in the prevention of child neglect and abuse in Germany: continuous care by qualified family midwives

OBJECTIVE

the aim of two related studies was an in-depth knowledge of psychosocially and health-related vulnerable families and the 'portfolio' of care that family midwives (FM) provide. Besides factors which influence acceptance and access from the mothers' perspective, the effectiveness of FM with regard to care, infant nutrition, and parent-child relationship as well as multidisciplinary collaboration were of interest, especially against the backdrop of Germany's national aim to strengthen prevention of neglect and abuse of infants. In addition, the reasons why families did not want FM care were explored.

DESIGN

two FM model projects in Saxony-Anhalt (SA) and Lower Saxony (LS), Germany, were evaluated. Quantitative data were prospectively collected on 93% of vulnerable families being cared for by FM (SA) and regarding vulnerable families that declined FM care (LS). These data were complemented by problem-focused interviews with 14 mothers and six social workers (LS).

SETTING AND INTERVENTIONS

the 33 FM in SA and 11 FM in LS are community-based and visit vulnerable families from pregnancy up to the first birthday of the child, maximally. They provide health promotion, maternal and infant care, and multidisciplinary support geared towards early prevention of child neglect and abuse.

PARTICIPANTS

from May 2006 until 2008 (SA) and from January 2008 until December 2009 (LS) 814 and 235 vulnerable families, respectively, were cared for by FM. Complete data on 734 families were analysed (SA) as were 30 questionnaires on 'non-compliant' families (LS). Problem-focused interviews were conducted with 14 mothers and 6 social workers (LS).

MEASUREMENTS AND FINDINGS

many families exhibited a high vulnerability score of complex risk factors. Four vulnerability patterns were statistically extracted explaining 40% of the total variance. The highest frequencies of care activities related to infant care and nutrition, giving advice on the Mother-Child relationship, and psychosocial support. The Youth Welfare Services (YWS) were significant collaboration partners, especially regarding families whose child was taken out for safety reasons. By conclusion of care, significantly higher mean scores were observed regarding 'parent-child relationship' and 'maternal care for child' (compared to the outset of care) when mean duration of care was at least 6 months. The children who were taken out of their families had significantly lower scores in nutritional care, and were given solids at a significantly earlier time. From the mothers' perspective it was important to have early access to the FM and easy between-visits communication via phone calls, or text messages. They appreciated the physical and psychosocial care for the infant and herself, an uncomplicated transition from caseload midwifery, and collaboration among providers. Families who declined FM care wanted to stay with their self-chosen midwife, were afraid of external control, or felt they were able to cope without professional support.

KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

when families can access FM early on and home-visits are sustained, maternal competencies in caring for, and relating to, the child can potentially be strengthened. FM seem to fill a gap between standard care by caseload midwives ending at 8 weeks postpartum and YWS whose personnel is not skilled in the assessment of health-related problems, such as inadequate infant nutrition. As a relatively high percentage of the families were challenged by domestic violence, drug addiction, and teenage pregnancy, ongoing educational activities should address these topics.