Smoking Cessation Following Text Message Intervention in Pregnant Women

Background: Smoking during pregnancy has detrimental effects on mother and fetus. Text messaging has been utilized to improve patient care. Objective: To evaluate the impact of text messaging on smoking cessation rates among pregnant women in addition to standard of care (SOC) smoking cessation services. Our SOC includes pharmacist-driven education with or without nicotine patch or bupropion. Methods: This randomized, open-label, prospective trial was conducted at a maternal fetal care center from May 2014 to January 2016. Pregnant patients in the preparation stage of change were randomized to text messaging or SOC. The primary outcome was smoking cessation verified with exhaled carbon monoxide levels (eCO) 2 weeks from quit date. All received clinical pharmacist weekly calls for 3 weeks and biweekly visits until pharmacotherapy completion. The text messaging group also received predetermined motivational messages. Results: Of 49 randomized patients, 13 withdrew, and 6 were lost to follow-up. The remaining included 14 texting and 16 SOC patients. eCO-verified cessation was achieved by 57.1% in the texting group versus 31.3% in the control ( P = 0.153). Overall, 64.3% of the texting group achieved an eCO below 8 ppm at ≥1 visit versus 37.5% in the control group ( P = 0.143). No difference was found in birth outcomes. The study was underpowered because of slow enrollment and high drop-out rates. Conclusions and Relevance: Text messaging had minimal impact on improving smoking cessation rates in the obstetric population. However, further research is warranted because of the underpowered nature of this trial. Given the detrimental effects of smoking in pregnancy, more comprehensive cessation strategies are warranted.

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Dropout and Abstinence Outcomes in a National Text Messaging Smoking Cessation Intervention for Pregnant Women, SmokefreeMOM: Observational Study (Preprint)

10.2196/preprints.14699 ◽

2019 ◽

Author(s):

Kristyn Kamke ◽

Emily Grenen ◽

Cendrine Robinson ◽

Sherine El-Toukhy

Keyword(s):

Smoking Cessation ◽

Pregnant Women ◽

Ethnic Differences ◽

Text Messaging ◽

College Education ◽

Hazard Ratio ◽

Drop Out ◽

Racial And Ethnic Differences ◽

Cessation Intervention

BACKGROUND Population-level text messaging smoking cessation interventions may reduce racial and ethnic differences in smoking among pregnant women. OBJECTIVE Our objective was to examine racial and ethnic differences in dropout, response, and abstinence rates among users of a US national, publicly available text messaging cessation intervention targeting pregnant women, SmokefreeMOM. METHODS Participants were online subscribers to SmokefreeMOM who set a prospective quit date within the 9 months before their due date. We examined demographics, smoking frequency, number of cigarettes smoked per day, and prequit time (up to 14 days of preparation time before quit date) as correlates of response rate and abstinence at 8 time points: quit date, day 7, day 14, day 21, day 28, day 35, day 42 (intervention end), and day 72 (1-month follow-up). We conducted survival analysis of time from quit date to dropout by race and ethnicity. RESULTS The mean age of the analytic sample of 1288 users was 29.46 (SD 7.11) years. Of these, 65.81% (848/1288) were white, 16.04% (207/1288) were black, 8.86% (114/1288) were Latina, and 9.29% (120/1288) were multiracial, American Indian/Alaska Native, Native Hawaiian Pacific Islander, or other; 82.68% (1065/1288) had some college education or less. Point-prevalence abstinence was 14.51% (157/1082) on quit day, 3.51% (38/1082) at intervention end, and 1.99% (21/1053) at 1-month follow-up. Black users (hazard ratio 0.68, 95% CI 0.51-0.91) and those with a high school degree or less (hazard ratio 0.66, 95% CI 0.49-0.89) or some college education (hazard ratio 0.75, 95% CI 0.57-0.99) were less likely to drop out than whites or users with a bachelor’s degree or higher. Response and abstinence rates were similar across race, ethnicity, and education. CONCLUSIONS Enrollment was low among racial and ethnic minority women but high among less-educated women. Abstinence at intervention end and 1-month follow-up was lower than that in controlled trials of text messaging cessation interventions for pregnant women (range 7%-20%). Increasing the reach, engagement, and effectiveness of SmokefreeMOM, especially among women with high rates of smoking during pregnancy, must be prioritized.

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Dropout and Abstinence Outcomes in a National Text Messaging Smoking Cessation Intervention for Pregnant Women, SmokefreeMOM: Observational Study

JMIR mhealth and uhealth ◽

10.2196/14699 ◽

2019 ◽

Vol 7 (10) ◽

pp. e14699 ◽

Cited By ~ 1

Author(s):

Kristyn Kamke ◽

Emily Grenen ◽

Cendrine Robinson ◽

Sherine El-Toukhy

Keyword(s):

Smoking Cessation ◽

Pregnant Women ◽

Ethnic Differences ◽

Text Messaging ◽

College Education ◽

Hazard Ratio ◽

Drop Out ◽

Racial And Ethnic Differences ◽

Cessation Intervention

Background Population-level text messaging smoking cessation interventions may reduce racial and ethnic differences in smoking among pregnant women. Objective Our objective was to examine racial and ethnic differences in dropout, response, and abstinence rates among users of a US national, publicly available text messaging cessation intervention targeting pregnant women, SmokefreeMOM. Methods Participants were online subscribers to SmokefreeMOM who set a prospective quit date within the 9 months before their due date. We examined demographics, smoking frequency, number of cigarettes smoked per day, and prequit time (up to 14 days of preparation time before quit date) as correlates of response rate and abstinence at 8 time points: quit date, day 7, day 14, day 21, day 28, day 35, day 42 (intervention end), and day 72 (1-month follow-up). We conducted survival analysis of time from quit date to dropout by race and ethnicity. Results The mean age of the analytic sample of 1288 users was 29.46 (SD 7.11) years. Of these, 65.81% (848/1288) were white, 16.04% (207/1288) were black, 8.86% (114/1288) were Latina, and 9.29% (120/1288) were multiracial, American Indian/Alaska Native, Native Hawaiian Pacific Islander, or other; 82.68% (1065/1288) had some college education or less. Point-prevalence abstinence was 14.51% (157/1082) on quit day, 3.51% (38/1082) at intervention end, and 1.99% (21/1053) at 1-month follow-up. Black users (hazard ratio 0.68, 95% CI 0.51-0.91) and those with a high school degree or less (hazard ratio 0.66, 95% CI 0.49-0.89) or some college education (hazard ratio 0.75, 95% CI 0.57-0.99) were less likely to drop out than whites or users with a bachelor’s degree or higher. Response and abstinence rates were similar across race, ethnicity, and education. Conclusions Enrollment was low among racial and ethnic minority women but high among less-educated women. Abstinence at intervention end and 1-month follow-up was lower than that in controlled trials of text messaging cessation interventions for pregnant women (range 7%-20%). Increasing the reach, engagement, and effectiveness of SmokefreeMOM, especially among women with high rates of smoking during pregnancy, must be prioritized.

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Regression of cardiac amyloid deposits with novel therapeutics: reaching new frontiers in cardiac ATTR amyloidosis

European Heart Journal ◽

10.1093/ehjci/ehaa946.2117 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

L Chacko ◽

A Martinez-Naharro ◽

T Kotecha ◽

R Martone ◽

D Hutt ◽

...

Keyword(s):

Treatment Group ◽

Cardiac Amyloidosis ◽

T1 Mapping ◽

Group Versus ◽

Control Group ◽

Cardiac Amyloid ◽

Attr Amyloidosis ◽

Amyloid Load ◽

The Impact

Abstract Background Cardiac involvement is the main driver of outcome in ATTR amyloidosis. Advances in therapeutics hold potential in transforming the course of the disease but the impact on cardiac amyloid load is unknown. The aim of this study was to evaluate the impact of patisiran, a new double stranded RNA based gene silencing therapy and a stabilizer, diflunisal, on cardiac amyloid load as measured by CMR and T1 mapping, in patients with ATTR amyloidosis. Methods and results Thirty-two patients with hereditary cardiac amyloidosis were studied. Sixteen patients received treatment with patisiran, and sixteen control subjects did not receive any disease modifying treatment. Patients were assessed with echocardiogram, CMR, NT-proBNP and six-minute walk time measurements at baseline and at 1 year (Mean interval 11.45±3.08 months in treatment group, mean interval 12.82±5.06 months in the control group). CMR analysis comprised LV volumes, T1 mapping to measure the extracellular volume (ECV) occupied by amyloid, T2 mapping and late gadolinium enhancement imaging. At 1-year follow-up, there was a substantial reduction in cardiac amyloid burden, in keeping with cardiac amyloid regression in 45% of patients on treatment. Overall the treatment group showed a reduction in ECV at 1 year follow up compared to an increase in ECV at 1 year in the control group (−1.37%, 95% CI: −3.43 to 0.68% versus 5.02%, 95% CI: 2.86% to 7.18% respectively, p<0.001). The treatment group also showed an improvement in change in 6MWT at 1 year follow up compared to 6MWT at 1 year in the control group (−8.12 meters, 95% CI: −50.8 to 34.6 meters in the treatment group versus −132.27 meters, 95% CI: −216 to −48.6 meters in the control group, p=0.002). The treatment group showed a reduction in BNP at 1 year follow up compared to an increase in the control group (−567.87, 95% CI: −1288.90 to 153.15 in the treatment group versus 2004, 95% CI: 12.82 to 3995.45 in the control group, p<0.001). There was no significant difference from baseline and 1-year data between the control and treatment groups for the difference in echocardiographic parameters, native T1, T2. There was a significant reduction in the percentage of injected dose by 99Tc-DPD scintigraphy in treated patients at 1 year compared to baseline. Conclusions These findings provide the first compelling evidence of substantial cardiac amyloid regression in ATTR amyloidosis, as well as the potential for CMR to be used to track response in treated patients with ATTR cardiac amyloidosis. Combination therapy with transthyretin knock down and stabilizing agents may well be synergistic given enhanced stoichiometry of stabilizers in the face of much reduced plasma transthyretin concentration. Funding Acknowledgement Type of funding source: None

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Evaluation of the online-based self-help programme “Selfapy” in patients with unipolar depression: study protocol for a randomized, blinded parallel group dismantling study

Trials ◽

10.1186/s13063-021-05218-4 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Rico Krämer ◽

Stephan Köhler

Keyword(s):

Depressive Symptoms ◽

Depression Scale ◽

Drop Out ◽

Control Group ◽

Hamilton Depression Scale ◽

Online Interventions ◽

Phone Calls ◽

Self Help ◽

Low Threshold ◽

The Impact

Abstract Background Patients with mild to moderate depressive symptoms can have limited access to regular treatment; to ensure appropriate care, low-threshold treatment is needed. Effective online interventions could increase the supply of low-threshold treatment. Further research is needed to evaluate the effectiveness of online interventions. This study aims to evaluate the online-based self-help programme “Selfapy” on a sample of depressive subjects and compares the impact of the programme’s unaccompanied version with its therapeutic accompanied version. Methods A sample of 400 subjects that have a mild to severe depressive episode (Becks Depression Inventory - II and Hamilton Depression Scale) will be used. Subjects are randomly assigned to immediate access to an unaccompanied course (no support from psychologist via weekly phone calls), immediate access to an accompanied course (support from a psychologist via weekly phone calls) or a waiting list control group (access to the intervention after 24 weeks). The intervention will last for a period of 12 weeks. Depressive symptoms as a primary parameter, as well as various secondary parameters, such as life satisfaction, therapeutic relationships, social activation, self-esteem, attitudes towards Internet interventions and drop-out rates, are recorded at four different points in time: at baseline (T1), 6 weeks after the start of the intervention (T2), 12 weeks after the start of the intervention (T3) and 3 months after completion of the treatment follow-up (T4). Conclusion This randomized and controlled, blinded study will make use of a “dismantled” approach to adequately compare the accompanied and unaccompanied versions of the intervention. Positive and meaningful results are expected that could influence the acceptance and implementation of online interventions. Trial registration German Clinical Trials Register DRKS00017191. Registered on 14 June 2019

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Positive Airway Pressure Therapy Adherence with Mask Resupply: A Propensity-Matched Analysis

Journal of Clinical Medicine ◽

10.3390/jcm10040720 ◽

2021 ◽

Vol 10 (4) ◽

pp. 720

Author(s):

Adam Benjafield ◽

Liesl Oldstone ◽

Leslee Willes ◽

Colleen Kelly ◽

Carlos Nunez ◽

...

Keyword(s):

Airway Pressure ◽

Positive Airway Pressure ◽

Group Versus ◽

Control Group ◽

Billing Data ◽

Pressure Therapy ◽

Therapy Termination ◽

Few Data ◽

And Control ◽

The Impact

There are currently few data on the impact of mask resupply on longer-term adherence to positive airway pressure (PAP) therapy. This retrospective analysis investigated the effects of mask/mask cushion resupply on the adherence to PAP versus no resupply. Deidentified patient billing data for PAP supply items were merged with telemonitoring data from Cloud-connected AirSense 10/AirCurve 10 devices via AirViewTM (ResMed). Eligible patients started PAP between 1 July 2014 and 17 June 2016, had ≥360 days of PAP device data, and achieved initial U.S. Medicare adherence criteria. Patients who received a resupply of mask systems/cushions (resupply group) were propensity-score-matched with those not receiving any mask/cushion resupply (control group). A total of 100,370 patients were included. From days 91 to 360, the mean device usage was 5.6 and 4.5 h/night in the resupply and control groups, respectively (p < 0.0001). The proportion of patients with a mean device usage ≥4 h/night was significantly higher in the resupply group versus the control group (77% vs. 59%; p < 0.0001). The therapy termination rate was significantly lower in the resupply group versus the control group (14.7% vs. 31.9%; p < 0.0001); there was a trend toward lower therapy termination rates as the number of resupplies increased. The replacement of mask interface components was associated with better longer-term adherence to PAP therapy versus no resupply.

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The Impact of Text Messaging on Iranian University Students as an English as a Foreign Language Instructional Tool to Enhance Learner Autonomy and Perception

International Journal of Learning Teaching and Educational Research ◽

10.26803/ijlter.19.11.11 ◽

2020 ◽

Vol 19 (11) ◽

pp. 184-202

Author(s):

Behnam Behforouz ◽

Anca Daniela Frumuselu

Keyword(s):

Foreign Language ◽

Text Messaging ◽

Learner Autonomy ◽

Structured Interview ◽

Control Group ◽

Instructional Tool ◽

Control Groups ◽

And Control ◽

The Impact ◽

Experimental Group

This paper investigates the efficiency of text messaging as an English as a Foreign Language (EFL) instructional tool to enhance learner autonomy and perception at the Islamic Azad University-South Tehran Branch, Iran. The study considers seventy-four learners to participate in the study after the administration of an Oxford Placement Test to measure their proficiency level. Participants are randomly assigned in experimental and control groups, including 37 participants each. A questionnaire is used as a pretest and posttest to measure learners` autonomy. Participants from the experimental group use text messaging (the treatment) to receive instructions, whereas those from the control group receive traditional classroom instructions in a face-to-face channel. A semi-structured interview is also used to collect date on experimental group participants` perception in using MALL in classrooms. The results reveal remarkable differences between the experimental and control groups’ means on their learner autonomy scores. However, the impact of the independent samples t-test has shown that there is no statistically meaningful gender difference among the learners regarding their autonomy scores. The findings based on the semi-structured interview showed complimentary views on MALL. The current study is beneficial since its outcomes could be relevant for EFL curriculum developers and English language teachers in the use of mobile learning and text messaging in the English classroom.

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The Impact of a Brief Intervention on Maternal Smoking Behavior

PEDIATRICS ◽

10.1542/peds.105.s2.267 ◽

2000 ◽

Vol 105 (Supplement_2) ◽

pp. 267-271

Author(s):

Judith A. Groner ◽

Karen Ahijevych ◽

Lindsey K. Grossman ◽

Leslie N. Rich

Keyword(s):

Smoking Cessation ◽

Controlled Trial ◽

Safety Information ◽

Stage Of Change ◽

Smoking Cessation Intervention ◽

Control Group ◽

Primary Care Center ◽

Cessation Intervention ◽

Quit Rate ◽

The Impact

Objective. To determine if mothers receiving a smoking cessation intervention emphasizing health risks of environmental tobacco smoke (ETS) for their children have a higher quit rate than 1) mothers receiving routine smoking cessation advice or 2) a control group. Design. Randomized, controlled trial. Setting. Primary care center in a large urban children's hospital. Intervention. Four hundred seventy-nine mothers were randomly assigned to a smoking cessation intervention either aimed at their child's health or their own health, or to a control group receiving safety information. Outcome Measures. Smoking status, stage of change, cigarettes/day, location smoking occurred, and knowledge of ETS effects. Results. Complete data (baseline and both follow-ups) were available for 166 subjects. There was no impact of group assignment on the quit rate, cigarettes/day, or stage of change. The Child Health Group intervention had a sustained effect on location where smoking reportedly occurred (usually outside) and on improved knowledge of ETS effects. Conclusions. Further research is needed to devise more effective methods of using the pediatric health care setting to influence adult smoking behaviors.

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116 An Experimental Study to Assess the Professional and Social Consequences of Tardive Dyskinesia

CNS Spectrums ◽

10.1017/s1092852920000346 ◽

2020 ◽

Vol 25 (2) ◽

pp. 275-276 ◽

Cited By ~ 1

Author(s):

Rajeev Ayyagari ◽

Debbie Goldschmidt ◽

Fan Mu ◽

Stanley N. Caroff ◽

Benjamin Carroll

Keyword(s):

Tardive Dyskinesia ◽

Involuntary Movement ◽

Population Sample ◽

Group Versus ◽

Test Group ◽

Categorical Variables ◽

Control Group ◽

Study Objective ◽

Social Lives ◽

The Impact

Abstract:Study Objective:Evaluate the impact of orofacial tardive dyskinesia (TD) symptoms on the professional and social lives of patients with TD.Background:TD, a movement disorder affecting the face and extremities, may arise in patients taking antipsychotics. The impact of social stigma on the professional and social lives of patients with orofacial manifestations of TD has not been thoroughly examined.Methods:This study is an experimental, randomized digital survey of a general population sample. Three component surveys were developed, corresponding to employment, dating, and friendship domains. For each domain, participants were randomized 1:1 into either a test group (who viewed a video of a scripted interview with a standardized patient actor depicting TD movements) or a control group (who viewed the same actors but without TD movements), and asked about their impressions of the video subject. Actor simulations were validated by physicians familiar with TD and rehearsed to simulate a total Abnormal Involuntary Movement Scale score between 6 and 10. Statistical comparison was made using Wilcoxon sign-rank or chi-squared tests for continuous and categorical variables, respectively.Results:A total of 800 respondents completed each survey. In all domains, respondents had more-negative perceptions of actors portraying TD movements than of the same actors without movements. Regarding employment, 34.8% fewer respondents in the test group versus the control group agreed that the actor would be suitable for client-facing jobs (P<0.001). Regarding dating, the proportions of respondents who agreed that they would like to continue talking to the actor and who would be interested in meeting them for coffee/drink were 25.0% and 27.2% lower, respectively, in the test group than in the control group (P<0.001). Regarding friendship, the proportions of respondents who rated the actor as interesting and who would be interested in friendship with them were 18.8% and 16.5% lower, respectively, in the test group than in the control group (P<0.001).Conclusions:Actors simulating orofacial TD movements were perceived to be statistically significantly less likely to move forward in a job interview, be considered as a potential romantic partner, or be a new friend. This is the first study to quantify the stigma faced by people with TD in a variety of professional and social situations.Funding Acknowledgements:This study was funded by Teva Pharmaceuticals, Petach Tikva, Israel.

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Influence of the Use of Wii Games on Physical Frailty Components in Institutionalized Older Adults

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18052723 ◽

2021 ◽

Vol 18 (5) ◽

pp. 2723

Author(s):

Jerónimo J. González-Bernal ◽

Maha Jahouh ◽

Josefa González-Santos ◽

Juan Mielgo-Ayuso ◽

Diego Fernández-Lázaro ◽

...

Keyword(s):

Older Adults ◽

Walking Speed ◽

Care Center ◽

Study Groups ◽

Control Group ◽

Static Balance ◽

Frailty Phenotype ◽

Game Console ◽

Falling Risk ◽

The Impact

Aging is a multifactorial physiological phenomenon in which cellular and molecular changes occur. These changes lead to poor locomotion, poor balance, and an increased falling risk. This study aimed to determine the impact and effectiveness of the use of the Wii® game console on improving walking speed and balance, as well as its influence on frailty levels and falling risk, in older adults. A longitudinal study was designed with a pretest/post-test structure. The study population comprised people over 75 years of age who lived in a nursing home or attended a day care center (n = 80; 45 women; 84.2 ± 8.7 years). Forty of them were included in the Wii group (20 rehabilitation sessions during 8 consecutive weeks), and the other 40 were in the control group. Falling risk and frailty were evaluated using the Downton scale and Fried scale; balance and walking speed were assessed with the Berg Balance scale and the Gait Speed Test, respectively, as well as the Short Physical Performance Battery (SPPB). The results showed that there was no significant association between Frailty Phenotype and study groups in baseline. However, there was significant association between Frailty Phenotype and study groups at the end of study. Moreover, a significantly higher and negative percentage change (Δ) in the Wii group with respect to the control group on the in falling risk (−20.05 ± 35.14% vs. 7.92 ± 24.53%) and in walking speed (−6.42 ± 8.83% vs. −0.12 ± 4.51%) during study, while there was a higher and positive significant percent change in static balance (6.07 ± 5.74% vs. 2.13 ± 4.64%) and on the SPPB (20.28 ± 20.05% vs. 0.71 ± 7.99%) after 8 weeks of study. The main conclusion of this study was that the use of the Wii® video console for 8 weeks positively influenced walking speed, falling risk, static balance, and frailty levels in older adults. Through a rehabilitation program with the Wii® game console in the older adults, frailty levels are reduced, accompanied by a reduction in falling risk and an increase in static balance and walking speed.

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Web-Based Training for Nurses on Shared Decision Making and Prenatal Screening for Down Syndrome: Protocol for a Randomized Controlled Trial

JMIR Research Protocols ◽

10.2196/17878 ◽

2020 ◽

Vol 9 (10) ◽

pp. e17878

Author(s):

Alex Poulin Herron ◽

Titilayo Tatiana Agbadje ◽

Melissa Cote ◽

Codjo Djignefa Djade ◽

Geneviève Roch ◽

...

Keyword(s):

Pregnant Women ◽

Training Program ◽

Decision Aid ◽

Prenatal Screening ◽

Decision Aids ◽

Control Group ◽

Intention To Use ◽

Shared Decision ◽

Web Based ◽

The Impact

Background Pregnant women often find it difficult to choose from among the wide variety of available prenatal screening options. To help pregnant women and their partners make informed decisions based on their values, needs, and preferences, a decision aid and a web-based shared decision making (SDM) training program for health professionals have been developed. In Canada, nurses provide maternity care and thus can train as decision coaches for prenatal screening. However, there is a knowledge gap about the effectiveness of SDM interventions in maternity care in nursing practice. Objective This study aims to assess the impact of an SDM training program on nurses’ intentions to use a decision aid for prenatal screening and on their knowledge and to assess their overall impressions of the training. Methods This is a 2-arm parallel randomized trial. French-speaking nurses working with pregnant women in the province of Quebec were recruited online by a private survey firm. They were randomly allocated (1:1 ratio) to either an experimental group, which completed a web-based SDM training program that included prenatal screening, or a control group, which completed a web-based training program focusing on prenatal screening alone. The experimental intervention consisted of a 3-hour web-based training hosted on the Université Laval platform with 4 modules: (1) SDM; (2) Down syndrome prenatal screening; (3) decision aids; and (4) communication between health care professionals and the patient. For the control group, the topic of SDM in Module 1 was replaced with “Context and history of prenatal screening,” and the topic of decision aids in Module 3 was replaced with “Consent in prenatal screening.” Participants completed a self-administered sociodemographic questionnaire with close-ended questions. We also assessed the participants' (1) intention to use a decision aid in prenatal screening clinical practice, (2) knowledge, (3) satisfaction with the training, (4) acceptability, and (5) perceived usefulness of the training. The randomization was done using a predetermined sequence and included 40 nurses. Participants and researchers were blinded. Intention to use a decision aid will be assessed by a t test. Bivariate and multivariate analysis will be performed to assess knowledge and overall impressions of the training. Results This study was funded in 2017 and approved by Genome Canada. Data were collected from September 2019 to late January 2020. This paper was initially submitted before data analysis began. Results are expected to be published in winter 2020. Conclusions Study results will inform us on the impact of an SDM training program on nurses’ intention to use and knowledge of decision aids for prenatal screening and their overall impressions of the training. Participant feedback will also inform an upgrade of the program, if needed. Trial Registration ClinicalTrials.gov NCT04162288; https://clinicaltrials.gov/ct2/show/NCT04162288 International Registered Report Identifier (IRRID) DERR1-10.2196/17878

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