scholarly journals Midwives’ Survey of Their Weight Management Practice Before and After the GLOWING Guideline Implementation Intervention: A Pilot Cluster Randomised Controlled Trial

2021 ◽  
Author(s):  
Nicola Heslehurst ◽  
Catherine McParlin ◽  
Falko F Sniehotta ◽  
Judith Rankin ◽  
Elaine McColl
Keyword(s):  
Physical Activity ◽  
Weight Management ◽  
Self Efficacy ◽  
Controlled Trial ◽  
Guideline Implementation ◽  
Cluster Randomised Controlled Trial ◽  
Post Intervention ◽  
Support Intervention ◽  
Cluster Randomised ◽  
Randomised Controlled

Abstract Background: Weight management is a priority for maternity services due to pregnancy risks and long-term health implications for women and babies. Pregnancy interventions significantly improve maternal diet, physical activity, weight, and some pregnancy outcomes. There are complex barriers, underpinned by self-efficacy, to midwives’ implementation of UK guidelines. The GLOWING intervention uses social cognitive theory (SCT) to address evidence-based barriers to practice, with the aim of supporting midwives’ implementation of guidelines into routine practice.Methods: An external rehearsal pilot cluster randomised controlled trial in four NHS Trusts (clusters) in England, UK. Clusters were randomised to intervention arm where all eligible midwives received the intervention, or control arm which received no intervention. A random sample of 100 midwives were invited to complete questionnaires pre- and post-intervention. UK guideline recommendations were grouped into communication-related behaviours (weight and risk communication) and support/intervention-related behaviours (diet/nutrition, physical activity, weight management, referrals/signposting). Questionnaires were developed using SCT constructs (self-efficacy, outcome expectancies, intentions, behaviours) and 7-point Likert scale. Data were converted to a 0-100 scale, where higher scores were more positive. Descriptive statistics compared intervention and control arms, pre- and post-intervention.Results: Seventy-four midwives consented and 68 returned questionnaires. Pre-intervention, self-efficacy for support/intervention-related behaviours scored lowest. In the control arm, there was limited difference between the pre- and post-intervention scores. Post-intervention, the mean scores were consistently higher in the intervention than control arm, particularly for support/intervention self-efficacy (71.4, SD 17.1 and 58.4, SD 20.1). Mean self-efficacy was higher post-intervention than pre-intervention for all behaviour categories in the intervention arm: weight communication (76.3, SD 16.7 vs. 67.2, SD 21.1), risk communication (79.4, SD 16.4, vs. 68.6, SD 14.9), diet/nutrition/physical activity (76.4, SD 16.0 vs. 49.3, SD 16.5), weight management (72.1, SD 18.3 vs. 48.3, SD 19.8), referrals/signposting (63.3, SD 26.0 vs. 47.9, SD 17.3), and consistently higher than controls.Conclusions: This study supports the theoretical models used to develop GLOWING, particularly that low self-efficacy is core to implementation barriers. Results suggest that the intervention is successfully targeting self-efficacy, which could have a positive impact on guideline implementation. A future definitive trial is required to determine effectiveness and cost-effectiveness. Trial registration: ISRCTN46869894, retrospectively registered 25/05/2016, http://isrctn.com/ISRCTN46869894

scholarly journals Effectiveness and cost-effectiveness of the PLAN-A intervention, a peer led physical activity program for adolescent girls: results of a cluster randomised controlled trial

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Russell Jago ◽  
Byron Tibbitts ◽  
Kathryn Willis ◽  
Emily Sanderson ◽  
Rebecca Kandiyali ◽  
...  
Keyword(s):  
Physical Activity ◽  
Cost Effectiveness ◽  
Randomised Controlled Trial ◽  
Primary Outcome ◽  
Controlled Trial ◽  
Cluster Randomised Controlled Trial ◽  
Control Group ◽  
Cluster Randomised ◽  
Secondary Outcomes ◽  
Randomised Controlled

Abstract Background Physical activity is associated with improved health. Girls are less active than boys. Pilot work showed that a peer-led physical activity intervention called PLAN-A was a promising method of increasing physical activity in secondary school age girls. This study examined the effectiveness and cost-effectiveness of the PLAN-A intervention. Methods We conducted a cluster randomised controlled trial with Year 9 (13–14 year old) girls recruited from 20 secondary schools. Schools were randomly assigned to the PLAN-A intervention or a non-intervention control group after baseline data collection. Girls nominated students to be peer leaders. The top 18 % of girls nominated by their peers in intervention schools received three days of training designed to prepare them to support physical activity. Data were collected at two time points, baseline (T0) and 5–6 months post-intervention (T1). Participants wore an accelerometer for seven days to assess the primary outcome of mean weekday minutes of moderate-to-vigorous physical activity (MVPA). Multivariable mixed effects linear regression was used to estimate differences in the primary outcome between the two arms on an Intention-to-Treat (ITT) basis. Resource use and quality of life were measured and a within trial economic evaluation from a public sector perspective was conducted. Results A total of 1558 girls were recruited to the study. At T0, girls in both arms engaged in an average of 51 min of MVPA per weekday. The adjusted mean difference in weekday MVPA at T1 was − 2.84 min per day (95 % CI = -5.94 to 0.25) indicating a slightly larger decline in weekday MVPA in the intervention group. Results were broadly consistent when repeated using a multiple imputation approach and for pre-specified secondary outcomes and sub-groups. The mean cost of the PLAN-A intervention was £2817 per school, equivalent to £31 per girl. Economic analyses indicated that PLAN-A did not lead to demonstrable cost-effectiveness in terms of cost per unit change in QALY. Conclusions This study has shown that the PLAN-A intervention did not result in higher levels of weekday MVPA or associated secondary outcomes among Year 9 girls. The PLAN-A intervention should not be disseminated as a public health strategy. Trial registration ISRCTN14539759–31 May, 2018.

Sign in / Sign up

Export Citation Format

Share Document