Piccinini-Vallis Helena, Vallis Michael
Department of Family Medicine, Dalhousie University, Halifax, NS, Canada,
Int J Womens Health. 2018 Oct 11;10:609-615. doi: 10.2147/IJWH.S172346. eCollection 2018.
Excess gestational weight gain (GWG) is a risk factor for several adverse outcomes for mothers and their offspring. In Nova Scotia, Canada, approximately 60% of women experience excess GWG. Outside the pregnancy arena, a patient-centered approach has been shown to promote increased patient adherence to clinician recommendations, and increased intentions for, and attempts at, behavior change. The 5As of Healthy Pregnancy Weight Gain is a tool that assists clinicians to have patient-centered discussions about GWG. This feasibility trial examined the association between training in the use of this tool and women's self-efficacy to manage GWG, readiness to adhere to GWG guidelines, perception of their clinicians' patient-centeredness when discussing GWG, and guideline concordance of total GWG.
Participants were 11 family physicians who provide prenatal care and 24 of their patients who were pregnant. Physicians were randomly assigned to a single 60-minute training session in the use of the tool or usual care. Consenting patients completed measures of social support, stress, patient-perceived patient-centeredness, self-efficacy, and motivation. At the end of each woman's pregnancy, data pertaining to guideline concordance of GWG were collected.
Comparison of patient participants with prenatal care providers in the trained and untrained groups showed no significant difference in patient-perceived physician patient-centeredness when discussing GWG, self-efficacy to manage GWG, readiness to adhere to GWG guidelines, or GWG congruence with the guidelines.
This feasibility study required very little time commitment and entailed minimal disruption to clinicians' practices. Nonetheless, it was very difficult to recruit clinicians for the study. Although recent theory-driven work showed that prenatal care providers have, overall, high perceived self-efficacy in discussing GWG with their patients, most studies have demonstrated that these providers do not often discuss GWG with their patients; so, there is clearly a mismatch in their perceived self-efficacy and what actually transpires.
孕期体重增加过多（GWG）是母亲及其后代出现多种不良结局的一个风险因素。在加拿大新斯科舍省，约60%的女性孕期体重增加过多。在非孕期领域，以患者为中心的方法已被证明可促进患者对临床医生建议的依从性提高，以及行为改变的意愿和尝试增加。健康孕期体重增加的5A法是一种帮助临床医生就孕期体重增加进行以患者为中心讨论的工具。这项可行性试验研究了使用该工具的培训与女性管理孕期体重增加的自我效能、遵守孕期体重增加指南的意愿、讨论孕期体重增加时对临床医生以患者为中心程度的认知以及孕期体重增加总量与指南的一致性之间的关联。
参与者包括11名提供产前护理的家庭医生及其24名怀孕患者。医生被随机分配接受一次60分钟的该工具使用培训或常规护理。同意参与的患者完成了社会支持、压力、患者感知的以患者为中心程度、自我效能和动机的测量。在每位女性孕期结束时，收集了与孕期体重增加指南一致性相关的数据。
对接受培训组和未接受培训组的患者参与者与产前护理提供者进行比较，结果显示在讨论孕期体重增加时患者感知的医生以患者为中心程度、管理孕期体重增加的自我效能、遵守孕期体重增加指南的意愿或孕期体重增加与指南的一致性方面均无显著差异。
这项可行性研究所需的时间投入极少，对临床医生的工作造成的干扰也最小。尽管如此，招募临床医生参与该研究非常困难。虽然最近基于理论的研究表明，总体而言，产前护理提供者在与患者讨论孕期体重增加方面具有较高的自我效能感，但大多数研究表明，这些提供者并不经常与患者讨论孕期体重增加；因此，他们的自我效能感认知与实际情况显然存在脱节。
