为妊娠期体重过度增加高危女性实施的孕期健康生活远程指导项目：一项有效性-实施混合研究的方案

Implementation of the Living Well During Pregnancy Telecoaching Program for Women at High Risk of Excessive Gestational Weight Gain: Protocol for an Effectiveness-Implementation Hybrid Study.

作者信息

de Jersey Susan, Meloncelli Nina, Guthrie Taylor, Powlesland Hilary, Callaway Leonie, Chang Angela T, Wilkinson Shelley, Comans Tracy, Eakin Elizabeth

机构信息

Centre for Clinical Research and Perinatal Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Australia.

Department of Nutrition and Dietetics, Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Brisbane, Australia.

出版信息

JMIR Res Protoc. 2021 Mar 18;10(3):e27196. doi: 10.2196/27196.

DOI:10.2196/27196

PMID:33734093

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8086782/

Abstract

BACKGROUND

Despite comprehensive guidelines for healthy gestational weight gain (GWG) and evidence for the efficacy of dietary counseling coupled with weight monitoring on reducing excessive GWG, reporting on the effectiveness of interventions translated into routine antenatal care is limited.

OBJECTIVE

This study aims to implement and evaluate the Living Well during Pregnancy (LWdP) program in a large Australian antenatal care setting. Specifically, the LWdP program will be incorporated into usual care and delivered to a population of pregnant women at risk of excessive GWG through a dietitian-delivered telephone coaching service.

METHODS

Metrics from the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework will guide the evaluation in this hybrid effectiveness-implementation study. All women aged ≥16 years without pre-exiting diabetes with a prepregnancy BMI >25 kg/m and gaining weight above recommendations at <20 weeks' gestation who are referred for dietetic care during the 12-month study period will be eligible for participation. The setting is a metropolitan hospital at which approximately 6% of the national births in Australia take place each year. Eligible participants will receive up to 10 telecoaching calls during their pregnancy. Primary outcomes will be service level indicators of reach, adoption, and implementation that will be compared with a retrospective control group, and secondary effectiveness outcomes will be participant-reported anthropometric and behavioral outcomes; all outcomes will be assessed pre- and postprogram completion. Additional secondary outcomes relate to the costs associated with program implementation and pregnancy outcomes gathered through routine clinical service data.

RESULTS

Data collection of all variables was completed in December 2020, with results expected to be published by the end of 2021.

CONCLUSIONS

This study will evaluate the implementation of an evidence-based intervention into routine health service delivery and will provide the practice-based evidence needed to inform decisions about its incorporation into routine antenatal care.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/27196.

摘要

背景

尽管有关于健康孕期体重增加（GWG）的全面指南，且有证据表明饮食咨询与体重监测相结合在减少过度GWG方面的有效性，但关于转化为常规产前护理的干预措施有效性的报告有限。

目的

本研究旨在在澳大利亚大型产前护理环境中实施并评估孕期健康生活（LWdP）计划。具体而言，LWdP计划将纳入常规护理，并通过营养师提供的电话指导服务，为有过度GWG风险的孕妇群体提供服务。

方法

来自RE-AIM（覆盖范围、有效性、采用率、实施情况和维持情况）框架的指标将指导这项混合有效性-实施情况研究的评估。在为期12个月的研究期间，所有年龄≥16岁、无孕前糖尿病、孕前BMI>25kg/m²且在妊娠<20周时体重增加超过建议值并被转介接受饮食护理的妇女均有资格参与。研究地点是一家大都市医院，每年澳大利亚约6%的新生儿在此出生。符合条件的参与者在孕期将接受多达10次电话指导。主要结果将是与回顾性对照组进行比较的覆盖范围、采用率和实施情况等服务水平指标，次要有效性结果将是参与者报告的人体测量和行为结果；所有结果将在项目完成前后进行评估。其他次要结果涉及与项目实施相关的成本以及通过常规临床服务数据收集的妊娠结局。