Table 3.
Change objectives for midwives
| Determinants→PO | Awareness of public health role (aw) | Knowledge (k) | Attitudes (a) | Social influences (si) | Self-efficacy/skills (se) | Barriers (b) |
|---|---|---|---|---|---|---|
| PO1. Midwives facilitate information supply about healthy GWG to all pregnant women in their first trimester | aw1a. Confirm the value of education about GWG on pregnant women’s behaviour | a1a. Believe it is important to stimulate healthy GWG a1b. Believe it is important to provide information about healthy GWG a1c. Believe it is important to draw pregnant women’s attention to strategies for reaching healthy GWG a1d. Believe it is important to inform pregnant women about healthy GWG | ||||
| PO2. At a gestational age of about 16 weeks, midwives adapt their care concerning healthy weight gain to individual needs of pregnant women | aw2a. Confirm the impact of societal temptations that inhibit healthy GWG | k2a. Describe advantages of healthy GWG for pregnant women and their offspring (short- and long-term) k2b. Describe short- and long-term consequences of unhealthy GWG k3c. Describe ways to reach a healthy GWG (diet, PA, well-being in general) k3d. Describe the content of healthy dietary behaviour k2e. Describe the content of healthy PA k2f. Describe the ingredients of well-being in general (WHO definition: physical, mental, societal well-being) k2g. Describe for each BMI category the appropriate target weight and healthy GWG per time episode (first trimester, after first trimester weekly GWG) k2h. Describe that information supply about GWG to pregnant women promotes reaching healthy GWG k2i. Describe a clear plan for the care of GWG, diet and PA k2j. Explain effective medical communication (interactive, effectual, etc.) k2k. Explain the effect of goal setting with regard to GWG at the end of pregnancy | a2a. Believe it is important to determine, together with the pregnant women, a target weight for the complete pregnancy | si2a. Recognize that pregnant women expect them to provide education about healthy GWG | se2a. Express confidence in matching BMI categories with specific target weights and specific GWG per time episode se2b. Demonstrate the ability to combine target weight according the guidelines with the personalized target weight of a pregnant woman se2c. Feel confidence in bringing healthy GWG under attention of pregnant overweight/obese women | b2a. Plan how to cope with time barriers that hinder providing GWG education b2b. Use a protocol to perform a weight anamnesis |
| PO3. Midwives support pregnant women with monitoring, appraisal of their GWG | aw3a. Confirm the value of midwife’s support on GWG and well-being | k3a. Explain the contribution of monitoring and evaluating GWG during pregnancy k3b. Describe how to monitor and evaluate GWG | a3a. Believe it is important to stimulate pregnant women to monitor and evaluate their GWG a3b. Believe it is important that pregnant women take responsibility for their GWG a3c. Believe it is important to show interest in pregnant women’s GWG | si3a. Believe that pregnant women think it is important to monitoring their (pregnant women’s) GWG | se3a. Express confidence in supporting pregnant women in monitoring and evaluating GWG se3b. Demonstrate the ability to proactively ask pregnant women about their GWG | |
| PO4. Midwives identify clients who are at greater risk for unhealthy GWG | k4a. Describe risk groups for gaining unhealthy GWG. k4b. Describe adequate weight anamneses k4c. Describe an healthy weight curve and the dangers of deviation from the curve | a4a. Believe it is important to identify those pregnant women who need support a4b. Believe it is important to carry out an adequate weight anamnesis a4c. Believe it is important to identify deviations from the curve | se4a. Demonstrate the ability to take an adequate weight anamnesis se4b. Express confidence in being able to detect a deviation from the curve | b4a. Plan sufficient time to perform an adequate weight anamnesis | ||
| PO5. Midwives empower those clients who are at greater risk for unhealthy GWG in reaching a healthy GWG | aw5a. Acknowledge the relationship between GWG/lifestyles and pregnant women’s well-being aw5b. Confirm the value of midwives’ support aw5c. Confirm the value of other professionals’ contribution in regard to GWG | k5a. Describe pregnancy complaints that increase the chance of unhealthy GWG | a5a. Believe it is important to support pregnant women in reaching a healthy GWG a5b. Express openness to questions and concerns from pregnant women about their GWG/lifestyle a5c. Believe it is important to search, together with the pregnant woman, for causes and solutions for GWG/lifestyle-related problems in order to retrieve a healthy GWG a5d. Believe it is important to refer pregnant women, if necessary, to professionals specialized in diet, exercise, well-being a5e. Express positive feelings towards engagement in collaborative partnership | si5a. Recognize that other midwives think that midwives’ support in reaching healthy GWG is important si5b. Recognize that pregnant women think that midwives’ support in reaching healthy GWG is important si5c. Recognize that pregnant women think it is important to find ways to reach healthy GWG si5d. Recognize that colleagues think it is important to find ways to reach healthy GWG | se5a. Express confidence in supporting pregnant women to a healthy GWG/lifestyle se5b. Express confidence in searching with pregnant women for causes for deviation from the curve se5c. Express confidence in searching with pregnant women for solutions to deviation from the curve se5d. Express confidence in supplying advice about diet, exercise and well-being in general se5e. Express confidence in discussing the GWG curve | b5a. Plan sufficient time to discuss with pregnant women healthy GWG/lifestyle and ways how to achieve it b5b. Make use of practical tools/guidelines for the coaching of a healthy GWG/lifestyle b5c. Plan sufficient time to coach pregnant women to healthy GWG/lifestyle b5d. Plan sufficient time to discuss causes with pregnant women who experience GWG/lifestyle problems and to find ways to return to a healthy GWG |
| PO6. Midwives identify those pregnant women who need special care, which exceeds midwives’ capabilities | k6a. Describe criteria for referral to specialized caregivers k6b. Explain that gaining unhealthy GWG necessitates specialized care | a6a. Believe it is important to identify those pregnant women who need support of other specialized professionals | b6a. Use guidelines to perform adequate lifestyle anamnesis | |||
| PO7. Midwives refer pregnant women, if necessary, to other health-care professionals | se7a. Express confidence to refer to professionals specialized in diet, PA, exercise programmes | b7a. Prepare/adapt a list of eligible local health-care professionals | ||||
| PO8. In case of referral of pregnant women to other health-care professionals, midwives support the care of those professionals | se8a. Express confidence to support professionals specialized in diet, PA, exercise programmes |
PO, performance objective; GWG, gestational weight gain; PA, physical activity.