Table 5.
Methods and strategies per determinant for midwives
| Determinant | Change objectives | Method | Theory | Strategy |
|---|---|---|---|---|
| Awareness (aw) | aw1a, aw2a, aw3a, aw5a, aw5b, aw5c | Consciousness raising | TTM( 52 ) SCT( 53 ) | Presentation at start of training with information, confrontation about prevalence, causes and consequences of unhealthy GWG, and invitation for feedback Attention on the easy access to junk food and on healthy alternatives (like raw vegetables instead of cookies) Attending, gaining experience with the programme during the training session |
| Knowledge (k) | k2a, k2b, k2c, k2d, k2e,k2f, k2g, k2h, k2i, k2j, k2k | Active learning Cooperative learning Discussion | ELM( 55 ) SCT( 53 ) | At the start of the training, the trainer identifies with participants’ most eye-catching issues related to GWG (health advantages, consequences of too high/low GWG, diet, PA, well-being, appropriate GWG, etc.) followed by a discussion about difficult situations in participants’ midwifery practices Information card Attending, gaining experience with the web-based tailored programme together with colleagues during the training session |
| Attitudes (a) | a1a, a1b, a1c, a1d, a2a, a3a, a3b, a3c, a4a, a4b,a4c, a5a, a5b, a5c, a5d, a5e, a6a | Arguments Active learning | ELM( 55 ) SCT( 53 ) | Presentation at start of training with information, confrontation about the discrepancy of what midwives think pregnant women need and women’s actual needs (at the start of pregnancy) Group discussion during training session about important learning questions related to GWG, disclosing the existing pros and cons. Discussion results in a collective casus that will later in the training be used as an exercise example Attending, gaining experience with the programme (e.g. with the GWG curve) together with colleagues during the training session During training a group discussion to prime and underpin the significance of the update of midwives’ social network (dietitian, physiotherapist, coach); who can help them, how is the actual/ideal cooperation, what can help to stimulate an effective cooperation |
| Social influences (si) | si2a, si3a, si5a, si5b, si5c, si5d | Information about others’ approval | SCT( 53 ) | Presentation (oral and visual) during training with information about pregnant women’s needs for information about GWG in particular and lifestyle in general, early in pregnancy Attending, gaining experience with the programme together with colleagues during the training session Discussion with midwives: during training a group discussion to prime and underpin the significance of the update of midwives’ social network (dietitian, physiotherapist, coach); who can help them, how is the actual/ideal cooperation, what can help to stimulate an effective cooperation |
| Self-efficacy/skills (se) | se2a, se2b, se2c, se3a, se3b, se4a, se4b, se5a, se5b, se5c, se5d, se5e, se7a, se8a | Guided practice Training Planning coping responses | SCT( 53 ) | During the training: Instructions about exercise with feedback on the use of the information card with special attention to appropriate interview techniques Instructions about calculation of adequate GWG categories and practising with information card according to pre-pregnancy BMI group Instructions for appropriate anticipating on specific barriers of pregnant women Instructions about communication with other professionals about appropriate referrals in case of unhealthy GWG Attending, gaining experience with the programme (e.g. with shaping the GWG curve) together with colleagues during the training session |
| Barriers (b) | b2b, b5b, b6a, b7a | Facilitating Enactive mastery | SCT( 53 ) | Information card for midwives and web-based tailored programme for pregnant women to structure GWG education and to make more efficient use of expensive time Guidelines for weight anamneses, for referral to relevant health-care professionals During training: start with/adapt social card with eligible local health-care professionals (dietitians/exercise programmes/coach) Explain during training that making use of the web-based tailored programme saves time of the midwife. Prepare midwives that further in pregnancy they need to invest some time to pay extra attention to GWG with their clients |
TTM, Transtheoretical Model; SCT, Social Cognitive Theory; ELM, Elaboration Likelihood Model; GWG, gestational weight gain; PA, physical activity.