baby buddy: reducing health inequalities through digital … ... loretta musgrave, ... greece (6%)...

Baby Buddy: reducing health inequalities

through digital parenting support

Chair: Dr Ann Hoskins @HoskinsAnn

Discussant: Prof. Mitch Blair @blair_mitch Imperial College London

Alison Baum OBE @AlisonBaum Best Beginnings

Dr Adrienne Gordon @AdrienneOz University of Sydney

Dr Sam Ginja @SamuelGinja representing the BaBBLeS research team

Dr Nicola Crossland, University of Central Lancashire

Dr Nicos Middleton, Cyprus University of Technology

Panel Discussion

CBC Conference 2018 - Behaviour Change for Health: Digital and Beyond

Parallel Session 6, 11.35am-12.40pm Symposium

@BestBeginnings @CyUniTech @imperialcollege @UniofNewcastle @UCLan @Sydney_Uni

@BabyBuddyApp

Baby Buddy Symposium: reducing health inequalities through digital parenting support


The role of co-creation in the development

and implementation of the Baby Buddy

app, a complex digital health intervention Alison Baum OBE, CEO, Best Beginnings

Shabira Papain, COO, Best Beginnings

Nilushka Perera, Evaluation & Impact Lead, Best Beginnings

@AlisonBaum @ShabiraPapain

@BestBeginnings @CyUniTech @imperialcollege @UniofNewcastle @UCLan @Sydney_Uni @BabyBuddyApp

Baby Buddy

Our purposeful public health intervention in

the guise of a fun mobile phone app

Using technology to empower parents,

support relationships, enhance conversations

and help parents maximise their:

own physical and mental health

child’s potential

Our VisionIs that all children in the

UK have the

best start in life

Our AimTo inform and empower

parents and professionals

to reduce inequalities in

child health outcomes

Infant Mortality Eg: a baby born @Birmingham is 4x more likely to die in infancy than a

baby born @Bath 7.2 per 1,000 births in Birmingham v 1.8 in Bath. Av: 4.3

Breastfeeding at 6-8 weeks Eg: a 6 wk old baby @Wandsworth is c.4x more likely to be

breastfed than baby of same age born @Knowsley Wandsworth=77.4% Knowsley=19.9%.

Av: 55%

Smoking on delivery Eg: a baby born @Blackpool is > 13x more likely to be born to a

mother who smokes than a baby born @Westminster Blackpool=27.2% Westminster=2.1%.

Ave: 10.7

Obesity at 4-5 years old Eg: a 4-5 year old @Barking&Dagenham is c. 3x more likely to be

obese than a child born @Richmond Barking&Dagenham=14.2% Richmond=5.5%. Ave:

9.5%

Dental decay Eg: children in Leicester are > 3x more likely to have had dental intervention

compared to children living in West Sussex Leicester=53.2% West Sussex=14.2%. Ave:

27.9%

Good development at end of Reception. Eg: almost 2x the number of children @Lewisham

Why are we bothering? Is this work a priority?

facebook/bestbeginningscharity | @bestbeginnings | www.bestbeginnings.org.uk

Pre-

conception

A child’s

3rd

birthday

Innovation Collaboration Evidence

Opportunity

facebook/bestbeginningscharity | @bestbeginnings | www.bestbeginnings.org.uk

Collaboration is key & it is why we are well

placed to develop & deliver Baby BuddyParents of all backgrounds

Other charities

Front-line professionals

Royal Colleges, other professional bodies

Government departments

Academics

Commissioners & other funders who fund us nationally AND locally

People in the public eye

Our three stage iterative approach

@BestBeginnings @BabyBuddyApp

@AlisonBaum #PowerOfCollaboration

July 11

First

funding

application

2011

Focus

groups

with

young

parents

2011

Baby Buddy

stakeholder

group

formed &

regular

meetings

begin

2012

Seed funding

to develop

Baby Buddy

prototype

Jan 13

Appreciative

enquiry

2012

GSTT co-

create &

plan Baby

Buddy

embedding

2012

Market

research

group/phone

/interview

Jun & July 13

Blackpool co-

create & plan

Baby Buddy

embedding

Tender process

for app developer

Dec 13

Big Lottery

Fund grant

awarded

Jan 14

Market

research

group/phone

/interview

June 14

Beta

testing

with over

500

parents

&

professio

nals

July 14

Soft launch

on app

stores

Nov 14

Official

launch

2014

Embedding

in

Bradford,

Lewisham,

Leicester,

M’brough

Dec 14

Baby

Buddy

Stakeholder

& Editorial

Meeting

2015

Embedding

gets

underway in

more areas

March 15

Baby Buddy

wins AXA

PPP Health

Tech & You

Award

People-driven digital health and wellbeing

The Baby Buddy Content Pipeline

Video content received

Written content received

Content review

BB

Content review

Editorial Board

Content review ParentPanel

Content added to

Baby Buddy

approved approved approved

Parent feedback

Healthcare professional feedback

Endorsing Organisations:

The Department of Health and

Awards we’ve won:Finalist for:



Best App

for Patients

& Carers

Baby Buddy and its 70+ mental health films is helping to change the

conversation about mental health and encouraging women get the

support they need when they need it.

We’re proud to

be part of

#HeadsTogether

#MaternalMHMatters

#PowerOfCollaboration

@HelloMag

@Heads_Together

@BabyBuddyApp

HELLO! Magazine

SMT meeting ‘Making it Work’

‘What do You Think?’ workshop(Service Users)

‘Content & Co-Creation’ workshop(Resource Leaders)

Project report

‘The Plan in Practice’ workshop

Local Launch

‘Progress, support & sharing’ (4 month progress meeting)

Progress report

Embedding into local care-pathways



Aylesbury

Blackpool

Bradford

Coventry

County Durham & Darlington

Cheshire West & Chester

East Sussex

Hillingdon

Hounslow

Nottingham

Norwich

Sites where Baby Buddy has been/is being embedded

locally & independent evaluation sites:Northumbria

Lambeth

Leeds

Leicester

Lewisham

Luton

Middlesbrough and Redcar & Cleveland

Solent

Warrington

West Sussex

Southwark

= Three data-collection sites of the DH funded North of England impact study – UCLAN

= Five data-collection sites of BIG funded evaluation – BaBBLes consortium led by UWE



In-app data on uptake usage & feedback

Types of users registering up to 08/02/2018

Active users by month (using Baby Buddy

eight times a month or more)

Confidence in the app knowing that the content has been extensively vetted by a

range of expert healthcare professionals with endorsements from an array of

organisations? 97%

Do you feel the Baby Buddy app would provide evidence-based/best practice-based

answers to questions that would be useful for parents-to-be or new parents? 94%

Recommend this app to parents-to-be or new parents with whom you work? 95%

Usefulness of the app for parents-to-be/new parents? 100%

Feedback from professionals using the Baby Buddy app up to

08/2/2018 completing the pop up surveys



Pregnant women and new mums completing pop-up in-app

surveys to 31/08/17 report the following about Baby Buddy:

Easy to use (n=9757): >99%

Easy to understand (n=9707): >99%

Helps me get more out of my appointments (n=5549): 86%

Helps me look after my mental health (n=2,254): 87%

Helps me look after my physical health (n=2,277): 90%

Helps me feel closer to my baby (n=2955): 90%

Helps me feel more confident caring for my baby (n=2753): 98%



Mum users by age band in England & Wales up to

08/2/2018 compared to 2014 ONS data

Registrants of Baby Buddy by Ward in Leeds pre-embedding,

after first wave of embedding & again in Jan 2018

Baby Buddy sign-ups by local authority as a percentage to

its local birth cohort for six months (01/07/17-31/01/18)

We are working to secure funds to:

Increase awareness and downloads of current version through eg:

addition of more sharable content

Embed Baby Buddy within more areas across the UK

Collaborate to create international versions of Baby Buddy

Create Baby Buddy 2020 including:

more intuitive offering up of content

mood-tracking functionality

content for fathers & to support the couple relationship

interoperability

content for neonatal parents & those with multiples

Together we can make a

difference for future

generations

#PowerOfCollaboration

@bestbeginnings

@AlisonBaum

[email protected]



Applying the Behaviour Change Wheel:

insights into the development of the

Breastfeeding Component of the Baby

Buddy App Dr Adrienne Gordon, Loretta Musgrave, Prof Caroline Homer

The University of Sydney

@AdrienneOz


@BabyBuddyApp


Breastfeeding - A healthy start to life

3

5


Breastfeeding - A healthy start to life

3

6

Victora CG, Bahl R, Barros AJ, Franca GV, Horton S, Krasevec J, Murch S, Sankar MJ, Walker N, Rollins NC et al:

Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect. Lancet 2016, 387(10017):475-490.


Breastfeeding in UK

Bottom five countries after 12

months

Top five countries after 12

months

UK (0.5%) Senegal (99.4%)

Saudi Arabia (2%) The Gambia (98.7)

Denmark (3%) Malawi (98.3%)

Greece (6%) Guinea-Bissau (97.8%)

Canada and France (both 9%) Ethiopia (97.3%)

3

7

• 81% of mothers try breastfeeding

• 74% breastmilk for first feed

• 34% breastfeeding at six months

• 0.5% at 12 months

1 in 200 women breastfeeding at a year

Victora CG, Bahl R, Barros AJ, Franca GV, Horton S, Krasevec J, Murch S, Sankar MJ, Walker N, Rollins NC et al:

Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect. Lancet 2016, 387(10017):475-490.


Rising use of smartphones in UK

Smartphone ownership in the UK 2012 – 2017 Statista


Smartphone as key information source

The rise of apps

– 5 Million apps available

– >165,000 medical and health apps

– Pregnant women high users of

Pregnancy Apps

– 73% use often in pregnancy

– 74% do not check validity of info

Ofcom Communications Market Report 2015, Statistia, 2017, Lupton 2016

Should we be App-rehensive?

• Validity and accuracy of information

• Equity

• Culturally appropriate

• Endorsement

• Stakeholder engagement

• Data privacy or security measures

• Concerns regarding pregnancy and fetal monitoring

• Health literacy

• Minimal high level evidence around efficacy

Lupton et al, 2016, Taki et al, 2015, Handley et al, 2016, Krishna et al, 2009,


Aim– To systematically map the existing breastfeeding content of Baby Buddy

using the guidance for digital behaviour change interventions and the behaviour change wheel


Methods

– Information received from Best Beginnings about the development, context and activities undertaken with respect to breastfeeding component of Baby Buddy

– Application of APPEASE criteria for evaluation of DBCIs

– Breastfeeding component of Baby Buddy mapped to the Behaviour Change Wheel

From Bump to Breastfeeding Co-creation/Production Timeline

Driving change through collaboration

Mid-2007

4 nations

commit to

funding the

DVD

Aug 07

Market research

with parents

Sep 07

1st round table

meeting

Oct 07Filming begins Feb 08

Editing of DVD

Mar 08

Further

parental input

& 2nd round

table meeting

Mar 08Extra filming

Apr 08

Expert input

on final films

Nov 08

Official DVD

launch

July08

Baseline data

collected for

evaluation

Apr 09

Post intervention

evaluation begins

Oct 10

Evaluation

published

demonstrating

impact

Nov 10

films included within

DH/UNICEF/Start4Life

Breastfeeding Care

pathways

Over 2 million

copies distributed

2013

DH funded update

and re-voice

Context

DBCI Item Addressed Detail

Goals To inform and empower women of all socioeconomic

backgrounds to breastfeed for the first 6 months.

Opportunities Bump to Breastfeeding Resources, Key need secondary to UK

data, Smartphone use, Filmmaking, Big Lottery funding

Constraints Money, Time

Skills in tech – partnership with app developers

Staff – partnership with academic institutions for evaluation

Stakeholders Women, families, health professionals, colleges, health service

management, NHS

Collaborators Universities, app developers, other charities and pregnancy

support organisations

Risks Projected cost analysis, sustainability plan, staffing support


Activities

DCBI Item Addressed Detail

Concept Literature review, qualitative and quantitive needs assessment

Barriers and enablers

Knowledge Market research, Literature and policy review, review of existing

interventions, computer science of user engagement

Development Person based approach’ for look, feel and functionality

Extensive qualitative research, co-creation and stakeholder input

Testing Focus groups, interviews, surveys, observation of use, in-app

data, pre/post embedding

Implementation Tested for usability and functionality pre implementation

Ongoing evaluation post implementation

Iterative process, sustainability, operating systems, servers

Promotion External advisory group, PR team

Endorsed by key agencies, eg NHS, Royal Colleges

Focus on pre-conception to three years

Inform and empower parents to improve outcomes

Aim to reduce health inequalities in the UK


APPEASE Criteria

Acceptability

Practicability

Effectiveness

Affordability

Safety

Equity

Users, Implementers, Funders

High reach, scalable, not limited by

geography

Academic Evaluations positive

Free for end-user

Evidence-based, best practice,

health literacy level age 11

Proportionate universalism


Behaviour Change Wheel

Michie et al (2011) The Behaviour Change Wheel: a new method for characterising and designing

behaviour change interventions, Implementation Science


Breastfeeding – understanding behaviour

Capability

Physical capabilitiy

Psychological capacity

1. Knowledge of how to attach and position the baby

2. Physical capability and skills to attach and position the baby

1. A lack of knowledge about the benefits of breastfeeding

2. Belief in ability to produce required amount of breast milk

3. Beliefs about the consequences of not breastfeeding

Motivation

Reflective motivation

Automatic motivation

1. Needing help with breastfeeding means there is a problem

2. Disappointment with self if unable to breastfeed

3. I don't need help - unrealistic optimism

1. Fear of failing at breastfeeds means offer bottle instead

2. Fear of being a bad mother

Opportunity

Physical opportunity

Social opportunity

1. Perception that breastfeeding is difficult due to the

unpredicatable nature of demand feeding

2. Provision of breastfeeding friendly social spaces

Breastfeeding – Intervention Functions


Breastfeeding – Policy Categories

Policy Categories

Service provision

Guidelines

Communication

Marketing

Links with evidence base, NHS Choices, current health

promotion campaigns


Conclusions

– Development of the breastfeeding component of Baby Buddy follows the principles on development of a DBCI and maps well to the BCW

– Using the structured process indicates room for improvement in future

– Evaluation of health outcomes will continue to inform Baby Buddy

– Ongoing input from stakeholders, key to relevance and sustainability


Take home messages

For the academics and researchers….– Retrospective application of BCW is possible and helpful

– Role for trials in DBCI to assess health outcomes

For practice and industry….– Sustainability of apps in competitive market

– Improved ability for consumer to assess app quality

Loretta Musgrave

Prof Caroline Homer

Dr Nathalie Kizirian

Alison Baum (UK)

Nilushka Perera (Sri Lanka)

The Team



A cohort study to evaluate the

effectiveness of Best Beginnings Baby

Buddy phone app in EnglandDr Sam Ginja

Representing the BaBBLes research team


@BabyBuddyApp

Evaluation of Best Beginnings’ ‘Baby Buddy’ Phone App:

Bumps and Babies Longitudinal study (BaBBLeS)

Research team: Toity Deave (CI), Jane Coad (PI), Crispin Day (PI), Sally Kendall (PI), Raghu Lingam (PI);

Elizabeth Bailey, Samuel Ginja, Trudy Goodenough, Samantha Nightingale, Jane Smiddy,

https://www.bestbeginnings.org.uk/baby-buddy

Aim of the BaBBLeS cohort study

• Assess impact of the Baby Buddy app on maternal self-efficacy• Tool to Measure Parenting Self-Efficacy (TOPSE) (Bloomfield & Kendall, 2006)

• Secondary outcomes• Mental wellbeing

• Warwick-Edinburgh Mental Well-being scale (WEMWBS)

• Instructed use of the app

• Effect of outcome levels at 35 weeks gestation

Other measures

• Socio-demographic information

• Age, ethnic background, socio-economic deprivation (IMD), education, employment, relationship status

• Social support

• Multidimensional Scale of Perceived Social Support (MSPSS) (Zimet et al, 1988)

• Technology use

• Media and Technology Usage and Attitudes Scale (MTUAS) (Rosen et al 2013)

• Breastfeeding

• Intentions (baseline)

• Actual breastfeeding (post-birth)

• Childbirth experience

• Childbirth Experience Questionnaire (Dencker et al, 2010)

Methods• Design: Prospective cohort study

• Data collection time points:• 12-16 weeks gestation (baseline)• 35 weeks gestation• 3 months post-birth

• Participants: first-time mothers, aged 16+, able to provide consent

• Five recruitment sites in England• North West• West Yorkshire• West Midlands• London• East Midlands

Sample size calculation

• Aiming for ½ standard deviation difference on TOPSE scores between Baby Buddy users vs non-Baby Buddy users

• At 90% power % app download

Ratio* Total sample size (final sample)

12.5% 7 39214.3% 6 35016.7% 5 30620.0% 4 26525.0% 3 22833.3% 2 19250% 1 170

* Ratio of app users: non-app users

Participant pathway

Identified by booking at maternity unit –questionnaire pack given or sent in post

Invitation to participate, consent form and baseline questionnaire returned by post or online

Telephone Interviews, focus groups

Follow-up questionnaires

12

mo

nth

s

Baseline recruitment

62 (12.7%)

Inclusion: 16 yrs +, first-time mothers, 12-16 weeks gestation

Able to provide consent

488 women across all 5 sites

Site 4 Site 1 Site 3 Site 2 Site 5

66 (13.5%)

168 (34.4%)

53 (10.9%)

139 (28.5%)

Nested qualitative study from three sites: - 17 mothers interviewed- 20 healthcare professionals interviewed and took part in focus groups

Baseline characteristics of initial sample (N=488)

Total across sites

Median (LQ-UQ) a:

Age 28 (24-32)

IMD decile b 4 (2-6)

n (%):

Ethnicity

- White British

- Other

305 (64.8%)

166 (35.2%)

Highest education

- Degree or higher 235 (49.0%)

Employment

- In paid employment 412 (86.4%)

Relationship

- Married or living with partner 408 (83.8%)a Med: Median; LQ-UQ: Lower quartile – Upper quartile. b IMD: Index of Multiple Deprivation,

based on postcode. Decile 1=most deprived; decile 10=least deprived.

Apps & Baby Buddy

Use of pregnancy and/or parenting apps at baseline

(N=488)

Variable n (%)

Uses and has used pregnancy/

parenting app(s)

355 (73.1%)

Uses or has used Baby Buddy app 51 (14.3%)

Challenges in evaluating app use

Challenge Action

Number of women using the app Recruit sufficient participants

Gaining access to in-app data Gain individual consent to look at specific app usage data

Matching in-app data with participants

Work with app developers re identifiers

Participants’ app usage Decide elements that constitute app usage

No data for time spent on app Number of elements used? Amount of usage?

Linking app usage to outcomes Compare high users with low users?

Thank you for your attention

Any questions?

Email: [email protected]

Chief investigator: [email protected]

mailto:[email protected]

mailto:[email protected]



Evaluation of Best Beginnings

ResourcesDr Nicola Crossland, Dr Victoria Hall Moran & Dr Gill

Thomson

Maternal and Infant Nutrition & Nurture Unit

University of Central Lancashire


@BabyBuddyApp

North of England project

• Three sites in the North of England

• Best Beginnings parenting resources including Baby Buddy app embedded into care pathways

North of England project

• Three sites

• Embedding model

• Regional Facilitator from Best Beginnings working with stakeholders in each site over a six-month period

• Training workshops for senior staff and for nominated champions

• Resource Leaders

• Staff members working with pregnant and postnatal women

• Act as champions within their service

• Train colleagues

Aims of the evaluation

To understand how the embedding process worked

To identify barriers and facilitators

To understand women’s and professionals’ views

To look at the impact of the embedding and usage of the resources on

• breastfeeding rates.

• women’s attitudes and self-efficacy in relation to breastfeeding.

• parenting confidence

• mother–infant relationships

Evaluation design

Process evaluation study using:

• Observations of embedding workshops

• Interviews with key stakeholders (10 per site, 3 sites)

• Women’s survey (pre- and post-embedding) – >500 questionnaires per stage to women with a baby under 6 months

• Professionals’ survey (post-embedding) – distributed to maternity and early years staff

Survey participants

• Women (n=161 pre; n=192 post )• Most of the women who responded to the surveys were:• first-time mothers• aged 30+ years• White British• married/civil partnership/living with their partners• stayed in full-time education until 19+ years • employed in a paid capacity• No significant differences pre- and post-embedding

• Professionals (n=146 post)• 30+ years• female• White British

Key embedding facilitators

Resource Leaders

Awareness

Senior staffCommunication

between agencies

Feedback on app use

Fit with care pathways

• Yeah and I think it’s been received well by staff because it’s so easy to use the resources, because it fits in well with our care pathway, our booking appointments, we do talk about where to get information from so it’s a good opening into giving the leaflet that explains about the app, so I think it’s been well received by the staff and there hasn’t been any negativity about it being an added pressure. (Interview participant 6, Site Three)

Baby Buddy downloads

0

100

200

300

400

500

600

700

800

Site One Site Two Site Three

Number of Baby Buddy app registrations before and after embedding

Before embedding After embedding

Outcomes: Breastfeeding

The app reminds you about how important breastfeeding is and what a great thing you are doing for your baby.

(Women’s post-embedding survey 139, Site Three)

No statistically significant changes breastfeeding outcomes pre/post-embedding

Outcomes: Confidence

No change in women’s scores on the Parenting Sense of Competency Scale pre/post-embedding.

I love checking the app daily to see what hints/tips are there for today. It has given me ideas about my baby’s development and reassured me on numerous occasions. (Women’s post-embedding survey 156, Site Three)

I was amazed at how well the “Today’s Information” was matched to my baby's progress, it gave me confidence he was making good progress and gave me reassurance/new ideas. (Women’s post-embedding survey 26, Site One)

Outcomes: Relationships

There is a client who I knew previously, and she has had maternal mood concerns in the past which had affected how she interacted with her baby at times, and she hadn’t really before shown interest in the pregnancy. I talked about the App and she had actually gone on it and she had got a push notification which had said, it was something innocuous I know what it was it was about the baby’s growing nails and it wasn’t something that I would ever have thought of discussing with a mum-to-be. This had really caught her imagination so it was the right thing at the right time. She was much more engaged with the bump she was touching her bump she was talking about it. I just felt there was a whole attachment building already which could absolutely only be a positive thing for her but also for the baby, her mood had lightened which all together was wonderful.(Interview participant 27, Site Three)

Women in the post-embedding survey scored more positively on the Mother–Baby Bonding Scale than pre-embedding (p<0.01)

Strengths & limitations

• Study conducted across three sites giving comparative data

• In-depth interviews with stakeholders giving rich data

• Small number of survey respondents in women’s surveys

• Sociodemographic characteristics of women surveyed different to overall population

• Timing of the study captures only the early stages of the embedding process

Conclusions & recommendations

• Incorporating mobile phone app into maternity and early years care can be beneficial

• Needs:Sufficient numbers of motivated, senior Resource Leaders appointed early in the embedding

process

Senior staff on board

Maintain awareness among staff – keeping embedding on the agenda

Early introduction of the Baby Buddy app

Publicity to maintain awareness among women

Thank you



Bringing Baby Buddy forward: assessing

cross-national transferability and co-creating a

web-based perinatal educational resource to

support the health professionals’ educational

role and enhance parental health literacy in

CyprusDr Nicos Middleton, Associate Professor Health Research

Methodology, Department of Nursing, School of Health Sciences,

Cyprus University of Technology


@BabyBuddyApp

“Baby Buddy – Forward” Key action: Cooperation for innovation. Strategic partnership: Adult Education

36 months: 1 Sept 2017 – 31 Aug 2020, Overall budget: ~ 350k euro

AIM: Bring the multi-award winning Baby Buddy (UK) forward

(1) assess cross-national relevance and transferability from high-resource to low-resource setting (Cyprus … and beyond)

(2) develop a modified educational resource & aid address learning needs of parents-to-be and support educational role of HP

CY context10000 birth/year: 70%-30% private-public split, different socio-demographic profile

2008-2015: C/S 60%, ~17% emergency (>30% public) Official MoH data

Bi-communal aspect, multi-cultural, high internet use (<30% reliable) Stylianou & Milioni 2016

Highly medicalized Hadjigeorgiou & Coxon. Midwifery 2014

Informed choice: physician dominance in communication Hadjigeorgiou et al Int J Childbirth 2012

Antenatal education Stylianides et al Int J Caring Sciences 2016

No Baby Friendly Hospitals Hadjiona et al Midwifery 2016

Exclusive breastfeeding: <20% 48 hours, <5% 6months Economou et al Public Health Nutr 2017

Postpartum depression: ~30% at 6 weeks; C/S, social gradient Stylianides et al Int J Caring Sciences 2016

Experience of labour: ~5.7 (SD 3.0) on a 1-10 VAS Stylianides et al unpublished PhD thesis 2015

Contextual and socio-cultural specificities and priorities

MethodsPriority-setting & consensus-building

approaches with professional communityIn-depth understanding of experiences and

expectations of parents-to-be & new parents

Priority-setting/NGT: identify priority areas

Online Delphi: views of wider professional community in terms of priorities

Focus groups: views and perceptions on learning needs of parents-to-be/parents

Priority-setting/NGT: felt & expressed needs

Survey: needs/use of internet sources

Focus groups: different population-groups

Baby Buddy ™Forward

Rating exercise: relevance and suitability of BB video and text material

BEHAVIOURAL CHANGE proposed intervention

for use/ uptake

Focus-groups

Workshops

Webanalytic

Observation: antenatal/ parenthood classes

STRUCTURED PRIORITY-SETTING EXERCISE(Nominal Group Technique)

“If you had to prioritize a number of topics or issues that you feel have to be included in an antenatal or parenthood preparation educational programme, based on your experience with regards to the learning

needs of parents-to-be in Cyprus, which would you select??”

Educators/ Coordinators from all district hospitals (N=10)

Private sector: parenthood classes, NGOs, freelancers (N=7)

1st step: Silent generation of ideas

2nd step: Round-robin nominations

3rd step: Grouping of suggestions

4th step: Ranking and voting

Select top 5 and score on 1-5 importance scale

Public sector –Educators/Coordinators of antenatal classes

(Midwives/ Health Visitors, N=10, topics=26

Private sector –Parenthood classes, Support groups, NGOs, freelance

(multi-disciplinary, N=7, topics=25

Epidural (use of) 0 Medical interventions 0

Pain management/ Complimentary & Alternative 8

Exercise in pregnancy/postnatally 0 Exercise of infant and family 2

Family involvement/support 0 Services/ community support groups 1

Infant feeding/ Family meal planning 0 Weaning/ Introducing solids/ Long-term BF 5

Normal development of infant 0 Common illnesses & conditions 0

Nutrition in Pregnancy 0 Nutrition of infant and family 2

Partner relationships/Family changes 0 Partner Relationship/ Communication 3

Play/ Interaction with baby 0 Emotional needs of baby/newborn 15

Sex in pregnancy 0

Child accident prevention 1

Environmental health (pregnant mother & child) 1

Ultrasounds (understanding) 1

Immunizations 2 Immunizations 0

Physical and mental development of baby 2 Recognizing signs/needs of infant (crying) 2

Role of the father 2 Role of father 5

High & Low-risk pregnancy 3

Caring for the newborn (bath, massage) 4 Emotional needs of baby/newborn 15

Psychosomatic changes in pregnancy/postnatally 4 Medication use in pregnancy/BF 0

Family Planning 6

Health Promotion/ Well-being in pregnancy 6 Management of emotions/ emotional well-being 2

Potential obstacles during vaginal birth 7 Support in the prospect of C/S 0

Antenatal care/ Screening 8

Empowerment & Rights 13 Empowerment/ In touch with instinct/ Myths and stereotypes/ Culture 3

Psychoprophylaxis/ Breathing 26 Stages of labour/ practical choices 5

Breastfeeding 28 BF and supplements – when& how 0

Recognizing when baby’s hungry/full 8

Breastfeeding – intention and motivation 13

Obstacles in BF/ dealing with problems 16

Breastfeeding – position & techniques 17

Birth – experience/what to expect 32 Stages of labour/ practical choices 5

Public sector –Educators/Coordinators of antenatal classes

(Midwives/ Health Visitors, N=10, topics=26

Private sector –Parenthood classes, Support groups, NGOs, freelance

(multi-disciplinary, N=7, topics=25

Epidural (use of) 0 Medical interventions 0

Pain management/ Complimentary & Alternative 8

Exercise in pregnancy/postnatally 0 Exercise of infant and family 2

Family involvement/support 0 Services/ community support groups 1

Infant feeding/ Family meal planning 0 Weaning/ Introducing solids/ Long-term BF 5

Normal development of infant 0 Common illnesses & conditions 0

Nutrition in Pregnancy 0 Nutrition of infant and family 2

Partner relationships/Family changes 0 Partner Relationship/ Communication 3

Play/ Interaction with baby 0 Emotional needs of baby/newborn 15

Sex in pregnancy 0

Child accident prevention 1

Environmental health (pregnant mother & child) 1

Ultrasounds (understanding) 1

Immunizations 2 Immunizations 0

Physical and mental development of baby 2 Recognizing signs/needs of infant (crying) 2

Role of the father 2 Role of father 5

High & Low-risk pregnancy 3

Caring for the newborn (bath, massage) 4 Emotional needs of baby/newborn 15

Psychosomatic changes in pregnancy/postnatally 4 Medication use in pregnancy/BF 0

Family Planning 6

Health Promotion/ General well-being in pregnancy 6 Management of emotions/ emotional well-being 2

Potential obstacles during vaginal birth 7 Support in the prospect of C/S 0

Antenatal care/ Screening 8

Empowerment & Rights 13 Empowerment/ In touch with instinct/ Myths and stereotypes/ Culture 3

Psychoprophylaxis/ Breathing 26 Stages of labour/ practical choices 5

Breastfeeding 28 BF and supplements – when& how 0

Recognizing when baby’s hungry/full 8

Breastfeeding – intention and motivation 13

Obstacles in BF/ dealing with problems 16

Breastfeeding – position & techniques 17

Birth – experience/what to expect 32 Stages of labour/ practical choices 5

Rating exercise: methods and material

237 Baby Buddy videos14 themes

Excl. Prematurity

Two independent ratersHealth/other professionals

Practicing or academic

Inter-disciplinary

Good inter-rater agreement

(58.7% absolute, 89.9% weighted)

One “holder of the experience”Rate slightly higher for relevance

Good inter-rater agreement

RELEVANCE OF TOPIC: “based on your opinion with

regards to the learning needs of expectant parents, to

what degree is the topic addressed in this video relevant,

and thus useful?”

1= Not relevant, 2= Somewhat relevant, 3= Largely relevant, 4= Relevant

SUITABILITY OF CONTENT: “given the socio-cultural

context and/or health care system, to what degree do you

feel this video is suitable for the intended purpose, and

thus appropriate to use?”

1= Not suitable, 2= Somewhat suitable (mismatch quite large), 3= Largely

suitable (mismatch not that large, and could be overlooked), 4= Suitable

OVERALL RECOMMENDATION given relevance & suitability

1= Neither use/Nor re-film, 2= Should re-film, 3=Could use, 4=Should use

Classification of videos (number, %) in terms of relevance of topic to learning needs and suitability of content, based on the ratings of three independent raters (N=237)

RELEVANCE ≥3 =4

Group N (%) N (%)

Group 1:

High relevance

High agreement

176 (74.3%)

CVI-S UA

All 3 raters voted 4 101 (42.6%)

All raters ≥3

(and at least one voted 3)

75 (31.6%)

Group 2:

Relatively high

relevance

Not high agreement

49 (20.7%) At least 2 raters voted 4

(but at least one voted < 3)

23 (9.7%)

At least 2 raters ≥3

(but at least one voted <3)

26 (11.0%)

Group 3:

Relatively low

relevance

Not high agreement

10 (4.2%) Only one person voted ≥3 10 (4.2%)

Group 4:

Low relevance

High agreement

2 (0.8%) Nobody voted ≥3 2 (0.8%)

237 (100%) 237 (100%)

SUITABILITY ≥3 =4

Group N (%) N (%)

Group 1:

High suitability

High agreement

147 (62.0%)

CVI-S UA

All 3 raters voted 4 42 (17.7%)

All raters ≥3

(and at least one voted 3)

105 (44.3%)

Group 2:

Relatively high

suitability

Not high agreement

59 (24.9%) At least 2 raters voted 4

(but at least one voted < 3)

16 (6.8%)

At least 2 raters ≥3

(but at least one voted <3)

43 (18.1%)

Group 3:

Relatively low

suitability

Not high agreement

23 (9.7%) Only one person voted ≥3 23 (9.7%)

Group 4:

Low suitability

High agreement

8 (3.4%) Nobody voted ≥3 8 (3.4%)

237 (100%) 237 (100%)

Group 1:

High relevance

High agreement

Group 2:

Relatively high relevance,

Not so high agreement

Group 3:

Relatively low relevance,

Not high agreement

Group 4:

Low relevance

High agreement

TOTAL

Group 1:

High suitability

High agreementTotal= 135 (57.0%)

Across themes

Total = 12 (5.1%) 147

(62.0%)

Group 2:

Relatively high

suitability,

Not high

agreement

Total = 41 (17.3%) Total = 49 (20.7%)

90

(38.0%)

Group 3:

Relatively low

suitability, Not

high agreement

Group 4:

Low suitability

High agreement

TOTAL176 (74.3%) 61 (25.7%)

237

(100%)

• Healthcare system (e.g. family

nurse, home visits, MH services)

• CY reality (e.g. C/S, birth partner,

passive exposure, societal taboos)

• Socio-cultural mismatch (e.g.

dietary choices) and/or

• Contextualization (e.g. BF

challenges, Public, Exercise)

• Young parents/ teenage pregnancy

• Baby shower/celebration

• Social benefits: specific schemes

• Services: Gas/Air, water birth, home births

All > could use:

66.7%

At least one re-film/

Neither use, nor re-film:

95.9%

All should/could use:

83.0%

>1 rater, re-film:

80.5%

Preliminary conclusions …and thoughts Good cross-national transferability Exceptions: healthcare system, maternal/child benefits etc

Text: similar, in 11% (50 out of ~460 day-to-day)

Local priorities: many addressed in Baby BuddySome not due emphasis; Some contextualization

Socio/cultural-specific issues among other population-groups?

Formative and participatory: alliances and co-ownership.

Context/Timing: small birth cohort, planned NHS 2019-2020

Determinants of COM-B in implementation phase is criticalCapability (self-efficacy? perceived effectiveness?)

Opportunity (limited time? inter-professional collaboration?)

Motivation (routine? demand by clients?)

Impact: client-provider communication

“…I really enjoyed meeting everybody, that we were asked, that we were heard, we shared experiences, it makes us all better…” Midwife 3

“…opened up new avenues to move forward...today I am very excited.”

Midwife 5

“ I believe…it is through teamwork we can achieve much more. We are all different pieces of the same puzzle”

Pediatrician

“Inspirational” Doula

“I could stay here and talk for hours”

Lactation consultant

Top-down: Better-equipped

health professionals

Bottom-upWider reach and

demand for better care by better-informed users

Agent-ledenhanced role of NGO &academics as advocates

Dialogue platform for inter-professional

collaboration

Baby Buddy: reducing health inequalities

through digital parenting supportChair: Dr Ann Hoskins @HoskinsAnn

Discussant: Prof. Mitch Blair, Imperial College London, @blair_mitch

Alison Baum OBE, Best Beginnings, @AlisonBaum

Dr Adrienne Gordon, University of Sydney, @AdrienneOz

Dr Sam Ginga, representing BaBBLeS research team

Dr Nicola Crossland, University of Central Lancashire

Dr Nicos Middelton, Cyprus University of Technology

PANEL DISCUSSIONCBC Conference 2018 - Behaviour Change for Health: Digital and Beyond

Parallel Session 6, 11.45am-12.40am Symposium


@BabyBuddyApp

Participatory formative action research

Enrich content (local priorities and socio-cultural specificities)

Engage in priority-setting and consensus-building exercise among health professionals

Enhance relevance, appeal and reach via active consultation (Greek, Turkish, Arabic, Russian)

Research insights into experiences and expectations of parents-to-be/new parents

Develop policy recommendations on system change with decision-makers

“Complimentary” model of care (“as well” rather than “instead of”)

EDUCATIONAL RESOURCEand complimentary EDUCATIONAL AID

LEARNING NEEDS, PRIORITIES

EXPERTISE & EXPERIENCE

CO-OWNERSHIP CO-CREATIONCOLLECTIVE INTELLIGENCE

baby buddy: reducing health inequalities through digital … ... loretta musgrave, ... greece (6%)...

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