Introduction
Methods
Study design
Setting and informants
Term | Description and clarification |
---|---|
Antenatal care and services | Pregnant women in Central Denmark Region are enrolled in a basic antenatal course, including five visits to The Antenatal Midwifery Clinic (week 18, 28, 35, 38 and 40). Women expecting their first child are invited to participate in a birth and family preparation course. |
Emento | A digital platform developed by Emento® for information and communication between health professionals and the pregnant women attending antenatal care in The Antenatal Midwifery Clinic. Pregnant women have access to the platform through an app. Approximately 85% of pregnant women use the Emento app during pregnancy. |
Health Professionals | Health professionals whom pregnant women interact with during pregnancy and birth, including general practitioners, midwives, obstetricians, nurses, and health nurses. |
Booking systems | General practitioners refer the pregnant women to The Antenatal Midwifery Clinic, which sends out invitations for ultrasound scans and midwifery appointments. All pregnant women receive notification of the time and location of their antenatal appointments. Women can see or change booked appointments on a webpage. |
Data collection
Analysis
Results
Identifier | Ethnicity | Age | Employment/education |
---|---|---|---|
ID1 | Turkish | 33 | Medical laboratory technologist |
ID2 | Danish | 23 | Nurse student |
ID3 | Danish | 41 | Doctor |
ID4 | Danish | 30 | Kindergarten teacher |
ID5 | Danish | 28 | Media and communications student |
ID6 | Danish | 26 | Social worker |
ID7 | Danish | 28 | Unemployed |
ID8 | Danish | 33 | Teacher |
ID9 | Romanian | 34 | Health professional |
ID10 | Danish | 24 | Nurse student |
The need for clear and specific action-oriented knowledge
“I am a bit of a tech nerd. I frequently use apps, the internet and social media. For example, I use Emento a lot.” ID5
Although participants reported receiving sufficient advice from health professionals, feeling well informed, and utilising multiple sources of information, they struggled to translate general health information into healthy everyday-life behaviours.“I think they’ve done a good job informing me. Initially, they said do you know Emento (app)? I think the amount of information I received has been sufficient. Not overwhelming. “ ID1
“I missed receiving a few proper recommendations about things. I don’t know if I should just rely on my commonsense or what. I didn’t receive more specific information. I had to search all kinds of blogs, web pages, etc. But it could be something directly from the health authorities or the health professionals, e.g. the physician or midwife.” ID7
Hence, participants’ knowledge was not necessarily reflected in their behaviour, and they expressed a need for more specific action-oriented knowledge. For example, ID2 explains that, despite knowing that physical activity is recommended during pregnancy, her husband’s daily use of their only car limits her options for accessing physical activity classes, courses or locations. We also identified a need for specific information about which types of physical activity are suitable during pregnancy and how best to undertake them.“I think that recommendations have been very general – including recommendations for daily exercise. You then have to find out which kind of exercise you need, and that’s not very specific.” ID6
“When I cannot go for a walk or bike ride due to back pain, what should I do then? “ID4
The receipt of test results is another example of the gap between the information provided by health professionals and pregnant women’s ability to receive, understand and apply it. Participants receive information from health professionals about their BMI status and glucose tolerance but are unsure how to understand and respond to these details. Aware that these results might negatively influence both their own and their child’s health but unsure how to positively change their behaviour, they require more support and guidance from health professionals.“I feel left alone with this part. I have to find out on my own what works for me. Especially during pregnancy. What exercise am I supposed to do? “ID8
“When they told me that my BMI was already too high at the beginning of my pregnancy, I was surprised they didn’t offer any recommendations for improving it. Should I be more careful about what I eat? I know that some women gain a lot of weight [...] – should I have eaten in a different way? Should I have been more careful? Should I have exercised more?” ID9
ID8 expresses a need for further explanation with a personalised “how-to” focus, illustrating a desire for a more precise explanation of what such results mean for pregnancy and everyday life and whether or not there is a need to change behaviour accordingly.“Mostly related to my result on the glucose tolerance test. They didn’t clarify its meaning. They didn’t explain the result, but wrote that I should be attentive to diet and physical activity. I thought that it would be nice to receive some explanation. Is it because I’m at risk of diabetes during my pregnancy? It would be nice to receive some more information.” ID8
Difficulties navigating a complex health system
“I think that it could be easier to navigate the booking system, or perhaps we could be given better instructions for using it. “ID4
“It’s been unclear sometimes whether I should book appointments myself or wait to be invited. An example is my glucose tolerance test; I had to figure out whether it would happen at my doctor’s surgery or the hospital. I asked if I should book the appointment myself, as I hadn’t received any information about it.” ID9
These examples suggest that the organisation of antenatal appointments is not always adequately managed by the clinic or other health professionals. Such ambiguity presents a challenge for pregnant women, who feel responsible for booking appointments and utilising available services at the right time via a navigation process that is not transparent for them.“A guide or timeline that explained what I was supposed to do in which week would have been beneficial for me. I’m sure that such a guide exists. I just didn’t receive one.” ID10
Difficulties reconciling conflicting information and options
Pregnant women’s ability to critically navigate conflicting advice and recommendations is therefore essential. However, even pregnant women with a health professional background might find such conflicting information challenging.“There are many different opinions about how you should behave when pregnant. You should do this and that. “ID6
Pregnant women encounter many different health professionals during their pregnancy. Participants described challenges in knowing whom to seek clarification from about conflicting information.“Even as a health professional myself, I find it hard to navigate.” ID3
Uncertainty about whom to ask for advice about conflicting information presents a challenge for pregnant women. The above example suggests that ID5 encountered numerous midwives during her pregnancy but did not feel she had a relationship with any particular midwife. Confusion about which midwife to ask may impact a woman’s ability to interact with health professionals when necessary.“They say that you should just ask your midwife, and I think to myself, ‘who is that?’” ID5
The Covid vaccination is an example of a topic that participants felt particularly conflicted over. Even though their health professionals recommended the vaccination, they reported strong and conflicting opinions from their family and social network.“I explained to my physician about the test my midwife performed, but I don’t think she had any understanding of it. It was as if she didn’t know about the test. “ID2
“I have many family members who are against vaccination. I cannot decide what is right or wrong.” ID6
These accounts suggest that family members’ opinions may significantly influence pregnant women; they are unsure whether to trust information received from health professionals if it conflicts with the opinion of one or more family members.“Then a family member sends you 10,000 posts and pictures about the side-effects of vaccination.” ID1
“I think you should distinguish between the information you receive from a health professional and, for example, the information you receive from your friend about her opinion on something.” ID3
Contradictions between the advice offered by health professionals versus that offered by family, friends or social media present a clear challenge for pregnant women.“When it is from my social network, I am friendly and say that it was nice of them to share, but I don’t immediately believe it as others might do. I consider it critically before I make any decisions.” ID2