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Evaluation of a bespoke training to increase uptake by midwifery teams of NICE guidance for membrane sweeping to reduce induction of labour : a stepped wedge cluster randomised design
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Kenyon, Sara, Dann, Sophie, Hope, Lucy, Clarke, Paula, Hogan, Amanda, Jenkinson, David J. and Hemming, Karla (2017) Evaluation of a bespoke training to increase uptake by midwifery teams of NICE guidance for membrane sweeping to reduce induction of labour : a stepped wedge cluster randomised design. Trials, 18 (1). 357. doi:10.1186/s13063-017-2106-1 ISSN 1745-6215.
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Official URL: http://dx.doi.org/10.1186/s13063-017-2106-1
Abstract
Background
National guidance recommends pregnant women are offered membrane sweeping at term to reduce induction of labour. Local audit suggested this was not being undertaken routinely across two maternity units in the West Midlands, UK between March and November 2012.
Methods
Bespoke training session for midwifery teams (nine community and one antenatal clinic) was developed to address identified barriers to encourage offer of membrane sweeping, together with an information leaflet for women and appointment of a champion within each team.
The timing of training session on membrane sweeping to ten midwifery teams was randomly allocated using a stepped wedge cluster randomised design. All women who gave birth in the Trusts after 39 + 3/40 weeks gestation within the study time period were eligible. Relevant anonymised data were extracted from maternity notes for three months before and after training. Data were analysed using a generalised linear mixed model, allowing for clustering and adjusting for temporal effects.
Primary outcomes were number of women offered and accepting membrane sweeping and average number of sweeps per woman. Sub-group comparisons were undertaken for adherence to Trust guidance and potential influence of pre-specified maternal characteristics. Data included whether sweeping was offered but declined and no record of membrane sweeping.
Results
Training was given to all teams as planned. Analyses included data from 2787 of the 2864 (97%) eligible low-risk women over 39 + 4 weeks pregnant. Characteristics of the women were similar before and after training. No evidence of difference in proportion of women being offered and accepting membrane sweeping (44.4% before training versus 46.8% after training (adjusted relative risk [aRR] = 0.90, 95% confidence interval [CI] = 0.71–1.13), nor in average number of sweeps per woman (0.603 versus 0.627, aRR = 0.83, 95% CI = 0.67–1.01). No differences in any secondary outcomes nor influence of maternal characteristics were demonstrated. The midwives evaluated training positively.
Conclusions
This stepped wedge cluster trial enabled randomised evaluation within a natural roll-out and demonstrates the importance of robust evaluation in circumstances in which it is rarely undertaken. While the midwives evaluated the training positively, it did not appear to change practice.
Item Type: | Journal Article | ||||||
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Subjects: | R Medicine > RG Gynecology and obstetrics | ||||||
Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School |
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SWORD Depositor: | Library Publications Router | ||||||
Library of Congress Subject Headings (LCSH): | Labor (Obstetrics), Midwifery -- Standards -- West Midlands (England), Midwives -- Training of | ||||||
Journal or Publication Title: | Trials | ||||||
Publisher: | Biomed Central | ||||||
ISSN: | 1745-6215 | ||||||
Official Date: | 27 July 2017 | ||||||
Dates: |
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Volume: | 18 | ||||||
Number: | 1 | ||||||
Article Number: | 357 | ||||||
DOI: | 10.1186/s13063-017-2106-1 | ||||||
Status: | Peer Reviewed | ||||||
Publication Status: | Published | ||||||
Access rights to Published version: | Open Access (Creative Commons) | ||||||
Date of first compliant deposit: | 20 November 2018 | ||||||
Date of first compliant Open Access: | 20 November 2018 | ||||||
RIOXX Funder/Project Grant: |
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