Authors' objectives:

1. To study methods and processes for disseminating the leaflets in 'real life' settings.

2. To assess the acceptability of the leaflets to pregnant women and health professionals.

3. To make recommendations for the design of the leaflets.

4. To develop appropriate methods for evaluating the impact of informed choice leaflets for pregnant women and health workers in both hospital and the community.

5. To identify appropriate outcome measures.

6. To develop instruments for assessing both processes and outcomes for use in a larger evaluation.

7. To assess the willingness of women to take part in a study of informed choice.

8. To report on other substantive findings arising in the pilot.

9. To make recommendations for the design of a larger evaluation.

Authors' results and conclusions: A number of different recommendations for the design and use of the leaflets emerge from this pilot evaluation. The main ones are that: 1. Greater use should be made of pictures and diagrams for clearer messages about positions in labour. 2. If midwives are to be the disseminators of the leaflets, enough time needs to be allowed for them to become familiar with the content and purpose of the leaflets before they give them to women. 3. Other useful strategies here might be holding study days to introduce the leaflets, and/or creating an 'Introduction and guidelines for use' letter. 4. Approval and support for the leaflets needs to be secured from all the groups of health workers involved; ideally the leaflets should be fully integrated into the system (like, for example, 'Bounty' packs which are the vehicle for advertisers to reach pregnant women and are designed to hold women's maternity notes). 5. Leaflets should be introduced to health workers by colleagues from their own professions. 6. Negotiations should be undertaken at the beginning, alongside consultation, with all stakeholders present or at least aware of what is happening. 7. Discrepancies between the views of different stakeholders are likely, and need to be addressed. If the leaflets are to be introduced as part of a further study: 8. 'Lead' midwives could be recruited as research midwives, with a responsibility to run a dissemination programme in the clinic and report back on it using standardised tools. The extra training and time required could be recognised as a certificate training and research day. 9. Clear lines of communication and demarcation of roles and responsibilities are essential if the consultative process is to reach all those likely to be involved, directly or indirectly.

Authors' recommendations: This pilot evaluation has uncovered some fundamental barriers both to the process of informed choice in maternity care and to a necessary element in informed choice, the dissemination of evidence-based information. It has also sketched an important context for the attempt to move both users and health professionals towards more evidence-based care: the structures and organisational factors which shape people's experiences and the possibilities for change. The most significant findings of the pilot concern the nature of the challenge posed to professionals by informed choice leaflets for childbearing women, the impact of these leaflets on women themselves, and the complex set of factors affecting what kind of impact introducing the leaflets may have on relationships and practice.

Authors' methods: Pilot study

Project Status: Completed

URL for project: http://www.york.ac.uk/inst/crd/CRD_Reports/crdreport7.pdf

Year Published: 1996

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: England

Organisation Name: University of York

Contact Address: University of York, York, Y01 5DD, United Kingdom. Tel: +44 1904 321040, Fax: +44 1904 321041,

Contact Name: crd@york.ac.uk

Contact Email: crd@york.ac.uk

Copyright: Centre for Reviews and Dissemination