Supplementing the provider’s advice with an educational video before the planned induction of labor | BMC Pregnancy and Birth

Study design

This is a pragmatic implementation of a quality improvement measure using an educational video for patients scheduled for an IOL. This is a single-site study at Eskenazi Hospital, the county hospital in Indianapolis, Indiana. There were 2547 births in 2021, approximately 25% of which were planned IOL deliveries and 16% were primary cesarean deliveries. The pre-implementation survey was conducted over a period of four weeks and the post-implementation survey was conducted over a period of eight weeks, from June to July and September to November 2021, respectively. There was a delay between the completion of the pre-implementation and post-implementation collection to enable the implementation of the video into the clinic workflow.

Eligibility criteria

Patients were eligible for the study if they were at least 18 years of age, were admitted to the postpartum care unit, could read English or Spanish, and had a medically indicated IOL (≥37 weeks) or an elective IOL (patient requested ≥39 weeks). ) was planned weeks). Patients admitted for IOL were excluded from triage or directly from the clinic because there was no time to view the video. The survey instructions specifically stated that completion of the survey required the participant’s informed consent. This study was approved by the Medical School Institutional Review Board and the Hospital Research Committee.

Participants were screened against the induction plan and eligibility criteria. Research team members distributed surveys to eligible participants while they were admitted to the postnatal ward 24–72 hours after delivery. Postpartum patients are routinely admitted approximately 48 hours after vaginal delivery and 72 hours after cesarean section. Written instructions described the participant’s implied consent and explained data extraction and confidentiality procedures. The patients could withdraw from the study at any time. Surveys were collected before discharge and responses were entered into a REDCap database after anonymization. Incomplete surveys were omitted. Paper copies were securely destroyed in accordance with federal patient privacy laws.

intervention

In our facility, IOL consultation is provided by obstetricians, family physicians, and gynecologists. There is no standardized counseling process or standardized counseling form. The video used in this study was evaluated in a randomized study in 2019 [11]. A Spanish version was subsequently prepared by this team and approved for use in this study. Permission to use the video in this study was obtained from the creators. The video uses animation to explain the reasons for an IOL, the typical duration, the mechanisms of available IOL agents, and the indications for cesarean delivery (Appendix A). It’s about three minutes long and ends with advice for patients preparing for an IOL. According to the previous study, informal feedback was obtained from nurses, patients, and obstetricians during the design. 67% of study participants said they would recommend the video to others [11].

Our hospital has eight locations for outpatient obstetric care. Providers were informed of the start of the intervention via email and verbally at staff meetings. Bilingual handouts containing instructions and a QR code linking to the video were provided to clinical managers and medical assistants to distribute to patients scheduled for an IOL with checkout documentation (Fig. 1). Staff should recommend the video to all scheduled patients, regardless of whether they met study eligibility criteria. The research team also sent electronic versions of the video handout to scheduled patients one week in advance via the patient-provider messaging application.

A Bilin14-item survey was developed to assess the study objectives. To our knowledge, there are no validated IOL knowledge assessments; Therefore, two questions about the active ingredients used and the duration were written by the authors and not externally validated. The post-implementation survey included a question about whether the participant viewed the video. These questions were translated by certified Spanish interpreters and back-translated into English to confirm fidelity (Appendix B).

The next survey section consisted of the Birth Satisfaction Scale-Revised (BSS-R), a 10-item psychometric survey validated in multiple languages, including American English and Spanish [13, 14]. The survey is written at a sixth grade reading level and validated for use in the first 10 days postpartum. An item from the Listening to Mothers questionnaire was used, which asked whether the respondent would choose induction in future pregnancies. Finally, there was a free text area for comments on what participants wished they had known before arriving.

Results

To assess knowledge of the IOL agents used, we compared patient selection on the induction agent list with those documented in the electronic medical record. The BSS-R is rated on a Likert scale of 0 to 4. The BSS-R is rated with a total of 40 points, with a higher score indicating higher satisfaction. There are three subgroups of the BSS-R: stress experienced during labor (items 3, 4, 9, 11), personal characteristics of the woman (6, 10), and quality of care (5, 7, 8, 12). There is no standard rating for “satisfied” versus “dissatisfied”, but rather it is a global perception of care [13]. The item “Listening to mothers” about the decision for future inclusion was rated on a Likert scale of 0 to 3.

Other measures and variables

We collected basic demographic characteristics including age, preferred language, race and ethnicity, BMI at admission, parity, indication for induction, initial cervical dilatation, medical comorbidities, mode of delivery, duration of labor, analgesic use, infant APGARs, and postpartum perinatal Edinburgh depression scale scores (collected routinely during postpartum inpatient care). This information was collected by members of the research team and entered electronically into REDCap under a study identification number to maintain confidentiality.

Sample size

We modeled the expected degree of change from the previous randomized control trial using this tool. This study found a mean difference of 0.6 based on responses on a Likert score scale of 1 to 5 with a standard deviation of 0.9. We extrapolated this difference to the BSS-R score, which corresponds to an increase of approximately four points. To take advantage of this difference, we needed at least 20 participants for each group. If the difference in means for our study was smaller given the practical implementation design, we decided to enroll at least 30 participants for each group. Based on the volume at our hospital, we estimated that approximately 30 patients in each group could be enrolled over six to eight week collection periods.

Statistical analysis

The primary objective of this study was to compare the change in satisfaction measured by mean total BSS-R scores between the groups before and after implementation, reported as a continuous score between 0 and 40. The secondary outcome is knowledge of IOL agents was assessed by each agent individually and not as an overall percentage correct. This analysis was chosen to recognize those who correctly identified unused agents and to reflect the variety of combinations that patients may receive. Continuous variables are reported with mean and associated standard deviations. Baseline categorical characteristics were compared using chi-square tests, while baseline continuous characteristics were compared using Mann-Whitney U tests. Knowledge items were assessed using chi-square analysis and satisfaction items were assessed using t-tests. Alpha was set to 5% for all tests and SPSS was used for analyses. Subanalyses were used to compare these differences in the post group between those who viewed the video and those who did not, the delivery method, and participants’ language.