Qualitative study of evidence based leaflets in maternity care BMJ Volume 324, pp 639-43
Leaflets used to promote informed choice in women using maternity services in the UK are not effective in everyday practice, say researchers from Sheffield University in this week’s BMJ.
Thirteen maternity units in Wales participated in the study. Units either used leaflets to promote informed choice (intervention units) or continued with usual care (control units).
Questionnaires were then sent to four different samples of women using these maternity services. Women in the antenatal samples received the questionnaire 28 weeks into their pregnancy, and women in the postnatal samples received the questionnaire eight weeks after delivering their babies.
There was no change in the proportion of women who reported exercising informed choice in the intervention units compared with the control units for either antenatal or postnatal women. Only 70% of women in the intervention units reported being given at least one of the leaflets, indicating problems with implementation.
The leaflets did not help to promote informed choice in maternity care, say the authors. They suggest that decision aids may not be effective in the real world.
Within the same study, Helen Stapleton and colleagues found that time constraints and other pressures on health professionals resulted in a lack of discussion of the content of the leaflets. Health professionals also promoted normative practices rather than choice and, as women valued their opinions, this ensured informed compliance rather than informed choice.
They conclude that these leaflets are unlikely to promote informed choice in maternity care unless they are introduced as part of a coherent strategy addressing power imbalances and the ambiguities currently underpinning choice.