GIZ method for parents-to-be: a shared decision-making method for the assessment of care needs in the first 1000 days

BACKGROUND To fight perinatal morbidity and mortality, without medicalisation or patronising clients, it is essential for the different disciplines in maternity care to collaborate and apply shared decision-making with parents-to-be. The GIZ method [Gezamenlijk Inschatten van Zorgbehoeften] is an accessible method for the identification of care needs during a dialogue with parents-to-be. It is an integral assessment method for the identification of the strengths and care needs, of a specific child or family. It is widely applicable in the chain of pre and postnatal care, for example by professionals in maternity care and Preventive Child Healthcare (PCH). The GIZ method is not yet implemented in prenatal care, but pilots with the GIZ for maternity care intakers revealed positive experiences of clients. OBJECTIVE & RESEARCH QUESTIONS This project aims at 1) reducing risk factors (e.g. stress, smoking, obesity etc.) for a) Big4 conditions (i.e., Premature birth, 'Small for Gestational Age' (SGA), low Apgar score, congenital anomalies) and b) for maternal morbidity; 2) stimulating shared decision-making between parents-to-be and midwives; 3) strengthening collaboration between maternity care and PCH, during the first 1000 days. For this goal we will 1) tailor the GIZ method to user needs in obstetric care/midwifery care, 2) implement the GIZ method in primary midwifery practices in three Dutch regions, and 3) study the effect of the GIZ method on collaboration and mitigation of risk factors, such as health behaviour and stress, for Big4 conditions and maternal morbidity. Main research questions: 1. What are the needs of midwives and parents-to-be in the context of maternity care, to identify and reduce risk factors for Big4 conditions and maternal morbidity? 2. How should the GIZ method be adapted to meet midwives’ needs and the needs of parents-to-be? 3. How can the adapted GIZ be implemented to contribute to midwifery care to identify and reduce risk factors for Big4 conditions and maternal morbidity? METHOD This project will be conducted in a partnership with TNO, GGD HM, LUMC, 10 midwifery practices in northern South-Holland (LEO) and practices in the northern Netherlands (‘Veenkolonien’) and two parent organisations. This research is conducted within a multidisciplinary consortium (ZEGNN) in the north of the Netherlands, in the Midwives Cooperative Leiden (LEO) and in the academic collaborative centre Northern South Holland (AWP SAMEN). This project applies a mixed-method approach, including co-creation, evaluation and implementation research on the GIZ method. The project will take three years and includes the following phases. The first step of the adaptation of the GIZ method is a needs assessment. This includes a literature review, inventory of existing instruments and co-creation sessions with end-users. Based on the results of step 1, we will draw client journeys and user requirements. We will develop redesigns (including mock ups) of a GIZ method that would fit in these client journeys and are tailored to parents-to-be in midwifery care. We will organize sessions with the user group, and with the client panel and advisory group, to review the redesigns through the mock ups. Finally, we will come to a proof of concept of the adapted GIZ method. The adapted GIZ method will be implemented in 10 midwifery practices: six midwifery practices in northern South-Holland (LEO) and four practices in the northern Netherlands (‘Veenkolonien’). The GIZ method is aimed to be used by midwives in the first trimester of the pregnancy. These practices include a diverse population with higher and lower socioeconomic status and from western and non-western origin. A quasi-experimental design will be used. First, we measure ‘care as usual’ (without GIZ) for a period of 3 months, i.e., control period. Then, midwives are trained in using the adapted GIZ and will use the GIZ for 2-3 months to gain experience. Sessions are organised with participants after 1-2 months to assess if there are any issues that need to be resolved and to exchange tips & tricks. Then finally, we will measure care with adapted GIZ for a period of 3 months. For the control period (usual care), 253 parents-to-be will be included. For the intervention period, after the GIZ is implemented, another 253 parents-to-be are included. We will measure the following primary outcomes: - Satisfaction of parents-to-be and care providers with the GIZ - Satisfaction of parents to be with prenatal care - Level of shared decision-making between midwives and parents-to-be - (Indicators for) risk factors for BIG 4 conditions and maternal morbidity In the final phase, the adapted GIZ method for midwives, the GIZ manual, and the results of the evaluation will be made available for use in practice and end-users (professionals and parents-to-be), researchers, and policymakers. Recommendations will be given for the optimal implementation of the adapted GIZ in midwifery care.