A loyalty program to motivate vulnerable women to engage in preconception care: ‘from voucher to tablet’
Kwetsbare vrouwen met een wens om zwanger te worden hebben vaker risicofactoren voor ongunstige zwangerschapsuitkomsten, maar zijn ook moeilijker te bereiken en te motiveren voor preconceptiezorg. In dit project willen wij deze vrouwen op een verantwoorde manier aanmoedigen om hun leefstijl al vóór de zwangerschap te verbeteren en om de weg naar het preconceptiezorgconsult beter te vinden. Dit doen wij door het ontwikkelen van een zogenaamd loyalty programma, waarin kwetsbare vrouwen in toenemende mate worden beloond voor gezonde leefstijl en deelname aan preconceptiezorg. Het programma wordt ontwikkeld en getest in samenwerking met de kwetsbare doelgroep zelf, om het zo goed mogelijk af te stemmen op hun specifieke wensen en behoeften. Deze aanpak kan zorgaanbieders helpen bij het ondersteunen van hun cliënten om hun eigen gezondheid te beheersen door hun ongezonde leefstijl te verbeteren en daardoor ook de kans op een zwangerschap met een ongecompliceerd verloop te vergroten.
Samenvatting van de aanvraag
Background Vulnerable women with a wish to conceive are more difficult to reach and motivate for preconception care. These women also have more poor lifestyle behaviors and medical risk factors for adverse pregnancy outcomes, such as congenital malformations, low birth weight and premature birth. These adverse pregnancy outcomes subsequently increase the risk of non-communicable diseases in mothers and their offspring in later life, such as obesity, cardiovascular disease and diabetes. Lifestyle interventions –as part of preconception care– can contribute to a reduction of adverse pregnancy and long-term health outcomes. The evidence-based mHealth platform Smarter Pregnancy, developed by the Erasmus MC, significantly empowers couples to adopt healthy lifestyle behaviors, before and during pregnancy. However, vulnerable women from deprived neighborhoods showed less improvement of these behaviors when using Smarter Pregnancy, which underlines the importance to customize the platform according to their specific needs. This may be pursued through an integrated loyalty program, in which women are ‘nudged’ using prospecting rewards of increasing value based on their own preferences. Yet, such a strategy should be ethically justified to explain why it is legitimate to introduce interventions that are aimed at reaching a specific group to ‘save’ them from poor lifestyle choices. Overall aim and approach The overall aim of this proposal is to reach and motivate vulnerable women, in an ethically justified way, to engage in preconception care, which will help them to better prepare for an uncomplicated pregnancy. We will accomplish this by framing, developing and testing a loyalty program in co-creation with the target population and other relevant stakeholders. In phase I, we will develop a framework to address the ethical pitfalls for reaching and motivating vulnerable women to engage in preconception care. In the development of this framework ample attention will be given to facilitating the transition from ‘extrinsic motivation’ (i.e. preparing for pregnancy for a reward) to ‘intrinsic motivation’ (i.e. preparing for pregnancy is the reward). In phase II, the ethical framework will be used to develop the loyalty program, which will be integrated in the Smarter Pregnancy platform. In phase III, the loyalty program will be used as a trigger to motivate vulnerable women to make an appointment for a face-to-face preconception care consultation (primary outcome) and to improve poor lifestyle behaviors (secondary outcome). These outcomes will be evaluated in a randomized controlled trial among vulnerable women with a wish to conceive. For 24 weeks, women in the control group will receive information/coaching regarding preconception care and poor lifestyle behaviors through the current version of Smarter Pregnancy. Women in the intervention group receive the same information/coaching, but will also be nudged through the loyalty program in which they are rewarded for their actions. Relevance and impact The development of an integrated loyalty program will enhance the uptake of preconception care consultations and the compliance and sustainability of healthy lifestyle behaviors through the Smarter Pregnancy platform. This approach will encourage vulnerable women to better prepare for pregnancy (self-management). Moreover, the loyalty program will equip health care providers in all lines of obstetric care in supporting their clients/patients to manage their own health by changing poor lifestyle behaviors and thereby also increase the chance of an ongoing pregnancy with an uncomplicated course and outcome. Strengths of the proposal are 1) the involvement of multiple stakeholders (including the target population) from beginning to end of the project; 2) more than 20 years of knowledge and expertise gained in previous projects on preconception care, ethics and mHealth carried out by the multidisciplinary project group; and 3) collaboration with partners that contribute to dissemination and implementation of the project, such as the Regional Consortium Pregnancy & Childbirth of the Southwest Netherlands, the national patient umbrella organization for rare and genetic disorders (VSOP) and the Municipality of Rotterdam. This project is relevant and fits the goals of the ZonMw Pregnancy and Childbirth program, because it contributes to reducing inequalities in health and care by investing in the earliest prevention (preconception care) of poor lifestyle behaviors that have consequences for fertility and pregnancy course and outcome, especially in vulnerable women. Our ultimate goal is that this project will lead to more awareness and uptake of preconception care and, consequently, improvement of short- and long-term health of mothers and their offspring. Hence, new opportunities will be provided to (further) develop targeted mHealth interventions for other target populations and for broader engagement throughout the life course.