Emma Doherty

Background: Modifiable health risks in pregnancy are common and contribute to adverse maternal and infant outcomes, yet preventive care addressing these risks can be difficult to deliver within time-limited antenatal appointments. Hybrid models combining in-person care with digital platforms offer a promising solution; however, there is limited evidence regarding consumer and health care professional perspectives on the preferred content and functionality of such platforms to inform their design. Objective: This study aimed to explore consumer and health care professional perspectives on the ideal content and functionality of a digital platform to support preventive antenatal care. Methods: A descriptive qualitative study was conducted across 2 regional maternity services in New South Wales, Australia. Four workshops were held with recently pregnant consumers and antenatal health care professionals, using purposive sampling to include Aboriginal and culturally and linguistically diverse participants. Data were analyzed using applied thematic analysis, guided by a predefined framework, which examined what content should be included, how the platform should function, and why it was needed. Results: A total of 23 consumers and 12 health care professionals participated. Participants identified key content requirements, including digital risk assessments, evidence-based and personalized information, practical resources, clear support options, and content extending into the postbirth period. Preferred functionalities included early access to the platform, appointment-aligned reminders, integration with routine workflows, tracking tools, multiple content delivery formats, filtering options, and information-sharing options. Participants described gaps in early pregnancy information and noted that digitally provided care could reduce stigma, support more honest disclosure, and enhance communication. Conclusions: Consumers and health care professionals identified key content and functionality requirements for a digital platform to support preventive antenatal care. Prioritizing credible information, early access, and integration with routine workflows may improve the acceptability and utility of digital solutions. Future research is needed to examine real-world implementation.

BACKGROUND Clinical guidelines recommend addressing modifiable risk factors throughout pregnancy; however, antenatal providers often face challenges delivering preventive care within routine appointments. A digital platform that allows pregnant people to receive preventive care alongside routine antenatal care may help address this gap. OBJECTIVE To assess pregnant people's access to, acceptability of, perceived barriers to, and preferences for a digital platform that provides preventive care alongside routine antenatal care, including exploratory analyses of priority population groups. METHODS Between May 2023 and May 2025, telephone and online surveys were conducted with pregnant people attending antenatal care in an Australian local health district. Data were analysed descriptively, with exploratory subgroup analyses for priority population groups. RESULTS A total of 4604 surveys were completed. Access to an internet-connected digital device was almost universal (99.6%), with similarly high access across priority population groups (98.7%-100.0%). Acceptability of receiving preventive care via a digital platform was high for health risk assessment (83.1%-87.7%), personalised information (75.2%-84.2%), and referral to support services (87.4%-89.2%). Aboriginal and Torres Strait Islander participants reported lower acceptability for completing assessments (73.9%-83.9%) and receiving information (66.9%-79.5%), whereas participants born in non-English-speaking countries reported higher acceptability for receiving personalised information (84.0%-92.0%) and referrals (87.2%-93.6%). Most participants reported no perceived barriers to platform use (66.2%); the most common barriers were time constraints (13.9%) and forgetting to complete tasks (11.0%). Preferences varied regarding assessment timing, frequency of use, communication methods, and information formats. CONCLUSIONS A digital platform for preventive care appears highly accessible and acceptable to most pregnant people. Platform design should address identified barriers, accommodate varied user preferences, and be co-designed with priority population groups to support equitable implementation.

BACKGROUND Modifiable health risks in pregnancy, including smoking, alcohol consumption, gestational weight gain outside recommended ranges, poor dietary intake and physical inactivity, are well established contributors to adverse obstetric outcomes. Although antenatal care guidelines recommend addressing these risks throughout pregnancy, antenatal providers often find it difficult to deliver preventive care within time limited appointments. Hybrid models that combine in person care with digital platforms offer a promising solution to address these barriers, yet little research has explored consumer and provider views on the preferred content and features of such platforms. OBJECTIVE To explore consumer and provider perspectives on the ideal content and functionality of a digital platform to deliver preventive care within a hybrid antenatal model. METHODS A descriptive qualitative study was conducted in May and June 2024 across two regional maternity services in New South Wales, Australia. Two workshops were held with recently pregnant consumers and two with antenatal providers. Purposive sampling was used, with targeted recruitment of Aboriginal and Torres Strait Islander people and people from culturally and linguistically diverse backgrounds. Data from structured group activities, observation notes, and audio recordings were thematically analysed using a deductive approach guided by an existing framework that examined what content the platform should include, how it should be delivered, and why it was needed. RESULTS Twenty-three consumers and twelve antenatal providers participated. Participants identified the need for digital risk assessments and for evidence-based, personalised information and practical resources. They emphasised a requirement for clear support options and extending content into labour, birth, and the postnatal period. Early access to the platform, reminders linked to appointments, and integration with routine antenatal care were viewed as important. Tracking, personalisation, multiple content formats, filtering functions, and sharing options were highlighted as desirable features. Participants described gaps in information early in pregnancy and noted that modifiable health risks were often not addressed in routine antenatal care. They also reported that digital assessments could reduce stigma and support more honest disclosure, and that a hybrid model of care could enhance communication between consumers and providers. CONCLUSIONS Consumers and providers identified key content and functionality for a digital platform to deliver preventive care within a hybrid model of antenatal care. Prioritising credible and culturally tailored content, early access to information that helps address modifiable health risks, and integration with routine antenatal care will be important for developing acceptable and sustainable digital solutions. As these insights were generated during the development stage, future research should examine real world implementation, including uptake, engagement, and how well the platform fits into the workflows and processes of antenatal care.

Background: Preventive care – asking, advising or referring patients for help with smoking, nutrition, alcohol, physical activity, and weight (SNAP-W) – is not consistently provided in routine outpatient care due to barriers such as time, other priorities, and forgetfulness. Digital health interventions (DHIs) integrated into routine care offer a promising solution and are acceptable to clinicians and patients. A systematic review is needed to synthesise existing evidence on the effectiveness of DHIs that engage patients, alongside routine care, to provide preventive care targeting SNAP-W in outpatient settings. Methods: We will include randomised and non-randomised studies that compare a DHI supporting the provision of preventive care for SNAP-W health behaviours with usual care. The DHI must integrate with routine clinician-provided care. Participants will be adult patients/clients of any outpatient healthcare service. The primary outcomes will be provision/receipt of preventive care elements addressing the SNAP-W health behaviours. Secondary outcomes will include SNAP-W behaviour change outcomes. Eligible studies will be identified via MEDLINE, EMBASE, PsycINFO, Scopus, and CINAHL. Two reviewers will independently conduct study selection, data extraction, and risk of bias assessment, with a third resolving disagreements. Risk of bias will be assessed using Cochrane RoB-2 for randomised and ROBINS-I for non-randomised trials. If feasible, a meta-analysis will be conducted to estimate the pooled effect of DHIs by health behaviour. Exploratory sub-group (e.g., type of clinical setting, preventive care element) analyses will be conducted to determine possible causes of statistical heterogeneity. If a meta-analysis is not feasible, results will be summarised using direction of effect per the Synthesis Without Meta-analysis guidelines. Discussion: This review will identify whether DHIs that engage patients as part of outpatient health care are effective at improving delivery of SNAP-W preventive care for adults attending these services. These findings will be of interest to service providers, policy makers and implementation researchers seeking to improve health outcomes through routine preventive care provision. Systematic review registration: PROSPERO CRD420251067831.

BACKGROUND Chronic disease risk factors including smoking/vaping, poor nutrition, alcohol misuse and physical inactivity, as well as falls (SNAPF), have a significant impact on population health. Delivering preventive care using evidence-based models (eg, Ask, Advise, Help (AAH) model) during clinical consultations is recommended and can reduce SNAPF risks. Rates of preventive care delivery within clinical consultations are variable, with barriers including limited time and competing priorities. One solution to increase preventive care delivery is using hybrid approaches that combine digital and clinician-delivered care. OBJECTIVE We aimed to test the use and acceptability of an online preventive care tool based on the AAH model and delivered through a hybrid care approach from the perspective of Community Health clients and clinicians. METHODS A convenience sample of adult clients with an upcoming appointment at two Australian Community Health services were sent an SMS containing a link to the online tool. The tool ‘Asked’ about SNAPF risk factors, and provided ‘Advice’ and ‘Help' via a summary message and information sheets. Data on use and acceptability was collected via analytics, semi-structured telephone interviews with clients, and semi-structured online interviews and focus groups with clinicians. Data analysis was conducted using descriptive statistics for quantitative data and thematic analysis for qualitative data. RESULTS Forty-three participants (56% female, mean age 55.0) completed the tool, out of 76 who received it (57%). Fifty-two participants who received the tool completed a semi-structured telephone interview (68%). Most participants found it acceptable to receive the tool via SMS (87%) and for the tool to provide ‘Advice’ and ‘Help’ (91%), although a smaller proportion of participants who completed the tool recalled the summary message (66%) or engaged with the information sheets (20%-53%). The main reasons reported for not completing the tool included receiving it at an inconvenient time, not being good with online forms, and being wary of opening links. Clinician feedback (n=7) highlighted client use barriers (eg, concerns about scams) and enablers (eg, assistance from family), as well as positive feedback on the tool itself (eg, clients receiving enhanced advice). CONCLUSIONS The online preventive care tool was used by over half of the clients to whom it was sent, and was acceptable to Community Health clients and clinicians. There is an opportunity to use digital tools to help enhance preventive care within clinical care.

Introduction: This is a secondary analysis of a stepped-wedge trial. The sustainment of evidence-based care is essential for ongoing population benefits. In a randomized stepped-wedge controlled trial of public maternity services across three health sectors in New South Wales, Australia, we demonstrated a positive practice change related to addressing alcohol use during pregnancy. This change followed a 7-month implementation strategy conducted between February 2018 and November 2019. However, evidence suggests that the impact of implementation strategies may reduce over time. It is important to document when and if recommended care reduces, so that timely support for sustainment can be provided.Methods: As a secondary analysis, an interrupted time series analysis of outcomes from the largest sector of the randomized stepped-wedge controlled trial was conducted. The analysis explored the rate, time points, and extent of change in women’s reported receipt of recommended antenatal care for alcohol consumption, following delivery of an effective implementation strategy.Results: A total of 4,909 (82% consented) women were surveyed. The proportion of pregnant women receiving recommended care reduced significantly per week following the withdrawal of implementation support, for three of the four outcomes: assessment of alcohol consumption (% change per week: −0.66, 95% CI: −1.1, −0.26); advice not to consume alcohol during pregnancy and of potential risks (% change per week: −0.63, 95% CI: −1.1, −0.22); and complete care relevant to alcohol risk level (advice and referral) (% change per week: −0.64, 95% CI: −1.1,-0.22). Similar results were observed regardless of the timing of antenatal visits. A more rapid decline occurred for most outcomes from the end of implementation until approximately 30 weeks post-implementation.Discussion: Despite a reduction in the receipt of recommended care, rates were still higher post-implementation than pre-implementation. Receipt of recommended antenatal care for alcohol consumption declined after active implementation support was withdrawn. The findings suggest the need for ongoing monitoring of care delivery and the introduction of additional sustainability strategies at key time points post-withdrawal of implementation support.

Introduction Globally, guideline-recommended antenatal care for smoking cessation is not routinely delivered by antenatal care providers. Implementation strategies have been shown to improve the delivery of clinical practices across a variety of clinical services but there is an absence of evidence in applying such strategies to support improvements to antenatal care for smoking cessation in pregnancy. This study aims to determine the effectiveness and cost effectiveness of implementation strategies in increasing the routine provision of recommended antenatal care for smoking cessation in public maternity services. Methods and analysis A non-randomised stepped-wedge cluster-controlled trial will be conducted in maternity services across three health sectors in New South Wales, Australia. Implementation strategies including guidelines and procedures, reminders and prompts, leadership support, champions, training and monitoring and feedback will be delivered sequentially to each sector over 4 months. Primary outcome measures will be the proportion of: (1) pregnant women who report receiving a carbon monoxide breath test; (2) smokers or recent quitters who report receiving quit/relapse advice; and (3) smokers who report offer of help to quit smoking (Quitline referral or nicotine replacement therapy). Outcomes will be measured via cross-sectional telephone surveys with a random sample of women who attend antenatal appointments each week. Economic analyses will be undertaken to assess the cost effectiveness of the implementation intervention. Process measures including acceptability, adoption, fidelity and reach will be reported. Ethics and dissemination Ethics approval was obtained through the Hunter New England Human Research Ethics Committee (16/11/16/4.07; 16/10/19/5.15) and the Aboriginal Health and Medical Research Council (1236/16). Trial findings will be disseminated to health policy-makers and health services to inform best practice processes for effective guideline implementation. Findings will also be disseminated at scientific conferences and in peer-reviewed journals. Trial registration number Australian New Zealand Clinical Trials Registry—ACTRN12622001010785.