Patricia A. Janssen

Pregnancy-specific anxiety (PSA) is prevalent and associated with adverse perinatal outcomes. The scarcity of health care resources hinders universal scree

Background: Web-based surveys are a cost-effective technique to engage a large population of participants in research projects, including those who were previously difficult to reach due to geographic location, safety, and vulnerability. While web-based surveys have many advantages, they can be more susceptible to fraud, especially when a generic invitation link or a financial incentive is offered. There is a paucity of literature presenting experiences for mitigating this type of fraudulent study response, yet this important foundation is needed to inform the work of researchers and institutional review boards (IRBs) to support the collection of high-quality, appropriate data. Objective: This study aims to analyze, compare, and contrast the range of strategies used to prevent, detect, and remove fraudulent responses by investigating 4 web-based surveys in Australia and Canada, each of which experienced fraudulent responses. Methods: Our descriptive multiple case study presents 4 research projects from Australia and Canada that experienced survey fraud. These web-based surveys recruited patients of, or clinicians providing, family planning services. We describe each study’s approach to preventing fraud (primary prevention; eg, CAPTCHA) and a screening protocol to detect fraudulent responses during data collection (secondary prevention). Once fraud was detected, each study team developed strategies to protect data integrity, in consultation with coinvestigators, ethics committees/ IRBs, and biostatisticians, to remove fraudulent respondents from the dataset (tertiary prevention). Results: All studies recruited via a generic survey link and provided remuneration, which are common risk factors for fraud. Several studies also relied on social media for recruitment. All 4 studies implemented tertiary fraud detection strategies to identify and remove fraudulent responses and maintain data integrity (removing between 16% and 45% of respondents). Including personal identifiers during data collection provided 3 of the studies with a more robust option to identify and remove fraudulent respondents. Where personal identifiers could not be used (eg, to protect the identity of a vulnerable study population), investigators relied on a complex fraud detection algorithm verified by manual team review. Conclusions: Commonly used web-based anonymized survey methods, particularly those offering incentives for participation, are at substantial risk for fraud. Across these 4 studies, robust fraud detection methods were essential to ensure data reliability, with varying strategies, such as using personal identifiers, applied based on specific survey contexts. Fraud mitigation criteria explored in this multicase analysis can be adapted to other web-based surveys, survey topics, and populations. Implementing the fraud prevention and detection methods within survey design will assist researchers and IRBs in protecting data integrity. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12622000655741; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=383919 and ClinicalTrials.gov NCT05793944; https://clinicaltrials.gov/study/NCT05793944

Background: The United Nations (UN) has a target for universal contraception access by 2030. Youth (aged 15–29) still have limited contraception access and lower usage. A unified understanding of the barriers youth face in high‐income countries (HIC) remains unclear. Objectives: Synthesized evidence on youth contraception barriers across HIC to identify continued healthcare inaccessibility and knowledge gaps. Search Strategy: A search strategy, including terms like “youth” and “barriers,” was applied to three databases, identifying articles published between January 2013–September 2024. Selection Criteria: Primary peer‐reviewed quantitative, qualitative, and mixed‐methods studies were included if they focused on youth and contraception barriers. Data Collection and Analysis: Following the Joanna Briggs Institute, articles were screened for inclusion, and data was extracted. Analyses included descriptive statistics and summarizing findings for quantitative and qualitative results. All articles were subjected to inductive and deductive content analysis to map barriers. Article quality was appraised by the Mixed Methods Appraisal Tool. Main Results: A total of 41 articles were included, of which 88% were from the USA. Youth struggled to receive quality contraception care from multiple access points from health systems and youth perspectives. Barriers included youth minimal knowledge, poor approachability and care appropriateness, physical barriers, costs, stigma, confidentiality concerns, and service gatekeeping. Youth experiences varied by social identities with those from lower economic, rural, and of younger age facing more obstacles. Conclusions: Contraception was inaccessible for many. To meet UN targets, efforts need to address described barriers to ensure accessible and equitable contraception care that respects and supports youth's choices.

BACKGROUND Web-based surveys are a cost-effective technique to engage a large population of participants in research projects, including those who were previously difficult to reach due to geographic location, safety, and vulnerability. While web-based surveys have many advantages, they can be more susceptible to fraud, especially when a generic invitation link or a financial incentive is offered. There is a paucity of literature presenting experiences for mitigating this type of fraudulent study response, yet this important foundation is needed to inform the work of researchers and institutional review boards (IRBs) to support the collection of high-quality, appropriate data. OBJECTIVE This study aims to analyze, compare, and contrast the range of strategies used to prevent, detect, and remove fraudulent responses by investigating 4 web-based surveys in Australia and Canada, each of which experienced fraudulent responses. METHODS Our descriptive multiple case study presents 4 research projects from Australia and Canada that experienced survey fraud. These web-based surveys recruited patients of, or clinicians providing, family planning services. We describe each study’s approach to preventing fraud (primary prevention; eg, CAPTCHA) and a screening protocol to detect fraudulent responses during data collection (secondary prevention). Once fraud was detected, each study team developed strategies to protect data integrity, in consultation with coinvestigators, ethics committees/ IRBs, and biostatisticians, to remove fraudulent respondents from the dataset (tertiary prevention). RESULTS All studies recruited via a generic survey link and provided remuneration, which are common risk factors for fraud. Several studies also relied on social media for recruitment. All 4 studies implemented tertiary fraud detection strategies to identify and remove fraudulent responses and maintain data integrity (removing between 16% and 45% of respondents). Including personal identifiers during data collection provided 3 of the studies with a more robust option to identify and remove fraudulent respondents. Where personal identifiers could not be used (eg, to protect the identity of a vulnerable study population), investigators relied on a complex fraud detection algorithm verified by manual team review. CONCLUSIONS Commonly used web-based anonymized survey methods, particularly those offering incentives for participation, are at substantial risk for fraud. Across these 4 studies, robust fraud detection methods were essential to ensure data reliability, with varying strategies, such as using personal identifiers, applied based on specific survey contexts. Fraud mitigation criteria explored in this multicase analysis can be adapted to other web-based surveys, survey topics, and populations. Implementing the fraud prevention and detection methods within survey design will assist researchers and IRBs in protecting data integrity. CLINICALTRIAL Australian New Zealand Clinical Trials Registry ACTRN12622000655741; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=383919 and ClinicalTrials.gov NCT05793944; https://clinicaltrials.gov/study/NCT05793944

Introduction: Group B streptococcus(GBS), orStreptococcus agalactiae, remains a leading cause of neonatal morbidity and mortality. Canadian guidelines advise universal maternal screening for GBS colonisation in pregnancy in conjunction with selective antibiotic therapy. This results in over 1000 pregnant individuals receiving antibiotic therapy to prevent one case of early-onset neonatal GBS disease, and over 20 000 pregnant individuals receiving antibiotic therapy to prevent one neonatal death. Given the growing concern regarding the risk of negative sequela from antibiotic exposure, it is vital that alternative approaches to reduce maternal GBS colonisation are explored.Preliminary studies suggest some probiotic strains could confer protection in pregnancy against GBS colonisation.Methods and analysis: This double-blind parallel group randomised trial aims to recruit 450 pregnant participants in Vancouver, BC, Canada and will compare GBS colonisation rates in those who have received a daily oral dose of three strains of probiotics with those who have received a placebo. The primary outcome will be GBS colonisation status, measured using a vaginal/rectal swab obtained between 35 weeks’ gestation and delivery. Secondary outcomes will include maternal antibiotic exposure and urogenital infections. Analysis will be on an intention-to-treat basis.Patient or public involvement: There was no patient or public involvement in the design of the study protocol.Ethics and dissemination: This study protocol received ethics approval from the University of British Columbia’s Clinical Research Ethics Board, Dublin City University and Health Canada. Findings will be presented at research rounds, conferences and in peer-reviewed publications.Trial registration number: NCT03407157.

Introduction Prenatal education is associated with positive health behaviours, including optimal weight gain, attendance at prenatal care, acceptance of routine screening tests, smoking cessation, decreased alcohol consumption and breast feeding. Adoption of these behaviours has been associated with reduced rates of caesarean birth, preterm birth and low birth weight. Barriers to prenatal class attendance faced by parents in Canada include geography, socioeconomic status, age, education, and, among Indigenous peoples and other equity-deserving groups, stigma. To address the need for easily accessible and reliable information, we created ‘SmartMom’, Canada’s first prenatal education programme delivered by short message service text messaging. SmartMom provides evidence-based information timed to be relevant to each week of pregnancy. The overall goal of SmartMom is to motivate the adoption of positive prenatal health behaviours with the ultimate goal of improving health outcomes among women and their newborns. Methods and analysis We will conduct a two-arm single-blinded randomised controlled trial. Blinding of participants to trial intervention will not be possible as they will be aware of receiving the intervention, but data analysts will be blinded. Our primary research questions are to determine if women experiencing uncomplicated pregnancies randomly assigned to receive SmartMom messages versus messages addressing general topics related to pregnancy but without direction for behaviour change, have higher rates of: (1) weight gain within ranges recommended for prepregnancy body mass index and (2) adherence to Canadian guidelines regarding attendance at prenatal care appointments. Ethics and dissemination The study has been granted a Certificate of Approval, number H22-00603, by the University of British Columbia Research Ethics Board. To disseminate our findings, we are undertaking both integrated and end-of-grant knowledge translation, which will proactively involve potential end-users and stakeholders at every phase of our project. Trial registration number NCT05793944.

INPLASY2023100071 Exploring Youths’ Barriers to Contraception in High-Income Countries: A Scoping Review Keywords: Youth Contraception, Family Planning, Healthcare Barriers, High Income Countries. …

Background: Prenatal education encourages healthy behavioral choices and reduces rates of adverse birth outcomes. The use of mobile health (mHealth) technologies during pregnancy is increasing and changing how pregnant people acquire prenatal education. SmartMom is an evidence-based prenatal education SMS text messaging program that overcomes barriers to prenatal class attendance, including rural or remote location, cost, stigma among participants, lack of instructors, and cessation of classes during the COVID-19 pandemic. Objective: We sought to explore perceived information needs and preferences for the content and structure of prenatal education mHealth programs among persons enrolled in or eligible to enroll in SmartMom. Methods: This was a qualitative focus group study conducted as part of a development and usability study of the SmartMom program. Participants were older than 19 years of age, Canadian residents, fluent in English, and either currently pregnant or pregnant within the last year. We asked open-ended questions about information-seeking behaviors during pregnancy, the nature of the information that participants were seeking, how they wanted to receive information, and if SmartMom was meeting these needs. Focus groups took place via videoconference technology (Zoom) between August and December 2020. We used reflexive thematic analysis to identify themes that emerged from the data and the constant comparison method to compare initial coding to emerging themes. Results: We conducted 6 semistructured focus groups with 16 participants. All participants reported living with a partner and owning a cell phone. The majority (n=13, 81%) used at least 1 app for prenatal education. Our analysis revealed that “having reliable information is the most important thing” (theme 1); pregnant people value inclusive, local, and strength-based information (theme 2); and SMS text messages are a simple, easy, and timely modality (“It was nice to have that [information] fed to you”; theme 3). Participants perceived that SmartMom SMS text messages met their needs for prenatal education and were more convenient than using apps. SmartMom’s opt-in supplemental message streams, which allowed users to tailor the program to their needs, were viewed favorably. Participants also identified that prenatal education programs were not meeting the needs of diverse populations, such as Indigenous people and LGBTQIA2S+ (lesbian, gay, bisexual, transgender, queer and/or questioning, intersex, asexual, Two-Spirit plus) communities. Conclusions: The shift toward digital prenatal education, accelerated by the COVID-19 pandemic, has resulted in a plethora of web- or mobile technology–based programs, but few of these have been evaluated. Participants in our focus groups revealed concerns about the reliability and comprehensiveness of digital resources for prenatal education. The SmartMom SMS text messaging program was viewed as being evidence-based, providing comprehensive content without searching, and permitting tailoring to individual needs through opt-in message streams. Prenatal education must also meet the needs of diverse populations.

BACKGROUND Prenatal education encourages healthy behavioral choices and reduces rates of adverse birth outcomes. The use of mobile health (mHealth) technologies during pregnancy is increasing and changing how pregnant people acquire prenatal education. SmartMom is an evidence-based prenatal education SMS text messaging program that overcomes barriers to prenatal class attendance, including rural or remote location, cost, stigma among participants, lack of instructors, and cessation of classes during the COVID-19 pandemic. OBJECTIVE We sought to explore perceived information needs and preferences for the content and structure of prenatal education mHealth programs among persons enrolled in or eligible to enroll in SmartMom. METHODS This was a qualitative focus group study conducted as part of a development and usability study of the SmartMom program. Participants were older than 19 years of age, Canadian residents, fluent in English, and either currently pregnant or pregnant within the last year. We asked open-ended questions about information-seeking behaviors during pregnancy, the nature of the information that participants were seeking, how they wanted to receive information, and if SmartMom was meeting these needs. Focus groups took place via videoconference technology (Zoom) between August and December 2020. We used reflexive thematic analysis to identify themes that emerged from the data and the constant comparison method to compare initial coding to emerging themes. RESULTS We conducted 6 semistructured focus groups with 16 participants. All participants reported living with a partner and owning a cell phone. The majority (n=13, 81%) used at least 1 app for prenatal education. Our analysis revealed that “having reliable information is the most important thing” (theme 1); pregnant people value inclusive, local, and strength-based information (theme 2); and SMS text messages are a simple, easy, and timely modality (“It was nice to have that [information] fed to you”; theme 3). Participants perceived that SmartMom SMS text messages met their needs for prenatal education and were more convenient than using apps. SmartMom’s opt-in supplemental message streams, which allowed users to tailor the program to their needs, were viewed favorably. Participants also identified that prenatal education programs were not meeting the needs of diverse populations, such as Indigenous people and LGBTQIA2S+ (lesbian, gay, bisexual, transgender, queer and/or questioning, intersex, asexual, Two-Spirit plus) communities. CONCLUSIONS The shift toward digital prenatal education, accelerated by the COVID-19 pandemic, has resulted in a plethora of web- or mobile technology–based programs, but few of these have been evaluated. Participants in our focus groups revealed concerns about the reliability and comprehensiveness of digital resources for prenatal education. The SmartMom SMS text messaging program was viewed as being evidence-based, providing comprehensive content without searching, and permitting tailoring to individual needs through opt-in message streams. Prenatal education must also meet the needs of diverse populations.