The impact of abortion doulas on women and providers' outcomes: An integrative review of the evidence.

The aim of this integrative review is to map the literature on the impact of abortion doulas on women and abortion care providers. This review followed a modified Whittemore and Knafl framework and PRISMA guidelines. Electronic databases (Medline, PubMed, CINAHL, the Cochrane Library, Scopus, Proquest, EMBASE, and PsycINFO) were searched using key terms: abortion and doula. Search was limited by date (2012-2022), type (primary research only), and language (English only). Of the 99 papers found, only 4 met inclusion criteria. The four papers - drawn from 2 studies - were analysed using NICE Appraisal checklists. In total, data from 328 participants (n = 314 women, n = 5 physicians, n = 5 staff members, n = 4 abortion doulas) was analysed. Of the 314 women, 160 women received doula support and 154 did not. Two qualitative papers showed women and abortion providers reported a beneficial impact of abortion doulas, but the two quantitative (RCTs) papers showed null impact for a doula support intervention vs. usual care on women's physical and psychological outcomes. Women reported wanting support during the abortion; however, the evidence is not yet clear on whether a doula is required to address this need for women undergoing a surgical abortion in clinic. It may be that abortion support is important in ways that are difficult to measure.

An integrative review of supportive relationships between child-bearing women and midwives.

AIMS: To review and evaluate the literature on the factors related to developing supportive relationships between women and midwives, including facilitators and barriers. DESIGN: An integrative review. METHOD: The search used CINAHL, MEDLINE, Embase, EMcare, Maternity and Infant Care, PsycINFO, and Google Scholar from January 2009-June 2020. Two reviewers screened the eligible studies, and 2,399 records were identified. Quality was assessed with the mixed methods appraisal tool, and 14 articles were included. RESULTS: The findings highlight that successful relationships require therapeutic communication, trust, respect, partnership, and shared decision-making. Supportive relationships improve women's satisfaction and birth outcomes, and continuity of care model is an enabling factor. Further research is required to understand supportive relationships in non-continuity of care models and when different cultural backgrounds exist.

Midwives' recognition and response to maternal deterioration: A national cross-sectional study.

BACKGROUND: Early warning systems (EWS) are used across health care settings as a tool for the early identification of clinical deterioration and to determine the need to escalate care. Early detection of clinical deterioration and appropriate escalation of care in maternity settings is critical to the safety of pregnant women and infants; however, underutilization of EWS tools and reluctance to escalate care have been consistently reported. Little is known about midwives' use of EWS in the Australian context. METHODS: Using a cross-sectional approach, we elicited the attitudes, beliefs, and behaviors of a purposive sample of Australian midwives (n = 87) with respect to the Maternal Early Warning Trigger Tool (MEWT). Participants answered a 25-question Likert scale survey and one open-ended question. Qualitative answers were analyzed using consensus coding. RESULTS: Midwives reported positive attitudes toward the MEWT, describing it as a valuable tool for identifying clinical deterioration, especially when used as an adjunct to clinical judgment. However, midwives also identified training gaps; 25% had received no training, and only half of those who had received training felt it was effective. In addition, professional tension can create a significant barrier to the effective use of the MEWT. Midwives also reported feeling influenced by their peers in their decision-making with respect to use of the MEWT and being afraid they would be chastised for escalating care unnecessarily. CONCLUSIONS: Although the MEWT is valued by Australian midwives as a useful tool, barriers exist to its effective use. These include a lack of adequate, ongoing training and professional tension. Improving interdisciplinary collaboration could enhance the use of this tool for the safety of birthing women and their infants.

Heutagogy: A self-determined learning approach for Midwifery Continuity of Care experiences.

AIM: The aim of this discussion paper is to discuss learning theories in midwifery education, as related to the Midwifery Continuity of Care Experience and to propose an original conceptual framework based on Heutagogy. BACKGROUND: Midwifery education curricula include a number of midwifery practice experiences. One of the requirements is for students to provide Midwifery Continuity of Care. To achieve these experiences, students in Australia are required to provide care to at least ten (10) women through pregnancy, be on call for the woman's birth and provide at least two visits post-birth. Continuity of care experiences appear to have been incorporated without sufficient consideration of the educational purpose of the experience, or how the experiences contribute to the development of the profession. Although we do know midwifery practice embraces woman-centred care as its philosophical underpinning, a learning approach that is congruent with this philosophy needs to be clearly articulated. DESIGN: A discussion paper that compared and contrasted learning theories to align with Midwifery Continuity of Care experiences. METHODS: A review of the literature on learning theories was conducted before comparing and contrasting the theories to arrive at a conceptual framework focused on learning theory and its application to the Midwifery Continuity of Care Experience. RESULTS: Heutagogy provides a potentially congruent educational learning approach to underpin the continuity of care experiences, in comparison to traditional learning theories of pedagogy and andragogy. With a paucity of research in the application of heutagogy to midwifery education, it's conceptual underpinnings and the possible application to the Continuity of Care Experience, this paper explores the possible theoretical applications of heutagogy to midwifery education. CONCLUSION: As a learning theory, heutagogy is well - aligned with woman-centred care. Heutagogy provides a theoretical framework suitable to underpin strategies, including the conceptual framework proposed, that may assist in empowering students to participate in their own education by giving them the ability to be self-determined in both their approach to learning and to evaluate their own learning needs.

What matters, what is valued and what is important in mentorship through the Appreciative Inquiry process of co-created knowledge.

BACKGROUND: A key element in the provision of safe and competent midwifery care is how learning experiences are construed and translated into practice. This process can be supported through clinical/professional mentoring. What constitutes 'good mentorship' has been the topic of much debate. While research exploring mentorship exists, there is less research exploring co-created perceptions of mentorship by the mentee and mentor. OBJECTIVES: To explore student and registered midwives' co-created perspectives of what matters, what is valued and what is important in mentorship. DESIGN: An adapted Appreciative Inquiry methodology guided this study with thematic analysis used for data analysis. SETTINGS: One regional Australian university. PARTICIPANTS: A convenience sampling, from a population of 39 third-year Bachelor of midwifery students and 39 registered midwives providing clinical supervision for students enrolled in a specific unit of study and concurrently undertaking midwifery practice experience were recruited into this study. METHODS: Following the four-step process of Appreciative Inquiry; Appreciate, Envision, Co-create and Embed, imagery cards were provided, and participants selected the image that resonated with their understanding of mentorship. Shared understandings were cultivated to co-create what worked well and what was valued in facilitating a positive learning experience. RESULTS: Trust developed over time is a valued component of mentorship relationships. Similarly valued is the sense of belonging and feeling safe, elements reliant on the establishment of effective and respectful communication. CONCLUSION: What matters, what is valued and what is important in midwifery mentorship is a mutually respectful relationship between mentee and mentor. This requires time and trust and the creation of a space where the student can develop a sense of professional belonging and feel safe to learn. Further research is needed to explore ways to co-create safe learning environments. Appreciative Inquiry is a method suited to studying this area.

Students together with academics ensures retention and success: The STARS project.

BACKGROUND: Approximately 23% of Australian undergraduate students who commenced a degree in 2018 will not complete their program of study. Of these students, approximately 25% cite their 'study is too hard' or 'too much' when withdrawing from their degree. Research has identified that the most common group of students to struggle with completing their program of study are those from equity groups. OBJECTIVES: This paper explores a support strategy aimed at improving the first-year student experience and progression rates. DESIGN: A proof of concept project was undertaken to explore undergraduate midwifery students' experiences of an Expectation Led Planned Organisational teaching strategy into a course. SETTINGS: The study was undertaken at two sites of a regional University in New South Wales, Australia. PARTICIPANTS: All students (n42) enrolled in a core course, in the first year of a Bachelor of Midwifery program. METHODS: A mixed methods approach was used. Quantitative data was collected through the university's program and course management systems and analysed using descriptive statistics to find patterns. Qualitative data were collected via a focus group to provide greater knowledge of the acceptability of the strategy and analysed using content analysis. RESULTS: The inclusion of sequenced email reminders for upcoming assessment tasks was valued by students. There were greater retention and progression rates and a shift in the grade distribution towards higher course grades overall. Student satisfaction with learning activities increased along with course assessment satisfaction. CONCLUSION: Student engagement in learning is enhanced and retention and success rates are increased when academics use technology in a student focused manner. Further research is required to further explore and evaluate strategies that are student focused and acceptable as well as sustainable for the higher education context.

'Continuity of Care Experiences' within pre-registration midwifery education programs: A scoping review.

BACKGROUND: Midwifery is based on the philosophy of woman-centred care. The continuity of care experience in pre-registration education programs exemplifies this philosophy. Wide variation in how education providers implement 'Continuity of Care Experiences' into their programs of study can challenge this valuable learning opportunity. AIM: To provide a comprehensive analysis of the governance and empirical evidence of knowledge, practice and enablers to support continuity of care experiences within pre-registration midwifery education. METHOD: A scoping review of research, policy and professional documents pertaining to the continuity of care experience in pre-registration education programs was conducted with 46 articles meeting the inclusion criteria. FINDINGS: Several factors were identified that support the implementation, facilitation and evaluation of the continuity of care experience within pre-registration midwifery education. These include: a woman-centred model of maternity care; enabling midwifery students and women to develop 'relational continuity'; tripartite support models; optimising the sequencing of these experiences within the program and, woman-led evaluations of student performance. There was little consensus regarding the pedagogical intent and, therefore, an inability to clearly define and measure the learning outcomes of the continuity of care experience. CONCLUSION: In countries where the predominant model of maternity care is fragmented and not woman-centred, further research is required to understand the pedagogical intent of the continuity of care experience.

Impact of Perinatal Depression and Anxiety on Birth Outcomes: A Retrospective Data Analysis.

OBJECTIVES: During the perinatal period, 10-20% of women experience anxiety and/or depression. Untreated perinatal depression has the potential for adverse effects on the family and infant resulting in long-term deleterious consequences. This study measured the association between self-reported depression using the Edinburgh Postnatal Depression Scale scores, self-reported anxiety and neonatal birth outcomes. METHODS: A retrospective design was used with ObstetriX™ data retrieved from 16 metropolitan and rural hospitals in NSW, Australia during 2009-2014. Data were available for 53,646 singleton births. The Edinburgh Postnatal Depression Scale was used to identify self-reported depression while women self-reported pregnancy related anxiety. Regression modelling measured the effects of self-reported depression and self-reported pregnancy related anxiety on neonatal birth outcomes. Linear regression and logistic regression were used to model the effect on birth weight, gestational age, admission to NICU or the SCN, outcome (stillborn vs livebirth), and Apgar scores. Cox proportional hazards regression was used to estimate the effect on neonatal length of stay. RESULTS: Babies born to women self-reporting anxiety were more likely to have birth complications, be admitted to the nursery, had lower Apgar scores and longer hospital stays. Babies born to women self-identifying as experiencing a level of depression were more likely to have a lower birth weight, shorter gestational age, and, lower Apgar score. These babies were more likely to be admitted to the nursery with an increased length of stay. CONCLUSIONS: Perinatal anxiety and depression contribute to poor birth outcomes. Early detection of maternal perinatal anxiety and depression is an important step towards treatment interventions. More research is needed to identify models of care that are effective in identifying and managing perinatal depression and anxiety to improve birth outcomes for women and their babies.

Neonatal resuscitation training for midwives in Australia: A discussion of current practice.

BACKGROUND: More than 300,000 babies are born in Australia each year, with almost 20% of newborns requiring some form of neonatal resuscitation at birth. The most common first responders to a neonatal resuscitation emergency are midwives. While the Australian and New Zealand Council on Resuscitation guides midwives' practice during a neonatal resuscitation, each state and territory uses varying strategies to train and assess midwives proficiency in neonatal resuscitation. AIM: To examine the neonatal resuscitation training requirements for midwives and raise awareness for the lack of consistency in training in Australia. DISCUSSION: A significant variation was found in the teaching methods and frequency of training for neonatal resuscitation across Australia. Neonatal resuscitation is mandated through a state-wide guideline or policy in only four of the states with seven formal neonatal resuscitation training programs used across seven states and territories. Although a multi-modal approach to learning is present in all of the programs, the combination of teaching methods differ. CONCLUSION AND RECOMMENDATIONS: A standardised, evidence-based training program is required to ensure consistency in training for midwives in Australia. Multi-modal learning is common across all current training programs; however, the best combination of multi-modal teaching methods needs to be determined. Neonatal resuscitation training needs to occur at least annually, as recommended by the Australian and New Zealand Council on Resuscitation.

Development and validation of the Australian Midwifery Standards Assessment Tool (AMSAT) to the Australian Midwife Standards for Practice 2018.

BACKGROUND: The Australian Midwifery Standards Assessment Tool (AMSAT) was developed against the Competency Standards for the Midwife in 2017 to enable consistent assessment of midwifery student performance in practice-based settings. The AMSAT requires revision and re-validation as the competency standards have now been superseded by the Midwife Standards for Practice 2018. OBJECTIVE: This research revised and validated the AMSAT to assess performance of midwifery students against the Midwife Standards for Practice 2018 and assessed its sensitivity. DESIGN: A mixed-methods approach was used in a two-phase process. Phase one involved the re-wording of the AMSAT and behavioural cue statements in an iterative participatory process with midwifery academics, assessors and students. The tool was field-tested in different assessment environments in phase two. Completed assessment forms were statistically analyzed, whilst assessor surveys were analysed using descriptive statistics and qualitative content analysis. FINDINGS: Analysis of AMSAT (n=255) indicates the tool as: internally reliable (Cronbach alpha>.9); valid (eigenvalue of 16.6 explaining 67% of variance); and sensitive (score analysis indicating increased levels of proficiency with progressive student experience). Analysis of surveys (n=108) found acceptance of the tool for the purpose of summative and formative assessment, and in the provision of feedback to midwifery students on their performance. CONCLUSION: This study demonstrates that the re-developed AMSAT is a valid, reliable and acceptable tool to assess midwifery students' performance against the Australian Midwife Standards for Practice This user-friendly tool can be used to standardize midwifery student assessment in Australia and enable continued benchmarking across education programs.

Nurses and midwives teaching in the academic environment: An appreciative inquiry.

BACKGROUND: The past two decades has seen significant change in nursing and midwifery education in Australia. Although, regulatory documents explicate expectations of teaching, and supervising in the context of being a nurse or midwife, the move from hospital-based to higher education learning nessitated a change in how students receive their education and who provides it. The quality of teaching by nurse or midwife academics is subject to the academic's ability to transition from a clinical educator to academic. OBJECTIVE: To explore the experiences of nurse and midwife academics teaching in the academic environment. DESIGN: Appreciative Inquiry (AI) was used to explore the experiences of academics teaching final year nursing and midwifery students. SETTING: Two regional universities in Australia. PARTICIPANTS: Seven nursing and midwifery academics teaching a unit of study focusing on mentorship, leadership and teaching. METHODS: Narrative data from interviews conducted using AI were collected, transcribed and analysed to produce themes. RESULTS: Three key themes were identified; 'Feeling valued', 'Feeling safe' and 'Having connections'. These themes and related subthemes impacted teaching experiences and role transition from experienced clinician to academic. CONCLUSION: Nursing and midwifery academics would benefit from organisational support in their role transition from clinician to academic. Further research is crucial regarding initiatives that can support academics to feel safe, valued and connected when teaching the next generation of nurses and midwives.

The Support for New Mums Project: A protocol for a pilot randomized controlled trial designed to test a postnatal psychoeducation smartphone application.

AIM: To report a pilot trial protocol for testing the effectiveness of the Support for New Mums smartphone application in a cohort of first-time mothers. DESIGN: A pilot/feasibility randomized controlled trial using a two-group pre-test and repeated post-test design. METHOD: This protocol follows the Standard Protocol Items: Recommendations for Intervention Trials (SPIRIT) guidelines. The Intervention group will receive access to the smartphone application for 6 weeks post birth. Both Intervention and control groups will receive standardized institutional postnatal care services. Trial funding was gained from respective grant sponsors in May and November 2016. DISCUSSION: The Support for New Mums smartphone application could be a novel method for addressing the gap in provision of postpartum care services providing psychoeducation and improving maternal parental self-efficacy for Australian childbearing women. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12618001580268.

Nursing and Midwifery Students' Sense of Connectedness Within Their Learning Communities.

BACKGROUND: Recognition of the importance of a supportive academic and clinical learning environment for nursing and midwifery students enrolled in health care programs is not new. However, the factors that influence social connections within these environments and the consequences for students' learning are not well understood. METHOD: This study used a multisite mixed-methods design to examine students' learning experiences. RESULTS: Participants stated that to develop a sense of professional connectedness, opportunities are needed to develop meaningful relationships with academic staff and peers through increased face-to-face on-campus learning experiences, as well as through off-campus contexts. CONCLUSION: To enhance nursing and midwifery students' sense of connectedness, the balance between online and face-to-face learning experiences needs to be reexamined, and a renewed focus on the development of quality clinical learning experiences that foster a sense of belonging also is needed. [J Nurs Educ. 2019;58(1):47-52.].

Mobile Breast Cancer e-Support Program for Chinese Women With Breast Cancer Undergoing Chemotherapy (Part 2): Multicenter Randomized Controlled Trial.

BACKGROUND: Women undergoing chemotherapy for the treatment of breast cancer have frequently reported unmet supportive care needs. Moreover, easily accessible and innovative support is lacking. OBJECTIVE: The purpose of this trial was to determine the effectiveness of an app-based breast cancer e-support program to address women's self-efficacy (primary outcome), social support, symptom distress, quality of life, anxiety, and depression. Secondary objectives included exploring the association between women's health outcomes and the breast cancer e-support usage data. METHODS: A multicenter, single-blinded, randomized controlled trial was conducted. A total of 114 women with breast cancer, who were commencing chemotherapy and were able to access internet through a mobile phone, were recruited in the clinics from 2 university-affiliated hospitals in China. Women were randomized either to the intervention group (n=57) receiving breast cancer e-support plus care as usual or the control group (n=57) receiving care as usual alone. The health care team and research assistants collecting data were blinded to the women's group allocation. Bandura's self-efficacy theory and the social exchange theory guided the development of the breast cancer e-support program, which has 4 components: (1) a Learning forum, (2) a Discussion forum, (3) an Ask-the-Expert forum, and (4) a Personal Stories forum. Moderated by an experienced health care professional, the breast cancer e-support program supported women for 12 weeks covering 4 cycles of chemotherapy. Health outcomes were self-assessed through paper questionnaires in clinics at baseline before randomization (T0), after 3 (T1), and 6 months (T2) of follow-ups. RESULTS: Fifty-five participants in the intervention group and 49 in the control group completed the follow-up assessments (response rate: 91.2%). During the 12-week intervention, the log-in frequency ranged from 0 to 774 times (mean 54.7; SD 131.4; median 11; interquartile range, IQR 5-27), and the total usage duration ranged from 0 to 9371 min (mean 1072.3; SD 2359.5; median 100; IQR 27-279). Repeated measures multivariate analysis of covariance (intention-to-treat) found that breast cancer e-support + care as usual participants had significant better health outcomes at 3 months regarding self-efficacy (21.05; 95% CI 1.87-40.22; P=.03; d=0.53), symptom interference (-0.73; 95% CI -1.35 to -.11; P=.02; d=-0.51), and quality of life (6.64; 95% CI 0.77-12.50; P=.03, d=0.46) but not regarding social support, symptom severity, anxiety, and depression compared with care as usual participants. These beneficial effects were not sustained at 6 months. Spearman rank-order correlation showed that the breast cancer e-support usage duration was positively correlated with self-efficacy (r=.290, P=.03), social support (r=.320, P=.02), and quality of life (r=.273, P=.04) at 3 months. CONCLUSIONS: The breast cancer e-support program demonstrated its potential as an effective and easily accessible intervention to promote women's self-efficacy, symptom interference, and quality of life during chemotherapy. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12616000639426; www.ANZCTR.org.au/ACTRN12616000639426.aspx (Archived by Webcite at http://www.webcitation.org/6v1n9hGZq).

Mobile Breast Cancer e-Support Program for Chinese Women With Breast Cancer Undergoing Chemotherapy (Part 1): Qualitative Study of Women's Perceptions.

BACKGROUND: Women with breast cancer undergoing chemotherapy experience difficulty in accessing adequate cancer care in China. Mobile apps have the potential to provide easily accessible support for these women. However, there remains a paucity of randomized controlled trials to evaluate the effectiveness of app-based programs targeting specifically women with breast cancer undergoing chemotherapy. Moreover, women's perceptions and experiences related to using and interacting within the app-based program have rarely been reported. Therefore, an app-based Breast Cancer e-Support program was developed and evaluated using a randomized controlled trial. Based on the incorporation of Bandura's self-efficacy and social exchange theory, Breast Cancer e-Support program lasted for 12 weeks covering 4 cycles of chemotherapy and had 4 components: (1) a Learning forum, (2) a Discussion forum, (3) an Ask-the-Expert forum, and (4) a Personal Stories forum. OBJECTIVE: As a part of the randomized controlled trial, the aim of this study was to explore the participants' perception of Breast Cancer e-Support program, its strengths and weaknesses, and suggestions to improve the program. METHODS: A descriptive qualitative study was employed. Thirteen women with breast cancer from 2 university-affiliated hospitals in China, who were randomly allocated to the Breast Cancer e-Support program in the randomized controlled trial, were interviewed from November 2016 to February 2017. Purposive sampling was used based on women's scores of self-efficacy after the completion of the intervention. Inductive content analysis was used to analyze the transcripts, allowing the categories and subcategories to flow from the data. RESULTS: The qualitative interviews revealed that participants perceived the Breast Cancer e-Support program to be helpful in enhancing knowledge, improving confidence level, and promoting emotional well-being. Women also identified access to tailored advice from experts and convenience as the benefits of this program. Physical or psychological health status, stigma related with breast cancer, and app instability were mentioned as the challenges to engagement. Suggestions for improvement included adding message reminders to prompt instant communication and search engine to locate information quickly, supplementing more interesting and practical knowledge, updating the information more often, and quickening the responses to women's questions. The participants recommended the Breast Cancer e-Support program to be incorporated as routine care to support women during chemotherapy. CONCLUSIONS: This study demonstrates the potential of the Breast Cancer e-Support program to support women during chemotherapy. Future app-based programs should apply a family-centered approach and provide more support on stigma associated with the disease to encourage engagement with the app. Suggestions of improvement regarding the design, content, and operation of the app-based intervention should be addressed in future studies. It is promising to incorporate the Breast Cancer e-Support program into routine care to generalize the benefits. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12616000639426; http://www.ANZCTR.org.au/ ACTRN12616000639426.aspx (Archived by WebCite at http://www.webcitation.org/6v1n9hGZq).

A historical account of the governance of midwifery education in Australia and the evolution of the Continuity of Care Experience.

BACKGROUND: Midwifery programs leading to registration as a midwife in Australia have undergone significant change over the last 20 years. During this time accreditation and governance around midwifery education has been reviewed and refined, moving from state to national jurisdiction. A major change has been the mandated inclusion of Continuity of Care Experiences as a clinical practice-based learning component. AIM: The purpose of this discussion is to present the history of the governance and accreditation of Australian midwifery programs. With a particular focus on the evolution of the Continuity of Care Experience as a now mandated clinical practice based experience. METHODS: Historical and contemporary documents, research and grey literature, are drawn together to provide a historical account of midwifery programs in Australia. This will form the background to the inclusion of the Continuity of Care Experience and discuss research requirements to enhance the model to ensure it is educationally sound. DISCUSSION: The structure and processes for the Continuity of Care Experience vary between universities and there is currently no standard format across Australia. As such, how it is interpreted and conducted varies amongst students, childbearing women, academics and midwives. The Continuity of Care Experience has always been strongly advocated for; however there is scant evidence available in terms of its educational theory underpinnings. CONCLUSION: Research concerned with the intended learning objectives and outcomes for the Continuity of Care Experience will support the learning model and ensure it continues into the future as an educationally sound learning experience for midwifery students.

A mobile application of breast cancer e-support program versus routine Care in the treatment of Chinese women with breast cancer undergoing chemotherapy: study protocol for a randomized controlled trial.

BACKGROUND: Women with breast cancer undergoing chemotherapy suffer from a number of symptoms and report receiving inadequate support from health care professionals. Innovative and easily accessible interventions are lacking. Breast Cancer e-Support is a mobile Application program (App) that provides patients with individually tailored information and a support group of peers and health care professionals. Breast Cancer e-Support aims to promote women's self-efficacy, social support and symptom management, thus improving their quality of life and psychological well-being. METHODS: A single-blinded, multi-centre, randomised, 6-month, parallel-group superiority design will be used. Based on Bandura's self-efficacy theory and the social exchange theory, Breast Cancer e-Support has four modules: 1) a Learning forum; 2) a Discussion forum; 3) an Ask-the-Expert forum; and 4) a Personal Stories forum. Women with breast cancer (n = 108) who are commencing chemotherapy will be recruited from two university-affiliated hospitals in China. They will be randomly assigned to either control group that receives routine care or intervention group that receives routine care plus access to Breast Cancer e-Support program during their four cycles of chemotherapy. Self-efficacy, social support, symptom distress, quality of life, and anxiety and depression will be measured at baseline, then one week and 12 weeks post-intervention. DISCUSSION: This is the first study of its kind in China to evaluate the use of a mobile application intervention with a rigorous research design and theoretical framework. This study will contribute to evidence regarding the effectiveness of a theory-based mobile application to support women with breast cancer undergoing chemotherapy. The results should provide a better understanding of the role of self-efficacy and social support in reducing symptom distress and of the credibility of using a theoretical framework to develop internet-based interventions. The results will provide evidence to support the implementation of an innovative and easily accessible intervention that enhances health outcomes. TRIAL REGISTRATION: ACTRN: ACTRN12616000639426 , Registered 17 May, 2016.

Integrative Review on the Effectiveness of Internet-Based Interactive Programs for Women With Breast Cancer Undergoing Treatment.

PROBLEM IDENTIFICATION: Internet-based interactive programs have been developed to address health needs for women with breast cancer undergoing treatment, but evidence has been inadequate to establish the effectiveness of these programs. This article aims to synthesize studies published in English or Chinese regarding the effectiveness of these programs on the outcomes of symptom distress, social support, self-efficacy, quality of life, and psychological well-being for women with breast cancer undergoing treatment.
. LITERATURE SEARCH: CINAHL Complete, MEDLINE®, Mosby's Nursing Index, PsycINFO®, Scopus, Web of Science, Joanna Briggs Institute, Cochrane Library, Embase, and China National Knowledge Infrastructure. Databases were searched from the start of the database to April 2015.
. DATA EVALUATION: 174 articles were retrieved, yielding 23 eligible articles. A manual search led to an additional five eligible articles. After 10 were excluded, 3 qualitative and 15 quantitative studies were evaluated. Data were analyzed to identify similarities and differences across articles.
. SYNTHESIS: Internet-based interactive programs moderated by healthcare professionals have demonstrated positive effects on women's self-efficacy, symptom distress, and psychological well-being, but inconclusive effects have been found on social support and quality of life.
. CONCLUSIONS: Moderated Internet-based interactive programs are a promising intervention for women with breast cancer undergoing treatment.
. IMPLICATIONS FOR RESEARCH: Studies with more robust research designs and theoretical frameworks and conducted in different countries and cultures are warranted to elucidate the effectiveness of these programs.

Development of a mobile application of Breast Cancer e-Support program for women with breast cancer undergoing chemotherapy.

BACKGROUND: Women with breast cancer undergoing chemotherapy experience a variety of physical and psychosocial symptoms, which have negative effect on women's quality of life and psychological well-being. Although M-health technologies provides innovative and easily accessible option to provide psychosocial support, mobile phone based interventions remain limited for these women in China. OBJECTIVE: To develop a new mobile application to offer information as well as social and emotional support to women with breast cancer undergoing chemotherapy to promote their self-efficacy and social support, thus improving symptom management strategies. METHODS: Basing on previous theoretical framework which incorporated Bandura's self-efficacy theory and the social exchange theory, a new mobile application, called Breast Cancer e-Support Program (BCS) was designed, with the content and functionality being validated by the expert panel and women with breast cancer. RESULTS: BCS App program has four modules: 1) Learning forum; 2) Discussion forum; 3) Ask-the-Expert forum; and 4) Personal Stories forum. BCS program can be applied on both android mobile phones and iPhones to reach more women. CONCLUSIONS: This is the first of its kind developed in China for women with breast cancer undergoing chemotherapy. A randomized controlled trial is undertaking to test the effectiveness of BCS program.

Weighing as a stand-alone intervention does not reduce excessive gestational weight gain compared to routine antenatal care: a systematic review and meta-analysis of randomised controlled trials.

BACKGROUND: Excessive gestational weight gain is associated with short and long-term adverse maternal and infant health outcomes, independent of pre-pregnancy body mass index. Weighing pregnant women as a stand-alone intervention during antenatal visits is suggested to reduce pregnancy weight gain. In the absence of effective interventions to reduce excessive gestational gain within the real world setting, this study aims to test if routine weighing as a stand-alone intervention can reduce total pregnancy weight gain and, in particular, excessive gestational weight gain. METHODS: A systematic review and meta-analysis of randomised controlled trials (RCTs) was conducted between November 2014 and January 2016, and reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Seven databases were searched. A priori eligibility criteria were applied to published literature by at least two independent reviewers. Studies considered methodologically rigorous, as per the Academy of Nutrition and Dietetics Quality Criteria Checklist for Primary Research, were included. Meta-analysis was conducted using fixed-effects models. RESULTS: A total of 5223 (non-duplicated) records were screened, resulting in two RCTs that were pooled for meta-analysis (n = 1068 randomised participants; n = 538 intervention, n = 534 control). No difference in total weight gain per week was observed between intervention and control groups (weighted mean difference (WMD) -0.00 kg/week, 95% confidence interval (CI) -0.03 to 0.02). There was also no reduction in excessive gestational weight gain between intervention and control, according to pre-pregnancy body mass index (BMI). However, total weight gain was lower in underweight women (n = 23, BMI <18.5 kg/m2) in the intervention compared to control group (-0.12 kg/week, 95% CI -0.23 to -0.01). No significant differences were observed for other pregnancy, birth and infant outcomes. CONCLUSION: Weighing as a stand-alone intervention is not worse nor better at reducing excessive gestational weight gain than routine antenatal care.