Cancer Survivorship Issues: Dissemination and Translation of Evidence-Based Knowledge.

This issue of Cancers is a Special Issue focusing on 'cancer survivorship' [...].

Palliative Care in Rural Aboriginal Communities: Conversations Around Experiences and Needs.

The aim of this study was to investigate the experiences and needs of Aboriginal community members with regard to rural community-based palliative care. Conversations with Aboriginal Elders were conducted. (In this Aboriginal community, Elders was not confined to older age. It referred to community leaders and includes [younger] emerging leaders.) The results were analyzed using descriptive analysis. Our study showed that there was a general lack of understanding of palliative care as distinct from curative care and limited awareness of services available. There was a strong need for clear information and on-call and practical support. Some concerns were expressed regarding limited awareness among health care providers of specific cultural needs. However, the home-based nature of palliative care was not, in itself, perceived as a barrier, provided that appropriate respect was displayed. We concluded that the current lack of understanding and awareness of services still impedes access to, and utilization of, care. More attention is needed for specific cultural needs. Adoption of a cultural humility approach for the promotion and delivery of palliative care seems to best fit the expressed needs and experiences of the participants.

The Impact of Illness Perceptions and Coping Strategies on Use of Supportive Care for Cancer.

Despite evidence that survivorship support programmes enhance physical and psychosocial wellbeing, cancer patients and survivors often do not use these supportive care services. This study investigated the utility of the Common Sense Model of Self-Regulation for predicting supportive care use following cancer, and the mediating role of coping strategies. Cancer patients and survivors (n = 336 from Australia, n = 61 from the UK; 191 males, 206 females) aged 20-83 years (Mean (M) = 62.73, Standard Deviation (SD) = 13.28) completed an online questionnaire. Predictor variables were cognitive and emotional representations of cancer, as measured by the Illness Perception Questionnaire-Revised (IPQ-R), and problem- and emotion-focused coping strategies, as measured by the Brief-Coping Orientation to Problems Experienced inventory (Brief-COPE). The outcome variable was survivorship support programme use within the preceding month. Perceived personal control over cancer predicted supportive care use, but cancer-related emotional distress did not. Coping was an inconsistent mediator of the relationships. Problem-focused coping mediated the relationship between personal control and supportive care use; emotion-focused coping did not mediate between emotional responses to cancer and the uptake of survivorship support programmes. The Common Sense Model provides a useful framework for understanding survivorship support programme use. However, more clarity around the relationship between illness beliefs and coping is required.

Best practice in the implementation of telehealth-based supportive cancer care: Using research evidence and discipline-based guidance.

OBJECTIVE: To investigate what factors need consideration for telehealth services for cancer supportive care, given the rapid transition to telehealth as a result of COVID-19. METHODS: A scoping review and a review of current guidance and guidelines provided by professional bodies, representing relevant discipline groups for cancer supportive care, were conducted. RESULTS: We identified 19 papers and 23 telehealth guidance documents. The results highlight how the characteristics of patient group and healthcare provider influence the acceptability and utility of the service and establish a minimum set of preconditions. The reviews primarily examined patient-focused difficulties or issues with acceptability and efficacy, with only a minority highlighting how provider issues might also be implicated. By contrast, the guidance and guidelines described a need to address skills gaps in providing and receiving support through telehealth. CONCLUSION: The capacity and willingness of services to adapt, in the context of COVID-19, is reassuring. It is important that the impact of the move to telehealth on service quality is assessed and systems put in place to ensure sustainability, acceptability, and adaptability. PRACTICE IMPLICATIONS: Key recommendations can be made to assist service telehealth optimisation, many of which apply irrespective of the specific service focus.

Making community palliative and end-of-life care sustainable; investigating the adaptability of rural Australian service provision.

With the increased attention and demand on community-based palliative and end-of-life (EOL) care services comes the question of how to ensure their sustainability. Sustainability has three key attributes: acceptability, affordability and adaptability. Having established the acceptability and affordability of the community-based service, this paper focussed on adaptability, as the remaining issue affecting long-term sustainability. The aim of this study was to identify components of the palliative and EOL service which require adaptability to ensure long-term sustainability for the service. A mixed methods approach was used for this study. Semi-structured interviews were conducted with family members. Semi-structured focus groups and interviews were held with health professionals. Patient data were included to describe frequency and nature of contacts. The results were analysed using descriptive analysis. The setting was a rural town in Victoria, Australia. Nine family members were interviewed, and 16 health professionals were interviewed or took part in a focus group. Patient data included 121 participants. Four themes were identified: the uniqueness of the patient, workforce issues, collaboration between services and symptom and pain management. All themes indicated that the palliative and EOL service faces challenges which may threaten the sustainability of the service and require adaptability. Families regard palliative and EOL care as special and valued, and appreciate the endeavour, care and support taken to assist their loved one to die with dignity regardless of the location and setting. With sufficient attention paid to the adaptability of the service, community palliative and EOL care service can become more sustainable, thus offering choice and dignity for people approaching the end of life.

An inventory of psychosocial oncological interventions in The Netherlands: identifying availability, gaps, and overlap in care provision.

Purpose: While a wide range of psychosocial oncological (PO) interventions has been developed, a systematic overview of interventions to inform patients, care providers, as well as researchers, policy makers and health insurers, is lacking. The aims of this paper were (1) to describe the attainment of this overview, which may be used in other jurisdictions and for other health conditions and (2) to reflect on what determines developments in this field.Methods: Dutch researchers and care providers were invited to describe PO-interventions they apply in research or clinical practice. Selection criteria for what constituted a PO-intervention were determined. The input was organized in 12 predefined categories (e.g. physical functioning, genetics).Findings: Sixty-six PO-interventions were included in the overview. Two major categories were psychosocial functioning (24%) and physical functioning and recovery (24%). Interventions are mostly directed at adults (65%) and not aimed at a specific type of cancer (61%). Nearly 25% of the interventions lacked scientific underpinning.Conclusions: This paper provides an overview of Dutch PO-interventions and input on what drives their development. The categorizing method can be used in other jurisdictions and for other health care conditions. A next step would be to investigate the effectiveness and evidence of PO-interventions.Implications for Psychosocial Providers and Policy: The open access overview of interventions provides referral information for care providers. By identifying possible gaps and overlap, the overview looks at possible drivers behind developments in this field which will be of interest to policy makers.

Factors influencing the engagement of cancer patients with advance care planning: A scoping review.

INTRODUCTION: Advance care planning (ACP) is increasingly regarded as the best way to optimise end-of-life (EOL) care. Studies have examined a multitude of factors impacting on the lagging uptake of ACP. In the current study, we specifically focused on patient factors related to the uptake of ACP in adult cancer patients. METHODS: A scoping review was conducted, for which we searched the CINAHL, Cochrane, MEDLINE and PsycINFO databases (January 2013-December 2018). Studies exploring patient-related factors influencing the uptake of ACP in cancer patients were eligible for inclusion. RESULTS: Eleven papers and two overarching themes: person-related (e.g. socio-demographic) factors and "comprehension and awareness," were identified. White, well-educated patients with a support network were more likely to be involved in ACP. However, there is limited comprehension and awareness among cancer patients regarding ACP. CONCLUSIONS: The identified themes warrant a tailored approach to ACP. With regard to person-related factors, the existing body of knowledge on health literacy, disparities and shared decision-making should be used when designing strategies to improve ACP uptake. Further, our findings regarding "comprehension and awareness" suggest that ACP should not be limited to a narrow process without acknowledging the complexity surrounding personalised cancer care near the EOL.

Maternity leave duration and adverse pregnancy outcomes: An international country-level comparison.

AIM: Preterm birth and low birthweight (LBW) lead to infant morbidity and mortality. The causes are unknown. This study evaluates the association between duration of maternity leave and birth outcomes at country level. METHOD: We compiled data on duration of maternity leave for 180 countries of which 36 specified prenatal leave, 190 specified income, 183 specified preterm birth rates and 185 specified the LBW rate. Multivariate and seemingly unrelated regression analyses were done in STATA. RESULTS: Mean maternity leave duration was 15.4 weeks ( SD=7.7; range 4-52 weeks). One additional week of maternity leave was associated with a 0.09% lower preterm rate (95% confidence interval [CI] -0.15 to -0.04) adjusting for income and being an African country. An additional week of maternity leave was associated with a 0.14% lower rate of LBW (95% CI -0.24 to -0.05). Mean prenatal maternity leave across 36 countries was six weeks ( SD=2.7; range 2-14 weeks). One week of prenatal maternity leave was associated with a 0.07% lower preterm rate (95% CI -0.10 to 0.24) and a 0.06% lower rate of LBW (95% CI -0.14 to 0.27), but these results were not statistically significant. By adjusting for income status categories, the preterm birth rate was 1.53% higher and the LBW rate was 2.17% higher in Africa compared to the rest of the world. CONCLUSIONS: Maternity leave duration is significantly associated with birth outcomes. However, the association was not significant among 36 countries that specified prenatal maternity leave. Studies are needed to evaluate the correlation between prenatal leave and birth outcomes.

Health behaviour information provided to clients during midwife-led prenatal booking visits: Findings from video analyses.

OBJECTIVE: to quantify to what extent evidence-based health behaviour topics relevant for pregnancy are discussed with clients during midwife-led prenatal booking visits and to assess the association of client characteristics with the extent of information provided. DESIGN: quantitative video analyses. SETTING AND PARTICIPANTS: 173 video recordings of prenatal booking visits with primary care midwives and clients in the Netherlands taking place between August 2010 and April 2011. MEASUREMENTS: thirteen topics regarding toxic substances, nutrition, maternal weight, supplements, and health promoting activities were categorized as either 'never mentioned', 'briefly mentioned', 'basically explained' or 'extensively explained'. Rates on the extent of information provided were calculated for each topic and relationships between client characteristics and dichotomous outcomes of the extent of information provided were assessed using Generalized Linear Mixed Modelling. FINDINGS: our findings showed that women who did not take folic acid supplementation, who smoked, or had a partner who smoked, were usually provided basic and occasionally extensive explanations about these topics. The majority of clients were provided with no information on recommended weight gain (91.9%), fish promotion (90.8%), caffeine limitation (89.6%), vitamin D supplementation (87.3%), physical activity promotion (81.5%) and antenatal class attendance (75.7%) and only brief mention of alcohol (91.3%), smoking (81.5%), folic acid (58.4) and weight at the start of pregnancy (52.0%). The importance of a nutritious diet was generally either never mentioned (38.2%) or briefly mentioned (45.1%). Nulliparous women were typically given more information on most topics than multiparous women. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: although additional information was generally provided about folic acid and smoking, when relevant for their clients, the majority of women were provided with little or no information about the other health behaviours examined in this study. Midwives may be able to improve prenatal health promotion by providing more extensive health behaviour information to their clients during booking visits.

Client-Related Factors Associated with a "Less than Good" Experience of Midwifery Care during Childbirth in the Netherlands.

BACKGROUND: A "less than good" experience during childbirth can affect a mother's early interaction with her child and may significantly influence a woman's emotional well-being. In this study, we focus on clients who experienced midwifery care provided during childbirth as "less than good" care. The aim of this study was to understand the relationship between client-related factors and the experience of midwifery care during childbirth to improve this care. METHODS: This study was part of the "DELIVER study" where mothers report on the care they received. We used generalized estimation equations to control for correlations within midwife practices. Forward multivariate logistic regression analyses were conducted to model the client-related factors associated with the experienced midwifery care during childbirth. RESULTS: We included the responses of 2,377 women. In the multivariable logistic regression model, odds of reporting "less than good care" were significantly higher for women who experienced an unplanned cesarean birth (OR 2.21 [CI 1.19-4.09]), an instrumental birth (OR 1.55 [CI 1.08-2.23]), and less control during the dilation phase (OR 0.98 [CI 0.97-0.99]) and pushing phase (OR 0.98 [CI 0.97-0.99]). DISCUSSION: Birth-related factors were more likely than maternal characteristics to be associated with the experience of midwifery care during childbirth. We conclude that there is room for midwives to improve their care for women during childbirth particularly in improving the patient centeredness of the care provider, using strategies to enhance sense of control, and focusing on the particular needs of those who experience instrumental vaginal or unplanned cesarean births.

Clients' psychosocial communication and midwives' verbal and nonverbal communication during prenatal counseling for anomaly screening.

OBJECTIVES: This study focuses on facilitation of clients' psychosocial communication during prenatal counseling for fetal anomaly screening. We assessed how psychosocial communication by clients is related to midwives' psychosocial and affective communication, client-directed gaze and counseling duration. METHODS: During 184 videotaped prenatal counseling consultations with 20 Dutch midwives, verbal psychosocial and affective behavior was measured by the Roter Interaction Analysis System (RIAS). We rated the duration of client-directed gaze. We performed multilevel analyses to assess the relation between clients' psychosocial communication and midwives' psychosocial and affective communication, client-directed gaze and counseling duration. RESULTS: Clients' psychosocial communication was higher if midwives' asked more psychosocial questions and showed more affective behavior (ß=0.90; CI: 0.45-1.35; p<0.00 and ß=1.32; CI: 0.18-2.47; p=0.025, respectively). Clients "psychosocial communication was not related to midwives" client-directed gaze. Additionally, psychosocial communication by clients was directly, positively related to the counseling duration (ß=0.59; CI: 0.20-099; p=0.004). CONCLUSIONS: In contrast with our expectations, midwives' client-directed gaze was not related with psychosocial communication of clients. PRACTICE IMPLICATIONS: In addition to asking psychosocial questions, our study shows that midwives' affective behavior and counseling duration is likely to encourage client's psychosocial communication, known to be especially important for facilitating decision-making.

Career plans of primary care midwives in the Netherlands and their intentions to leave the current job.

BACKGROUND: In labour market policy and planning, it is important to understand the motivations of people to continue in their current job or to seek other employment. Over the last decade, besides the increasingly medical approach to pregnancy and childbirth and decreasing home births, there were additional dramatic changes and pressures on primary care midwives and midwifery care. Therefore, it is important to re-evaluate the career plans of primary care midwives and their intentions to leave their current job. METHODS: All 108 primary care midwives of 20 selected midwifery care practices in the Netherlands were invited to fill out a written questionnaire with questions regarding career plans and intentions to leave. Bivariate analyses were carried out to compare career plans and work-related and personal characteristics and attitudes towards work among the group of midwives who indicated that they intended to leave their current job (ITL group) and those who indicated they had no intention to leave (NITL group). Significant predictors of ITL were included in the multiple binary logistic regression with 'intention to leave' as the dependent variable. RESULTS: In 2010, 32.7% of the 98 participating primary care midwives surveyed had considered an intention to leave their current type of job in the past year. Fewer ITL midwives wanted to be a self-employed practitioner with the full range of primary care tasks and work full-time. Significant predictors of the primary care midwives' intention to leave included a lower overall score on the job satisfaction scale (OR = 0.18; 95% CI = 0.06-0.58; p = 0.004) and being between 30 and 45 years old (OR = 2.69; 95% CI = 1.04-7.0; p = 0.041). CONCLUSION: Our study shows that, despite significant changes in the reproductive, maternal and newborn health service delivery that impact on independent midwifery practice, the majority of primary care midwives intended to stay in primary care. The absence of job satisfaction, and being in the age group between 30 and 45 years old, is associated with primary care midwives' intention to leave their current job. Ongoing monitoring will be important in the future.

Explanatory factors for first and second-generation non-western women's inadequate prenatal care utilisation: a prospective cohort study.

BACKGROUND: Little research into non-western women's prenatal care utilisation in industrialised western countries has taken generational differences into account. In this study we examined non-western women's prenatal care utilisation and its explanatory factors according to generational status. METHODS: Data from 3300 women participating in a prospective cohort of primary midwifery care clients (i.e. women with no complications or no increased risk for complications during pregnancy, childbirth and the puerperium who receive maternity care by autonomous midwives) in the Netherlands (the DELIVER study) was used. Gestational age at entry and the total number of prenatal visits were aggregated into an index. The extent to which potential factors explained non-western women's prenatal care utilisation was assessed by means of blockwise logistic regression analyses and percentage changes in odds ratios. RESULTS: The unadjusted odds of first and second-generation non-western women making inadequate use of prenatal care were 3.26 and 1.96 times greater than for native Dutch women. For the first generation, sociocultural factors explained 43% of inadequate prenatal care utilisation, socioeconomic factors explained 33% and demographic and pregnancy factors explained 29%. For the second generation, sociocultural factors explained 66% of inadequate prenatal care utilisation. CONCLUSION: Irrespective of generation, strategies to improve utilisation should focus on those with the following sociocultural characteristics (not speaking Dutch at home, no partner or a first-generation non-Dutch partner). For the first generation, strategies should also focus on those with the following demographic, pregnancy and socioeconomic characteristics (aged ≤ 19 or ≥ 36, unplanned pregnancies, poor obstetric histories (extra-uterine pregnancy, molar pregnancy or abortion), a low educational level, below average net household income and no supplementary insurance.

Midwives' perceptions of communication during videotaped counseling for prenatal anomaly tests: how do they relate to clients' perceptions and independent observations?

OBJECTIVE: This study aimed to provide insight into Dutch midwives' self-evaluation of prenatal counseling for anomaly screening in real life practice and, the degree of congruence of midwives' self-assessments with clients' perceptions and with observed performance. METHODS: Counseling sessions were videotaped. We used the QUOTE(prenatal) questionnaire to have each midwife (N = 20) and her client (N = 240) rate the prenatal counseling that they had together. We used an adapted version of the RIAS video-coding system to assess actual counseling during videotaped prenatal counseling (N = 240). RESULTS: Midwives perceived the following functions of counseling performed well: 100% of Client-Counselor relation (CCR); 80% of Health Education (HE); and 17% Decision-Making Support (DMS). Congruence on HE of midwives with observers and with clients was ≥ 75%; congruence on DMS was higher between midwives and observers (80%) compared to midwives and clients (62%). CONCLUSION: Midwives perceive that during prenatal counseling the CCR and HE functions of counseling were performed well, whereas DMS was not. Furthermore, this study shows incongruence between midwives and clients about the discussion during DMS, indicating DMS is more difficult to assess than HE. PRACTICE IMPLICATIONS: The best way to measure prenatal counseling practice might be by using assessments of different sources within one study.

Factorial invariance of pregnancy-specific anxiety dimensions across nulliparous and parous pregnant women.

The 10-item version of the Pregnancy-Related Anxiety Questionnaire-Revised was developed based on a sample of nulliparous women. Whether this measure is also a valuable tool for future research on pregnancy-specific anxiety is unclear. Our study tested for invariance of this measure across nulliparous women and parous women by using a dataset of 6004 women pregnant up to 35 weeks. Results showed that whereas the factor structure of the 10-item version of the Pregnancy-Related Anxiety Questionnaire-Revised was noninvariant, removing item 8 from the measure created a measure with invariant factor loadings that can be used for all pregnant women.

Introducing video recording in primary care midwifery for research purposes: procedure, dataset, and use.

BACKGROUND: video recording studies have been found to be complex; however very few studies describe the actual introduction and enrolment of the study, the resulting dataset and its interpretation. In this paper we describe the introduction and the use of video recordings of health care provider (HCP)-client interactions in primary care midwifery for research purposes. We also report on the process of data management, data coding and the resulting data set. METHODS: we describe our experience in undertaking a study using video recording to assess the interaction of the midwife and her client in the first antenatal consultation, in a real life clinical practice setting in the Netherlands. Midwives from six practices across the Netherlands were recruited to videotape 15-20 intakes. The introduction, complexity of the study and intrusiveness of the study were discussed within the research group. The number of valid recordings and missing recordings was measured; reasons not to participate, non-response analyses, and the inter-rater reliability of the coded videotapes were assessed. Video recordings were supplemented by questionnaires for midwives and clients. The Roter Interaction Analysis System (RIAS) was used for coding as well as an obstetric topics scale. FINDINGS: at the introduction of the study, more initial hesitation in co-operation was found among the midwives than among their clients. The intrusive nature of the recording on the interaction was perceived to be minimal. The complex nature of the study affected recruitment and data collection. Combining the dataset with the questionnaires and medical records proved to be a challenge. The final dataset included videotapes of 20 midwives (7-23 recordings per midwife). Of the 460 eligible clients, 324 gave informed consent. The study resulted in a significant dataset of first antenatal consultations involving recording 269 clients and 194 partners. CONCLUSION: video recording of midwife-client interaction was both feasible and challenging and resulted in a unique dataset of recordings of midwife-client interaction. Video recording studies will benefit from a tight design, and vigilant monitoring during the data collection to ensure effective data collection. We provide suggestions to promote successful introduction of video recording for research purposes.

Antenatal counselling for congenital anomaly tests: an exploratory video-observational study about client-midwife communication.

OBJECTIVE: antenatal counselling for congenital anomaly tests is conceptualised as having both Health Education (HE) and Decision-Making Support (DMS) functions. Building and maintaining a client-midwife relation (CMR) is seen as a necessary condition for enabling these two counselling functions. However, little is known about how these functions are fulfilled in daily practice. This study aims to describe the relative expression of the antenatal counselling functions; to describe the ratio of client versus midwife conversational contribution and to get insight into clients' characteristics, which are associated with midwives' expressions of the functions of antenatal counselling. DESIGN: exploratory video-observational study. PARTICIPANTS AND SETTING: 269 videotaped antenatal counselling sessions for congenital anomaly tests provided by 20 midwives within six Dutch practices. MEASUREMENTS: we used an adapted version of the Roter Interaction Analysis System to code the client-midwife communication. Multilevel linear regression analyses were used to analyse associations between clients' characteristics and midwives' expressions of antenatal counselling in practice. FINDINGS: most utterances made during counselling were coded as HE (41%); a quarter as DMS (23%) and 36% as CMR. Midwives contributed the most to the HE compared to clients or their partners (91% versus 9%) and less to the DMS function of counselling (61% versus 39%). Multilevel analyses showed an independent association between parity and shorter duration of antenatal counselling; (ß=-3.01; p<0.001). The amount of utterances concerning HE and DMS during counselling of multipara was less compared to nulliparous. KEY CONCLUSIONS: antenatal counselling for congenital anomaly tests by midwives is focused on giving HE compared to DMS. The relatively low contribution of clients during DMS might indicate poor DMS given by midwives. Counselling of multipara was significantly shorter than counselling of nulliparous; multiparae received less HE as well as DMS compared to nulliparous women. IMPLICATIONS FOR PRACTICE: our findings should encourage midwives to reflect on the process of antenatal counselling they offer with regards to the way they address the three antenatal counselling functions during counselling of nulliparous women compared to multiparae.

Knowledge and acceptability of Chlamydia trachomatis screening among pregnant women and their partners; a cross-sectional study.

BACKGROUND: Chlamydia trachomatis infections in pregnancy can cause maternal disease, adverse pregnancy outcomes and neonatal disease, which is why chlamydia screening during pregnancy has been advocated. The effectiveness of a screening program depends on the knowledge of health care professionals, women and partners and the acceptability for screening of the target population. We assessed the knowledge of chlamydia infection among pregnant women and their partners in the Netherlands, their attitudes towards testing, and their experiences of being offered a chlamydia test. In addition, we evaluated the association between participants' background characteristics and knowledge of chlamydia. METHODS: Pregnant women aged ≤ 30 years and their partners (regardless of their age) attending one of the participating primary midwifery care practices in the Netherlands were invited to participate. All participants completed a questionnaire, pregnant women provided a vaginal swab and partners provided a urine sample to test for C. trachomatis. RESULTS: In total, 383 pregnant women and 282 partners participated in the study of whom 1.9% women and 2.6% partners tested chlamydia positive. Participants had high levels of awareness (92.8%) of chlamydial infection. They were knowledgeable about the risk of chlamydia infection; median knowledge score was 9.0 out of 12.0. Lower knowledge scores were found among partners (p-value <0.001), younger aged (p-value 0.02), non-western origin (p-value <0.001), low educational level (p-value <0.001), and no history of sexually transmitted infections (p-value <0.001). In total, 78% of respondents indicated that when pregnant women are tested for chlamydia, their partners should also be tested; 54% believed that all women should routinely be tested. Pregnant women more often indicated than partners that testing partners for chlamydial infection was not necessary (p-value <0.001). The majority of pregnant women (56.2%) and partners (59.2%) felt satisfied by being offered the test during antenatal care. CONCLUSION: Pregnant women and their partners were knowledgeable about chlamydial infection, found testing, both pregnant women and their partners, for chlamydia acceptable and not stigmatizing.

What information do Dutch midwives give clients about toxoplasmosis, listeriosis and cytomegalovirus prevention? An exploratory study of videotaped consultations.

OBJECTIVE: To assess information provided by midwives about methods to prevent toxoplasmosis, listeriosis and cytomegalovirus, and whether the amount of provided information varied according to clients' and midwives' characteristics. METHODS: Intake consultations with 229 clients in four midwifery practices were videotaped between August 2010 and April 2011. Videotaped intake consultations, where infectious disease prevention were discussed, were evaluated, using a specifically designed nine-item scoring tool. Midwives and clients filled in a questionnaire about their background characteristics. Multilevel linear regression analysis was performed to establish associations between the amount of information provided and clients' and midwives' characteristics. RESULTS: In total 172 consultations with fifteen midwives were suitable for analyses. Information about not eating raw or undercooked meat and not consuming unpasteurized dairy products was provided most often. Information about not sharing eating utensils with small children and thoroughly reheating all ready-to-eat foods were rarely provided. More information was provided when the client was a primigravidae or the consultation lasted longer than 50min. CONCLUSION: Information on infectious disease prevention given to pregnant women by primary care midwives was insufficient; especially for cytomegalovirus prevention. PRACTICE IMPLICATIONS: A guideline for professionals on preventable infectious diseases may be useful to inform pregnant women properly.