Oral Presentation Women's Health Forum 2021

Key learnings from a process of embedding a digital platform in a new antenatal service: the txt4two experience (#17)

Jane Willcox 1 , Sheridan Guyatt 2 3 , Brianna Fjeldsoe 4 , Shelley Wilkinson 5 6
  1. School of Nursing & Midwifery, Deakin University, Melbourne, Victoria
  2. Physiotherapy, Mater Mothers Hospital, Brisbane, Queensland
  3. Mater Research Institute-The University of Queensland, Brisbane
  4. Enable Health Consulting, Brisbane, Queensland
  5. (Formerly) Department of Dietetics & Foodservices, Mater Mothers Hospital, Brisbane, Queensland
  6. School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Queensland

Introduction: Optimal antenatal nutrition, physical activity and gestational weight gain (GWG) confer positive outcomes for mother and child. txt4two is a multi-modality intervention that aims to promote healthy nutrition, physical activity and GWG in pregnant women.  Delivery modalities include health professional introduction, tailored, bi-directional text messages, information website, videos, and chat room (Facebook®). Program components were developed and mapped to behaviour change techniques and included goal setting and self-monitoring. A txt4twofeasibility RCT (n=91) demonstrated a significantly lower GWG (7.8kg + 4.7 versus 9.7 kg + 3.9; p= 0.041) and smaller reductions in physical activity (p=0.001).

Following the feasibility trial, another antenatal service wished to comparatively evaluate a pragmatic implementation of an adapted version of txt4two.  Modifications included a comparison of three modes of initial engagement for health professional introduction (F2F, group, telehealth) and embedded other txt4two modalities into the antenatal platform.

Transferring a research program to embed in another context brought up numerous implementation bridges (facilitators) and areas for negotiation.

Bridges

  • Implementation focus of txt4two and transparent implementation plan
  • Early inclusion of key stakeholders
  • Embedded research dietitian with in-depth understanding of context and funding
  • Health services redesign priority embracing digital disruption in dietetics to explore the potential of broad reach/low intensity methods of delivery

Areas for negotiation

  • Refocusing towards the needs of women in different region
  • Intellectual property ownership and transactions
  • Legal agreements across institutions
  • Technology infrastructure
  • Additional ethics requirements for digital delivery
  • Health professional behavior change and digital intervention perspectives

Conclusion: As we move beyond pilots and embed research programs within health services, we need to understand the facilitators and barriers to implementation to strengthen the evidence for the refinement of implementation plans. Further dialogue is also required to understand the implementation transformation of programs and the impact on program fidelity and quality and subsequent health outcomes.