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class="bkr_bib"><h1 id="_NBK571570_"><span itemprop="name">Provision of information about the postnatal health of women</span></h1><div class="subtitle">Postnatal care</div><p><b>Evidence review G</b></p><p><i>NICE Guideline, No. 194</i></p><p class="contrib-group"><h4>Authors</h4><span itemprop="author">National Guideline Alliance (UK)</span>.</p><div class="half_rhythm">London: <a href="https://www.nice.org.uk" ref="pagearea=meta&targetsite=external&targetcat=link&targettype=publisher"><span itemprop="publisher">National Institute for Health and Care Excellence (NICE)</span></a>; <span itemprop="datePublished">2021 Apr</span>.<div class="small">ISBN-13: <span itemprop="isbn">978-1-4731-4078-3</span></div></div><div><a href="/books/about/copyright/">Copyright</a> © NICE 2021.</div></div><div class="bkr_clear"></div></div><div id="niceng194er7.s1"><h2 id="_niceng194er7_s1_">Provision of information about the postnatal health of women</h2><div id="niceng194er7.s1.1"><h3>Review question</h3><p>When and how should information be given to mothers and their partners about postnatal health of the mother?</p><div id="niceng194er7.s1.1.1"><h4>Introduction</h4><p>The life-change for families, most obviously after the birth of their first child but also after subsequent births, gives the woman new and unfamiliar problems with her own health to understand and handle. Providing information related to a woman’s postnatal health addresses the needs of mothers and their partners. In addition to supporting good health, it should enable them to take an active part in decision-making related to their care. The aim of this review was to find out from the woman’s perspective when the optimal time would be and through what method of delivery information should be provided.</p></div><div id="niceng194er7.s1.1.2"><h4>Summary of the protocol</h4><p>See <a class="figpopup" href="/books/NBK571570/table/niceng194er7.tab1/?report=objectonly" target="object" rid-figpopup="figniceng194er7tab1" rid-ob="figobniceng194er7tab1">Table 1</a> for a summary of the Population, (Phenomenon of) Interest and Context characteristics of review.</p><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng194er7tab1"><a href="/books/NBK571570/table/niceng194er7.tab1/?report=objectonly" target="object" title="Table 1" class="img_link icnblk_img figpopup" rid-figpopup="figniceng194er7tab1" rid-ob="figobniceng194er7tab1"><img class="small-thumb" src="/books/NBK571570/table/niceng194er7.tab1/?report=thumb" src-large="/books/NBK571570/table/niceng194er7.tab1/?report=previmg" alt="Table 1. Summary of the protocol (PICo table)." /></a><div class="icnblk_cntnt"><h4 id="niceng194er7.tab1"><a href="/books/NBK571570/table/niceng194er7.tab1/?report=objectonly" target="object" rid-ob="figobniceng194er7tab1">Table 1</a></h4><p class="float-caption no_bottom_margin">Summary of the protocol (PICo table). </p></div></div><p>For further details see the review protocol in <a href="#niceng194er7.appa">appendix A</a>.</p></div><div id="niceng194er7.s1.1.3"><h4>Methods and process</h4><p>This evidence review was developed using the methods and process described in <a href="https://www.nice.org.uk/process/pmg20/chapter/introduction-and-overview" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Developing NICE guidelines: the manual 2014</a>. Methods specific to this review question are described in the review protocol in <a href="#niceng194er7.appa">appendix A</a>.</p><p>Declarations of interest were recorded according to NICE’s 2014 conflicts of interest policy until March 2018. From April 2018 until June 2019, declarations of interest were recorded according to NICE’s 2018 conflicts of interest policy. From July 2019 onwards, the declarations of interest were recorded according to NICE’s 2019 <a href="https://www.nice.org.uk/about/who-we-are/policies-and-procedures" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">conflicts of interest policy</a>. Those interests declared before July 2019 were reclassified according to NICE’s 2019 conflicts of interest policy (see Register of Interests).</p></div><div id="niceng194er7.s1.1.4"><h4>Clinical evidence</h4><div id="niceng194er7.s1.1.4.1"><h5>Included studies</h5><p>Eleven qualitative studies were included (<a class="bibr" href="#niceng194er7.s1.1.ref1" rid="niceng194er7.s1.1.ref1">Brown 2014</a>, <a class="bibr" href="#niceng194er7.s1.1.ref2" rid="niceng194er7.s1.1.ref2">Haith-Cooper 2018</a>, <a class="bibr" href="#niceng194er7.s1.1.ref3" rid="niceng194er7.s1.1.ref3">Henshaw 2018</a>, <a class="bibr" href="#niceng194er7.s1.1.ref4" rid="niceng194er7.s1.1.ref4">Olander 2012</a>, <a class="bibr" href="#niceng194er7.s1.1.ref5" rid="niceng194er7.s1.1.ref5">Persson 2011</a>, <a class="bibr" href="#niceng194er7.s1.1.ref8" rid="niceng194er7.s1.1.ref8">Shorey 2015</a>, <a class="bibr" href="#niceng194er7.s1.1.ref7" rid="niceng194er7.s1.1.ref7">Shorey 2018</a>, <a class="bibr" href="#niceng194er7.s1.1.ref6" rid="niceng194er7.s1.1.ref6">Shorey 2019</a>, <a class="bibr" href="#niceng194er7.s1.1.ref9" rid="niceng194er7.s1.1.ref9">Sundstrom 2016</a>, <a class="bibr" href="#niceng194er7.s1.1.ref10" rid="niceng194er7.s1.1.ref10">Weckesser 2019</a> and <a class="bibr" href="#niceng194er7.s1.1.ref11" rid="niceng194er7.s1.1.ref11">Weston 2014</a>). Three studies were conducted in the US, four studies were conducted in the UK, three studies were conducted in Singapore and one study was conducted in Sweden. One study was on adolescent women (<a class="bibr" href="#niceng194er7.s1.1.ref1" rid="niceng194er7.s1.1.ref1">Brown 2014</a>), the remaining ten were not age-range specific. One study (<a class="bibr" href="#niceng194er7.s1.1.ref2" rid="niceng194er7.s1.1.ref2">Haith-Cooper 2018</a>) included a subgroup of vulnerable women, described as migrant women who were attending a specialist National Childbirth Trust (NCT)-funded postnatal support group. This study (<a class="bibr" href="#niceng194er7.s1.1.ref2" rid="niceng194er7.s1.1.ref2">Haith-Cooper 2018</a>) specifically discussed information provision surrounding sepsis prevention and included midwives. Data from the midwives were not extracted as the population of interest for this review were just the women who have given birth. One study (<a class="bibr" href="#niceng194er7.s1.1.ref10" rid="niceng194er7.s1.1.ref10">Weckesser 2019</a>) recruited women who had had a caesarean section in order to discuss caesarean section recovery and infection prevention. Two studies recruited a mix of postnatal and antenatal women. In these studies, data has only been extracted when it is clear they are the views of postnatal women (<a class="bibr" href="#niceng194er7.s1.1.ref4" rid="niceng194er7.s1.1.ref4">Olander 2012</a> and <a class="bibr" href="#niceng194er7.s1.1.ref11" rid="niceng194er7.s1.1.ref11">Weston 2014</a>).</p><p>Studies focused on how particular information sharing interventions were received or how they felt about seeking information rather than specifically addressing the review question of when and how do women wish to receive information about their postnatal health. One study discussed healthy eating support services for pregnant and postnatal women (<a class="bibr" href="#niceng194er7.s1.1.ref4" rid="niceng194er7.s1.1.ref4">Olander 2012</a>). Four studies evaluated an intervention: receiving text blasts (<a class="bibr" href="#niceng194er7.s1.1.ref1" rid="niceng194er7.s1.1.ref1">Brown 2014</a>), a psychoeducation programme (<a class="bibr" href="#niceng194er7.s1.1.ref8" rid="niceng194er7.s1.1.ref8">Shorey 2015</a>), use of a health app (mHealth; <a class="bibr" href="#niceng194er7.s1.1.ref7" rid="niceng194er7.s1.1.ref7">Shorey 2018</a>) and use of a technology-based supportive educational parenting program (<a class="bibr" href="#niceng194er7.s1.1.ref6" rid="niceng194er7.s1.1.ref6">Shorey 2019</a>). Two studies focused on specific postnatal health conditions: sepsis (<a class="bibr" href="#niceng194er7.s1.1.ref2" rid="niceng194er7.s1.1.ref2">Haith-Cooper 2018</a>) and caesarean section wound infection (<a class="bibr" href="#niceng194er7.s1.1.ref10" rid="niceng194er7.s1.1.ref10">Weckesser 2019</a>). The remaining studies reported data about women’s preferences for receiving information generally that is not specific to their health (<a class="bibr" href="#niceng194er7.s1.1.ref3" rid="niceng194er7.s1.1.ref3">Henshaw 2018</a>, <a class="bibr" href="#niceng194er7.s1.1.ref5" rid="niceng194er7.s1.1.ref5">Persson 2011</a>, <a class="bibr" href="#niceng194er7.s1.1.ref9" rid="niceng194er7.s1.1.ref9">Sundstrom 2016</a> and <a class="bibr" href="#niceng194er7.s1.1.ref11" rid="niceng194er7.s1.1.ref11">Weston 2014</a>), or about where they go to seek information.</p><p>Data from the included studies were explored in a number of central themes and subthemes:
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<ul class="simple-list"><li class="half_rhythm"><div><b>Theme 1. Preferences about timing of specific information provision</b>
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<ul class="simple-list"><li class="half_rhythm"><div>Sub-theme 1.1. When pregnant.</div></li><li class="half_rhythm"><div>Sub-theme 1.2. After birth.</div></li><li class="half_rhythm"><div>Sub-theme 1.3. After caesarean section surgery.</div></li><li class="half_rhythm"><div>Sub-theme 1.4. Before discharge whilst in hospital.</div></li><li class="half_rhythm"><div>Sub-theme 1.5. At discharge.</div></li></ul></div></li><li class="half_rhythm"><div><b>Theme 2. Level of detail</b>
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<ul class="simple-list"><li class="half_rhythm"><div>Sub-theme 2.1. Too much or too little information.</div></li></ul></div></li><li class="half_rhythm"><div><b>Theme 3. Receiving information privately or as a group</b>
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<ul class="simple-list"><li class="half_rhythm"><div>Sub-theme 3.1. Group sessions.</div></li><li class="half_rhythm"><div>Sub-theme 3.2. With their partner.</div></li></ul></div></li><li class="half_rhythm"><div><b>Theme 4. Format of the information provided</b>
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<ul class="simple-list"><li class="half_rhythm"><div>Sub-theme 4.1. Text messages.</div></li><li class="half_rhythm"><div>Sub-theme 4.2. Practical sessions.</div></li><li class="half_rhythm"><div>Sub-theme 4.3. Hand book.</div></li><li class="half_rhythm"><div>Sub-theme 4.4. Mixture.</div></li><li class="half_rhythm"><div>Sub-theme 4.5. Verbally.</div></li><li class="half_rhythm"><div>Sub-theme 4.6. Leaflets.</div></li><li class="half_rhythm"><div>Sub-theme 4.7. Phone-App.</div></li><li class="half_rhythm"><div>Sub-theme 4.8. Web-based.</div></li><li class="half_rhythm"><div>Sub-theme 4.9. Through media.</div></li></ul></div></li><li class="half_rhythm"><div><b>Theme 5. Consistency of information</b>
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<ul class="simple-list"><li class="half_rhythm"><div>Sub-theme 5.1. Being given consistent advice.</div></li></ul></div></li><li class="half_rhythm"><div><b>Theme 6. Who delivers the information</b>
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<ul class="simple-list"><li class="half_rhythm"><div>Sub-theme 6.1. Women with direct experience</div></li><li class="half_rhythm"><div>Sub-theme 6.2. Health professionals.</div></li></ul></div></li><li class="half_rhythm"><div><b>Theme 7. Communication skills of the person delivering information</b>
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<ul class="simple-list"><li class="half_rhythm"><div>Sub-theme 7.1. Need for clarity</div></li></ul></div></li><li class="half_rhythm"><div><b>Theme 8. Location of information sessions</b>
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<ul class="simple-list"><li class="half_rhythm"><div>Sub-theme 8.1. Convenient locations.</div></li></ul></div></li></ul></p><p>The included studies are summarised in <a class="figpopup" href="/books/NBK571570/table/niceng194er7.tab2/?report=objectonly" target="object" rid-figpopup="figniceng194er7tab2" rid-ob="figobniceng194er7tab2">Table 2</a>.</p><p>See the literature search strategy in <a href="#niceng194er7.appb">appendix B</a> and study selection flow chart in <a href="#niceng194er7.appc">appendix C</a>.</p></div><div id="niceng194er7.s1.1.4.2"><h5>Excluded studies</h5><p>Studies not included in this review are listed, and reasons for their exclusion are provided in <a href="#niceng194er7.appk">appendix K</a>.</p></div></div><div id="niceng194er7.s1.1.5"><h4>Summary of studies included in the evidence review</h4><p>Summaries of the studies that were included in this review are presented in <a class="figpopup" href="/books/NBK571570/table/niceng194er7.tab2/?report=objectonly" target="object" rid-figpopup="figniceng194er7tab2" rid-ob="figobniceng194er7tab2">Table 2</a>.</p><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng194er7tab2"><a href="/books/NBK571570/table/niceng194er7.tab2/?report=objectonly" target="object" title="Table 2" class="img_link icnblk_img figpopup" rid-figpopup="figniceng194er7tab2" rid-ob="figobniceng194er7tab2"><img class="small-thumb" src="/books/NBK571570/table/niceng194er7.tab2/?report=thumb" src-large="/books/NBK571570/table/niceng194er7.tab2/?report=previmg" alt="Table 2. Summary of included studies." /></a><div class="icnblk_cntnt"><h4 id="niceng194er7.tab2"><a href="/books/NBK571570/table/niceng194er7.tab2/?report=objectonly" target="object" rid-ob="figobniceng194er7tab2">Table 2</a></h4><p class="float-caption no_bottom_margin">Summary of included studies. </p></div></div><p>See the full evidence tables in <a href="#niceng194er7.appd">appendix D</a>. No meta-analysis was conducted (and so there are no forest plots in <a href="#niceng194er7.appe">appendix E</a>).</p></div><div id="niceng194er7.s1.1.6"><h4>Quality assessment of studies included in the evidence review</h4><p>See the evidence profiles in <a href="#niceng194er7.appf">appendix F</a>.</p></div><div id="niceng194er7.s1.1.7"><h4>Economic evidence</h4><div id="niceng194er7.s1.1.7.1"><h5>Included studies</h5><p>A single economic search was undertaken for all topics included in the scope of this guideline but no economic studies were identified which were applicable to this review question. See the literature search strategy in <a href="#niceng194er7.appb">appendix B</a> and economic study selection flow chart in <a href="#niceng194er7.appg">appendix G</a>.</p></div><div id="niceng194er7.s1.1.7.2"><h5>Excluded studies</h5><p>No economic studies were reviewed at full text and excluded from this review.</p></div></div><div id="niceng194er7.s1.1.8"><h4>Economic model</h4><p>No economic modelling was undertaken for this review because the committee agreed that other topics were higher priorities for economic evaluation.</p></div><div id="niceng194er7.s1.1.9"><h4>Evidence statements</h4><div id="niceng194er7.s1.1.9.1"><h5>Clinical evidence statements</h5><div id="niceng194er7.s1.1.9.1.1"><h5>Theme 1. Preferences about timing of specific information provision</h5><ul><li class="half_rhythm"><div><b>Sub-theme 1.1. When pregnant.</b> Low quality evidence from 5 studies from the UK (2 studies), Sweden (1 study) and Singapore (2 studies) report that women and partners preferred receiving information whilst the woman was pregnant and had more time to participate in courses, read and digest information and prepare for health issues that might arise. Particularly in the case of health information that required behaviour changes such as healthy eating, women felt that making these changes whilst pregnant would increase the likelihood of sustaining them once the baby had arrived.</div></li><li class="half_rhythm"><div><b>Sub-theme 1.2. After birth.</b> Low quality evidence from 1 study from Sweden reported that women wished to have a postpartum talk with the delivery midwife enabling them to ask questions and get help as necessary.</div></li><li class="half_rhythm"><div><b>Sub-theme 1.3. After caesarean section surgery.</b> Low quality evidence from 1 study from the UK reported how women were unable to recall information that was given to them about wound care and infection prevention if given shortly after the surgery. From this we can infer that providing information soon after surgery would not be appropriate.</div></li><li class="half_rhythm"><div><b>Sub-theme 1.4. Before discharge whilst in hospital.</b> Very low quality evidence from 2 studies from Sweden (1 study) and the US (1 study) suggested there are mixed views about whether information should be given before discharge from hospital. One study reported that women wished to receive preventive information before discharge from the hospital including hints and advice about problems and situations that are common during the first days after discharge. Women had worried about what they now saw as ‘very small problems’, which could have been avoided if they had known that the ‘small problem’ was not unusual. Whilst one study reported how women found it hard to recall information that was given to them in hospital, suggesting this is not the best time to provide information.</div></li><li class="half_rhythm"><div><b>Sub-theme 1.5. At discharge.</b> Low quality evidence from 1 UK study suggested that the point of discharge was not the best time to provide information. During the discharge process women felt they were being given a lot of verbal information that was difficult to retain whilst also feeling rushed by the midwife to leave. This resulted in women feeling they were not receiving all the information they should. In addition, some women were themselves in a rush to get out of the hospital and consequently were not making full use of the information available to them.</div></li></ul></div><div id="niceng194er7.s1.1.9.1.2"><h5>Theme 2. Level of detail</h5><ul><li class="half_rhythm"><div><b>Sub-theme 2.1. Too much or too little information.</b> Low quality evidence from 3 studies from the UK (2 studies) and US (1 study) showed there are mixed views about the ideal amount of information that should be shared in the postnatal period. One study reported how women felt there was too much verbal information given at discharge for them to be able to recall specific details. Some women also felt they were given too many leaflets that went unread. On the other hand 2 studies reported how women did not feel like they were given enough information, particularly regarding caesarean section aftercare and postpartum depression.</div></li></ul></div><div id="niceng194er7.s1.1.9.1.3"><h5>Theme 3. Receiving information privately or as a group</h5><ul><li class="half_rhythm"><div><b>Sub-theme 3.1. Group sessions.</b> Very low quality evidence from 1 study from the UK indicated that women receiving information on behaviour change (healthy eating) would prefer this to be in a group session however, it was acknowledged that group sessions might not work for everyone and a choice should be offered.</div></li><li class="half_rhythm"><div><b>Sub-theme 3.2. With their partner.</b> Low quality evidence from 1 study from Sweden indicated that women wished for their partner to be involved, acknowledged and included in discussions. Women found that their partners were often dismissed by healthcare professionals.</div></li></ul></div><div id="niceng194er7.s1.1.9.1.4"><h5>Theme 4. Format of the information provided</h5><ul><li class="half_rhythm"><div><b>Sub-theme 4.1. Text messages.</b> Very low quality evidence from 2 studies from the US reported that women viewed texting as a flexible, accessible and familiar method of communication. Information given via text message is easily stored, can be forwarded on to friends and family and can be referred to at a later date.</div></li><li class="half_rhythm"><div><b>Sub-theme 4.2. Practical sessions.</b> Very low quality evidence from 1 study from the UK suggested that information about healthy eating should be delivered as practical sessions where women could be shown how to alter their diet and cook healthy meals. Practical sessions would be preferable to leaflets describing how to cook healthy meals.</div></li><li class="half_rhythm"><div><b>Sub-theme 4.3. Hand book.</b> Very low quality evidence from 1 study from Singapore reported mixed views about receiving information in a hand book. Women who received a hand book in addition to a psychoeducation programme said it was easy to understand with a good structure, simple layout and pictures and it helpfully had a contents page, important contact details, and was a good size. However, the hand book did not contain all the information women wanted.</div></li><li class="half_rhythm"><div><b>Sub-theme 4.4. Mixture.</b> Very low quality evidence from 1 study from Singapore reported that women were happy to receive information though home visits followed by telephone calls and supported with an educational booklet as part of the psychoeducation programme. When reflecting on the number of visits or phone calls women generally wanted more than the programme offered. Web-based learning was also suggested to be added.</div></li><li class="half_rhythm"><div><b>Sub-theme 4.5. Verbally.</b> Low quality evidence from 1 study from the UK reported that women felt there was too much information given to them verbally, particularly at discharge. Women were unable to recall specific details.</div></li><li class="half_rhythm"><div><b>Sub-theme 4.6. Leaflets.</b> Low quality evidence from 3 studies from the UK (2 studies) and the US (1 study) reported how women felt they were given too many leaflets to read. Women also reported that the leaflets did not provide enough information. On the other-hand some women favour leaflets because they could be taken home and be referred to at a later time.</div></li><li class="half_rhythm"><div><b>Sub-theme 4.7. Phone-App.</b> Very low quality evidence from 2 studies from Singapore reported mixed experiences with phone apps. Some women and partners found using the app a good resource for information, with user-friendly features and easy to find, tailored information. It was valuable that midwives could be contacted through the app and that different learning styles were catered for with information being provided in pdfs, audio and videos. However, there were some technical issues with the app, and some people wanted it to cover a wider range of topics.</div></li><li class="half_rhythm"><div><b>Sub-theme 4.8. Web-based.</b> Very low quality evidence from 3 studies from Singapore (1 study), the UK (1 study) and the US (1 study) suggested that women were interested in web-based learning as it would offer a longer-term support system. The information would need to be provided by a reputable organisation, for example the NHS. Online chat or forums were desirable, where women could post their queries at any time of the day.</div></li><li class="half_rhythm"><div><b>Sub-theme 4.9. Through media.</b> Very low quality evidence from 1 study from the US reported that whilst TV and magazines are an easy way to disseminate information to a large proportion of women, women find it hard to trust the media, it can raise unnecessary fears and there is typically too much information already out there. Whilst adverts may increase awareness about causal links to a child’s illness and medication taken during pregnancy, those depending on such medications find them too upsetting to watch.</div></li></ul></div></div><div id="niceng194er7.s1.1.9.2"><h5>Subgroup – younger women (19 years or younger)</h5><ul><li class="half_rhythm"><div>Very low quality evidence from 1 study from the US relating to receiving information from text messages for younger women (19 years or younger). Women felt that texting is a flexible, accessible and familiar method of communication. Information given via text message is easily stored, can be forwarded on to friends/family and can be referred to at a later date.</div></li></ul><div id="niceng194er7.s1.1.9.2.1"><h5>Theme 5. Consistency of information</h5><ul><li class="half_rhythm"><div><b>Sub-theme 1. Being given consistent advice.</b> Low quality evidence from 2 studies from the UK (1 study) and from Sweden (1 study) indicated that women wished to receive consistent advice from all healthcare professionals. Women experienced inconsistent and conflicting advice generally, and especially in hospital. Inconsistency in advice left women feeling staff were not well-informed and that they would benefit from an update of their knowledge.</div></li></ul></div><div id="niceng194er7.s1.1.9.2.2"><h5>Theme 6. Who delivers the information</h5><ul><li class="half_rhythm"><div><b>Sub-theme 6.1. Women with direct experience</b>. Low quality evidence from 2 studies from the UK (1 study) and the US (1 study) showed that women felt that information was more valuable and relatable when given by women who had experienced pregnancy and had children.</div></li><li class="half_rhythm"><div><b>Sub-theme 6.2. Health professionals.</b> Low quality evidence from 2 UK studies showed that women held health professionals in high regard and would prefer to receive information from them rather than the internet. They also felt that a reminder of information from health professionals would help keep them on track – particularly for healthy eating behaviour changes. However, women found that health visitors do not always have the time for their queries.</div></li></ul></div><div id="niceng194er7.s1.1.9.2.3"><h5>Theme 7. Communication skills of the person delivering information</h5><ul><li class="half_rhythm"><div><b>Sub-theme 7.1. Need for clarity.</b> Low quality evidence from 1 study from Sweden indicated that women wanted information, advice and explanations to be given in a clear manner so they can easily understand the message.</div></li></ul></div><div id="niceng194er7.s1.1.9.2.4"><h5>Theme 8. Location of information sessions</h5><ul><li class="half_rhythm"><div><b>Sub-theme 8.1 Convenient locations.</b> Low quality evidence from 2 studies from the UK (1 study) and Singapore (1 study) showed that women wished for information to be delivered in a location that was convenient to them. The preferred location differed depending on the type of information being offered. If away from the home, a childcare service would be required. If within the first month postpartum, at home was preferred.</div></li></ul></div></div><div id="niceng194er7.s1.1.9.3"><h5>Economic evidence statements</h5><p>No economic evidence was identified which was applicable to this review question.</p></div></div><div id="niceng194er7.s1.1.10"><h4>The committee’s discussion of the evidence</h4><div id="niceng194er7.s1.1.10.1"><h5>Interpreting the evidence</h5><div id="niceng194er7.s1.1.10.1.1"><h5>The outcomes that matter most</h5><p>This review focused on the way in which information about self-care (including both physical health and emotional well-being) is provided, and the timing of information provision. To address this issue the review was designed to include qualitative data and as a result the committee could not specify in advance the data that would be located. Instead they identified the following main themes to guide the review although the list was not exhaustive and the committee were aware that additional themes may be identified.</p><p>Suggested themes for information about the postnatal health of the woman included:
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<ul><li class="half_rhythm"><div>Preferences on whether specific information should be provided before or after transfer to community care</div></li><li class="half_rhythm"><div>Level of detail in relation to potential complications</div></li><li class="half_rhythm"><div>Woman’s preferences in relation to receiving specific information privately or together with partner</div></li><li class="half_rhythm"><div>Format of information provision (for example, using videos)</div></li><li class="half_rhythm"><div>Consistency of information</div></li><li class="half_rhythm"><div>Modality of birth</div></li><li class="half_rhythm"><div>Healthcare professional delivering the information</div></li><li class="half_rhythm"><div>Communication skills of the person providing the information</div></li><li class="half_rhythm"><div>Setting in which information is delivered</div></li></ul></p><p>The evidence review provided data relating to all the suggested themes set out in the protocol except for modality of birth.</p></div><div id="niceng194er7.s1.1.10.1.2"><h5>The quality of the evidence</h5><p>The evidence was assessed using GRADE-CERQual methodology and the overall confidence in the review findings were very low to low.</p><p>Concerns about relevance for the context and population of interest to this guideline ranged from serious to moderate; for the majority of review findings concerns were moderate. The most common concern was related to the transferability of findings to ethnic minorities; in 11 studies the population was either all or mostly white (these include the 3 studies on young women); four studies did not report ethnicity data; only 1 study focussed specifically on ethnic minorities. Concerns about coherence ranged from moderate to minor; for the majority of review findings concerns were minor, as there were no data that contradicted these findings nor were there ambiguous data. Where findings were downgraded for coherence, the data were contradictory in the sense of there being different preferences, rather than being ambiguous. Concerns about adequacy ranged from serious to minor; for the majority of review findings concerns were minor or moderate, serious concerns occurred when the study on a text-message intervention provided the information, as this study reported how women found receiving information through text messages as opposed to their opinion on different information provision formats. The number of studies used for each review finding ranged from 1 to 5. Despite these concerns with the evidence that was identified, the committee felt that it was consistent with their clinical experience</p></div><div id="niceng194er7.s1.1.10.1.3"><h5>Benefits and harms</h5><p>The committee agreed that one of the key principles of care in the postnatal period is to listen to the women and be responsive to their needs and preferences. For example, the woman’s concerns about her or her baby’s condition should be taken seriously. The importance of listening to the women was also highlighted in the recent <a href="https://www.donnaockenden.com/the-ockenden-review-sath/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Ockenden report on maternity services at the Shrewsbury and Telford hospital NHS trust</a>. Furthermore, the committee were aware of the disproportionate maternal and neonatal mortality rates among women and babies from Black, Asian and minority ethnic backgrounds and those living in deprived areas, as highlighted by the 2020 <a href="https://www.npeu.ox.ac.uk/mbrrace-uk/reports" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">MBRRACE-UK reports</a> on maternal mortality and perinatal mortality. Black women in particular had a more than a four-fold risk of death during pregnancy, childbirth and up to 6 weeks after birth compared with white women. Asian women had a 2-fold risk compared to white women. It should be noted that ‘Asian’ ethnicity appears to be largely South Asian ethnicity. ‘Chinese’ ethnicity was analysed separately and showed no difference in maternal mortality compared to white women. Women living in the most deprived areas were almost 3 times more likely to die compared with women living in the least deprived areas. Neonatal mortality rates are also significantly higher in babies of black or Asian ethnicity compared to white babies. Neonatal mortality rates increased the more deprived the area where the mother lives is. The committee discussed that healthcare professionals caring for women and babies should be aware of the increases risk of mortality in these groups. The reasons and mechanisms behind these disparities are complex and likely related to wider societal issues and inequalities. However, in clinical practice, it is important to recognise that the increased risk indicates that closer monitoring and lower threshold for further care or admission may be needed. Future research could explore the mechanisms underlying these disparities and which interventions could improve the outcomes.</p><p>The committee discussed the importance of the partner and family in supporting the woman in the postnatal period and what a positive impact a partner’s involvement and support can have on the wellbeing of the mother and the baby. However, they also discussed that it is up to the woman who she wants to involve and committee recognised the various different family situations and arrangements that exist and acknowledged that some women live in a situation where they do not wish to involve their partners. The committee agreed that the healthcare professionals should involve the woman’s partner (who could be the baby’s father, her partner, family member or friend, or anyone she feels supported by) according to her wishes. However, the committee also recognised that involvement in the woman’s care and the baby’s care are different because those with parental responsibility of the baby have the right to be involved in the baby’s care if they so choose or wish.</p><p>The committee discussed the harms identified in the evidence, which seem to result from the poor provision of information. Inconsistency in terms of information content was the primary concern, given that it leads to the woman feeling confused about her postnatal health. From the committees experience it may also reduce women’s trust in the health care system and as a consequence may lead to poor self-care and in extreme cases, an increase in maternal morbidity. In addition to the information provided by health professionals, women increasingly have access to a range of information sources for example internet and social networks that provide information which may or may not be evidence based. A further harm resulting from poor communication of information was women not understanding the information they were receiving. The committee therefore made a recommendation to attempt to avoid some of these problems. They recommended some general principles around information sharing, namely that the mode of delivery, timing and content should be tailored to the woman’s preferences and that clear language should be used.</p><p>They also drew on the evidence to set out a number of other principles which should underpin the provision of information. For example, information should be evidence-based, consistent and offered in face to face discussion as well as in a suitable written format, which was on the basis that although they value face to face interaction, women also often want to be able to refer back to written information as and when it becomes relevant. The committee also recognised the potential importance of virtual or telephone contacts in addition to face to face contacts. Although none of the review findings specifically demonstrated the importance of information being provided in a supportive and respectful way, the committee agreed it was a fundamental point to make because it would increase the likelihood of a positive interaction between professionals and women and also the likelihood of the information being retained and acted on. The committee also discussed how each woman’s home, family circumstances and support network will be different, and how it should be up to the woman who she wants to be involve in her postnatal care. Finally, the committee also noted an absence of evidence about the role of interpretation services in the provision of information but agreed it was an essential consideration, particularly to promote equality of access to vital health messages. Aware of a related NICE guideline with recommendations about the provision of information to support shared decision making, the committee signposted to this [<a href="https://www.nice.org.uk/guidance/cg138" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">CG138</a>] as well as the NHS Accessible Information Standard. The evidence presented in this review, which highlighted the value women place on being able to ask questions highlighted, in the committee’s opinion, the importance of information provision being a dialogue rather than something simply ‘given’ to women. They therefore recommended that healthcare professionals provide regular opportunities for women to ask questions and discuss concerns and to also take time to ensure the information has been clearly understood.</p><p>The committee were aware of the NICE guideline on pregnancy and complex social factors [<a href="https://www.nice.org.uk/guidance/cg110" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">CG110</a>] which covers various considerations during pregnancy for women who misuse substances, young women under 20 years old, women who experience domestic abuse and women who are recent migrants, asylum seekers or refugees, or women who have difficulty reading or speaking English. The committee agreed that while the guideline covers antenatal period, the principles can be applied to the postnatal period and therefore cross referred to this guideline in the recommendations.</p><p>The committee agreed that these recommendations would achieve clear benefits, encouraging the delivery of timely, person-centred information in a way that would ensure the uptake of the information and greater, evidence based awareness of women’s own needs during the postnatal period.</p></div></div><div id="niceng194er7.s1.1.10.2"><h5>Cost-effectiveness and resource use</h5><p>Providing appropriate information about a woman’s health, in a range of formats, to women and, potentially, their partners entails small costs (that is, additional health professional time and cost of materials required to provide information in different formats), although some information is already provided in current practice. However, these recommendations are expected to increase the women’s and their partners’ confidence in the information provided, so that they are more likely to actively engage with the advice given. In turn, this is expected to reduce the clinical, psychological, social and economic burden of maternal morbidity and mortality to the family and society.</p><p>The recommendation aiming at increasing awareness of the need for closer monitoring of women and their babies from black, Asian and minority ethnic backgrounds and those who live in deprived areas due to an increased risk of developing adverse outcomes is expected to have moderate resource implications in terms of health professionals’ extra time spent on closer monitoring of these sub-groups; however, it is expected that extra costs associated with monitoring will be offset by benefits from earlier identification of adverse outcomes and earlier intervention, leading to improved health outcomes (reduced mortality and morbidity) in those women and their babies.</p></div><div id="niceng194er7.s1.1.10.3"><h5>Other factors the committee took into account</h5><p>The committee noted that there are potential equality issues relating to literacy, learning disabilities, language and accessibility to healthcare and technology (for example the internet) for some women. Therefore, the committee made recommendations to ensure the provision of information for women is available using a variety of formats and delivered in a way that the women prefers. The committee signposted to the NHS Accessible Information Standard to support these recommendations.</p></div></div><div id="niceng194er7.s1.1.rl.r1"><h4>References</h4><ul class="simple-list"><li class="half_rhythm"><p><div class="bk_ref" id="niceng194er7.s1.1.ref1"><p id="p-199">
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<strong>Brown 2014</strong>
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</p>Brown, S., Brage Hudson, D., Campbell-Grossman, C., Yates, B. C., Health promotion text blasts for minority adolescent mothers, MCN, American Journal of Maternal Child Nursing, 39, 357–62, 2014 [<a href="https://pubmed.ncbi.nlm.nih.gov/25333802" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 25333802</span></a>]</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="niceng194er7.s1.1.ref2"><p id="p-200">
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<strong>Haith-Cooper 2018</strong>
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</p>Haith-Cooper
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M. Stacey
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T. Bailey
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F. Hospital postnatal discharge and sepsis advice: Perspectives of women and midwifery students, British Journal of Midwifery, 26, 248–253, 2018</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="niceng194er7.s1.1.ref3"><p id="p-201">
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<strong>Henshaw 2018</strong>
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</p>Henshaw, E. J., Cooper, M. A., Jaramillo, M., Lamp, J. M., Jones, A. L., Wood, T. L., “Trying to Figure Out If You’re Doing Things Right, and Where to Get the Info”: Parents Recall Information and Support Needed During the First 6 weeks Postpartum, Maternal & Child Health Journal, 22, 1668–1675, 2018 [<a href="https://pubmed.ncbi.nlm.nih.gov/29978309" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 29978309</span></a>]</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="niceng194er7.s1.1.ref4"><p id="p-202">
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<strong>Olander 2012</strong>
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</p>Olander, E. K., Atkinson, L., Edmunds, J. K., French, D. P., Promoting healthy eating in pregnancy: what kind of support services do women say they want?
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Primary health care research & development, 13, 237–243, 2012 [<a href="https://pubmed.ncbi.nlm.nih.gov/22313583" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 22313583</span></a>]</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="niceng194er7.s1.1.ref5"><p id="p-203">
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<strong>Persson 2011</strong>
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</p>Persson, E. K., Fridlund, B., Kvist, L. J., Dykes, A. K., Mothers’ sense of security in the first postnatal week: Interview study, Journal of Advanced Nursing, 67, 105–116, 2011 [<a href="https://pubmed.ncbi.nlm.nih.gov/20969617" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 20969617</span></a>]</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="niceng194er7.s1.1.ref6"><p id="p-204">
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<strong>Shorey 2019</strong>
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</p>Shorey, S., Ng, E. D., Evaluation of a Technology-Based Peer-Support Intervention Program for Preventing Postnatal Depression (Part 2): Qualitative Study, Journal of medical Internet research, 21, e12915, 2019 [<a href="/pmc/articles/PMC6740164/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC6740164</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/31469080" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 31469080</span></a>]</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="niceng194er7.s1.1.ref7"><p id="p-205">
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<strong>Shorey 2018</strong>
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</p>Shorey
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S. Yang
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Y.Y. Dennis
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C.-L. A mobile health app-based postnatal educational program (home-but not alone): Descriptive qualitative study, Journal of medical Internet research, 20, 2018 [<a href="/pmc/articles/PMC5934535/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC5934535</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/29674314" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 29674314</span></a>]</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="niceng194er7.s1.1.ref8"><p id="p-206">
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<strong>Shorey 2015</strong>
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</p>Shorey, S., Chan, S. W. C., Chong, Y. S., He, H. G., Perceptions of primiparas on a postnatal psychoeducation programme: The process evaluation, Midwifery, 31, 155–163, 2015 [<a href="https://pubmed.ncbi.nlm.nih.gov/25174540" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 25174540</span></a>]</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="niceng194er7.s1.1.ref9"><p id="p-207">
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<strong>Sundstrom 2016</strong>
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</p>Sundstrom, B., Mothers “Google It Up:” Extending Communication Channel Behavior in Diffusion of Innovations Theory, Health communication, 31, 91–101, 2016 [<a href="https://pubmed.ncbi.nlm.nih.gov/26075413" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 26075413</span></a>]</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="niceng194er7.s1.1.ref10"><p id="p-208">
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<strong>Weckesser 2019</strong>
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</p>Weckesser
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A. Farmer
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N. Dam
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R. Wilson
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A. Morton
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V.H. Morris
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R.K. Women’s perspectives on caesarean section recovery, infection and the PREPS trial: A qualitative pilot study, BMC Pregnancy and Childbirth, 19, 2019 [<a href="/pmc/articles/PMC6631540/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC6631540</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/31307417" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 31307417</span></a>]</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="niceng194er7.s1.1.ref11"><p id="p-209">
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<strong>Weston 2014</strong>
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</p>Weston, C., Anderson, J.L., Internet use in pregnancy, British Journal of Midwifery, 22, 488–493, 2014</div></p></li></ul></div></div></div><div id="appendixesappgroup1"><h2 id="_appendixesappgroup1_">Appendices</h2><div id="niceng194er7.appa"><h3>Appendix A. Review protocol</h3><p id="niceng194er7.appa.et1"><a href="/books/NBK571570/bin/niceng194er7-appa-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Review protocol for review question: When and how should information be given to mothers and their partners about postnatal health of the mother?</a><span class="small"> (PDF, 298K)</span></p></div><div id="niceng194er7.appb"><h3>Appendix B. Literature search strategies</h3><p id="niceng194er7.appb.et1"><a href="/books/NBK571570/bin/niceng194er7-appb-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Literature search strategies for review question: When and how should information be given to mothers and their partners about postnatal health of the mother?</a><span class="small"> (PDF, 310K)</span></p></div><div id="niceng194er7.appc"><h3>Appendix C. Clinical evidence study selection</h3><p id="niceng194er7.appc.et1"><a href="/books/NBK571570/bin/niceng194er7-appc-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Study selection for: When and how should information be given to mothers and their partners about postnatal health of the mother?</a><span class="small"> (PDF, 200K)</span></p></div><div id="niceng194er7.appd"><h3>Appendix D. Clinical evidence tables</h3><p id="niceng194er7.appd.et1"><a href="/books/NBK571570/bin/niceng194er7-appd-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Evidence tables for review question: When and how should information be given to mothers and their partners about postnatal health of the mother?</a><span class="small"> (PDF, 450K)</span></p></div><div id="niceng194er7.appe"><h3>Appendix E. Forest plots</h3><div id="niceng194er7.appe.s1"><h4>Forest plots for review question: When and how should information be given to mothers and their partners about postnatal health of the mother?</h4><p>No meta-analysis was conducted for this review question and so there are no forest plots.</p></div></div><div id="niceng194er7.appf"><h3>Appendix F. GRADE-CERQual tables</h3><p id="niceng194er7.appf.et1"><a href="/books/NBK571570/bin/niceng194er7-appf-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">GRADE-CERQual tables for review question: When and how should information be given to mothers and their partners about postnatal health of the mother?</a><span class="small"> (PDF, 366K)</span></p></div><div id="niceng194er7.appg"><h3>Appendix G. Economic evidence study selection</h3><p id="niceng194er7.appg.et1"><a href="/books/NBK571570/bin/niceng194er7-appg-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Economic evidence study selection for review question: When and how should information be given to mothers and their partners about postnatal health of the mother?</a><span class="small"> (PDF, 266K)</span></p></div><div id="niceng194er7.apph"><h3>Appendix H. Economic evidence tables</h3><div id="niceng194er7.apph.s1"><h4>Economic evidence tables for review question: When and how should information be given to mothers and their partners about postnatal health of the mother?</h4><p>No economic evidence was identified which was applicable to this review question.</p></div></div><div id="niceng194er7.appi"><h3>Appendix I. Economic evidence profiles</h3><div id="niceng194er7.appi.s1"><h4>Economic evidence profiles for review question: When and how should information be given to mothers and their partners about postnatal health of the mother?</h4><p>No economic evidence was identified which was applicable to this review question.</p></div></div><div id="niceng194er7.appj"><h3>Appendix J. Economic analysis</h3><div id="niceng194er7.appj.s1"><h4>Economic analysis for review question: When and how should information be given to mothers and their partners about postnatal health of the mother?</h4><p>No economic analysis was conducted for this review question.</p></div></div><div id="niceng194er7.appk"><h3>Appendix K. Excluded studies</h3><div id="niceng194er7.appk.s1"><h4>Excluded studies for review question: When and how should information be given to mothers and their partners about postnatal health of the mother?</h4></div><div id="niceng194er7.appk.s2"><h4>Clinical studies</h4><p id="niceng194er7.appk.et1"><a href="/books/NBK571570/bin/niceng194er7-appk-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Download PDF</a><span class="small"> (220K)</span></p></div><div id="niceng194er7.appk.s3"><h4>Economic studies</h4><p>No economic evidence was identified for this review.</p></div></div><div id="niceng194er7.appl"><h3>Appendix L. Research recommendations</h3><div id="niceng194er7.appl.s1"><h4>Research recommendations for review question: When and how should information be given to mothers and their partners about postnatal health of the mother?</h4><p>No research recommendations were made for this review question.</p></div></div></div></div><div class="fm-sec"><div><p>Final</p></div><div><p>Evidence review underpinning recommendations 1.1.1 to 1.1.7</p><p>These evidence reviews were developed by the National Guideline Alliance, part of the Royal College of Obstetricians and Gynaecologists</p></div><div><p><b>Disclaimer</b>: The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or service users. The recommendations in this guideline are not mandatory and the guideline does not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian.</p><p>Local commissioners and/or providers have a responsibility to enable the guideline to be applied when individual health professionals and their patients or service users wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with compliance with those duties.</p><p>NICE guidelines cover health and care in England. Decisions on how they apply in other UK countries are made by ministers in the <a href="http://wales.gov.uk/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Welsh Government</a>, <a href="http://www.scotland.gov.uk/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Scottish Government</a>, and <a href="http://www.northernireland.gov.uk/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Northern Ireland Executive</a>. All NICE guidance is subject to regular review and may be updated or withdrawn.</p></div><div class="half_rhythm"><a href="/books/about/copyright/">Copyright</a> © NICE 2021.</div><div class="small"><span class="label">Bookshelf ID: NBK571570</span><span class="label">PMID: <a href="https://pubmed.ncbi.nlm.nih.gov/34191450" title="PubMed record of this title" ref="pagearea=meta&targetsite=entrez&targetcat=link&targettype=pubmed">34191450</a></span></div></div><div class="small-screen-prev"></div><div class="small-screen-next"></div></article><article data-type="table-wrap" id="figobniceng194er7tab1"><div id="niceng194er7.tab1" class="table"><h3><span class="label">Table 1</span><span class="title">Summary of the protocol (PICo table)</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK571570/table/niceng194er7.tab1/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng194er7.tab1_lrgtbl__"><table><tbody><tr><th id="hd_b_niceng194er7.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Population</th><td headers="hd_b_niceng194er7.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Women who have given birth (to a singleton, twins or triplets), from the birth of the baby to 8 weeks after birth, and their partners.</td></tr><tr><th id="hd_b_niceng194er7.tab1_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Phenomenon of Interest</th><td headers="hd_b_niceng194er7.tab1_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Views and experiences of the way in which information about self-care (including both physical health and emotional well-being) is provided, and the timing of information provision.</p>
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<p>Themes will be identified from the available literature, but expected themes are:
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<ul><li class="half_rhythm"><div>Preferences on whether specific information should be provided before or after transfer to community care</div></li><li class="half_rhythm"><div>Level of detail in relation to potential complications</div></li><li class="half_rhythm"><div>Woman’s preferences in relation to receiving specific information privately or together with partner</div></li><li class="half_rhythm"><div>Format of information provision (for example, using videos)</div></li><li class="half_rhythm"><div>Consistency of information</div></li><li class="half_rhythm"><div>Modality of birth</div></li><li class="half_rhythm"><div>Healthcare professional delivering the information</div></li><li class="half_rhythm"><div>Communication skills of the person providing the information</div></li><li class="half_rhythm"><div>Setting in which information is delivered</div></li></ul></p>
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</td></tr><tr><th id="hd_b_niceng194er7.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Context</th><td headers="hd_b_niceng194er7.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Studies from the UK and high income countries.</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobniceng194er7tab2"><div id="niceng194er7.tab2" class="table"><h3><span class="label">Table 2</span><span class="title">Summary of included studies</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK571570/table/niceng194er7.tab2/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng194er7.tab2_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng194er7.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Study and aim of study</th><th id="hd_h_niceng194er7.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Participants</th><th id="hd_h_niceng194er7.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Methods</th><th id="hd_h_niceng194er7.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Themes</th></tr></thead><tbody><tr><td headers="hd_h_niceng194er7.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p><a class="bibr" href="#niceng194er7.s1.1.ref1" rid="niceng194er7.s1.1.ref1">Brown 2014</a></p><p>US</p><p><b>Aim of the study</b></p>
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<ul><li class="half_rhythm"><div>To examine use of technology for delivering a health promotion intervention via text blasts in single, low-income, adolescent, minority mothers and to describe their perceptions and experiences with the intervention.</div></li></ul></td><td headers="hd_h_niceng194er7.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">N=5 single, low-income postpartum adolescents individuals who had taken part in a health promotion intervention via text blasts.</td><td headers="hd_h_niceng194er7.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Semi-structured face-to-face interviews, monthly during the 6 month intervention</td><td headers="hd_h_niceng194er7.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<ul><li class="half_rhythm"><div>Format of the information provided</div></li></ul></td></tr><tr><td headers="hd_h_niceng194er7.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p><a class="bibr" href="#niceng194er7.s1.1.ref2" rid="niceng194er7.s1.1.ref2">Haith-Cooper 2018</a></p><p>England, UK</p><p><b>Aim of the study</b></p>
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<ul><li class="half_rhythm"><div>To explore the perceptions of women and senior student midwives related to the postnatal hospital discharge process and maternal sepsis prevention advice.</div></li></ul></td><td headers="hd_h_niceng194er7.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>N=23</p>
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<p>n=9 student midwives</p>
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<p>n=9 Women who had given birth in the past year</p>
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<p>n=5 vulnerable migrant women</p>
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</td><td headers="hd_h_niceng194er7.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">3 focus groups</td><td headers="hd_h_niceng194er7.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<ul><li class="half_rhythm"><div>Preference on when specific information should be provided</div></li><li class="half_rhythm"><div>Level of detail</div></li><li class="half_rhythm"><div>Format of the information provided</div></li><li class="half_rhythm"><div>Consistency of information</div></li></ul></td></tr><tr><td headers="hd_h_niceng194er7.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p><a class="bibr" href="#niceng194er7.s1.1.ref3" rid="niceng194er7.s1.1.ref3">Henshaw 2018</a></p><p>US</p><p><b>Aim of the study</b></p>
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<ul><li class="half_rhythm"><div>To explore common challenges along with support and education needs experienced during the first 6 weeks postpartum</div></li></ul></td><td headers="hd_h_niceng194er7.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>N=33</p>
|
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<p>n=26 women</p>
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<p>n=6 partners</p>
|
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<p>n=1 sister</p>
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|
</td><td headers="hd_h_niceng194er7.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Focus groups of 4-10 participants</td><td headers="hd_h_niceng194er7.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<ul><li class="half_rhythm"><div>Preference on when specific information should be provided</div></li><li class="half_rhythm"><div>Level of detail</div></li><li class="half_rhythm"><div>Format of the information provided</div></li></ul></td></tr><tr><td headers="hd_h_niceng194er7.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p><a class="bibr" href="#niceng194er7.s1.1.ref4" rid="niceng194er7.s1.1.ref4">Olander 2012</a></p><p>England, UK</p><p><b>Aim of the study</b></p>
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<ul><li class="half_rhythm"><div>To explore what type of healthy eating services and support prenatal and postnatal women want</div></li></ul></td><td headers="hd_h_niceng194er7.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">N=14 postnatal women (also N=9 prenatal, but their quotes were not extracted) from a deprived area in the Midlands of England</td><td headers="hd_h_niceng194er7.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Semi-structured focus groups</td><td headers="hd_h_niceng194er7.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<ul><li class="half_rhythm"><div>Preference on when specific information should be provided</div></li><li class="half_rhythm"><div>Receiving information privately or as a group</div></li><li class="half_rhythm"><div>Format of the information provided</div></li><li class="half_rhythm"><div>Who should deliver the information</div></li><li class="half_rhythm"><div>Location of information sessions</div></li></ul></td></tr><tr><td headers="hd_h_niceng194er7.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p><a class="bibr" href="#niceng194er7.s1.1.ref5" rid="niceng194er7.s1.1.ref5">Persson 2011</a></p><p>Sweden</p><p><b>Aim of the study</b></p>
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<ul><li class="half_rhythm"><div>To report factors which influence mothers’ sense of security during the first postnatal week.</div></li></ul></td><td headers="hd_h_niceng194er7.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">N=14 postnatal women, n=11 with their first child and n=3 with their second</td><td headers="hd_h_niceng194er7.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Interviews 1, 3 and 6 were focus group discussions with five, three and two respondents, respectively whilst interviews 2, 4, 5 and 7 were individual interviews.</td><td headers="hd_h_niceng194er7.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<ul><li class="half_rhythm"><div>Preference on when specific information should be provided</div></li><li class="half_rhythm"><div>Receiving information privately or as a group</div></li><li class="half_rhythm"><div>Consistency of information</div></li><li class="half_rhythm"><div>Communication skills of the person delivering information</div></li></ul></td></tr><tr><td headers="hd_h_niceng194er7.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p><a class="bibr" href="#niceng194er7.s1.1.ref8" rid="niceng194er7.s1.1.ref8">Shorey 2015</a></p><p>Singapore</p><p><b>Aim of the study</b></p>
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<ul><li class="half_rhythm"><div>To explore the perceptions of primiparas on the contents, delivery and personal impact of postnatal psychoeducation programme</div></li></ul></td><td headers="hd_h_niceng194er7.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">N=18 postnatal women who had previously been recruited to the RCT that assessed a postnatal psychoeducation programme</td><td headers="hd_h_niceng194er7.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Semi-structured interviews that were face-to-face at weeks 6 to 9 post-partum in the mothers home.</td><td headers="hd_h_niceng194er7.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<ul><li class="half_rhythm"><div>Format of the information provided</div></li><li class="half_rhythm"><div>Location of information sessions</div></li></ul></td></tr><tr><td headers="hd_h_niceng194er7.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p><a class="bibr" href="#niceng194er7.s1.1.ref7" rid="niceng194er7.s1.1.ref7">Shorey 2018</a></p><p>Singapore</p><p><b>Aim of the study</b></p>
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<ul><li class="half_rhythm"><div>To explore the views of parents of newborns with regard to the content and delivery of a mobile health (mHealth) app–based postnatal educational program</div></li></ul></td><td headers="hd_h_niceng194er7.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">N=17 women (from the intervention group of a RCT)</td><td headers="hd_h_niceng194er7.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Semi-structured interviews</td><td headers="hd_h_niceng194er7.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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|
<ul><li class="half_rhythm"><div>Preference on when specific information should be provided</div></li><li class="half_rhythm"><div>Format of the information provided</div></li></ul></td></tr><tr><td headers="hd_h_niceng194er7.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p><a class="bibr" href="#niceng194er7.s1.1.ref6" rid="niceng194er7.s1.1.ref6">Shorey 2019</a></p><p>Singapore</p><p><b>Aim of the study</b></p>
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|
<ul><li class="half_rhythm"><div>To examine the experiences and perceptions of participants who participated in a supportive education parenting program intervention study.</div></li></ul></td><td headers="hd_h_niceng194er7.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>N=16 women (recruited from a RCT)</p>
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<p>n=6 from the control group</p>
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<p>n=10 from the intervention group</p>
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</td><td headers="hd_h_niceng194er7.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Face-to-face semi-structured interviews</td><td headers="hd_h_niceng194er7.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<ul><li class="half_rhythm"><div>Preference on when specific information should be provided</div></li><li class="half_rhythm"><div>Format of the information provided</div></li></ul></td></tr><tr><td headers="hd_h_niceng194er7.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p><a class="bibr" href="#niceng194er7.s1.1.ref9" rid="niceng194er7.s1.1.ref9">Sundstrom 2016</a></p><p>US</p><p><b>Aim of the study</b></p>
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<ul><li class="half_rhythm"><div>Understanding women’s feelings towards media for health issues</div></li></ul></td><td headers="hd_h_niceng194er7.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">N=44 postnatal women</td><td headers="hd_h_niceng194er7.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Semi-structured interviews either at hospital or over the phone</td><td headers="hd_h_niceng194er7.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<ul><li class="half_rhythm"><div>Format of the information provided</div></li><li class="half_rhythm"><div>Who should provide the information</div></li></ul></td></tr><tr><td headers="hd_h_niceng194er7.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p><a class="bibr" href="#niceng194er7.s1.1.ref10" rid="niceng194er7.s1.1.ref10">Weckesser 2019</a></p><p>England, UK</p><p><b>Aim of the study</b></p>
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<ul><li class="half_rhythm"><div>To understand women’s own priorities and information needs in relation to caesarean section recovery and infection prevention</div></li></ul></td><td headers="hd_h_niceng194er7.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">N=21 postnatal women following a caesarean section</td><td headers="hd_h_niceng194er7.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Focus groups (n=15) and telephone interviews (n=6)</td><td headers="hd_h_niceng194er7.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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|
<ul><li class="half_rhythm"><div>Preference on when specific information should be provided</div></li><li class="half_rhythm"><div>Level of detail</div></li><li class="half_rhythm"><div>Format of the information provided</div></li></ul></td></tr><tr><td headers="hd_h_niceng194er7.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p><a class="bibr" href="#niceng194er7.s1.1.ref11" rid="niceng194er7.s1.1.ref11">Weston 2014</a></p><p>England, UK</p><p><b>Aim of the study</b></p>
|
|
<ul><li class="half_rhythm"><div>To explore the experiences of midwives, antenatal and postnatal women to try to discover their perceptions of the value of internet use in pregnancy</div></li></ul></td><td headers="hd_h_niceng194er7.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">N=6 postnatal women (also N=13 midwives and N=7 antenatal women, but their quotes were not extracted)</td><td headers="hd_h_niceng194er7.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">One focus group for postnatal women and one-to-one interviews with two women who were uninvolved in the focus groups</td><td headers="hd_h_niceng194er7.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<ul><li class="half_rhythm"><div>Format of information provided</div></li><li class="half_rhythm"><div>Who should deliver the information</div></li></ul></td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt></dt><dd><div><p class="no_margin">RCT: randomised controlled trial</p></div></dd></dl></dl></div></div></div></article></div><div id="jr-scripts"><script src="/corehtml/pmc/jatsreader/ptpmc_3.22/js/libs.min.js"> </script><script src="/corehtml/pmc/jatsreader/ptpmc_3.22/js/jr.min.js"> </script></div></div>
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