An Evaluation of the Implementation of Maternal Obesity Pathways of Care: A Mixed Methods Study with Data Integration

Objectives
Maternal obesity has multiple associated risks and requires substantial intervention. This research evaluated the implementation of maternal obesity care pathways from multiple stakeholder perspectives.
Study Design
A simultaneous mixed methods model with data integration was used. Three component studies were given equal priority. 1: Semi-structured qualitative interviews explored obese pregnant women’s experiences of being on the pathways. 2: A quantitative and qualitative postal survey explored healthcare professionals’ experiences of delivering the pathways. 3: A case note audit quantitatively assessed pathway compliance. Data were integrated using following a thread and convergence coding matrix methods to search for agreement and disagreement between studies.
Results
Study 1: Four themes were identified: women’s overall (positive and negative) views of the pathways; knowledge and understanding of the pathways; views on clinical and weight management advice and support; and views on the information leaflet. Key results included positive views of receiving additional clinical care, negative experiences of risk communication, and weight management support was considered a priority. Study 2: Healthcare professionals felt the pathways were worthwhile, facilitated good practice, and increased confidence. Training was consistently identified as being required. Healthcare professionals predominantly focussed on women’s response to sensitive obesity communication. Study 3: There was good compliance with antenatal clinical interventions. However, there was poor compliance with public health and postnatal interventions. There were some strong areas of agreement between component studies which can inform future development of the pathways. However, disagreement between studies included a lack of shared priorities between healthcare professionals and women, different perspectives on communication issues, and different perspectives on women’s prioritisation of weight management.
Conclusion
The differences between healthcare professionals’ and women’s priorities and perspectives are important factors to consider when developing care pathways. Shared perspectives could help facilitate more effective implementation of the pathway interventions that have poor compliance.

研究目的
孕产妇肥胖存在多重相关风险，且需要开展大量针对性干预措施。本研究从多方利益相关者视角出发，评估孕产妇肥胖照护路径的落地实施情况。

研究设计
本研究采用同步混合研究设计并整合多源数据，三项子研究均被赋予同等优先级：1. 半结构化质性访谈：探究肥胖孕妇对该照护路径的使用体验；2. 定量与定性结合的邮寄问卷调查：探究医护人员实施该照护路径的实践体验；3. 病例记录审计：定量评估照护路径的依从性。研究数据采用线索追踪与收敛编码矩阵法进行整合，以挖掘各子研究间的共识与分歧。

研究结果
研究1：共识别出4个核心主题，分别为受试者对该照护路径的整体评价（涵盖正面与负面感受）、对该照护路径的认知与掌握情况、对临床照护与体重管理相关建议及支持服务的看法，以及对配套信息手册的评价。核心结果包括：对获得额外临床照护持有积极态度、在风险沟通环节存在负面体验、体重管理支持被视作核心优先事项。
研究2：医护人员普遍认为该照护路径具有实践价值，能够规范临床操作并提升从业信心；培训需求被反复提及。医护人员主要关注受试者对敏感性肥胖相关沟通的接受与反应。
研究3：产前临床干预的依从性表现良好，但公共卫生干预与产后干预的依从性较差。各子研究间存在若干高度共识的结论，可为该照护路径的后续优化提供参考依据；但各研究间也存在分歧，具体包括医护人员与孕产妇双方未能达成共同优先级、对沟通相关问题的认知存在差异，以及对孕产妇体重管理优先级的看法各不相同。

研究结论
在开发孕产妇肥胖照护路径时，医护人员与孕产妇双方在优先级与认知视角上的差异是需要重点考量的关键因素。达成共识视角有助于更高效地推动依从性较差的路径干预措施落地实施。