Table_1_Psychological Intervention to Improve Communication and Patient Safety in Obstetrics: Examination of the Health Action Process Approach.DOCX

BackgroundHuman failure and a lack of effective communication are the main reasons for preventable adverse events, compromising patient safety in obstetrics. In order to improve safety, team and communication interventions have been implemented but lack feasibility in obstetric care. Psychological models such as the health action process approach might help to improve interventions.
MethodsIn a cross-sectional online survey with N = 129 healthcare workers (Study 1) and a paper-pencil survey with N = 137 obstetric healthcare workers at two obstetric university hospitals (Study 2), associations of social-cognitive variables were tested in a path analysis and a multiple regression. Preliminary results informed a communication training for all obstetric healthcare workers. A repeated-measures MANOVA was used to compare pre- and post-intervention data.
ResultsSocial-cognitive variables were associated according to model suggestions (β = –0.26 to 0.45, p < 0.05) except for planning in the first study. Triggers of adverse events were associated (β = –0.41 to 0.24, p < 0.05) with communication behavior (Study 2), action self-efficacy and planning (Study 1), as well as barriers to effective communication (both studies). The intervention was rated positively (M = 3.3/4). Afterward, fewer triggers were reported and coping self-efficacy increased. There were group differences regarding hospital, experience, and time.
DiscussionThe health action process approach was examined in the context of safe communication in obstetrics and can be used to inform interventions. A theory-based, short training was feasible and acceptable. Perceived patient safety improved but communication behavior did not. Future research should aim to test a more comprehensive psychological communication intervention in a thorough RCT design.

背景 人为失误与有效沟通匮乏是可预防性不良事件的核心诱因，严重危及产科领域的患者安全。为提升产科护理安全，学界已引入团队协作与沟通干预策略，但此类方案在产科临床场景中可行性欠佳。健康行动过程取向（Health Action Process Approach）等心理学模型，或可为优化此类干预方案提供理论支撑。

方法 本研究包含两项实证调研：研究1为横断面在线调查，共纳入129名医护人员（N=129）；研究2为纸笔问卷调查，在两所产科大学附属医院开展，纳入137名产科医护人员（N=137）。本研究通过路径分析与多元回归模型，检验社会认知变量间的关联关系。基于初步调研结果，我们为全体产科医护人员设计了针对性沟通培训课程，并采用重复测量多变量方差分析（repeated-measures MANOVA）对比干预前后的调研数据。

结果 社会认知变量间的关联均符合模型理论预期（β = –0.26 至 0.45，p < 0.05），仅研究1中的计划行为变量例外。不良事件诱因与沟通行为（研究2）、行动自我效能与计划行为（研究1），以及有效沟通障碍（两项研究）均存在统计学意义上的显著关联（β = –0.41 至 0.24，p < 0.05）。参训人员对本次培训的整体评价较为积极（均值M=3.3/4）。干预后，参训人员报告的不良事件诱因数量显著减少，应对自我效能水平有所提升。此外，不同医院、从业年限与调研时段的组别间存在显著差异。

讨论 本研究在产科安全沟通的场景下验证了健康行动过程取向模型的适用性，该模型可为相关干预方案的开发提供理论指导。本次基于理论开发的简短培训方案具备良好的可行性与接受度。参训人员感知到的患者安全水平有所提升，但实际沟通行为未出现显著改善。未来研究应采用严谨的随机对照试验（RCT）设计，对更全面的心理学沟通干预手段开展系统性测试。