脚规模[信用：母亲母亲的医院]

Why focus on healthy weight gain in pregnancy?

指南之外的妊娠体重增加（GWG）与negative health consequencesfor both the mother and her baby. Pregnant women who gain weight in accordance with the美国医学研究所（IOM）指南，也采用在澳大利亚使用的（我们进行了研究），妊娠和与出生有关的并发症的风险最低。收获更多的妇女更有可能在怀孕期间患上高血压和糖尿病，出生后留下的时间更长以及剖宫产。在婴儿出生后，他们也很可能会减轻体重，并难以母乳喂养。体重增加不足的女性更有可能及早分娩。

Less than a third of pregnant women gain the right amount.

In a recent systematic review and meta-analysis of over 1 million pregnant women, linked above, 47% had GWG greater than and 23% had GWG less than IOM recommendations. With the service changes made in our hospital’s antenatal care processes, we have been able to记录大量多余的GWG(decreasing from 57.3% to 32.6%).

How can we support women’s healthy weight gain?

如果您（正确）构建它，它们将会来。

Gut instinct says that if you tell people what to do they will do it – disseminate guidelines, deliver training, display posters – but evidence shows otherwise. Just as telling someone they need to exercise regularly for good health rarely results in a long-term change in routine, similarly, a more nuanced and tailored approach is required to facilitate sustainable changes in healthcare delivery.

进入实施科学- 促进研究发现和其他基于证据的实践对常规护理的方法的科学研究领域。我们在大型三级产妇服务中采取的方法遵循了制定有效医疗干预措施的建议步骤。在这种情况下，我们希望卫生专业人员，团队和组织的行为改变。

We asked:

1. 谁需要做不同的事情？
2. What barriers and enablers need to be addressed?
3. Which intervention components (behavior change techniques and modes of delivery) could help?
4. 如何衡量和理解行为改变？

通过从文献中综合数据，临床观察和staff调查（即理论，证据和实际问题），我们遵循这种四步方法来选择最合适的组成部分我们的实施干预.

Elements of a system-wide intervention to improve GWG guideline adherence.

我们工作的早期步骤导致了许多服务和系统更改，这是通过我们使用的理论领域框架（TDF）。这使我们能够分类和分类我们为实现最佳GWG实践所面临的障碍。TDF与我们的产妇服务相关的域名包括：知识,技能,Social and professional role/identity,关于能力的信念， 和Environmental context and resources.This led to us increasing dietitian time in clinic (including a营养师领导的早期产前研讨会），开发GWG资源供产妇工作人员使用（包括重量跟踪器), and staff training around GWG. Our changes were small but targeted – made within service capacity and with reorientation of existing resources.

We showed better compliance with individual guideline elements but overall adherence did not improve. The focus of this research related to the same identified gaps, and strategies were implemented in stages including:

• staff in-services training outlining and incorporating the evidence into practice via voiceover PowerPoint presentation (2014),
• 获取每个产前诊所室（2014）的尺度和
• removal of a default ‘skip’ option from the e-health record where weight is recorded, to promote mandatory entries (September 2016).

确保怀孕的体重记录更有效吗？

This study评估了这些干预措施对员工对产前重量记录的依从性的累积影响。使用在我们的干预措施的同一时期中经常收集的数据，使我们能够轻松地比较员工在产前访问时妇女体重的文档，以衡量每种干预措施如何影响实践。

Across three 15-month cohorts (from April 2014 to December 2017), there were approximately 39,000 pregnancies. The proportion of women who had a weight recorded at each visit per cohort differed significantly between cohorts, from 4.2% (baseline) to 18.9% (scales and in-services) to 61.8% (medical record prompts) (p <0.001). Improvements were observed across the entire service, in all models of care and with all professional groups.

想想全球，本地行动。

与常规结构变化相比，依靠记忆遵循建议的做法遵循建议的做法，从而引起了行为的改变，以促进其实施。我们的干预措施比以前记录了提醒系统（通常只有〜4％），也许是通过为当地障碍量身定制的。在这种产前重量记录的情况下，简单的系统变化对于可持续成果最有效。这反映了一个发现recent eHealth reviewthat highlighted substantial improvements in accuracy and completeness of clinical information as well as guideline adherence when electronic medical records are integrated into workflow processes (used at the point of care). Future guideline implementation projects should look beyond education sessions to harnessing systems and technology which will support their desired changes.