Shared decision-making in integrated maternity care

Systematic development of health literacy-sensitive strategies for clients and professionals

Geplaatst op

Low health literacy challenge for shared decision-making in maternity care

While integrated maternity care increasingly aims at Shared Decision-making (SDM), it seems that clients with low health literacy (HL) do not optimally benefit. Low HL is a barrier in communication with health care professionals, obtaining and understanding information on options, and evaluating the importance of pros and cons. Despite the growing awareness that HL matters to SDM, intervention development is lagging behind. Current decision support strategies in maternity care tend to apply a ‘one size fits al’ approach, and have not been designed for or evaluated among clients with low HL. A lack of SDM may result in miscommunication during labour, low satisfaction with care and even traumatic experiences.


This project aims to systematically develop and evaluate strategies to improve SDM in integrated maternity care. Strategies for clients will focus on decision support that is sensitive to HL levels. Strategies for professionals will focus on skills development, following educational theories, innovative methods and existing Dutch training interventions.


Stage 1 Needs assessment clients and professionals (12 months)

1.1 To specify clients’ skills for SDM and their needs for support in SDM in integrated maternity care

1.2 To assess how current SDM and support adheres to these skills and needs

1.3 To gain insight into professionals’ responsiveness to clients’ skills and their needs for support in SDM with low HL clients

Stage 2 Strategy development (8 months)

2.1 To co-create a decision support tool for and with clients and professionals

2.2 To pretest the decision support tool among clients and professionals

2.3 To develop and pilot-implement training elements for and with professionals

Stage 3 Evaluation of SDM strategies (20 months)

3.1 To assess the effect of the training elements on observed SDM among professionals

3.2 To assess the effect of the combination of training and decision support tools on perceived SDM among clients

3.3 To gain insight in accessibility and usability of new SDM strategies for clients and professionals (process evaluation)

Stage 4 Plan for implementation (2 months)

4.1 To develop a toolkit and plan for further implementation of SDM strategies in integrated maternity care



Our findings can be used to optimize SDM for all clients, especially those with lower HL. Developed SDM strategies can be used by all professionals in integrated maternity care, ultimately facilitating client involvement and continuity of care. However, the reliance on an active client role may increase socioeconomic inequalities in health. Those who are more able to find their way in integrated maternity care and adequately communicate with professionals are likely better off than those who cannot. Those who are more able to find their way in maternity care and adequately communicate with professionals may be better off than those who cannot. The strategies envisioned in our project will therefore explicitly optimize SDM for low HL clients, to ensure that SDM will reduce rather than increase health inequalities.


Dr. M.P. Fransen en Dr. O.C. Damman


Drs. L. Murugesu


Westfries Gasthuis
VUmc Midwifery Science
Academie Verloskunde Maastricht
Cooperatie Geboortehart U.A.
Ouder-kindcentrum Amsterdam UMC
Netwerk Geboortezorg Noordwest Nederland




dr. O.C. Damman


01/11/2018 – 01/04/2022

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