Feet on scale [credit: Mater Mothers’ Hospitals]

为什么要关注健康的重量增长？

Gestational weight gain (GWG) outside of guidelines is linked with负面健康后果对于母亲和她的宝宝。孕妇按照US Institute of Medicine (IOM) guidelines那also adopted for use in Australia (where we did our study), have the lowest risk of pregnancy and birth-related complications. Women who gain more are more likely to experience high blood pressure and diabetes in pregnancy, longer hospital stays after birth, and Cesarean sections. They are also more likely to have trouble losing weight after the baby is born and to have difficulty breastfeeding. Women who do not gain enough weight are more likely to deliver their baby early.

不到三分之一的孕妇获得适当的金额。

在最近有超过100万岁的孕妇的系统评审和荟萃分析中，高于上述1百万，GWG的47％比IO更多的GWG大于IOM建议。随着我们医院的产前护理流程所做的服务变化，我们已经能够document significant reduction in excess GWG（减少57.3％至32.6％）。

我们如何支持女性的健康体重增加？

If you build it (properly), they will come.

GUT Instonct说，如果你告诉别人该做什么，他们会做什么 - 传播指南，提供培训，展示海报 - 但证据表明否则。正如告诉某人，他们需要定期锻炼身体良好的健康，很少导致常​​规的长期变化，同样，需要更细致和量身定制的方法来促进医疗保健的可持续变化。

EnterImplementation Science– the field of scientific study of methods to promote the systematic uptake of research findings and other evidence-based practices into routine care. The approach we took in our large tertiary maternity service follows the recommended steps to develop effective health care interventions. In this case, we wanted behaviors of health professionals, teams, and the organization to change.

我们问：

1. Who needs to do what, differently?
2. 需要解决哪些障碍和推动者？
3. 哪些干预组件（行为改变技术和交付方式）可以有所帮助？
4. How can behavior change be measured and understood?

Through a body of work that synthesized data from the literature, clinical observations, and职员surveys（i.e. theory, evidence, and practical issues), we followed this four-step approach to select the most appropriate components ofour implementation intervention。

系统范围内干预的要素，以提高GWG指南遵守。

Early steps in our work resulted in a number of service and system changes, informed by our use of thetheoretical domains framework（TDF). This allowed us to sort and categorize the barriers we faced to achieving best GWG practice. The domains from the TDF relevant to our maternity service included:Knowledge那Skills那社会和专业角色/身份那Beliefs about capabilities那and环境背景和资源。这导致了我们在诊所增加营养师时间（包括一个dietitian-led early antenatal workshop的）那development of GWG resources for maternity staff to use (including aWeight tracker）和GWG周围的员工培训。我们的变化很小但有针对性的 - 在服务能力内，并重新定向现有资源。

我们表现​​出更好的遵守个人准则元素，但整体遵守并未改善。该研究与相同的识别差距和策略相关的焦点在包括：

• 员工的服务培训概述并通过Voiceover PowerPoint演示文稿纳入实践（2014），
• obtaining scales for each antenatal clinic room (2014), and
• 从记录重量的电子健康记录中删除默认的“跳过”选项，以促进强制性条目（2016年9月）。

What is more effective for ensuring weight recording in pregnancy?

这项研究assessed the cumulative influence of these interventions on staff’s compliance to recording of antenatal weights. Using routinely collected data across the same periods of our interventions allowed us to easily compare staff’s documentation of women’s weights at antenatal visits to measure how each intervention affected practice.

跨越三个15个月的队列（从2014年4月到2017年12月），有大约39,000名怀孕。每个群组每次参观的妇女重量的妇女的比例在群组之间显着不同，从4.2％（基线）到18.9％（秤和服务）至61.8％（医学记录提示）（P <0.001）。在整个服务中，在所有的服务和所有专业团体中都观察到整个服务的改进。

Think global, act local.

Reliance on memory to follow recommended practices from guidelines less-consistently elicits behavior change compared to routine structural changes to facilitate their implementation. Our interventions showed greater improvements thanpreviously documented for reminder systems(通常只有~ 4%),也许通过独特tailored to the local barriers. Simple system changes appear to be most effective for sustainable outcomes in this instance of antenatal weight recording. This reflects findings from a最近的电子健康评论这突出了临床信息的准确性和完整性以及当电子医疗记录集成到工作流程过程中的准确性和完整性以及准则依从性的重大提高（在护理点使用）。未来的指南实施项目应超越教育会话，以利用将支持其所需更改的系统和技术。