Behaviour change towards effective communication supported by an app for pregnant women: Social-cognitive HAPA determinants and dropout exploration in a longitudinal study in German (Preprint)

Abstract

In the medical field of obstetrics, communication plays a crucial role, and pregnant women in particular can benefit from interventions improving their self-reported communication behaviour. Effective communication behaviour can be understood as correct transmission of information without misunderstandings, confusions, or losses. While effective communication can be trained, there is limited research testing this concept but research testing this is scarce. Thus, little is known about the success of such an endeavour, potential behavioural barriers for engagement, as well as the processes by which such an internet intervention might improve self-reported communication behaviour.

The current study filled this research gap, by applying a web-app aiming at improving pregnant women’s communication behaviour in clinical care. The goals of the present study were (1) to uncover potential risk factors for early dropout from the digital intervention and (2) to investigate which social-cognitive factors predict self-reported communication behaviour after having used the digital intervention i.e. an app.

N = 1187 pregnant women were recruited. They all started to use a theory-based app focusing on intention, planning, self-efficacy, and outcome expectancy to improve communication behaviour. Mechanisms of behaviour change as a result of exposure to the app were explored using step-wise regression and path analysis. Moreover, determinants of dropout were tested using logistic regression.

Results revealed that dropout was associated with younger age (P=.014). Mechanisms of behaviour change were consistent with the predictions of the HAPA. The step-wise regression analysis revealed that action planning was the best predictor for successful behavioural change over the course of the app (β =.331; P<.001). The path analyses proved that self-efficacy beliefs affected the intention to communicate effectively which in turn elicited action planning and thereby improved communication behaviour (ß = .017; CFI =.994; TLI = 971; RMSEA = .055).

To conclude, this research can guide the development and improvement of apps addressing communication behaviour in obstetrics. First, such tools would enable action planning to improve communication behaviour, as it is the key predictor of behaviour change. Second, younger women need more attention to keep them from dropping out. However, future research should build upon the gained insights by conducting similar internet interventions in related fields of clinical care. The focus should be on processes of behaviour change, internet intervention success, and strategies to minimize dropout rates.

Trial registration: ClinicalTrials.gov Identifier: NCT03855735; date of registration: February 27, 2019.