Birth after Caesarean: An Investigation of Factors that Influence Choice of Mode of Delivery
Advancing Health Lead: Sarah Munro
Summary: Clinical practice guidelines indicate that over 80% of women with a previous caesarean should be offered a planned vaginal birth after caesarean (VBAC), however only one third of eligible women choose to plan a VBAC. Based on findings from a mixed methods program of research and integrated knowledge translation, we have developed an interactive website to support decision-making for mode of birth after caesarean section in British Columbia. The KT tool is part of a multi-faceted shared decision-making intervention that is being co-developed with the BC Ministry of Health, Perinatal Services BC, regional health authorities, and experts at the Preference Laboratory at Dartmouth College. We have also conducted implementation science surveys to understand the contextual factors that support uptake of shared decision making in routine care.
Navigating Sexual and Reproductive Health Care in BC: Unmet Needs of Migrant Youth
Advancing Health Lead: Sarah Munro, with trainee Zeba Khan and Options for Sexual Health
Summary: Im/migrant populations, particularly youth, experience higher rates of unmet sexual and reproductive health needs. In the absence of culturally appropriate and accessible sexual and reproductive health care, they may face an increased risk of harm when engaging in normal, healthy sexual behaviours for their age. Dr. Munro and trainee Zeba Khan hope to describe and analyze the individual, sociocultural, economic and immigration specific factors that influence the access of sexual and reproductive health among im/migrant youth. The project involves interviews guided by KT and user-centred design principles. Understanding the specific needs of the im/migrant youth will allow them to develop KT strategies to address these gaps, including mHealth decision support tools. This work is funded by a grant from the Vancouver Foundation and is conducted in collaboration with Options for Sexual Health and researchers at the University of Alberta.
Past Projects
Shared Decision Making and Infant Feeding: Literature Review and Expert Engagement
Advancing Health Lead: Sarah Munro
Summary: Currently, BC does not have provincial, evidence-informed practice support resources or KT tools to help health care professionals to engage with families in order to support them to make quality decisions about their infant feeding options (such as breastfeeding or supplementing with formula) in a non-stigmatizing/non-judgmental manner. In partnership with the Ministry of Health and the BCCDC, our aim was to develop a suite of evidence-informed practice support resources. Our objectives were (i) To conduct a literature review to understand decision-making behaviours, needs, challenges, and opportunities for infant feeding choices faced by patient populations when they are making infant feeding choices prenatally, during antepartum admission, and postpartum; (ii) To engage with health care professionals through key informant interviews and focus groups to understand their practice support needs and create a KT strategy for putting resources into practice to improve patient care.
Where and How You Birth (WHY Birth): Development of a Patient Decision Aid for Model of Care and Place of Birth
Advancing Health Lead: Sarah Munro
Summary: Shared decision making is a form of patient-oriented knowledge translation. It involves the exchange of best evidence and patient values to ensure that families make health care decisions that reflect their informed preferences. Patient decision aids are knowledge translation tools to support the shared decision making process. We developed an online interactive patient decision aid to support women and health care providers when making decisions about model of care and place of birth. This work was conducted in partnership with Prof. Saraswathi Vedam and the Birthplace Lab in the UBC Department of Family Practice, and was funded by the Vancouver Coastal Health Research Institute.
Right For Me: A Cluster Randomised Trial of Two Interventions for Facilitating Shared Decision-Making About Contraceptive Methods
Advancing Health Lead: Sarah Munro
Summary: In the United States, over half of all pregnancies are unintended. Unintended pregnancy often occurs because women do not have a contraceptive method that fits their needs and lifestyle. The purpose of this implementation science research was to learn the best way to support women and their providers as they together compare contraceptive methods and choose a method based on what matters most to the woman. The Right for Me study was a large multi-centre randomized control trial in the eastern US that aimed to improve shared conversations about birth control methods between patients and providers. It was led by Dr. Rachel Thompson at Dartmouth College, involved patients as partners in all stages of the research process, and was funded by the Patient-Centered Outcomes Research Institute. Dr. Munro conducted the qualitative evaluation of the implementation of the shared decision-making interventions, informed by the Theoretical Domains Framework. The evaluation explored how clinics implemented the shared decision-making interventions. This evidence will help policy makers and researchers understand what strategies are best for implementing shared decision-making into routine care.
