Use of evidence based leaflets to promote informed choice in maternity care: randomised controlled trial in everyday practice

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Abstract
Objective: To assess the effect of leaflets on promoting informed choice in women using maternity services. Design: Cluster trial, with maternity units randomised to use leaflets (intervention units) or offer usual care (control units). Data collected through postal questionnaires. Setting: 13 maternity units in Wales. Participants: Four separate samples of women using maternity services. Antenatal samples: women reaching 28 weeks' gestation before (n=1386) and after (n=1778) the intervention. Postnatal samples: women at eight weeks after delivery before (n=1741) and after (n=1547) the intervention. Intervention: Provision of 10 pairs of Informed Choice leaflets for service users and midwives and a training session for staff in their use. Main outcome measures: Change in the proportion of women who reported exercising informed choice. Secondary outcomes: changes in women's knowledge; satisfaction with information, choice, and discussion; and possible consequences of informed choice. Results: There was no change in the proportion of women who reported that they exercised informed choice in the intervention units compared with the control units for either antenatal or postnatal women. There was a small increase in satisfaction with information in the antenatal samples in the intervention units compared with the control units (odds ratio 1.40, 95% confidence interval 1.05 to 1.88). Only three quarters of women in the intervention units reported being given at least one of the leaflets, indicating problems with the implementation of the intervention. Conclusion: In everyday practice, evidence based leaflets were not effective in promoting informed choice in women using maternity services.