Proposed guidelines for antenatal care of teenage mothers : a modified delphi study

Abstract

It is generally accepted that a teenage pregnancy is a high-risk pregnancy associated with psychosocial problems causing these young women to default from antenatal care. Whilst pregnant teenage mothers are provided with antenatal care locally, the service provided is not directly focused on the needs of these teenage mothers. Being a vulnerable group, teenage mothers require additional antenatal care focusing mainly on their individualised needs. In view of this, a Modified Delphi study was carried out using a self-designed questionnaire/s to design and develop a set of guidelines with the aim of enhancing the provision of antenatal care for teenage mothers. To achieve this goal, the researcher identified and formulated clinical practice items required in the provision of antenatal care for teenage mothers through an in-depth literature review, and validated these items using a Modified Delphi approach. A heterogeneous sample comprising Clinical Midwives, Obstetric Doctors, Midwifery Educators, Mothers, Policy-Makers and Counsellors/Guidance Teachers were recruited by purposive, non-probability sampling technique and snowballing technique. This Modified Delphi Study consisted of two rounds of questionnaires. A sample size of 186 participants (68.6%) were recruited in Round 1. The response rate of Round 2 was 46.5% (n = 126) contributing to a total of 32% dropout rate. The homogeneity of the tool was demonstrated by testing its reliability using test-retest and internal consistency. Data analysis involved identifying the level of consensus for each clinical item in both rounds and was analysed using frequencies, cross-tabulations and correlational statistics. Through the in-depth literature review, 37 items and 4 themes were generated. These items formed the Modified Delphi questionnaire. Upon completion of Round 2, 34 items achieved the pre-determined 70% level of consensus, with the majority of items (n=21) scoring above 90%. Clinical items that gained consensus included those related to barriers issues, that is, amongst others, problems associated with a standard clinic and the socio-demographic statuses of the pregnant teenagers. Other items that gained consensus included those related to the need for follow-up sessions and additional support programmes for pregnant teenagers, family counselling sessions, continuity of care, alternative models of care, antenatal care in the community, after-school antenatal clinic, liaison with other relevant services, as well as the request for more training and guidelines for staff and student midwives. Items related to topics on the provision of transport for pregnant teenagers, the presence of older pregnant women in the antenatal clinic and the impact of unfriendly attitudes from health workers did not gain consensus and were excluded from the refined proposed guidelines. By using Carper’s Theory of Knowing, the Model of Change and the Practice Guidelines Evaluation and Adaptation Cycle as a guide, the researcher discussed how the responses of this study correlated with trends reported in previous literature. Based on the findings of this study, the conclusion provided recommendations for clinical practice, research and education, including among others, the need to publish the proposed guidelines for them to be used as a basis for the provision of local antenatal care, and the need to offer comprehensive training to those midwives who wish to extend their role and specialise in this field. It was concluded that the possibility of the development of a teenage antenatal clinic would require subsequent research, including the evaluation of the competencies needed of health professionals and the investigation of the success of this teenage antenatal clinic over time. Other suggestions for further practice, research and education were also drawn up.