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Preterm birth is associated with severe short and long-term consequences for the child, including increased morbidity and mortality. Therefore, good preventive strategies are a powerful resource to reduce these adverse outcomes. Preventive behaviours include adequate nutrition, physical activity, good stress management, regular health check-ups, and the ability to identify and act on risk symptoms. Yet every woman is different, has different knowledge and self-efficacy when it comes to nutrition or exercise. How can healthcare professionals be sure which expectant mother is able to follow these behaviours independently and which mother needs more support and for what activity? That is why the SMSE-BPB scale was developed! Almost 700 women participated in the development of this tool, which allows women to be screened for their individual risk factors. The results can be used to guide early healthcare interventions and possibly prevents some preterm births.
Preterm birth (PTB) occurs in around 9-12% of live births globally. Being born preterm increases the infant’s morbidity and mortality and causes challenges related to health and development into adulthood. Prevention measures to reduce the number of preterm births are therefore vital.
In order to establish a successful prevention programme, it is necessary to understand the determinants that influence preterm birth. Variables that can alter PTB are the mother’s health status before pregnancy, including her body mass index, smoking habits, birth spacing, unintended pregnancies, gestational age, and prenatal care. During pregnancy, the quality of the mother’s diet can contribute to PTB.
These behaviours can be managed by the woman herself with the support of information and collaboration. Self-efficacy plays a key role here. It is the ability to stick to necessary preventive behaviours such as following a healthy diet despite cravings for an unhealthy alternative or following an exercise routine despite feeling tired. For healthcare professionals, being able to identify self-efficacy in women of childbearing age is a great resource as these women’s self-efficacy can be turned into a means to encourage PTB preventive behaviour.
Developing the first pregnancy-specific self-efficacy measurement tool
However, it is difficult to measure self-management self-efficacy (SMSE). Therefore, a SMSE scale was developed in the context of general health self-efficacy measurement. As this scale cannot simply be used for the special circumstances of PTB prevention before and during pregnancy, a new study was conducted to further develop the original scale into the specialised SMSE-BPB (SMSE for Premature Birth Prevention) scale. By applying the SMSE-BPB to women of childbearing age, health centres are able to develop effective, individualised interventions for the prevention of PTB.
The scale is divided into a period before pregnancy, during pregnancy, and after hospital admission to acknowledge the different risks changing over time. The relevant dimensions were collected from interviews and later tested in surveys with almost 700 participating women.
The SMSE-BPB scale proves effective to support PTB prevention
In all three periods, different dimensions of preventive behavior are addressed, such as a proactive lifestyle before and during pregnancy, including diet, stress reduction, exercise, and sleep. In addition, the women’s collaboration and communication with healthcare professionals and their ability to deal with problems, identify and act on risk symptoms were included.
The SMSE-BPB showed high validity and is therefore able to accurately assess the attributes of self-management self-efficacy. It can thus serve as a screening tool to guide healthcare interventions for the prevention of PTB. Expectant mothers should take the test early in their pregnancy to determine their individual, modifiable risk factors. Subsequently, health-related interventions can be tailored to their individual needs and risks can be reduced so that potentially adverse birth outcomes are prevented.
However, caution is required in the application of the tool. Taking the test could increase the stress and anxiety levels of expectant mothers who already struggle with pregnancy-related mental health problems and could have the opposite negative effect.
Paper available at: https://bmcwomenshealth.biomedcentral.com/articles/10.1186/s12905-024-02964-w
Ful list of authors: Sun-Hee Kim and Yu-Jin Lee
