ABSTRACT
BACKGROUND: In Brazil and other low- and middle-income countries, excess interventions in childbirth are associated with an increase in preterm and early-term births, contributing to stagnant morbidity and mortality of mothers and neonates. The fact that women often report a negative experience with vaginal childbirth, with physical pain and feelings of unsafety, neglect, or abuse, may explain the high acceptability of elective cesarean sections. The recognition of information needs and of the right to informed choice during childbirth can help change this reality. The internet has been the main source of health information, but its quality is highly variable. OBJECTIVE: This study aimed to develop and evaluate an information and communication strategy through a smartphone app with respect to childbirth, to facilitate informed choices for access to safer and evidence-based care in the context of the COVID-19 pandemic. METHODS: A randomized controlled trial, with 2 arms (intervention and control) and a closed, blind, parallel design, will be conducted with a smartphone app designed for behavior and opinion research in Brazil, with women of reproductive age previously registered on the app. After completing an entry questionnaire to verify the eligibility criteria and obtaining ethical consent, approximately 20,000 participants will be randomly allocated to the intervention and control groups at a 1:1 ratio. Participants allocated to the intervention group will be invited to engage in a digital information and communication strategy, which is designed to expand evidence-based knowledge on the advantages and disadvantages of options for labor and childbirth and the safety of the care processes. The information is based on the guidelines of the Ministry of Health and the World Health Organization for a positive childbirth experience and has been updated to include the new challenges and disruptions in maternity care within the context of the COVID-19 pandemic. The control group will receive information regarding disposable and reusable diapers as a placebo intervention. The groups will be compared in their responses in generating the birth plan and the entry and exit questionnaires, regarding responses less or more aligned with the guidelines for a positive childbirth experience. A qualitative component to map information needs is included. RESULTS: The digital trial started recruiting participants in late October 2020, and data collection has been projected to be complete by December 2020. CONCLUSIONS: This study will evaluate an innovative intervention that has the potential to promote better communication between women and providers, such that they can make better choices using an approach suitable for use during the COVID-19 pandemic. TRIAL REGISTRATION: The Brazilian Clinical Trials Registry U1111-1255-8683; http://www.ensaiosclinicos.gov.br/rg/RBR-3g5f9f/. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/25016.
ABSTRACT
Introdução: No Brasil, a maioria dos nascimentos é por cirurgia cesárea (CC), sendo amplamente utilizada no setor privado, mesmo com pesquisas indicando que quando as taxas de CC ultrapassam10-15%, os riscos adicionais superam os benefícios. A informação sobre benefícios e riscos das intervenções é fundamental para uma assistência segura e efetiva. É considerável o aumento de busca na web durante a gestação, no entanto, a qualidade das informações é questionável. Objetivo: avaliar a qualidade e abrangência das informações disponíveis sobre cesariana para leigos, em português, após um conjunto de políticas públicas para regular esta prática (2014/2015), na internet em geral e no site da Federação Brasileira de Associações de Ginecologia e Obstetrícia (FEBRASGO). Métodos: Trata-se de estudo documental observacional, transversal e analítico. A palavra "cesárea" e 25 sinônimos foram submetidos no campo de procura do site da FEBRASGO e em cinco motores de pesquisa para avaliar a preferência dos termos de busca. Os links catalogados foram analisados por dois pesquisadores independentes utilizando dois checklists: o DISCERN e um checklist específico para conteúdo. Adicionalmente, apresentou-se um debate sobre o sentido do nascimento, o ciberativismo e as políticas público no Brasil. Optou-se pela apresentação da tese no formato de três publicações, sendo duas já submetidas. Resultados: A palavra "cesaria" é a forma mais frequente, seguida de "cesarea". Na análise do conteúdo geral da internet, a produção de dado proveniente do Google.com.br representou apenas 45,5% (n = 235, 2018), sendo que este buscador tem a preferência de 94,5% dos brasileiros. Um terço do conteúdo esteve associado com informações relativas à recuperação da CC, resultado similar ao apontado pelo Google Trends com termos preferencias de busca na internet. As páginas Web foram melhor avaliadas em 2018 que em 2013, principalmente no critério de confiabilidade. O número páginas Web obtídos em 2018 foi 33% maior que em 2013, sendo que 93% eram inéditas. No site da FEBRASGO, foram observadas três fases distintas: 1) sem informação para leigos sobre CC, até 2014; 2) momento defensivo, onde os conteúdos estavam associados às medidas de redução de CC; 3) informativo, melhor redigido e autoral em 2018, porém, sem debater indicações, riscos e seu uso abusivo, no qual a CC é apenas citada dentro de outros temas. O debate sobre os ritos, mitos e as narrativas utilizadas no nascimento institucionalizado do Brasil traçou um paralelo teórico dos estudos entre o interacionismo simbólico de Mead e Blumer, com Davis Floyd e Diniz. Conclusões: Comparando os períodos de 2013 e 2018, nota-se melhora na confiabilidade da informação, porém, com uma queda do número de indicações e danos potenciais, e mais informação sobre recuperação. A cesárea é tratada frequentemente como fato consumado, tema que as gestantes estão mais interessadas. As associações médicas profissionais não tem promovido a devida informação sobre gravidez e parto, em linguagem apropriada para leigos, a Febrasgo poderia ocupar um lugar de referência na apomediação da relação médico-paciente, através de uma área dedicada a pacientes. O questionamento à epidemia de cesáreas se beneficiou da participação de iniciativas coletivas que representam narrativas independentes, como de grupos organizados de usuárias. Para a oferta de informações úteis à promoção de melhores resultados maternos e infantis, é necessária a mobilização em todas esferas sociais, públicas e privadas, e entre movimentos sociais, para a produção de conteúdo sobre CS com bases científicas, e uma orientação aos profissionais de saúde em recomendar páginas Web de qualidade às gestantes
Introduction: In Brazil, the majority of births are due to cesarean surgery (CC), being widely used in the private sector, even with research indicating that when CC rates exceed 10-15%, the additional risks outweigh the benefits. Information on benefits and risks of interventions is critical to safe and effective care. There is a growing trend for web research during pregnancy; however, the quality of information found is questionable. Objectives: This research aims to evaluate the quality and comprehensiveness of available information on CC for laypeople in Portuguese, following implementation of a set of public policies aimed at regulating this practice (2014/2015), on the internet in general and on the website of the Brazilian Federation of Associations of Gynecology and Obstetrics (FEBRASGO). Methods: An observational, transversal, analytical documentary research. The word "cesarean" and 25 synonyms were submitted in the search field of the FEBRASGO website and in five search engines to evaluate the preference of search terms.Two independent researchers using checklists to analyze the cataloged links: the DISCERN and a specific checklist for content.In addition, a debate was presented on the meaning of birth, cyberpolitics and public policies in Brazil.The thesis is presented in the article format, of the three publications, two already submitted.Results:The preliminary results on Internet search shows that the word "cesaria" is the most frequent form of the internet, followed by "cesarea". In the analysis of the general content of the internet, the production of data from Google.com.br represented only 45.5% (n = 235, 2018), and this search engine has the preference of 94.5% of Brazilians.One-third of the content was associated with CC recovery, a similar result to the one pointed out by Google Trends as preferences for internet search terms.The webpage (WP) number collected in 2018 was 33% higher than in 2013, and 93% of the previous were unpublished before. In 2018, WP were better endorsed than 2013 ones, particularly concerning the reliability criterion. On the FEBRASGO's website, analysis went through three phases: 1) no information for lay people about CC in 2014; 2) defensive texts associated with the CC reduction measures, in 2016; 3) a more informative, better written and authorial content in 2018, but with no debate on indications and abusive use of CC, only mentioned in other topic CC. The debate about the rites, myths and narratives used in the institutionalized birth of Brazil drew a theoretical parallel between the symbolic interactionism by Mead and Blumer and those by Davis Floyd and Diniz. Conclusions: When comparing the two periods, there is an improvement in the quality of information on CS, but with a decrease in the number of texts on indications and potential damages, as well as a rise on information about recovery from the surgery - often treated as a fait accompli - which is also a theme of great interest to pregnant women. Medical corporations have not promoted adequate information on pregnancy and childbirth in language appropriate for laypeople and need to be a reference in apomediation the physician-patient relationship through an area dedicated to patients. The questioning of the CS epidemy has benefited from the participation of collective initiatives that represent independent narratives, such as organized groups of healthcare consumers. To provide useful information that will improve the lives of mothers and infants, it's necessary to act in all social spheres, such as the public and the private, and across different social movements, producing CS related content based on scientific evidence, and guide healthcare professionals to recommending quality PW to pregnant women
