A pilot study of 'Informed Choice' leaflets on positions in labour and routine ultrasound

The background to this pilot project is the growing enthusiasm for informed user choice and evidence-based practice in NHS maternity care. This is leading to various attempts to provide those who work in the maternity services with the kind of information that can advance both informed choice and more appropriate and 'scientific' forms of intervention.

The Midwives's Information and Resource Service (MIDIRS) and the Centre for Reviews and Dissemination (CRD) have developed a set of 'Informed Choice' leaflets for pregnant women and for professionals which they wish to evaluate. These leaflets cover a variety of topics, and each leaflet for maternity service users is paired with one for health professionals. Each pair of leaflets draws on the same evidence. The role of the Social Science Research Unit (SSRU) has been to work with MIDIRS and CRD in designing, conducting and reporting a pilot of these. The pilot project may be followed by a larger multicentre study of the impact of the leaflets on maternity care practice.

The pilot was carried out by a research team at the SSRU over a six month period from January to June 1995 with the co-operation of women and health workers in 3 London hospitals. This report presents a summary of the main findings, inevitably drawing on only a proportion of the data collected. In addition to eliciting views on the leaflets and describing how they may be used by pregnant women and their midwives, the findings also throw light on the task of evaluating the introduction of informed choice leaflets into 'real life' settings.

The aims of the pilot project were:

1. To study methods and processes for disseminating the leaflets in 'real life' settings.

2. To assess the acceptability of the leaflets to pregnant women and health professionals.

3. To make recommendations for the design of the leaflets.

4. To develop appropriate methods for evaluating the impact of informed choice leaflets for pregnant women and health workers in both hospital and the community.

5. To identify appropriate outcome measures.

6. To develop instruments for assessing both processes and outcomes for use in a larger evaluation.

7. To assess the willingness of women to take part in a study of informed choice.

8. To report on other substantive findings arising in the pilot.

9. To make recommendations for the design of a larger evaluation.

Measuring 'informed choice' requires an assessment of how well the information needs of service users are met and to what extent service users are able to exercise choice. The process of enabling informed choice was investigated in the pilot project by asking three questions:

Was sufficient information available in the leaflets?

Were the leaflets accessible to all women?

Was the information read and understood by all women?