Using the Behaviour Change Wheel to shape the ‘Baby Buddy Champions’ intervention for re-framing antenatal education in Cyprus

Abstract Background Τhe Baby Buddy Cyprus webapp was co-created with parents and health professionals within a Participatory Action Research framework. Baby Buddy can support the educational role of mother-child healthcare providers (HP); however, antenatal education (AE) may be currently perceived as a formal activity within the physical space of the antenatal class. We aimed to gain an understanding of influences on midwives engaging in an educational role during routine appointments and propose, on the basis of the ‘behaviour diagnosis’, a potential intervention using the Behaviour Change Wheel (BCW) framework. Methods This is a formative research study guided by the COM-B model and related Theoretical Domains Framework (TDF). Complimentary methods were used to collect information from in-training and registered midwives: focus group (N = 11), questionnaire survey (N = 24) and Nominal Group Technique during workshops (N = 40). Deductive content analysis of qualitative data and quantitative survey analysis, tapping on 6 COM-B and 14 TDF domains, guided the design of a multicomponent intervention. Results AE is viewed as a core function of the professional role, yet neither supported nor prioritized by current practices. Problematic areas relate to organizational context, such as weak interprofessional collaboration and lack of policy, protocols and resources. In addition, medicalization of birth and related socio-cultural norms, pertaining to users and providers, are sustaining alienation of the midwife and conditions of power dynamics. AE was perceived as a means to enhance the autonomy of the profession but there are might be issues with procedural knowledge and the need for skill development was identified. Several intervention functions were identified as promising, however cognitive re-framing through strategic communication and modelling may also be needed both in terms of providing “credible models” for the role itself as well as re-framing AE through the concept of “making every contact count”. Conclusions AE is currently perceived to be a ‘bad fit’ with routine practice. The study proposed an intervention to enhance midwives’ educational role and professional identity, while embedding Baby Buddy in clinical practice to facilitate the process. In addition to designing a theory-driven research-informed potential intervention, the process functioned as a participatory learning experience through collective reflection.