A systematic literature review of computer-based behaviouralchange interventions to inform the design of an online VBACintervention for the OptiBIRTH European randomised trial(project HEALTH – F3 – 2012-305208)

Research output: Contribution to journalArticle

Abstract

Aim. To systematically review computer-based, behaviour change interventions during pregnancy and their design componentsin order to determine their best application within the context of the OptiBIRTH intervention.Design. A systematic literature review was undertaken using the Cochrane Collaboration Guidelines for Systematic Reviewsof Health Promotion and Public Health Interventions. Literature searches were conducted in: Ovid MEDLINE, PubMed,Cochrane Library, Embase, PsycINFO, from database inception to June 2015. Cochrane Risk of Bias criteria was applied toassess the methodological quality and a taxonomy of behaviour change techniques was used to appraise the interventions.PICO. Participants: included healthy pregnant women who were ≥18 years old. Types of Intervention: Computer-basedinterventions designed to facilitate a behaviour change approach in a sample of pregnant women. Comparison: routineantenatal care. Outcomes: The primary outcome included improved health behaviour(s), as an indicator of the intentionbehind the intervention design.Results. A total of 343 papers were identified through database searching and hand searching methods; 80 duplicates wereremoved. From the remaining 263 papers, 244 did not explicitly address the subject under review. Therefore, 19 full textarticles were assessed for eligibility; 16 did not meet eligibility criteria and were excluded at this stage. This resulted in a totalof three studies being selected for inclusion in this review (Jackson et al, 2011; Tzilos et al, 2011 and Tsoh et al, 2010). Thecomputer-based interventions were designed to bring about behavioural change in relation to alcohol consumption, smokingor diet and exercise during pregnancy. Interventions delivered varied between two types: purely computer-delivered (Tzilos etal, 2011) or a combination of both computer plus face-to-face input (Jackson et al, 2011, Tsoh et al, 2010). Techniques usedincluded motivational interviewing, problem-solving cognitive dissonance and goal setting. Types of measurement outcomesvaried but were all self-reported behavioural outcomes. Statistically significant improvements in behavioural outcomes wereseen in the interventions by Jackson et al, (2011) and Tsoh et al, (2010) but not Tzilos et al (2011). The GRADE analysisidentified that all studies combined lacked blinding and relied on self-reported data therefore increasing risk of bias.Conclusion. This systematic review reports on the best available evidence and theory to design an online component of acomplex intervention for use in a RCT to enhance women’s shared-decision making experience about VBAC. The reviewreports the differences between the observed behavioural change approach and that of a decision-making approach: BCTsare applied when a predetermined, directional goal is evidentially understood by the clinicians as being focused on a morehealthy option. As a result, techniques designed to create dissonance are considered appropriate. Shared decision-making,however, is conceptually different, in that the goal is to facilitate a woman in discovering the best direction of travel forher as a person. Therefore, the authors argue that it is crucial for health care professionals designing complex healthcareinterventions (either BCTs or SDMs) to ensure that a person’s self-determination is respected through having access torelevant and understandable information and health care professionals’ who understand a woman’s motivation. However,it is not possible to draw firm conclusions from three studies and there is a requirement for further research.
LanguageEnglish
Pages5-13
JournalEvidence Based Midwifery
Volume15
Issue number1
Publication statusPublished - 11 Apr 2017

Fingerprint

Decision Making
Health Promotion
Pregnant Women
Cognitive Dissonance
Databases
Motivational Interviewing
Delivery of Health Care
Pregnancy
Personal Autonomy
Health Behavior
PubMed
MEDLINE
Alcohol Drinking
Libraries
Motivation
Healthy Volunteers
Public Health
Guidelines
Exercise
Diet

Keywords

  • VBAC
  • technology
  • pregnancy
  • information technology
  • decision making
  • midwifery
  • systematic review
  • evidencebased

Cite this

@article{727cfb75bede460799f21c22584459c5,
title = "A systematic literature review of computer-based behaviouralchange interventions to inform the design of an online VBACintervention for the OptiBIRTH European randomised trial(project HEALTH – F3 – 2012-305208)",
abstract = "Aim. To systematically review computer-based, behaviour change interventions during pregnancy and their design componentsin order to determine their best application within the context of the OptiBIRTH intervention.Design. A systematic literature review was undertaken using the Cochrane Collaboration Guidelines for Systematic Reviewsof Health Promotion and Public Health Interventions. Literature searches were conducted in: Ovid MEDLINE, PubMed,Cochrane Library, Embase, PsycINFO, from database inception to June 2015. Cochrane Risk of Bias criteria was applied toassess the methodological quality and a taxonomy of behaviour change techniques was used to appraise the interventions.PICO. Participants: included healthy pregnant women who were ≥18 years old. Types of Intervention: Computer-basedinterventions designed to facilitate a behaviour change approach in a sample of pregnant women. Comparison: routineantenatal care. Outcomes: The primary outcome included improved health behaviour(s), as an indicator of the intentionbehind the intervention design.Results. A total of 343 papers were identified through database searching and hand searching methods; 80 duplicates wereremoved. From the remaining 263 papers, 244 did not explicitly address the subject under review. Therefore, 19 full textarticles were assessed for eligibility; 16 did not meet eligibility criteria and were excluded at this stage. This resulted in a totalof three studies being selected for inclusion in this review (Jackson et al, 2011; Tzilos et al, 2011 and Tsoh et al, 2010). Thecomputer-based interventions were designed to bring about behavioural change in relation to alcohol consumption, smokingor diet and exercise during pregnancy. Interventions delivered varied between two types: purely computer-delivered (Tzilos etal, 2011) or a combination of both computer plus face-to-face input (Jackson et al, 2011, Tsoh et al, 2010). Techniques usedincluded motivational interviewing, problem-solving cognitive dissonance and goal setting. Types of measurement outcomesvaried but were all self-reported behavioural outcomes. Statistically significant improvements in behavioural outcomes wereseen in the interventions by Jackson et al, (2011) and Tsoh et al, (2010) but not Tzilos et al (2011). The GRADE analysisidentified that all studies combined lacked blinding and relied on self-reported data therefore increasing risk of bias.Conclusion. This systematic review reports on the best available evidence and theory to design an online component of acomplex intervention for use in a RCT to enhance women’s shared-decision making experience about VBAC. The reviewreports the differences between the observed behavioural change approach and that of a decision-making approach: BCTsare applied when a predetermined, directional goal is evidentially understood by the clinicians as being focused on a morehealthy option. As a result, techniques designed to create dissonance are considered appropriate. Shared decision-making,however, is conceptually different, in that the goal is to facilitate a woman in discovering the best direction of travel forher as a person. Therefore, the authors argue that it is crucial for health care professionals designing complex healthcareinterventions (either BCTs or SDMs) to ensure that a person’s self-determination is respected through having access torelevant and understandable information and health care professionals’ who understand a woman’s motivation. However,it is not possible to draw firm conclusions from three studies and there is a requirement for further research.",
keywords = "VBAC, technology, pregnancy, information technology, decision making, midwifery, systematic review, evidencebased",
author = "Sinclair, {Marlene .}",
note = "OA should be changing but not updated as at 29-Jul-19. See info in 'Other files' Reference text: Armstrong R, Waters E, Jackson N, Oliver S, Popay J, Shepherd J, Petticrew M, Anderson L, Bailie R & Brunton G. (2007) Guidelines for systematic reviews of health promotion and public health interventions. Version 2. Melbourne University: Australia. Barry MJ & Edgman-Levitan S. (2012) Shared decision making--pinnacle of patient-centered care. New England Journal of Medicine 366(9): 780-781. British Medical Council (2009) Developing and Evaluating Complex Interventions. See https://www.mrc.ac.uk/documents/pdf/complexinterventions- guidance/ Deci EL & Ryan RM. (2000) The “what” and “why” of goal pursuits: Human needs and the self-determination of behavior. Psychological Inquiry 11(4): 227-268. Frosch DL & Kaplan RM. (1999) Shared decision making in clinical medicine: past research and future directions. American Journal of Preventive Medicine 17(4), 285-294. Glyn E, Frosch D &Thomson R. (2012) Shared Decision Making: A model for clinical Practice. J Gen Intern Med. 27:1361. Doi 10.1007/s11606- 012-2077-6 Jackson RA, Stotland NE, Caughey AB & Gerbert B. (2011) Improving diet and exercise in pregnancy with Video Doctor counselling: a randomized trial. Patient Education & Counseling: 83(2), 203-209. Kasper JF, Mulley AG & Wennberg JE. (1992) Developing shared decisionmaking programs to improve the quality of health care. Quality Review Bulletin: 18(6), 183-190. Kelders SM, Kok RN, Ossebaard HC & Van Gemert-Pijnen JE. (2012) Persuasive system design does matter: a systematic review of adherence to web-based interventions. Journal of Medical Internet Research: 14(6), e152. doi: 10.2196/jmir.2104 Lehto T & Oinas-Kukkonen H. (2011) Persuasive features in web-based alcohol and smoking interventions: a systematic review of the literature. Journal of Medical Internet Research: 13(3), e46. doi: 10.21961/jmir.1559 Lundgren I, Begley C, Gross MM & Bondas T. (2012) ‘Groping through the fog’: a metasynthesis of women’s experiences on VBAC (vaginal birth after caesarean section). BMC Pregnancy & Childbirth: 12(85). doi:10.1186/1471-2393-12-85 Michie S, Richardson M, Johnston M, Abraham C, Francis J, Hardeman W, Eccles MP, Cane J & Wood CE. (2013) The behavior change technique taxonomy (v1) of 93 hierarchically clustered techniques: building an international consensus for the reporting of behavior change interventions. Annals of Behavioral Medicine: 46(1), 81-95. Michie S, Free C &West R(2012) Characterising the ‘Txt2Stop’smoking cessation text messaging intervention in terms of behaviour change techniques. Journal of Smoking Cessation: 7(01), 55-60. Miller, WR& Rollnick, S. (2012) Motivational interviewing: helping people change. Guilford: London. Moher, D. Liberati A, Tetzlaff J, Altman DG & PRISMA Group. (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med: 6(7): e1000097. doi:10.1371/journal. pmed.1000097 Moulton B & King JS (2010) Aligning ethics with medical decision-making: the quest for informed patient choice. Journal of Law, Medicine & Ethics 38(1), 85-97. National Institute for Health and Care Excellence (2014) Behaviour change: individual approaches: NICE Public Health Guideline 49: See https:// www.nice.org.uk/guidance/ph49 (accessed 16th March 2017). National Institute for Health and Care Excellence (2007) Behaviour change: the principles for effective interventions: NICE Public Health Guideline 6. Seehttps://www.nice.org.uk/guidance/ph6 (accessed 16 March 2017). Oinas-Kukkonen, H & Harjumaa M (2009) Persuasive systems design: Key issues, process model, and system features. Communications of the Association for Information Systems: 24(1), 28. OptiBIRTH Project. Improving the organisation of health service delivery. Seehttp://www.optibirth.eu. (accessed 16 March 2017). Patrick H & Williams GC. (2012) Self-determination theory: its application to health behavior and complementarity with motivational interviewing. International Journal of Behavioral Nutrition & Physical Activity: 9(8). doi:10.1186/1479-5868-9-18 Phelan S (2010) Pregnancy: a “teachable moment” for weight control and obesity prevention. American Journal of Obstetrics & Gynecology: 202(2), 135.e1-135.e8. Rubak S, Sandbaek A, Lauritzen T & Christensen B. (2005) Motivational interviewing: a systematic review and meta-analysis. British Journal of General Practice: 55(513), 305-312. Stacey D., L{\'e}gar{\'e} F., Col NF, Bennett CL, Barry MJ, Eden K B, Holmes- Rovner M Llewellyn-Thomas, Lyddiatt A, Thomson R, Trevena L & Wu JHC. (2014) Decision aids for people facing health treatment or screening decisions. Cochrane Database of Systematic Reviews: 10, CD001431. doi: 10.1002/14651858.CD001431 Stockdale J, Sinclair M, Wiseman H & Bonazzo R (2014) The challenge of designing and integrating three motivating, sequential apps for optimising birth after C Section, Proceedings of the eChallenges e-2014 Conference: Belfast, Northern Ireland, 1-8 October. Tsoh JY, Kohn MA & Gerbert B. (2010) Promoting smoking cessation in pregnancy with Video Doctor plus provider cueing: a randomized trial. Acta Obstetricia et Gynecologica Scandinavica: 89(4), 515-523. Tzilos GK, Sokol RJ & Ondersma SJ. (2011) A randomized phase I trial of a brief computer-delivered intervention for alcohol use during pregnancy. Journal of Women’s Health: 20(10), 1517-1524. Webb T, JosephJ. Yardley L & Michie, S. (2010) Using the internet to promote health behavior change: a systematic review and meta-analysis of the impact of theoretical basis, use of behavior change techniques, and mode of delivery on efficacy. Journal of Medical Internet Research 12(1), e4. doi: 10.2196/jmir.1376",
year = "2017",
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T1 - A systematic literature review of computer-based behaviouralchange interventions to inform the design of an online VBACintervention for the OptiBIRTH European randomised trial(project HEALTH – F3 – 2012-305208)

AU - Sinclair, Marlene .

N1 - OA should be changing but not updated as at 29-Jul-19. See info in 'Other files' Reference text: Armstrong R, Waters E, Jackson N, Oliver S, Popay J, Shepherd J, Petticrew M, Anderson L, Bailie R & Brunton G. (2007) Guidelines for systematic reviews of health promotion and public health interventions. Version 2. Melbourne University: Australia. Barry MJ & Edgman-Levitan S. (2012) Shared decision making--pinnacle of patient-centered care. New England Journal of Medicine 366(9): 780-781. British Medical Council (2009) Developing and Evaluating Complex Interventions. See https://www.mrc.ac.uk/documents/pdf/complexinterventions- guidance/ Deci EL & Ryan RM. (2000) The “what” and “why” of goal pursuits: Human needs and the self-determination of behavior. Psychological Inquiry 11(4): 227-268. Frosch DL & Kaplan RM. (1999) Shared decision making in clinical medicine: past research and future directions. American Journal of Preventive Medicine 17(4), 285-294. Glyn E, Frosch D &Thomson R. (2012) Shared Decision Making: A model for clinical Practice. J Gen Intern Med. 27:1361. Doi 10.1007/s11606- 012-2077-6 Jackson RA, Stotland NE, Caughey AB & Gerbert B. (2011) Improving diet and exercise in pregnancy with Video Doctor counselling: a randomized trial. Patient Education & Counseling: 83(2), 203-209. Kasper JF, Mulley AG & Wennberg JE. (1992) Developing shared decisionmaking programs to improve the quality of health care. Quality Review Bulletin: 18(6), 183-190. Kelders SM, Kok RN, Ossebaard HC & Van Gemert-Pijnen JE. (2012) Persuasive system design does matter: a systematic review of adherence to web-based interventions. Journal of Medical Internet Research: 14(6), e152. doi: 10.2196/jmir.2104 Lehto T & Oinas-Kukkonen H. (2011) Persuasive features in web-based alcohol and smoking interventions: a systematic review of the literature. Journal of Medical Internet Research: 13(3), e46. doi: 10.21961/jmir.1559 Lundgren I, Begley C, Gross MM & Bondas T. (2012) ‘Groping through the fog’: a metasynthesis of women’s experiences on VBAC (vaginal birth after caesarean section). BMC Pregnancy & Childbirth: 12(85). doi:10.1186/1471-2393-12-85 Michie S, Richardson M, Johnston M, Abraham C, Francis J, Hardeman W, Eccles MP, Cane J & Wood CE. (2013) The behavior change technique taxonomy (v1) of 93 hierarchically clustered techniques: building an international consensus for the reporting of behavior change interventions. Annals of Behavioral Medicine: 46(1), 81-95. Michie S, Free C &West R(2012) Characterising the ‘Txt2Stop’smoking cessation text messaging intervention in terms of behaviour change techniques. Journal of Smoking Cessation: 7(01), 55-60. Miller, WR& Rollnick, S. (2012) Motivational interviewing: helping people change. Guilford: London. Moher, D. Liberati A, Tetzlaff J, Altman DG & PRISMA Group. (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med: 6(7): e1000097. doi:10.1371/journal. pmed.1000097 Moulton B & King JS (2010) Aligning ethics with medical decision-making: the quest for informed patient choice. Journal of Law, Medicine & Ethics 38(1), 85-97. National Institute for Health and Care Excellence (2014) Behaviour change: individual approaches: NICE Public Health Guideline 49: See https:// www.nice.org.uk/guidance/ph49 (accessed 16th March 2017). National Institute for Health and Care Excellence (2007) Behaviour change: the principles for effective interventions: NICE Public Health Guideline 6. Seehttps://www.nice.org.uk/guidance/ph6 (accessed 16 March 2017). Oinas-Kukkonen, H & Harjumaa M (2009) Persuasive systems design: Key issues, process model, and system features. Communications of the Association for Information Systems: 24(1), 28. OptiBIRTH Project. Improving the organisation of health service delivery. Seehttp://www.optibirth.eu. (accessed 16 March 2017). Patrick H & Williams GC. (2012) Self-determination theory: its application to health behavior and complementarity with motivational interviewing. International Journal of Behavioral Nutrition & Physical Activity: 9(8). doi:10.1186/1479-5868-9-18 Phelan S (2010) Pregnancy: a “teachable moment” for weight control and obesity prevention. American Journal of Obstetrics & Gynecology: 202(2), 135.e1-135.e8. Rubak S, Sandbaek A, Lauritzen T & Christensen B. (2005) Motivational interviewing: a systematic review and meta-analysis. British Journal of General Practice: 55(513), 305-312. Stacey D., Légaré F., Col NF, Bennett CL, Barry MJ, Eden K B, Holmes- Rovner M Llewellyn-Thomas, Lyddiatt A, Thomson R, Trevena L & Wu JHC. (2014) Decision aids for people facing health treatment or screening decisions. Cochrane Database of Systematic Reviews: 10, CD001431. doi: 10.1002/14651858.CD001431 Stockdale J, Sinclair M, Wiseman H & Bonazzo R (2014) The challenge of designing and integrating three motivating, sequential apps for optimising birth after C Section, Proceedings of the eChallenges e-2014 Conference: Belfast, Northern Ireland, 1-8 October. Tsoh JY, Kohn MA & Gerbert B. (2010) Promoting smoking cessation in pregnancy with Video Doctor plus provider cueing: a randomized trial. Acta Obstetricia et Gynecologica Scandinavica: 89(4), 515-523. Tzilos GK, Sokol RJ & Ondersma SJ. (2011) A randomized phase I trial of a brief computer-delivered intervention for alcohol use during pregnancy. Journal of Women’s Health: 20(10), 1517-1524. Webb T, JosephJ. Yardley L & Michie, S. (2010) Using the internet to promote health behavior change: a systematic review and meta-analysis of the impact of theoretical basis, use of behavior change techniques, and mode of delivery on efficacy. Journal of Medical Internet Research 12(1), e4. doi: 10.2196/jmir.1376

PY - 2017/4/11

Y1 - 2017/4/11

N2 - Aim. To systematically review computer-based, behaviour change interventions during pregnancy and their design componentsin order to determine their best application within the context of the OptiBIRTH intervention.Design. A systematic literature review was undertaken using the Cochrane Collaboration Guidelines for Systematic Reviewsof Health Promotion and Public Health Interventions. Literature searches were conducted in: Ovid MEDLINE, PubMed,Cochrane Library, Embase, PsycINFO, from database inception to June 2015. Cochrane Risk of Bias criteria was applied toassess the methodological quality and a taxonomy of behaviour change techniques was used to appraise the interventions.PICO. Participants: included healthy pregnant women who were ≥18 years old. Types of Intervention: Computer-basedinterventions designed to facilitate a behaviour change approach in a sample of pregnant women. Comparison: routineantenatal care. Outcomes: The primary outcome included improved health behaviour(s), as an indicator of the intentionbehind the intervention design.Results. A total of 343 papers were identified through database searching and hand searching methods; 80 duplicates wereremoved. From the remaining 263 papers, 244 did not explicitly address the subject under review. Therefore, 19 full textarticles were assessed for eligibility; 16 did not meet eligibility criteria and were excluded at this stage. This resulted in a totalof three studies being selected for inclusion in this review (Jackson et al, 2011; Tzilos et al, 2011 and Tsoh et al, 2010). Thecomputer-based interventions were designed to bring about behavioural change in relation to alcohol consumption, smokingor diet and exercise during pregnancy. Interventions delivered varied between two types: purely computer-delivered (Tzilos etal, 2011) or a combination of both computer plus face-to-face input (Jackson et al, 2011, Tsoh et al, 2010). Techniques usedincluded motivational interviewing, problem-solving cognitive dissonance and goal setting. Types of measurement outcomesvaried but were all self-reported behavioural outcomes. Statistically significant improvements in behavioural outcomes wereseen in the interventions by Jackson et al, (2011) and Tsoh et al, (2010) but not Tzilos et al (2011). The GRADE analysisidentified that all studies combined lacked blinding and relied on self-reported data therefore increasing risk of bias.Conclusion. This systematic review reports on the best available evidence and theory to design an online component of acomplex intervention for use in a RCT to enhance women’s shared-decision making experience about VBAC. The reviewreports the differences between the observed behavioural change approach and that of a decision-making approach: BCTsare applied when a predetermined, directional goal is evidentially understood by the clinicians as being focused on a morehealthy option. As a result, techniques designed to create dissonance are considered appropriate. Shared decision-making,however, is conceptually different, in that the goal is to facilitate a woman in discovering the best direction of travel forher as a person. Therefore, the authors argue that it is crucial for health care professionals designing complex healthcareinterventions (either BCTs or SDMs) to ensure that a person’s self-determination is respected through having access torelevant and understandable information and health care professionals’ who understand a woman’s motivation. However,it is not possible to draw firm conclusions from three studies and there is a requirement for further research.

AB - Aim. To systematically review computer-based, behaviour change interventions during pregnancy and their design componentsin order to determine their best application within the context of the OptiBIRTH intervention.Design. A systematic literature review was undertaken using the Cochrane Collaboration Guidelines for Systematic Reviewsof Health Promotion and Public Health Interventions. Literature searches were conducted in: Ovid MEDLINE, PubMed,Cochrane Library, Embase, PsycINFO, from database inception to June 2015. Cochrane Risk of Bias criteria was applied toassess the methodological quality and a taxonomy of behaviour change techniques was used to appraise the interventions.PICO. Participants: included healthy pregnant women who were ≥18 years old. Types of Intervention: Computer-basedinterventions designed to facilitate a behaviour change approach in a sample of pregnant women. Comparison: routineantenatal care. Outcomes: The primary outcome included improved health behaviour(s), as an indicator of the intentionbehind the intervention design.Results. A total of 343 papers were identified through database searching and hand searching methods; 80 duplicates wereremoved. From the remaining 263 papers, 244 did not explicitly address the subject under review. Therefore, 19 full textarticles were assessed for eligibility; 16 did not meet eligibility criteria and were excluded at this stage. This resulted in a totalof three studies being selected for inclusion in this review (Jackson et al, 2011; Tzilos et al, 2011 and Tsoh et al, 2010). Thecomputer-based interventions were designed to bring about behavioural change in relation to alcohol consumption, smokingor diet and exercise during pregnancy. Interventions delivered varied between two types: purely computer-delivered (Tzilos etal, 2011) or a combination of both computer plus face-to-face input (Jackson et al, 2011, Tsoh et al, 2010). Techniques usedincluded motivational interviewing, problem-solving cognitive dissonance and goal setting. Types of measurement outcomesvaried but were all self-reported behavioural outcomes. Statistically significant improvements in behavioural outcomes wereseen in the interventions by Jackson et al, (2011) and Tsoh et al, (2010) but not Tzilos et al (2011). The GRADE analysisidentified that all studies combined lacked blinding and relied on self-reported data therefore increasing risk of bias.Conclusion. This systematic review reports on the best available evidence and theory to design an online component of acomplex intervention for use in a RCT to enhance women’s shared-decision making experience about VBAC. The reviewreports the differences between the observed behavioural change approach and that of a decision-making approach: BCTsare applied when a predetermined, directional goal is evidentially understood by the clinicians as being focused on a morehealthy option. As a result, techniques designed to create dissonance are considered appropriate. Shared decision-making,however, is conceptually different, in that the goal is to facilitate a woman in discovering the best direction of travel forher as a person. Therefore, the authors argue that it is crucial for health care professionals designing complex healthcareinterventions (either BCTs or SDMs) to ensure that a person’s self-determination is respected through having access torelevant and understandable information and health care professionals’ who understand a woman’s motivation. However,it is not possible to draw firm conclusions from three studies and there is a requirement for further research.

KW - VBAC

KW - technology

KW - pregnancy

KW - information technology

KW - decision making

KW - midwifery

KW - systematic review

KW - evidencebased

M3 - Article

VL - 15

SP - 5

EP - 13

JO - Evidence Based Midwifery

T2 - Evidence Based Midwifery

JF - Evidence Based Midwifery

SN - 1479-4489

IS - 1

ER -