USABILITY TESTING OF A PATIENT EDUCATION TOOL FOR VAGINAL BIRTH AFTER CESAREAN (VBAC)

Purpose: Vaginal birth after cesarean (VBAC) is considered a safe and cost-effective option for the majority of women with a previous cesarean, yet only 20% of eligible women actually choose a VBAC. The objective of this study was to test the usability of a patient information brochure on VBAC. 

Method: Brochure development was guided by a multidisciplinary steering group. Data on clinical risks and benefits of VBAC were derived from a population-based perinatal database in British Columbia (BC), Canada. Testing of comprehensibility and usability was conducted in 4 geographically stratified focus groups of BC women who had had a cesarean and were pregnant or considering pregnancy. Sessions consisted of: (1) a 5-item knowledge pre-test; (2) reading the brochure; (3) knowledge post-test; (4) a moderated discussion eliciting women’s perspectives on their decisional needs and the brochure’s content and design. Iterative data collection and analysis were guided by constructionist grounded theory. Discussions were audiotaped, transcribed, and enhanced with observations documented by a designated note-taker. Transcripts were coded for recurring concepts and refined into categories. Change in knowledge was measured by comparing pre- and post-test knowledge scores and reporting percentage changed.

Result: 17 women participated in the focus groups. Most participants were 30-39 years old, had 1-2 children, were born in Canada (60%), and had at least a college education. Knowledge scores for all questions increased after participants read the brochure, with the greatest improvement observed for the questions on likelihood of successful VBAC (53% to 100%) and risks to mother (20% to 73%). In focus group discussions, participants expressed that the brochure was clear and well-presented, and they valued learning about the clinical risks and benefits faced by BC women like them. However, most participants felt their personal risks for VBAC were higher than those presented in the brochure. Women also desired personal testimonies from women who had had successful VBACs and information on a range of non-clinical attributes, such as parenting during postpartum recovery. 

Conclusion: This brochure was effective in educating women about VBAC, suggesting it is a promising shared decision-making tool. Despite their knowledge increase, women had high perceptions of personal risk for VBAC. Next steps include revising the brochure to include a values clarification exercise and feasibility testing in antenatal clinics across BC.