(1) Background: Obstetric work requires good communication, which can be trained through interventions targeting healthcare providers and pregnant women/patients. This systematic review aims to aggregate the current state of research on communication interventions in obstetrics. (2) Methods: Using the PICOS scheme, we searched for studies published in peer-reviewed journals in English or German between 2000 and 2020. Out of 7018 results, 71 studies were included and evaluated in this synthesis using the Oxford Level of Evidence Scale. (3) Results: The 63 studies that included a communication component revealed a positive effect on different proximal outcomes (i.e., communication skills). Three studies revealed a beneficial effect of communication trainings on distal performance indicators (i.e., patient safety), but only to a limited extent. Most studies simultaneously examined different groups, however, those addressing healthcare providers were more common than those with students (61 vs. 12). Only nine studies targeted expectant mothers. Overall, the evidence level of studies was low (only 11 RCTs), with 24 studies with an evidence level I-II, 35 with level III, and 10 with level IV. (4) Conclusions: Communication trainings should be more frequently applied to improve communication of staff, students, and pregnant women and their partners, thereby improving patient safety.

COVID‐19 restrictions such as lockdowns or quarantines may increase the risk for social isolation and perceived loneliness. The mechanisms can be modeled by Cacioppo's Evolutionary Theory of Loneliness (ETL), which predicts that a lack of perceived social connectedness may lead, in the long‐term, to mental and physical health consequences. However, the association between COVID‐19 pandemic distress, mental health, and loneliness is not sufficiently understood. The present longitudinal study examined the relationship between distress and depression, and the mediating effects of anxiety and loneliness in a German rehabilitation sample ( N = 403) at two timepoints (≤6 weeks pre‐rehabilitation; ≥12 weeks post‐rehabilitation; mean time between T1 and T2 was 52 days). Change scores between T1 and T2 were examined for the variables COVID‐19 Peritraumatic Distress Index (CPDI), anxiety, loneliness, and depression. The results of the serial mediation analysis indicated that anxiety and loneliness were able to explain the relationship between distress and depression with 42% of variance in depression accounted for. Findings extend research on the relationship between COVID‐19 and mental health by considering anxiety and loneliness as sustaining factors of depressive symptoms, thus, successfully applying the ETL. Results stress the necessity to consider anxiety and loneliness in the treatment or prevention of depression.

Background: Patient safety is a key target in public health, health services and medicine. Communication between all parties involved in gynecology and obstetrics (clinical staff/professionals, expectant mothers/patients and their partners, close relatives or friends providing social support) should be improved to ensure patient safety, including the avoidance of preventable adverse events (pAEs). Therefore, interventions including an app will be developed in this project through a participatory approach integrating two theoretical models. The interventions will be designed to support participants in their communication with each other and to overcome difficulties in everyday hospital life. The aim is to foster effective communication in order to reduce the frequency of pAEs. If communication is improved, clinical staff should show an increase in work satisfaction and patients should show an increase in patient satisfaction. Methods: The study will take place in two maternity clinics in Germany. In line with previous studies of complex interventions, it is divided into three interdependent phases. Each phase provides its own methods and data. Phase 1: Needs assessment and a training for staff (n = 140) tested in a pre-experimental study with a pre/post-design. Phase 2: Assessment of communication training for patients and their social support providers (n = 423) in a randomized controlled study. Phase 3: Assessment of an app supporting the communication between staff, patients, and their social support providers (n = 423) in a case-control study. The primary outcome is improvement of communication competencies. A range of other implementation outcomes will also be assessed (i.e. pAEs, patient/treatment satisfaction, work satisfaction, safety culture, training-related outcomes). Discussion: This is the first large intervention study on communication and patient safety in gynecology and obstetrics integrating two theoretical models that have not been applied to this setting. It is expected that the interventions, including the app, will improve communication practice which is linked to a lower probability of pAEs. The app will offer an effective and inexpensive way to promote effective communication independent of users’ motivation. Insights gained from this study can inform other patient safety interventions and health policy developments. Trial registration: ClinicalTrials.gov Identifier: NCT03855735; date of registration: February 27, 2019.

Social media is increasingly used by patients to source information for managing chronic disease. The aim of this study was to understand patient information needs about gout by a content analysis of questions posted on the social news website Reddit. We analysed questions posted onto the ‘Gout sufferers unite’ subreddit site. Two reviewers coded questions into categories (inter-reviewer kappa 0.70), with discordant coding resolved by a third reviewer. Data were analysed by calculating the frequency of questions within the categories. Where relevant, categories were further separated into sub-categories to allow organisation and interpretation of the data. We analysed 359 questions in 287 posts by 213 individuals. A wide range of questions arose. The single most common category related to uncertainty of diagnosis (22.3% questions), with questions about disease management common. Information-seeking about medications was generally cautious, with questions about side-effects, risk of flares after starting urate-lowering therapy, and decision to start urate-lowering therapy. Community users experiencing flares posted questions about flare management, including medications, sometimes in real-time. Dietary management questions included the effectiveness of dietary changes as a management strategy, choice of alcoholic beverage, and weight loss strategies. Questions about serum urate levels were rare (2.8% questions). Questions about gout posted on the subreddit site most often related to uncertainty about symptoms and disease management strategies, with infrequent questions about serum urate testing, results or targets. These findings may inform development of strategies to address the information needs of people with gout.

Background: Hand hygiene is crucial to avoid healthcare‐associated infections and the transmission of COVID‐19. Although the WHO has issued global hand hygiene recommendations for healthcare, adherence remains challenging. Considering social‐cognitive theories such as the health action process approach (HAPA) can help to improve healthcare workers’ adherence. This study aimed to observe adherence and to assess determinants in obstetric hospitals during and after the onset of the COVID‐19 pandemic. Methods: In all, 267 observations of behaviour were conducted in two German obstetric university hospitals over three time periods ( pre‐COVID‐19 pandemic , heightened awareness , and strict precautions ). In addition, 115 healthcare workers answered questionnaires regarding social‐cognitive determinants of hand hygiene behaviour. Multiple regression and multiple mediation analyses were used to analyse associations. Results: Adherence to hand hygiene recommendations increased from 47 per cent pre‐COVID‐19 pandemic to 95 per cent just before lockdown while simple measures against the pandemic were taken. Self‐efficacy was associated with the intention to sanitise hands (β = .397, p < .001). Coping self‐efficacy mediated the association of intention with hand hygiene adherence. Conclusions: Obstetric healthcare workers seem to adapt their hand hygiene behaviour to prevent infections facing the global COVID‐19 pandemic. To further improve interventions, social‐cognitive determinants should be considered, especially intention and (coping) self‐efficacy.

Patient safety is an important objective in health care. Preventable adverse events (pAEs) as the counterpart to patient safety are harmful incidents that fell behind health care standards and have led to temporary or permanent harm or death. As safe communication and mutual understanding are of crucial importance for providing a high quality of care under everyday conditions, we aimed to identify barriers and facilitators that impact safe communication in obstetrics from the subjective perspective of health care workers. A qualitative study with 20 semi-structured interviews at two university hospitals in Germany was conducted to explore everyday perceptions from a subjective perspective (subjective theories). Physicians, midwives, and nurses in a wide span of professional experience and positions were enrolled. We identified a structural area of conflict at the professional interface between midwives and physicians. Mandatory interprofessional meetings, acceptance of subjective mistakes, mutual understanding, and debriefings of conflict situations are reported to improve collaboration. Additionally, emergency trainings, trainings in precise communication, and handovers are proposed to reduce risks for pAEs. Furthermore, the participants reported time-constraints and understaffing as a huge burden that hinders safe communication. Concluding, safety culture and organizational management are closely entwined and strategies should address various levels of which communication trainings are promising.