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Table 1 Key lessons from stage 1–4

From: Systematically developing a family-based health promotion intervention for women with prior gestational diabetes based on evidence, theory and co-production: the Face-it study

Stages Intervention content Intervention delivery Data sources
Stage 1: Evidence review, qualitative research and stakeholder consultations No intervention type identified as superior Initiate intervention approximately 3 months after delivery Systematic review: Behavioural interventions targeting women with prior GDM [21]
Targeting multiple barriers and determinants for health behaviour social support, motivation, self-efficacy, risk perception and health literacy Multilevel strategy targeting the individual, family and health system level Systematic review: Barriers and determinants for GDM health services and postpartum follow-up [13]
Scientific symposium with experts [22]
Not assigning blame or medicalising women with prior GDM   Qualitative study: Danish women with prior GDM to understand the needs and barriers of women with prior GDM (n = 6) [23]
Partner involvement to ensure social support / improve intervention uptake and address own risk Include the whole family as the target group Qualitative study: Partners of women with prior GDM (n = 5) [24]
Scientific symposium with experts [22]
Secure a coherent healthcare system to align knowledge transfer and collaboration across sectors and create a coherent preventive pathway   Qualitative study: Healthcare professionals caring for women with GDM during and after pregnancy (n = 9) [25]
Relationship with health visitor* imperative to talk about healthy habits in the family
Intervention needs to be tailored and adapted to individual needs in the family, daily family life (role modelling) and based on a broad positive health concept
Need for education to health visitors addressing risk behaviours and prevention
Health visitors as main intervention deliverers Workshop and interviews with families where the mother had GDM (n = 5)
Focus group discussions with teams of health visitors (n = 8)
Scientific symposium with experts [22]
Expert consultations
Women expect a digital component to increase engagement and
availability
Introducing the LIVA app as an intervention component
Digital support as a way to prompt individual and family-based health behaviours
Digital health coaching Evidence from literature on the potential of digital interventions targeting women with prior GDM
Scientific symposium with experts [22]
Stage 2: Co-production of the intervention Coherent cross-sectional preventive care pathway for the families
Women recommended to contact their own GP for GDM counselling following the intervention
Discharge summary from obstetric department to health visitors prior to intervention Workshop meetings with local stakeholders and hospital-based health-care professionals from the obstetric departments at the project hospitals, general practices and leading health visitors (n = 3)
Adopt the family wheel as an interactive health pedagogic dialogue tool
Health visitors take on a health promoting role
Home visits to the families by the health visitor as a primary component of the intervention Meetings with leading health visitors (n = 3)
Adapting the family wheel to support talking about future diabetes risk
Adapting the digital health app, making health information available in the app to use for counselling and produce family tailored content in the app
Digital coaching by a digital supervisor should motivate realistic, positive goals in the family Co-production workshops with health visitors (n = 2)
Interviews with families where the mother had prior GDM (n = 3)
Stage 3: Prototyping, feasibility and pilot testing Health coaches tailoring health information per request from families
Possibility for continuously digital communication with the family online instead of home visits
Ensure strong communication practices between health coach and health visitor
Adaption of intervention delivery mode to intervention sites Meetings with local health visitors and GDM experts (n = 4)
Interviews with families where the mother had prior GDM (n = 4)
Adapt intervention manuals to support individual practices
Ensure proper training and competences for intervention deliverers
Adaption of family wheel design
Support and qualify health visitors to deliver the intervention Expert review of the intervention manuals by researchers, health visitors as intervention deliverers and various health care professionals providing care to women with current and prior GDM
Training days with health visitors
Stage 4: Involvement in developing outcomes for evaluation Realistic and relevant core outcomes for evaluation
Biochemical measurements (blood samples), blood pressure, anthropometric measures and a self-administrated questionnaire to assess dimensions of health behaviour, social support, motivation, program delivery and family dynamics among others
The questionnaire contained both validated scales and self-constructed questions building on the qualitative evidence from the earlier stages of intervention development
The full list of measurements is available in the trial protocol [26]
  Core outcome set for diabetes after pregnancy prevention [27]
Based on the core outcome set, the qualitative interviews performed at stage two and the consensus meetings with core stakeholders (n = 130)
Implementing minor adjustments to the questionnaire to avoid assigning blame or stigmatisation and to enhance validity   Pilot testing of the questionnaire among women with prior GDM (n = 5)
  1. *Specialised nurses within postnatal and child health, who conduct home visits to families with a new-born