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Adu-Bonsaffoh K, Tamma E, Nwameme A, Dako-Gyeke P, Srofenyoh E, Ansah EK, Grobbee DE, Franx A, Browne JL. Provision and experience of care among women with hypertension in pregnancy: a multi-center qualitative study in Ghana. Reprod Health 2023; 20:49. [PMID: 36966326 PMCID: PMC10039538 DOI: 10.1186/s12978-023-01593-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 03/05/2023] [Indexed: 03/27/2023] Open
Abstract
BACKGROUND Hypertensive disorders of pregnancy (HDP) remain a leading global health problem with complex clinical presentations and potentially grim birth outcomes for both mother and fetus. Improvement in the quality of maternal care provision and positive women's experiences are indispensable measures to reduce maternal and perinatal adverse outcomes. OBJECTIVE To explore the perspectives and lived experiences of healthcare provision among women with HDP and the associated challenges. METHODS A multi-center qualitative study using in-depth interviews (IDIs) and focus group discussions (FGDs) was conducted in five major referral hospitals in the Greater Accra Region of Ghana between June 2018 and March 2019. Women between 26 and 34 weeks' gestation with confirmed HDP who received maternity care services were eligible to participate. Thematic content analysis was performed using the inductive analytic framework approach. RESULTS Fifty IDIs and three FGDs (with 22 participants) were conducted. Most women were between 20 and 30 years, Akans (ethnicity), married/cohabiting, self-employed and secondary school graduates. Women reported mixed (positive and negative) experiences of maternal care. Positive experiences reported include receiving optimal quality of care, satisfaction with care and good counselling and reassurance from the health professionals. Negative experiences of care comprised ineffective provider-client communication, inappropriate attitudes by the health professionals and disrespectful treatment including verbal and physical abuse. Major health system factors influencing women's experiences of care included lack of logistics, substandard professionalism, inefficient national health insurance system and unexplained delays at health facilities. Patient-related factors that influenced provision of care enumerated were financial limitations, chronic psychosocial stress and inadequate awareness about HDP. CONCLUSION Women with HDP reported both positive and negative experiences of care stemming from the healthcare system, health providers and individual factors. Given the importance of positive women's experiences and respectful maternal care, dedicated multidisciplinary women-centered care is recommended to optimize the care for pregnant women with HDP.
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Affiliation(s)
- Kwame Adu-Bonsaffoh
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
- Department of Obstetrics and Gynaecology, University of Ghana Medical School, Korle-Bu, P.O. Box 77, Accra, Ghana.
- Holy Care Specialist Hospital, Accra, Ghana.
| | | | - Adanna Nwameme
- Department of Social and Behavioural Sciences, School of Public Health, University of Ghana, Accra, Ghana
| | - Phyllis Dako-Gyeke
- Department of Social and Behavioural Sciences, School of Public Health, University of Ghana, Accra, Ghana
| | - Emmanuel Srofenyoh
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Department of Obstetrics and Gynaecology, Greater Accra Regional Hospital (Ridge), Accra, Ghana
| | - Evelyn K Ansah
- Institute for Health Research, University of Health and Allied Sciences, Ho, Ghana
| | - Diederick E Grobbee
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Arie Franx
- Department of Obstetrics and Gynecology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Joyce L Browne
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
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Sakurai S, Shishido E, Horiuchi S. Experiences of women with hypertensive disorders of pregnancy: a scoping review. BMC Pregnancy Childbirth 2022; 22:146. [PMID: 35193516 PMCID: PMC8864783 DOI: 10.1186/s12884-022-04463-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 02/08/2022] [Indexed: 12/25/2022] Open
Abstract
Background Hypertensive disorders of pregnancy (HDP) constitute one of the leading causes of maternal and perinatal mortality worldwide, and are associated with an increased risk of recurrence and future cardiovascular disease. HDP affect women’s health condition, mode of birth and timing, length of hospital stay, and relationship with their newborn and family, with future life repercussions. Aims To explore the experiences of women with HDP from pregnancy to postpartum, and to identify (a) their perceptions and understanding of HDP, (b) their understanding of future health risks, and (c) the possible interventions by healthcare providers. Methods A scoping review was conducted following the Joanna Briggs Institute method and in accordance with the PRISMA-ScR checklist. The following databases were searched from 1990 to 2020 (October): MEDLINE (PubMed), EMBASE, Cochrane Library, CINAHL, PsycINFO, and Google Scholar database. The Critical Appraisal Skills Programme (CASP) checklist was used as a guide for the qualitative analysis. Content analysis and synthesis of findings were conducted using Nvivo12. Results Of the 1971 articles identified through database searching, 16 articles met the inclusion criteria. After data extraction, content analysis yielded six categories: ‘Life-threatening disorder’, ‘Coping with HDP’, ‘Concerns for baby and challenges of motherhood’, ‘Fear of recurrence and health problems’, ‘Necessity of social and spiritual support’, and ‘Positive and negative experiences in the healthcare context’. Women faced complex difficulties from the long treatment process while transitioning to motherhood. Conclusion Our findings revealed the perceptions and understanding of women regarding HDP as a life-threatening disorder to both mothers and their babies which mothers need to cope with. Recovery of physical condition and the long-term psychological effects of HDP on women should be given attention by mothers and HCP to reduce future health risks. Importantly, a lifelong follow-up system is recommended for women with HDP. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-022-04463-y.
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Affiliation(s)
- Sachiko Sakurai
- Department of Midwifery, Graduate School of Nursing Science, St Luke's International University, 10-1 Akashi-cho, Chuo-ku, Tokyo, 1040044, Japan.
| | - Eri Shishido
- Department of Midwifery, Graduate School of Nursing Science, St Luke's International University, 10-1 Akashi-cho, Chuo-ku, Tokyo, 1040044, Japan
| | - Shigeko Horiuchi
- Department of Midwifery, Graduate School of Nursing Science, St Luke's International University, 10-1 Akashi-cho, Chuo-ku, Tokyo, 1040044, Japan
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Band R, Hinton L, Tucker KL, Chappell LC, Crawford C, Franssen M, Greenfield S, Hodgkinson J, McCourt C, McManus RJ, Sandall J, Santos MD, Velardo C, Yardley L. Intervention planning and modification of the BUMP intervention: a digital intervention for the early detection of raised blood pressure in pregnancy. Pilot Feasibility Stud 2019; 5:153. [PMID: 31890265 PMCID: PMC6925434 DOI: 10.1186/s40814-019-0537-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 11/28/2019] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Hypertensive disorders in pregnancy, particularly pre-eclampsia, pose a substantial health risk for both maternal and foetal outcomes. The BUMP (Blood Pressure Self-Monitoring in Pregnancy) interventions are being tested in a trial. They aim to facilitate the early detection of raised blood pressure through self-monitoring. This article outlines how the self-monitoring interventions in the BUMP trial were developed and modified using the person-based approach to promote engagement and adherence. METHODS Key behavioural challenges associated with blood pressure self-monitoring in pregnancy were identified through synthesising qualitative pilot data and existing evidence, which informed guiding principles for the development process. Social cognitive theory was identified as an appropriate theoretical framework. A testable logic model was developed to illustrate the hypothesised processes of change associated with the intervention. Iterative qualitative feedback from women and staff informed modifications to the participant materials. RESULTS The evidence synthesis suggested women face challenges integrating self-monitoring into their lives and that adherence is challenging at certain time points in pregnancy (for example, starting maternity leave). Intervention modification included strategies to address adherence but also focussed on modifying outcome expectancies, by providing messages explaining pre-eclampsia and outlining the potential benefits of self-monitoring. CONCLUSIONS With an in-depth understanding of the target population, several methods and approaches to plan and develop interventions specifically relevant to pregnant women were successfully integrated, to address barriers to behaviour change while ensuring they are easy to engage with, persuasive and acceptable.
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Affiliation(s)
- Rebecca Band
- Academic unit of psychology, University of Southampton, Southampton, SO17 1BJ UK
| | - Lisa Hinton
- Nuffield Department of Primary Care Health Sciences, Radcliffe Infirmary Quarter University of Oxford, Oxford, OX2 6GG UK
| | - Katherine L. Tucker
- Nuffield Department of Primary Care Health Sciences, Radcliffe Infirmary Quarter University of Oxford, Oxford, OX2 6GG UK
| | - Lucy C. Chappell
- Division of Women and Children’s Health, King’s College London, London, SE1 7EH UK
| | - Carole Crawford
- Nuffield Department of Primary Care Health Sciences, Radcliffe Infirmary Quarter University of Oxford, Oxford, OX2 6GG UK
| | - Marloes Franssen
- Nuffield Department of Primary Care Health Sciences, Radcliffe Infirmary Quarter University of Oxford, Oxford, OX2 6GG UK
| | - Sheila Greenfield
- Institute of Applied Health, University of Birmingham, Birmingham, B15 2TT UK
| | - James Hodgkinson
- Institute of Applied Health, University of Birmingham, Birmingham, B15 2TT UK
| | - Christine McCourt
- Centre for Maternal and Child Health, School of Health Sciences, City University, London, EC1R IUW UK
| | - Richard J. McManus
- Nuffield Department of Primary Care Health Sciences, Radcliffe Infirmary Quarter University of Oxford, Oxford, OX2 6GG UK
| | - Jane Sandall
- Division of Women and Children’s Health, King’s College London, London, SE1 7EH UK
| | - Mauro Dala Santos
- Institute of Biomedical Engineering, Department of Engineering Science, Building, University of Oxford, Oxford, OX3 7DQ UK
| | - Carmelo Velardo
- Institute of Biomedical Engineering, Department of Engineering Science, Building, University of Oxford, Oxford, OX3 7DQ UK
| | - Lucy Yardley
- Academic unit of psychology, University of Southampton, Southampton, SO17 1BJ UK
- School of Psychological Science, University of Bristol, Bristol, UK
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Parsa S, Khajouei R, Baneshi MR, Aali BS. Improving the knowledge of pregnant women using a pre-eclampsia app: A controlled before and after study. Int J Med Inform 2019; 125:86-90. [PMID: 30914185 DOI: 10.1016/j.ijmedinf.2019.03.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Revised: 02/11/2019] [Accepted: 03/04/2019] [Indexed: 01/23/2023]
Abstract
OBJECTIVE The objective of this study was to investigate the effect of a pre-eclampsia mobile application on the knowledge of pregnant women. METHODS Following development of a pre-eclampsia mobile application, we conducted a controlled before and after study during a three-month period in 2018. The study population consisted of pregnant women attended to obstetrician clinics and offices in Kerman, Iran of whom, 110 sample participants were divided into two intervention and control groups. The participants completed a questionnaire of pre-eclampsia knowledge at baseline and 1-month follow up. Data were analyzed using inferential statistics including chi-square, independent sample t-test, paired t-test and linear regression. RESULTS A total of 108 pregnant women with an average age of 28 years participated in this study. There was no significant difference between the scores of the two groups before the intervention (p=0.94). Their difference after the intervention was highly significant (p<0.001). The difference between the knowledge of the participants before and after the intervention was significant in the both groups (p<0.05). The results showed that the knowledge score of the participants after the intervention was significantly associated with their group and assessment score before the intervention (p<0.001). CONCLUSION The results showed that the use of a mobile-based educational application improves the knowledge of pregnant women about pre-eclampsia. Increasing women's knowledge about pre-eclampsia may enables them to identify its signs and symptoms, resulting in the early detection and management of this condition, and likely reduction of its adverse consequences. TRIAL REGISTRATION IRCT2017050633837N1.
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Affiliation(s)
- Sara Parsa
- Health Service Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Reza Khajouei
- Medical Informatics Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.
| | - Mohammad Reza Baneshi
- Modeling in Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Bibi Shahnaz Aali
- Physiology Research Center, Department of Obstetrics and Gynecology, Afzalipour Hospital, Kerman University of Medical Sciences, Kerman, Iran
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Vaerland IE, Vevatne K, Brinchmann BS. Mothers' experiences of having a premature infant due to pre-eclampsia. Scand J Caring Sci 2017; 32:527-534. [DOI: 10.1111/scs.12476] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Accepted: 04/05/2017] [Indexed: 12/17/2022]
Affiliation(s)
| | - Kari Vevatne
- Department of Health; University of Stavanger; Stavanger Norway
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CARVALHO NSD, ARRUDA SPM, RAMOS LMR, MACHADO MMT, AZEVEDO DVD. Dietary patterns and significance of nutrition for women with low-risk pregnancy. REV NUTR 2017. [DOI: 10.1590/1678-98652017000200007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
ABSTRACT Objective: To evaluate dietary patterns and significance of diet for pregnant women. Methods: Cross-sectional study carried out in eight health units in Fortaleza, Ceará, Brazil, with 201 pregnant women. The following instruments were used: a socio-economic and health questionnaire, the Free-Word Association Test, and a Food Frequency Questionnaire. Dietary patterns were identified using principal components and factor analysis. Poisson regression with 5% significance level was used. Results: Three dietary patterns were identified: current Brazilian pattern (beans, rice, processed meats, fats, refined grains, pasta and pastries, soft drink, sugar and sweets, cookies and crackers); healthy pattern (fruits and fruit juices, vegetables, whole grains, seafood, dairy products); and energy-rich pattern (salty deep-fried snacks, popcorn, packaged snacks, instant noodles, tubers, and chicken). Women who did not receive nutrition guidance during prenatal care showed less chance of adherence to the current Brazilian dietary pattern (PR=0.87), and therefore their level of consumption of foods commonly present in Brazilian diets was low. For most women, the significance of diet was reported as important and healthy, but it was not associated with any of the diet patterns identified. However, the women who did not consider that during pregnancy diet should be healthy showed greater chance of adherence to the energy-rich pattern (PR=1.18). This finding deserves special attention since excessive weight gain can have a negative effect on pregnancy. Conclusion: Nutrition guidance during prenatal care and the way pregnant women perceive their eating habits can influence their food choices during pregnancy.
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Carter W, Bick D, Mackintosh N, Sandall J. A narrative synthesis of factors that affect women speaking up about early warning signs and symptoms of pre-eclampsia and responses of healthcare staff. BMC Pregnancy Childbirth 2017; 17:63. [PMID: 28193255 PMCID: PMC5309733 DOI: 10.1186/s12884-017-1245-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2016] [Accepted: 02/04/2017] [Indexed: 11/10/2022] Open
Abstract
Background One of the challenges for treating pre-eclampsia and preventing further deterioration is determining how best to enable early detection. If women or their partners and families are able to raise early warnings about potential signs and symptoms of pre-eclampsia in pregnancy, birth and in the postnatal period, women may be able to receive earlier intervention to prevent severe pre-eclampsia from developing. The aim of this study was to improve understanding of factors affecting the ability of women to recognise symptoms and signs of pre-eclampsia/eclampsia and seek appropriate medical help and factors affecting health care professionals’ responses to women and their families who ‘speak up’ about early warning signs and symptoms. Methods A narrative synthesis was conducted of evidence relevant to address the research question. The following electronic data bases were searched for qualitative studies which met inclusion criteria from January 1980 to April 2016; Medline, CINAHL, HMIC, PsycINFO, Embase, BNI, ASSIA, Scopus, Maternity and Infant Care, Web of Science, Google Scholar, Cochrane, JBI and IBSS with the support of an Information Service Consultant. Results Following thematic analysis, three themes were identified; 1: Women’s understanding and knowledge of pre-eclampsia/eclampsia; 2: Factors affecting help seeking behaviour from perspectives of women and their families’; 3: Factors affecting staff response. There was widespread lack of knowledge and understanding of signs and symptoms of pre-eclampsia/eclampsia among women and their families, with some women not exhibiting signs and symptoms of pre-eclampsia or unable to distinguish them from ‘normal’ pregnancy changes. Conclusions Women and their families not only need to be made aware of signs and symptoms of pre-eclampsia/eclampsia but also require information on the most effective ways to seek urgent medical assessment and care. Some women did not experience prodromal signs and symptoms, which raises concerns about how women and families can detect early onset, and is an issue which needs further exploration. There is very limited research exploring clinical staff response to women who raise concerns about their health when experiencing symptoms and signs of pre-eclampsia/eclampsia with further research needed if safety and quality of care are to be improved.
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Affiliation(s)
- Wendy Carter
- King's College London, Division of Women's Health, Faculty of Life Sciences and Medicine, London, UK. .,King's College London, Women's Health Academic Centre, King's Health Partners, 10th Floor North Wing, St Thomas' Hospital, Westminster Bridge Road, SE1 7EH, London, UK.
| | - Debra Bick
- King's College London, Florence Nightingale Faculty of Nursing and Midwifery, London, UK
| | - Nicola Mackintosh
- King's College London, Division of Women's Health, Faculty of Life Sciences and Medicine, London, UK
| | - Jane Sandall
- King's College London, Division of Women's Health, Faculty of Life Sciences and Medicine, London, UK
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An Integrative Review of Mothers' Experiences of Preeclampsia. J Obstet Gynecol Neonatal Nurs 2016; 45:300-7. [PMID: 27063399 DOI: 10.1016/j.jogn.2016.02.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2016] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To describe and synthesize the extant research on women's experiences with preeclampsia into the postpartum period, when birth is necessary to save the mother's or infant's life. DATA SOURCES The PubMed, PsycINFO, CINAHL, and ISI Web of Science databases were searched for relevant articles published between 2004 and 2014. STUDY SELECTION Although a comprehensive search was performed, only eight studies were found that answered the research question and were included in the review. DATA EXTRACTION Data were extracted and analyzed from each article that addressed women's experiences of pre-eclampsia: authors, year, country, study purpose, design, sample size, setting, main focus, data collection method, study findings, and limitations. DATA SYNTHESIS The following themes emerged from the synthesis of how women experience severe preeclampsia: (a) From Feeling Fear and Closeness to Death to Feeling Hope, (b) Relationship With the Infant, (c) Separation From Loved Ones, and (d) Communication With Health Professionals. CONCLUSION Fear and feeling close to death characterized the experience of childbirth for many of these women, and the premature birth was a shock for many. Having a newborn in the NICU was experienced as a transition from fear to hope as the newborn's life was sustained outside the womb. Separation of the mother from the newborn when one or both need special care remains a problem. Health care professionals must ensure that women in this situation receive the information and support they need and that the information is understood. This review revealed that more research is necessary regarding this specific mother-infant dyad and their families in the context of Western countries and developing countries.
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Magee LA, Pels A, Helewa M, Rey E, von Dadelszen P. Diagnosis, evaluation, and management of the hypertensive disorders of pregnancy. Pregnancy Hypertens 2014; 4:105-45. [PMID: 26104418 DOI: 10.1016/j.preghy.2014.01.003] [Citation(s) in RCA: 245] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Accepted: 01/17/2014] [Indexed: 02/05/2023]
Abstract
OBJECTIVE This guideline summarizes the quality of the evidence to date and provides a reasonable approach to the diagnosis, evaluation and treatment of the hypertensive disorders of pregnancy (HDP). EVIDENCE The literature reviewed included the previous Society of Obstetricians and Gynaecologists of Canada (SOGC) HDP guidelines from 2008 and their reference lists, and an update from 2006. Medline, Cochrane Database of Systematic Reviews (CDSR), Cochrane Central Registry of Controlled Trials (CCRCT) and Database of Abstracts and Reviews of Effects (DARE) were searched for literature published between January 2006 and March 2012. Articles were restricted to those published in French or English. Recommendations were evaluated using the criteria of the Canadian Task Force on Preventive Health Care and GRADE.
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Affiliation(s)
| | - Anouk Pels
- Academic Medical Centre, Amsterdam, The Netherlands
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