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Cox A, Ip A, Watkin S, Matuska G, Bunford S, Gallagher A, Taylor C. Implementing and evaluating resources to support good maternity care for parents with learning disabilities: A qualitative feasibility study in England. Midwifery 2024; 133:104001. [PMID: 38643599 DOI: 10.1016/j.midw.2024.104001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 04/08/2024] [Accepted: 04/13/2024] [Indexed: 04/23/2024]
Abstract
PROBLEM Parents with learning disabilities are often disadvantaged and their needs not well understood in maternity services. BACKGROUND Despite a global vision to improve maternity care, current evidence confirms poor pre- and post-natal care for parents with learning disabilities and their families. Midwives have expressed a need for support in the delivery of good care to this population of parents. AIM To test the feasibility of implementing and evaluating two evidence-based and values-based resources - the Together Toolkit and Maternity Passport - to support good maternity care for people with learning disabilities. METHODS A qualitative feasibility study employing semi-structured interviews with 17 midwives and 6 parents who had used the resources in practice in four NHS Trusts in the south of England. FINDINGS Midwives and parents described how the resources positively impacted maternity care by enabling midwives, connecting networks and empowering parents. Factors affecting effective implementation of the resources were reported at an individual and setting level. DISCUSSION Staff training to raise awareness and confidence in supporting parents with learning disabilities, and improved systems for recording parent's individual needs are required to enable the delivery of personalised care. CONCLUSION Reasonable adjustments need to be prioritised to facilitate implementation of resources to support personalised maternity care and to address inequity for parents with learning disabilities. Aspirations for equity suggested commitment from midwives to challenge and overcome barriers to implementation. Recommendations were made to improve the resources and their implementation. These resources are free and accessible for use [www.surrey.ac.uk/togetherproject].
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Affiliation(s)
- Anna Cox
- School of Health Sciences, University of Surrey, Surrey GU2 7XH, United Kingdom.
| | - Athena Ip
- Research Fellow, School of Health Sciences, University of Surrey, United Kingdom
| | | | - George Matuska
- Learning Disability and Autism Lead, Kent and Medway NHS and Social Care Partnership Trust, United Kingdom
| | - Sharon Bunford
- Named Midwife for Safeguarding Vulnerable Women and Babies, Royal Surrey NHS Foundation Trust, United Kingdom
| | - Ann Gallagher
- Professor/Head of Department of Health Sciences, Brunel University, United Kingdom
| | - Cath Taylor
- Professor of Healthcare Workforce Organisation and Wellbeing, School of Health Sciences, University of Surrey, United Kingdom
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Jeffers NK, Lu SV, Gross SM, West A. Infant Feeding Support for Pregnant and Postpartum Parents With Intellectual and Developmental Disabilities: Perspectives of WIC Staff. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2024; 56:399-405. [PMID: 38849192 DOI: 10.1016/j.jneb.2024.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 01/18/2024] [Accepted: 02/26/2024] [Indexed: 06/09/2024]
Abstract
OBJECTIVE To describe the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) staff experiences, perceptions, and training needs surrounding the provision of infant feeding support for parents with intellectual and developmental disabilities (IDD). METHODS We conducted in-depth semistructured interviews between October and November 2021 with Maryland WIC staff (N = 10) who provide infant feeding counseling and support. We analyzed interviews using conventional content analysis. RESULTS Three themes were identified: identifying and documenting IDD, facilitating effective communication and infant feeding education, and assessing WIC staff competence and readiness. CONCLUSIONS AND IMPLICATIONS The interviews suggested the need to explore the risks and benefits of routine and compassionate processes for identifying and documenting disability, create accessible teaching materials that facilitate understanding and engagement, and educate and train staff to provide tailored support in WIC. Engaging parents with IDD to better understand their perspectives and experiences should guide future efforts to improve inclusivity and accessibility.
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Affiliation(s)
| | - Stacy V Lu
- Department of Population Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Susan M Gross
- Department of Population Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Allison West
- Department of Population Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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Hampton S, Allison C, Baron-Cohen S, Holt R. Autistic People's Perinatal Experiences I: A Survey of Pregnancy Experiences. J Autism Dev Disord 2024; 54:211-223. [PMID: 36261629 PMCID: PMC10791798 DOI: 10.1007/s10803-022-05754-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2022] [Indexed: 01/07/2023]
Abstract
Qualitative studies of autistic people's pregnancy experiences have indicated sensory and communication related barriers to accessing adequate prenatal healthcare. However, quantitative work on the topic is scarce. This online survey study explored pregnancy experiences among 417 autistic and 524 non-autistic people. Compared with non-autistic people, autistic people reported heightened sensory and physical experiences during pregnancy and were more likely to experience prenatal depression and anxiety. Autistic people experienced lower satisfaction with prenatal healthcare, including having lower perceptions of their relationships with healthcare professionals and greater difficulties with antenatal classes. This study identifies key adjustments that can be made to prenatal healthcare, including sensory and communication adjustments. The findings highlight the need for greater autism understanding and awareness among professionals.
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Affiliation(s)
- Sarah Hampton
- Autism Research CentreDepartment of Psychiatry, University of Cambridge, Cambridge, UK
| | - Carrie Allison
- Autism Research CentreDepartment of Psychiatry, University of Cambridge, Cambridge, UK
| | - Simon Baron-Cohen
- Autism Research CentreDepartment of Psychiatry, University of Cambridge, Cambridge, UK
| | - Rosemary Holt
- Autism Research CentreDepartment of Psychiatry, University of Cambridge, Cambridge, UK
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Douglass E, Johnson C, Lucas G, Dowling S. "Work with us… to make it more accessible". What women with intellectual disabilities want from infant-feeding health resources: an exploratory study. Int Breastfeed J 2023; 18:67. [PMID: 38066508 PMCID: PMC10704706 DOI: 10.1186/s13006-023-00606-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 12/03/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND More women with intellectual disabilities are becoming mothers but fewer are known to breastfeed compared with other women. Women with intellectual disabilities are entitled to accessible antenatal and infant feeding information, yet are rarely asked for their views on available resources. This article reports on the final stage of a UK project exploring how women with intellectual disabilities are supported to make infant feeding decisions. The wider project includes a scoping review and interviews with healthcare professionals, here we focus on the voices of the women themselves. METHODS Four women with an intellectual disability participated in a focus group where they were asked to give their views on the accessibility of currently available infant feeding resources and on alternative representations of infant feeding. All were interested in women's health issues, including infant feeding. Photo-elicitation was used to gather views on videos, bespoke 'Easy Read' material and several alternative representations of infant feeding. A transcription of the discussion was thematically analysed whilst a critical visual analysis was undertaken of the women's preferred images/resources. The study took place in Bristol, UK, during 2022. RESULTS Two themes were identified from the group discussion: 'The desire for choice' and 'How easy is 'Easy Read'?' The desire for choice was expressed in terms through agreements and disagreements about preferred imagery, differing tastes, and reasons for these preferences. We identified a challenge to 'Easy Read' as a default standard and concerns that some forms of 'Easy Read' can confuse rather than inform. Critical visual analysis identified the importance of the story and social setting of the preferred infant feeding image. CONCLUSIONS Findings suggest a need for a suite of resources, avoiding the one-size-fits-all approach, including people with an intellectual disability at every stage of the design and production process. Resources should recognise and embrace differences in terms of understanding, visual literacy and cultural taste, as well as being freely available to support women with intellectual disabilities to make informed infant feeding decisions. An accessible film was co-produced, to disseminate the findings from all three stages of the completed project.
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Affiliation(s)
- Emma Douglass
- School of Health and Social Wellbeing, College of Health, Science and Society, University of the West of England, Glenside Campus, Blackberry Hill, Fishponds, Bristol, BS16 1DD, UK
| | - Clare Johnson
- School of Arts, College of Arts, Technology and Environment, University of the West of England Bristol, City Campus, Arnolfini, 6 Narrow Quay, Bristol, BS1 4QA, UK
| | - Geraldine Lucas
- School of Health and Social Wellbeing, College of Health, Science and Society, University of the West of England, Glenside Campus, Blackberry Hill, Fishponds, Bristol, BS16 1DD, UK
| | - Sally Dowling
- Bristol Medical School, Faculty of Health Sciences, University of Bristol, 69 St Michael's Hill, Bristol, BS2 8DZ, UK.
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Smith LD, Valentine A, Moore Simas TA, Parish SL, Levy A, Mitra M. Clinician-reported barriers to providing perinatal care to women with intellectual and developmental disabilities. JOURNAL OF INTELLECTUAL & DEVELOPMENTAL DISABILITY 2022; 48:12-22. [PMID: 36969147 PMCID: PMC10036077 DOI: 10.3109/13668250.2022.2086110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Background Research suggests that women with intellectual and developmental disabilities are at increased risk for adverse pregnancy outcomes. Further, they report unmet perinatal care needs. This qualitative study examined clinician perspectives on barriers to providing perinatal care to women with intellectual and developmental disabilities. Method We conducted semi-structured interviews and one focus group with US obstetric care clinicians (n=17). We used a content analysis approach to code data and analyse them for larger themes and relationships. Results The majority of participants were white, non-Hispanic, and female. Participants reported barriers providing care to pregnant women with intellectual and developmental disabilities across individual (e.g., communication challenges), practice (e.g., identification of disability status), and system levels (e.g., lack of clinician training). Conclusions Clinician training and evidence-based guidelines for perinatal care of women with intellectual and developmental disabilities as well as services and supports during pregnancy are needed.
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Affiliation(s)
- Lauren D. Smith
- Lurie Institute for Disability Policy, Heller School for Social Policy and Management, Brandeis University, Waltham, MA, USA
| | - Anne Valentine
- Lurie Institute for Disability Policy, Heller School for Social Policy and Management, Brandeis University, Waltham, MA, USA
| | - Tiffany A. Moore Simas
- Department of Obstetrics and Gynecology, University of Massachusetts Medical School, UMass Memorial Medical Center, Worcester , MA, USA
| | - Susan L. Parish
- College of Health Professions, Virginia Commonwealth University, Richmond, VA, USA
| | - Alanna Levy
- Lurie Institute for Disability Policy, Heller School for Social Policy and Management, Brandeis University, Waltham, MA, USA
| | - Monika Mitra
- Lurie Institute for Disability Policy, Heller School for Social Policy and Management, Brandeis University, Waltham, MA, USA
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Ransohoff JI, Kumar PS, Flynn D, Rubenstein E. Reproductive and pregnancy health care for women with intellectual and developmental disabilities: A scoping review. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2022; 35:655-674. [PMID: 35064736 PMCID: PMC10119781 DOI: 10.1111/jar.12977] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 11/22/2021] [Accepted: 01/09/2022] [Indexed: 12/25/2022]
Abstract
BACKGROUND Women with intellectual and developmental disabilities face poorer reproductive and pregnancy outcomes partially due to health care inequity. Our objective was to conduct a scoping review of reproductive and pregnancy related health care among women with intellectual and developmental disabilities. METHODS We systematically reviewed three databases for keywords pertaining to pregnancy, reproductive health, and intellectual and developmental disabilities. Two reviewers screened abstracts and extracted full text. We synthesised included papers, identifying common themes. RESULTS Thirty-six papers met review criteria. Women with intellectual and developmental disabilities had lower fertility rates and were less likely to receive adequate sexual education compared to peers. While most women received prenatal care, uptake was lower and received later than women without intellectual and developmental disabilities. CONCLUSIONS Pregnancy-related health care is often lacking for women with intellectual and developmental disabilities. There are gaps inhibiting our understanding which prevents action to reduce health disparities.
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Affiliation(s)
- Jade I. Ransohoff
- School of Public Health, Boston University, Boston, Massachusetts, USA
| | - Prisha Sujin Kumar
- School of Public Health, Boston University, Boston, Massachusetts, USA
- Boston University Medical Campus, Boston University, Boston, Massachusetts, USA
| | - David Flynn
- Boston University Medical Campus, Boston University, Boston, Massachusetts, USA
| | - Eric Rubenstein
- School of Public Health, Boston University, Boston, Massachusetts, USA
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Johnson C, Douglass E, Lucas G, Dowling S. Supporting women with learning disabilities in infant feeding decisions: A scoping review. MATERNAL & CHILD NUTRITION 2022; 18:e13318. [PMID: 35090089 PMCID: PMC8932700 DOI: 10.1111/mcn.13318] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 11/28/2021] [Accepted: 12/22/2021] [Indexed: 11/30/2022]
Abstract
Mothers with learning disabilities face many challenges during the perinatal period including preparing for and establishing infant feeding. Evidence shows that women with learning disabilities are less likely to breastfeed than other mothers. A scoping review was undertaken using Arksey and O'Malley's methodology to understand what is known about how women with learning disabilities can be supported to make infant feeding decisions, particularly in relation to the use of appropriate and accessible images. An additional aim was to understand what further research is needed to achieve sustainable improvements to policy and practice in this area. A comprehensive search of fourteen electronic databases was undertaken to look for both published and grey literature. Initial searches, after removal of duplicates, resulted in 467 primary research articles plus 22 items of grey literature. Following a systematic process, three published papers and six items of grey literature were identified which met inclusion and exclusion criteria, five of which were resources. Little is known about the acceptability of existing resources, specifically in relation to the use of visual images. A synthesis of the grey literature and a thematic analysis of published literature was conducted and confirmed that women with learning disabilities need tailored support with infant feeding, including accessible resources and that there is a need for more in-depth research in this area. There is a high level of agreement about the importance of using easily read visual images within these resources, but little evaluation of the types of imagery used or their aesthetic histories.
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Affiliation(s)
- Clare Johnson
- School of Art and Design, Faculty of Arts, Creative Industries and EducationUniversity of the West of EnglandBristolUK
| | - Emma Douglass
- School of Health and Social Wellbeing, Faculty of Health and Applied SciencesUniversity of the West of EnglandBristolUK
| | - Geraldine Lucas
- School of Health and Social Wellbeing, Faculty of Health and Applied SciencesUniversity of the West of EnglandBristolUK
| | - Sally Dowling
- School of Health and Social Wellbeing, Faculty of Health and Applied SciencesUniversity of the West of EnglandBristolUK
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Cox A, Parsons T, Watkin S, Gallagher A. Supporting the delivery of good maternity care for parents with learning disabilities. Midwifery 2021; 102:103073. [PMID: 34265502 DOI: 10.1016/j.midw.2021.103073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 02/19/2021] [Accepted: 06/17/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND AND OBJECTIVE Despite directives to improve maternity care in general and to improve care for parents with learning disabilities, the maternity experience of parents with learning disabilities is often poor and lacking reasonable adjustments to care. The objective of this study was to develop resources - in collaboration with key stakeholders - to support the workforce in delivering good maternity care to parents with learning disabilities. DESIGN A two-phase mixed-methods study. PARTICIPANTS Phase 1: 16 key stakeholders (health and social care professionals, parents with learning disabilities and their informal supporters/carers) were interviewed to understand views of best practice and inform resource development. Phase 2: 20 healthcare professionals engaged with the resources and gave feedback via online survey or discussion group to further refine them. FINDINGS Thematic analysis of key stakeholder interviews indicated that good maternity care for parents with learning disabilities requires a positive and proactive approach to identifying need; reasonable adjustments to communication and providing information; and professionals working together to support and enable parents. KEY CONCLUSIONS Health and social care professionals identified barriers to the delivery of good maternity care for parents with learning disabilities, including how to identify whether a parent has learning disabilities. Professionals in maternity services require additional resources to ensure parents' needs are recognised and they are provided with personalised preparation for parenthood and sufficient support. IMPLICATIONS FOR PRACTICE The Together Toolkit and Maternity Passport were coproduced to support the workforce to deliver good maternity care to parents with learning disabilities, these resources are free and accessible for use [https://www.surrey.ac.uk/research-projects/together-project-supporting-delivery-goodpractice-maternity-services-parents-learning-disabilities]. Further evaluation will explore acceptability and perceived impact of these resources in maternity services.
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Affiliation(s)
- Anna Cox
- School of Health Sciences, University of Surrey, United Kingdom.
| | - Treena Parsons
- School of Health Sciences, University of Surrey, United Kingdom
| | | | - Ann Gallagher
- College of Medicine and Health, University of Exeter, United Kingdom
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