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James TG, McKee KS, Moore Simas TA, Smith LD, McKee MM, Mitra M. Cesarean birth and adverse birth outcomes among sub-populations of deaf and hard-of-hearing people. Disabil Health J 2024; 17:101639. [PMID: 38811248 PMCID: PMC11401748 DOI: 10.1016/j.dhjo.2024.101639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 04/24/2024] [Accepted: 05/09/2024] [Indexed: 05/31/2024]
Abstract
BACKGROUND Deaf and hard-of-hearing (DHH) people are at higher risk than their non-DHH counterparts of experiencing adverse birth outcomes. There is a lack of research focusing on social, linguistic, and medical factors related to being DHH which may identify groups of DHH people who experience more inequity. OBJECTIVE Examine difference in prevalence of cesarean and adverse birth outcomes among diverse sub-groups of DHH people. METHODS We conducted a cross-sectional survey of DHH birthing people in the U.S. who gave birth within the past 10 years. The sample was predominantly white, college educated, and married. We assessed cesarean birth and three adverse birth outcomes: preterm birth, low birthweight, and NICU admission post-delivery. DHH-specific variables were genetic etiology of hearing loss, preferred language (i.e., American Sign Language, English, or bilingual), severity of hearing loss, age of onset of hearing loss, and self-reported quality of perinatal care communication. We estimated prevalence, 95 % confidence intervals, and unadjusted prevalence ratios. RESULTS Thirty-one percent of our sample reported a cesarean birth. Overall, there were no significant differences in prevalence across the outcome variables with respect to preferred language, genetic etiology, severity, and age of onset. Poorer perinatal care communication quality was associated with higher prevalence of preterm birth (PR = 2.37) and NICU admission (PR = 1.91). CONCLUSIONS Our study found no evidence supporting differences in obstetric outcomes among DHH birthing people across medical factors related to deafness. Findings support the important role of communication access for DHH people in healthcare environments.
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Affiliation(s)
- Tyler G James
- Department of Family Medicine, University of Michigan, USA.
| | | | - Tiffany A Moore Simas
- Department of Obstetrics and Gynecology, UMass Chan Medical School, Worcester, MA, USA
| | - Lauren D Smith
- Lurie Institute for Disability Policy, Brandeis University, Waltham, MA, USA
| | | | - Monika Mitra
- Lurie Institute for Disability Policy, Brandeis University, Waltham, MA, USA
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Tan NS, James TG, McKee KS, Moore Simas TA, Smith LD, McKee MM, Mitra M. Antenatal depression and drug use among deaf and hard-of-hearing birthing parents: results from a U.S. National Survey. Arch Womens Ment Health 2024:10.1007/s00737-024-01512-7. [PMID: 39259355 DOI: 10.1007/s00737-024-01512-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 08/27/2024] [Indexed: 09/13/2024]
Abstract
PURPOSE This study aimed to investigate antenatal depression and drug use among deaf and hard-of-hearing (DHH) birthing parents who use American Sign Language (ASL), spoken English, or bilingually both ASL and English. METHODS DHH participants in the United States responded to the Survey on Pregnancy Experiences of Deaf and Hard-of-Hearing Women. Respondents self-reported their antenatal depression diagnoses and drug use (i.e., pain relievers, cannabis, or illicit drugs) during their last pregnancy. Poisson regression models were used to estimate prevalence ratios, adjusting for age, race/ethnicity, education, marital status, and parity. RESULTS The average age of respondents (n = 587) was 35 years. Respondents were predominantly non-Hispanic white (80%), college educated (60%), and married (74%). Relative to DHH English-speakers, DHH ASL-users had lower prevalence of reporting antenatal depression diagnosis (aPR = 0.40, 95% CI: 0.23 to 0.72). DHH people who reported antenatal depression diagnosis had higher prevalence of reporting antenatal drug use (PR = 2.34, 95% CI: 1.65 to 3.33). There were no significant associations between preferred language and antenatal drug use. CONCLUSIONS DHH ASL-users are less likely to report receiving an antenatal depression diagnosis compared to DHH English-speakers. Given well-documented patient-provider communication barriers among DHH ASL-users, it is unclear if the lower prevalence observed in this study is the result of inadequate or inaccessible screening during pregnancy. Future work should consider universal use of linguistically appropriate screening tools for DHH birthing parents in both clinical and research settings.
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Affiliation(s)
- Nasya S Tan
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Tyler G James
- Department of Family Medicine, University of Michigan Medical School, Ann Arbor, MI, USA.
| | - Kimberly S McKee
- Department of Family Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Tiffany A Moore Simas
- Departments of Obstetrics & Gynecology, Pediatrics, Psychiatry, and Population & Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Lauren D Smith
- Lurie Institute for Disability Policy, Brandeis University, Waltham, MA, USA
| | - Michael M McKee
- Department of Family Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Monika Mitra
- Lurie Institute for Disability Policy, Brandeis University, Waltham, MA, USA
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Deierlein AL, Park C, Patel N, Gagnier R, Thorpe M. Mental health outcomes across the reproductive life course among women with disabilities: a systematic review. Arch Womens Ment Health 2024:10.1007/s00737-024-01506-5. [PMID: 39222078 DOI: 10.1007/s00737-024-01506-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 08/14/2024] [Indexed: 09/04/2024]
Abstract
PURPOSE This systematic review examined literature on mental health outcomes among women with disabilities living in high-income countries within the context of reproductive health, spanning menstruation through menopause. METHODS Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we searched MEDLINE, CINAHL, and PsycINFO databases for studies published through June 2023. Eligible studies were observational, quantitative, and included a comparison group without disabilities. RESULTS A total of 2,520 studies were evaluated and 27 studies met inclusion criteria. These studies assessed mental health during prepregnancy, pregnancy, postpartum, and parenting among women with and without disabilities. None of the studies examined reproductive health time periods related to menstruation, fertility, or menopause. Women of reproductive age with disabilities were more likely to have poor mental health outcomes compared to women without disabilities. During pregnancy and the postpartum, women with disabilities were at greater risk of diagnosed perinatal mental disorders and psychiatric-related healthcare visits. Findings also suggested mental distress and inadequate emotional and social support related to parenting among women with disabilities. The greatest risks of poor mental health outcomes were often observed among women with intellectual and developmental disabilities and among women with multiple types of disabilities, compared to women without disabilities. CONCLUSIONS Routine reproductive healthcare visits provide significant prevention and treatment opportunities for poor mental health among women with disabilities. Further research examining mental health outcomes within the context of reproductive health, especially understudied areas of menstruation, fertility, parenting, and menopause, among women with disabilities is needed.
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Affiliation(s)
| | - Curie Park
- School of Global Public Health, New York University, New York, NY, USA
| | - Nishtha Patel
- School of Global Public Health, New York University, New York, NY, USA
| | - Robin Gagnier
- School of Global Public Health, New York University, New York, NY, USA
| | - Michele Thorpe
- Rory Meyers College of Nursing, New York University, New York, NY, USA
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4
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Diamanti A, Zampeli MV, Taskou C, Lykeridou A, Sarantaki A. Midwives' Knowledge and Attitudes Regarding Perinatal Care for Women With Disabilities. Cureus 2024; 16:e67456. [PMID: 39310571 PMCID: PMC11415772 DOI: 10.7759/cureus.67456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/22/2024] [Indexed: 09/25/2024] Open
Abstract
INTRODUCTION Women with disabilities (WWD) face significant barriers to accessing quality perinatal care, resulting in adverse outcomes for mothers and newborns. Midwives are crucial in providing this care, but their knowledge and attitudes can impact the quality of services delivered. This study aims to examine midwives' knowledge and attitudes toward perinatal care for WWD and identify factors influencing these aspects. METHODS A cross-sectional study was conducted from January to April 2023, involving 149 midwives from various healthcare settings. Data were collected using a self-administered questionnaire addressing demographics, knowledge, attitudes, and perceived barriers related to perinatal care for WWD. Descriptive statistics and non-parametric tests were used for analysis, with a significance level set at 0.05. RESULTS The sample comprised predominantly female midwives (146, 98%), with a mean age of 33.7 years and a mean of 9.8 years of work experience. Only 48 (32.2%) reported workplaces equipped for perinatal care for WWD. Most participants rated the perinatal care services in Greece for WWD as moderate (87, 58.4%) and believed that the medical staff's knowledge in this area was insufficient (148, 99.3%). The mean knowledge score was 35 points out of 100, indicating a low level of knowledge. Key barriers included the lack of adapted services (148, 99.3%) and insufficient infrastructure (143, 96%). Despite these challenges, 142 (95.3%) midwives supported the right of WWD to have children. Significant correlations were found between higher knowledge scores and less specialized attitudes, while more perceived barriers correlated with a greater need for further education. CONCLUSIONS This study highlights the urgent need for improved education and training programs for midwives to enhance their knowledge and attitudes toward perinatal care for WWD. Addressing educational and structural barriers is essential to provide equitable and high-quality care. Policymakers should prioritize creating inclusive healthcare environments and support ongoing professional development for midwives.
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Affiliation(s)
- Athina Diamanti
- Department of Midwifery, University of West Attica, Athens, GRC
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Rotenberg SH, Davey C, McFadden E. Women with disabilities' use of maternal care services in sub-Saharan Africa. Afr J Disabil 2024; 13:1327. [PMID: 39114455 PMCID: PMC11304128 DOI: 10.4102/ajod.v13i0.1327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 05/25/2024] [Indexed: 08/10/2024] Open
Abstract
Background Quality maternal health care is central to the Sustainable Development Goals efforts to reduce maternal mortality, yet there remain limited quantitative data on maternal care inequities for women with disabilities in sub-Saharan Africa. Objectives This study aims to understand the differences in maternal care providers for women with and without disabilities. Method We used Multiple Indicator Cluster Surveys from 13 sub-Saharan African countries conducted between 2017-2020. We used logistic and multinomial logistic regression to examine the relationship between disability (Washington Group definition) and antenatal care attendance and the type of care provider for antenatal care, skilled birth attendance, and postnatal and postpartum checks. All analyses were adjusted for age, wealth, country, and location. Results The sample included 10 021 women, including 306 (3.1%) women with disabilities. There were small absolute and no relative differences in antenatal care attendance, qualified antenatal care provider, postnatal, and postpartum checks, for disabled and women without disabilities. Women with disabilities had some evidence of higher odds of having a doctor at their birth compared to women without disabilities (aOR = 1.52, 95% CI: 0.99-2.33). Conclusion This study shows small absolute and no relative differences between women with and without disabilities for antenatal access and provider types for maternal care, though these findings are limited by a small sample and no data on care quality, acceptability, or outcomes. More research on care quality and outcomes is needed. Contribution This study is the first quantitative, multi-country study in sub-Saharan Africa to examine maternal care seeking patterns, demonstrating important data on maternal health indicators for women with disabilities.
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Affiliation(s)
- Sara H Rotenberg
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
- International Centre for Evidence in Disability, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Calum Davey
- International Centre for Evidence in Disability, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Emily McFadden
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
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Harkins SE, Barcelona V. An evaluation of conceptual frameworks to improve reproductive health outcomes among women with physical disabilities. J Adv Nurs 2024. [PMID: 38969486 DOI: 10.1111/jan.16304] [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: 03/20/2024] [Revised: 05/17/2024] [Accepted: 06/15/2024] [Indexed: 07/07/2024]
Abstract
AIM(S) To identify and evaluate conceptual frameworks intended to guide reproductive health research among women with physical disabilities. DESIGN Discussion paper. METHODS We identified and evaluated frameworks related to the reproductive health of women with physical disabilities using modified criteria by Fawcett and DeSanto-Madeya with constructs from the International Classification of Functioning, Disability, and Health. DATA SOURCES We conducted a systematic review of literature published from 2001 to 2024 in four databases. RESULTS Our review revealed two frameworks: (1) A perinatal health framework for women with physical disabilities is applicable to studies that consider multiple socioecological determinants in pregnancy; (2) A conceptual framework of reproductive health in the context of physical disabilities can guide the development of patient-reported outcome measures for a range of reproductive health outcomes. CONCLUSION The identified frameworks have high potential to guide studies that can improve the reproductive health of women with physical disabilities. However, they have low social congruence among racially and ethnically minoritized women. IMPLICATIONS FOR NURSING Future frameworks must take an intersectional approach and consider the compounding injustices of ableism, racism, classism and ageism on reproductive health. A holistic approach that is inherent to the discipline of nursing is essential to address these knowledge gaps. IMPACT The reproductive health of women with disabilities is a research priority. Nurses and other researchers can select the framework most applicable to their research questions to guide study designs and should incorporate multi-level determinants to eliminate reproductive health disparities.
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Affiliation(s)
- Sarah E Harkins
- Columbia University School of Nursing, New York, New York, USA
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Acuff K, Wu JH, Varkhedi V, Baxter SL. Social determinants of health and health disparities in glaucoma: A review. Clin Exp Ophthalmol 2024; 52:276-293. [PMID: 38385607 PMCID: PMC11038416 DOI: 10.1111/ceo.14367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 01/30/2024] [Accepted: 02/02/2024] [Indexed: 02/23/2024]
Abstract
Social determinants of health and barriers to care can significantly impact patients' access to glaucoma care and treatment, resulting in disparities within disease presentation, progression, management, and treatment outcomes. The widespread adoption of electronic health record systems has allowed researchers and clinicians to further explore these relationships, identifying factors such as race, ethnicity, and socioeconomic status to be risk factors for more severe disease and lower treatment adherence. These disparities highlight potential targets for interventions to combat these disparities and improve overall patient outcomes. This article provides a summary of the available data on health disparities within glaucoma disease presentation, progression, management, treatment, and outcomes and discusses interventions to improve care delivery and outcomes among patients with glaucoma.
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Affiliation(s)
- Kaela Acuff
- Division of Ophthalmology Informatics and Data Science, Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, La Jolla, California, USA
- Health Department of Biomedical Informatics, University of California San Diego, La Jolla, California, USA
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla, CA, USA
| | - Jo-Hsuan Wu
- Division of Ophthalmology Informatics and Data Science, Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, La Jolla, California, USA
- Health Department of Biomedical Informatics, University of California San Diego, La Jolla, California, USA
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla, CA, USA
| | - Varsha Varkhedi
- Division of Ophthalmology Informatics and Data Science, Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, La Jolla, California, USA
- Health Department of Biomedical Informatics, University of California San Diego, La Jolla, California, USA
| | - Sally L. Baxter
- Division of Ophthalmology Informatics and Data Science, Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, La Jolla, California, USA
- Health Department of Biomedical Informatics, University of California San Diego, La Jolla, California, USA
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla, CA, USA
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Temane AM, Magagula FN, Nolte AGW. Midwives' lived experiences of caring for women with mobility disabilities during pregnancy, labour and puerperium in Eswatini: a qualitative study. BMC Womens Health 2024; 24:207. [PMID: 38561691 PMCID: PMC10986101 DOI: 10.1186/s12905-024-03032-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 03/18/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Midwives encounter various difficulties while aiming to achieve excellence in providing maternity care to women with mobility disabilities. The study aimed to explore and describe midwives' experiences of caring for women with mobility disabilities during pregnancy, labour and puerperium in Eswatini. METHODS A qualitative, exploratory, descriptive, contextual research design with a phenomenological approach was followed. Twelve midwives working in maternal health facilities in the Hhohho and Manzini regions in Eswatini were interviewed. Purposive sampling was used to select midwives to participate in the research. In-depth phenomenological interviews were conducted, and Giorgi's descriptive phenomenological method was used for data analysis. RESULTS Three themes emerged from the data analysis: midwives experienced physical and emotional strain in providing maternity care to women with mobility disabilities, they experienced frustration due to the lack of equipment to meet the needs of women with mobility disabilities, and they faced challenges in providing support and holistic care to women with mobility disabilities during pregnancy, labour and puerperium. CONCLUSIONS Midwives experienced challenges caring for women with mobility disabilities during pregnancy, labour and the puerperium in Eswatini. There is a need to develop and empower midwives with the knowledge and skill to implement guidelines and enact protocols. Moreover, equipment and infrastructure are required to facilitate support and holistic maternity care for women with mobility disabilities.
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Affiliation(s)
- Annie M Temane
- Health Sciences, University of Johannesburg, Johannesburg, South Africa.
| | | | - Anna G W Nolte
- Health Sciences, University of Johannesburg, Johannesburg, South Africa
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Gréaux M, Moro MF, Kamenov K, Russell AM, Barrett D, Cieza A. Health equity for persons with disabilities: a global scoping review on barriers and interventions in healthcare services. Int J Equity Health 2023; 22:236. [PMID: 37957602 PMCID: PMC10644565 DOI: 10.1186/s12939-023-02035-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 10/11/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Persons with disabilities experience health inequities in terms of increased mortality, morbidity, and limitations in functioning when compared to the rest of the population. Many of the poor health outcomes experienced by persons with disabilities cannot be explained by the underlying health condition or impairment, but are health inequities driven by unfair societal and health system factors. A synthesis of the global evidence is needed to identify the factors that hinder equitable access to healthcare services for persons with disabilities, and the interventions to remove these barriers and promote disability inclusion. METHODS We conducted a scoping review following the methodological framework proposed by Arksey and O'Malley, Int J Soc Res Methodol 8:19-32. We searched two scholarly databases, namely MEDLINE (Ovid) and Web of Science, the websites of Organizations of Persons with Disabilities and governments, and reviewed evidence shared during WHO-led consultations on the topic of health equity for persons with disabilities. We included articles published after 2011 with no restriction to geographical location, the type of underlying impairments or healthcare services. A charting form was developed and used to extract the relevant information for each included article. RESULTS Of 11,884 articles identified in the search, we included 182 articles in this review. The majority of sources originated from high-income countries. Barriers were identified worldwide across different levels of the health system (such as healthcare costs, untrained healthcare workforces, issues of inclusive and coordinated services delivery), and through wider contributing factors of health inequities that expand beyond the health system (such as societal stigma or health literacy). However, the interventions to promote equitable access to healthcare services for persons with disabilities were not readily mapped onto those needs, their sources of funding and projected sustainability were often unclear, and few offered targeted approaches to address issues faced by marginalized groups of persons with disabilities with intersectional identities. CONCLUSION Persons with disabilities continue to face considerable barriers when accessing healthcare services, which negatively affects their chances of achieving their highest attainable standard of health. It is encouraging to note the increasing evidence on interventions targeting equitable access to healthcare services, but they remain too few and sparce to meet the populations' needs. Profound systemic changes and action-oriented strategies are warranted to promote health equity for persons with disabilities, and advance global health priorities.
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Affiliation(s)
- Mélanie Gréaux
- Faculty of Education, University of Cambridge, Cambridge, UK.
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10
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Merits M, Lubi K, Tammes M. Experiences of women with impaired physical mobility during pregnancy, childbirth and postpartum: A case study. Eur J Midwifery 2023; 7:26. [PMID: 37808525 PMCID: PMC10552004 DOI: 10.18332/ejm/170433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 07/23/2023] [Accepted: 08/23/2023] [Indexed: 10/10/2023] Open
Abstract
INTRODUCTION The research deals with a little-studied topic in Estonia: the experiences of women with impaired physical mobility (IPM) during pregnancy, childbirth, and in the postpartum period. Women with IPM, a vulnerable group, have a higher risk of complications and a higher probability of missing out on comprehensive maternity care. METHODS The method of the present research is qualitative. It is a case study of three women with IPM with whom semi-structured interviews were conducted. RESULTS It was found that women with IPM encountered several obstacles and problems during pregnancy, childbirth, and the postpartum period; despite this, women's experiences with maternity care were mostly positive. Furthermore, there are several areas for improvement to ensure more comprehensive maternity care. Women with IPM need more support and help, and midwives are expected to have additional knowledge regarding the specifics or limitations resulting from mobility impairments. CONCLUSIONS In the future, the topic needs greater attention and improvement in the Estonian context to ensure more comprehensive maternity care for women with IPM. It is important to provide midwives the knowledge and skills to assist women with IPM during pregnancy, childbirth, and the postpartum period.
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Affiliation(s)
- Marika Merits
- Midwifery Department, Health Education Centre, Tallinn Health Care College, Tallinn, Estonia
| | - Kadi Lubi
- Department of Health Technologies, School of Information Technologies, Tallinn University of Technology, Tallinn, Estonia
| | - Meelike Tammes
- Midwifery Department, Health Education Centre, Tallinn Health Care College, Tallinn, Estonia
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Robinson-Whelen S, Hughes RB, Alhusen JL, Beers L, Minard CG, Davidson D. Health information seeking in the digital age: a national survey of women with disabilities. Disabil Rehabil 2023; 45:2751-2760. [PMID: 35916449 PMCID: PMC9892349 DOI: 10.1080/09638288.2022.2105960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 06/30/2022] [Accepted: 07/19/2022] [Indexed: 02/04/2023]
Abstract
PURPOSE Access to high quality and accessible online health information (OHI) is critical for reducing disparities, overcoming barriers, and improving the health of women with disabilities. This study aimed to understand women with physical disabilities' use of the Internet to access OHI, most often searched health topics, perceived usefulness of OHI, and self-reported eHealth literacy and challenges in OHI seeking. METHODS We conducted a national online survey with 508 women with physical disabilities who used the Internet. RESULTS Respondents utilized a wide variety of OHI resources. They searched a broad array of health and disability-related topics, with bowel/bladder and finding a physician the most highly searched topics. They generally had confidence in their eHealth literacy skills and ability to understand statistics in OHI. Nevertheless, although our sample consisted of a majority of highly educated internet-users, a sizeable percentage found OHI seeking difficult and frustrating, did not find the information very helpful, and had concerns about the quality of information. CONCLUSIONS This study serves as a call to action to disability and rehabilitation scientists, health care providers, and other health professionals to enhance the availability and accessibility of OHI critical to empowering women with physical disabilities to make well-informed health decisions. Implications for rehabilitationAccess to high quality online health information (OHI) is critical for reducing disparities, overcoming barriers, and improving the health of women with disabilities.Many of the women with disabilities in our study found OHI seeking difficult and frustrating, did not find the information very helpful, and had concerns about the quality of the information.Disability and rehabilitation scientists, health care providers, and public health and health policy professionals need to do more to enhance the availability and accessibility of OHI and resources critical to empowering women with physical disabilities to make well-informed health decisions.Physical medicine and rehabilitation scientists are encouraged to develop and improve assistive technologies needed for accessing OHI, which in turn can promote the independent functioning of people with disabilities.
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Affiliation(s)
- Susan Robinson-Whelen
- Baylor College of Medicine, Center for Research on Women with Disabilities, TIRR Memorial Hermann, Spinal Cord Injury and Disability Research, Houston, TX 77030, USA, 281-467-2349
| | - Rosemary B. Hughes
- University of Montana, Rural Institute for Inclusive Communities and Department of Psychology, Missoula, MT, USA
| | | | - Leanne Beers
- University of Montana, Rural Institute for Inclusive Communities, Missoula, MT, USA
| | - Charles G. Minard
- Baylor College of Medicine, Institute for Clinical and Translational Research, Houston, TX, USA
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James TG, Panko T, Smith LD, Helm KVT, Katz GR, Caballero ME, Cooley MM, Mitra M, McKee MM. Healthcare communication access among deaf and hard-of-hearing people during pregnancy. PATIENT EDUCATION AND COUNSELING 2023; 112:107743. [PMID: 37060682 PMCID: PMC10167864 DOI: 10.1016/j.pec.2023.107743] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 03/30/2023] [Accepted: 04/03/2023] [Indexed: 05/09/2023]
Abstract
OBJECTIVE Deaf and hard-of-hearing (DHH) people report ineffective healthcare communication. Limited research has been conducted on healthcare communication during pregnancy. This study's aim was to assess communication accommodations and experiences during pregnancy for DHH people. METHODS An accessible web-based survey was administered to a non-probability sample of DHH people through national organizations, social media, and snowball sampling. Eligibility criteria included being 21 years or older; given birth in the U.S. within the past 10 years, report hearing loss prior to the most recent birth. Questions focused on healthcare experiences and information access during their last pregnancy. The sample included 583 respondents for the present analysis. We describe the communication accommodations requested and received during pregnancy, segmented by preferred language. RESULTS Most DHH participants reported communication with prenatal clinicians as "good" or "very good". On-site interpreter services were most commonly requested by American Sign Language (ASL) only and bilingual DHH people. Interpersonal communication modification requests (e.g., speaking louder) were rarely obliged. CONCLUSION This study is the first national examination of requested and received communication accommodations for DHH patients during the perinatal period. PRACTICE IMPLICATIONS Healthcare providers should work closely with patients to ensure effective communication access is provided.
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Affiliation(s)
- Tyler G James
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, USA.
| | - Tiffany Panko
- Deaf Health Laboratory, Center for Culture and Language, National Technical Institute for the Deaf, Rochester Institute of Technology, USA
| | - Lauren D Smith
- Lurie Institute for Disability Policy, The Heller School for Social Policy and Management, Brandeis University, Waltham, MA, USA
| | - Kaila V T Helm
- Ichan School of Medicine at Mount Sinai, New York, NY, USA
| | - Gabrielle R Katz
- Lurie Institute for Disability Policy, The Heller School for Social Policy and Management, Brandeis University, Waltham, MA, USA
| | | | - Margarita M Cooley
- Lurie Institute for Disability Policy, The Heller School for Social Policy and Management, Brandeis University, Waltham, MA, USA
| | - Monika Mitra
- Lurie Institute for Disability Policy, The Heller School for Social Policy and Management, Brandeis University, Waltham, MA, USA
| | - Michael M McKee
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, USA
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Tarasoff LA, Saeed G, Lunsky Y, Welsh K, Proulx L, Havercamp SM, Parish SL, Brown HK. Prenatal Care Experiences of Childbearing People With Disabilities in Ontario, Canada. J Obstet Gynecol Neonatal Nurs 2023; 52:235-247. [PMID: 36940781 DOI: 10.1016/j.jogn.2023.02.001] [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: 12/01/2022] [Revised: 02/16/2023] [Accepted: 02/25/2023] [Indexed: 03/19/2023] Open
Abstract
OBJECTIVE To explore the care experiences of childbearing people with physical, sensory, and/or intellectual/developmental disabilities during pregnancy. DESIGN Descriptive qualitative. SETTING Ontario, Canada, where physician and midwifery care during pregnancy are provided at no direct cost to residents. PARTICIPANTS Thirty-one people with physical, sensory, and/or intellectual/developmental disabilities (who self-identified as cisgender women [n = 29] and trans or nonbinary persons [n = 2]) who gave birth in the last 5 years. METHODS We recruited childbearing people with disabilities through disability and parenting organizations, social media, and our team's networks. Using a semistructured guide, we conducted in-person and virtual (e.g., telephone or Zoom) interviews with childbearing people with disabilities in 2019 to 2020. We asked participants about the services they accessed during pregnancy and if services met their needs. We used a reflexive thematic analysis approach to analyze interview data. RESULTS Across disability groups, we identified four common themes: Unmet Accommodation Needs, Lack of Coordinated Care, Ableism, and Advocacy as a Critical Resource. We found that these experiences manifested in unique ways based on disability type. CONCLUSION Our findings suggest the need for accessible, coordinated, and respectful prenatal care for people with disabilities, with the requirements of such care depending on the needs of the individual person with a disability. Nurses can play a key role in identifying the needs and supporting people with disabilities during pregnancy. Education and training for nurses, midwives, obstetricians, and other prenatal care providers should focus on disability-related knowledge and respectful prenatal care.
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Kalpakjian CZ, Haapala HJ, Ernst SD, Orians BR, Barber ML, Mulenga L, Bolde S, Kreschmer JM, Parten R, Carlson S, Rosenblum S, Jay GM. Development and pilot test of a pregnancy decision making tool for women with physical disabilities. Health Serv Res 2023; 58:223-233. [PMID: 36401816 PMCID: PMC9836953 DOI: 10.1111/1475-6773.14103] [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] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE Design and pilot test a new decision making tool for women with physical disabilities (impairment of physical function due to chronic conditions) considering pregnancy. DATA SOURCES AND STUDY SETTING Quantitative surveys and qualitative interviews were collected from participants living in the community. STUDY DESIGN Clinical guidelines and survey and focus group data about pregnancy informational and decisional needs guided content development. The tool was pilot tested in a 12-week trial with participants with physical disabilities considering or actively planning a pregnancy. Feasibility outcomes were acceptability, implementation, and demand (collected at end of the trial); preliminary efficacy focused on decisional conflict and readiness (baseline, 6 weeks, and end of trial). DATA COLLECTION Survey data were collected using an online form. One-on-one interviews were conducted to learn more about experience using the tool. PRINCIPAL FINDINGS Thirty eight participants with mild, moderate, or severe physical disabilities participated. Feasibility outcomes indicated that the tool provided participants with information, guiding questions, and helped them to consider multiple aspects of the decision about pregnancy. Most participants responded positively to the new decision making tool, finding it easy to use and the information balanced. Feedback highlighted opportunity for improvement, such as more specific information, peer stories, and the limitations of a paper format. There was significant linear effect of time, with increased decisional certainty and readiness, values clarity, and decisional support (partial η2 [90% CI] = 0.310 [0.08, 0.46], 0.435 [0.19, 0.60], 0.134 [0, 0.29], 0.178 [0.01, 0.35], respectively). Decisional certainty and readiness had high observed power (96.7% and 99.3%, respectively) with lower observed power for clarity and support (60.6% and 75.1%, respectively). CONCLUSIONS The new tool shows promise for supporting women with physical disabilities in navigating pregnancy decision making. Future development of complementary strategies to support health care providers will help improve shared decision making and patient-centered care.
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Affiliation(s)
- Claire Z. Kalpakjian
- Department of Physical Medicine and RehabilitationUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
| | - Heidi J. Haapala
- Department of Physical Medicine and RehabilitationUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
| | - Susan D. Ernst
- Department of Obstetrics and GynecologyUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
| | | | | | - Lukonde Mulenga
- Department of Physical Medicine and RehabilitationUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
| | - Shannen Bolde
- Department of Physical Medicine and RehabilitationUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
| | - Jodi M. Kreschmer
- Department of Physical Medicine and RehabilitationUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
| | - Rebecca Parten
- Department of Physical Medicine and RehabilitationUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
| | - Susan Carlson
- Department of Obstetrics and GynecologyUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
- Department of Obstetrics and GynecologyDuke University School of MedicineDurhamNorth CarolinaUSA
| | - Sara Rosenblum
- Department of Physical Medicine and RehabilitationUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
| | - Gina M. Jay
- Department of Physical Medicine and RehabilitationUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
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Campbell EG, Rao SR, Ressalam J, Bolcic-Jankovic D, Lawrence R, Moore JM, Iezzoni LI. Caring for Adults With Significant Levels of Intellectual Disability in Outpatient Settings: Results of a National Survey of Physicians. AMERICAN JOURNAL ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2023; 128:36-48. [PMID: 36548375 DOI: 10.1352/1944-7558-128.1.36] [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] [Received: 07/30/2021] [Accepted: 02/15/2022] [Indexed: 06/17/2023]
Abstract
Between 1% and 2% of the U.S. population has an intellectual disability (ID) and often experience disparities in health care. Communication patterns and sedation use for routine medical procedures are important aspects of care for this population. We explored physicians' communication patterns and sedation use in caring for patients with significant levels of ID through a mailed survey of 1,400 physicians among seven specialties in outpatient settings (response rate = 61.0%). Among physicians who saw at least one patient with significant levels of ID in an average month, 74.8% reported usually/always communicating primarily with someone other than the patient. Among specialists, 85.5% (95% CI: 80.5%-90.5%) reported doing so, compared to 69.9% (95% CI: 64.4%-75.4%) for primary care physicians (p < 0.001). Also, 11.4% reported sedating at least one patient with significant levels of ID for a routine procedure. Three quarters of physicians reported communicating primarily with persons other than the patient usually or always-an approach that, in some instances, may not align with best medical practice. The percentage of physicians who report sedating at least one individual is associated with significant ID and the physician's volume of patients with significant ID.
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Affiliation(s)
| | - Sowmya R Rao
- Sowmya R. Rao, Massachusetts General Hospital Biostatistics Center and Boston University School of Public Health
| | - Julie Ressalam
- Julie Ressalam, University of Colorado School of Medicine
| | | | - Rosa Lawrence
- Rosa Lawrence, University of Colorado School of Medicine
| | - Jaime M Moore
- Jaime M. Moore, University of Colorado School of Medicine
| | - Lisa I Iezzoni
- Lisa I. Iezzoni, Massachusetts General Hospital and Harvard Medical School
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16
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Accommodating hearing loss in outpatient physician offices in the U.S. Disabil Health J 2023; 16:101397. [PMID: 36376146 DOI: 10.1016/j.dhjo.2022.101397] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 10/17/2022] [Accepted: 10/17/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND Approximately 16.2 million Americans ages 18 and older (5.7%) report being deaf or having serious difficulty hearing. Hearing loss impedes effective communication during clinical encounters putting patients' safety at risk. A large fraction of Americans with Disabilities Act lawsuits addresses whether providers offered auxiliary aids and services required to ensure effective communication. OBJECTIVE Examine use of different hearing accommodations for deaf or hard of hearing patients by U.S. physicians. METHODS We surveyed randomly selected physicians nationwide representing 7 specialties about their reported use of 8 types of accommodations when communicating with adult outpatients who are deaf or have significant difficulty hearing, even with hearing aids (overall weighted response rate = 61.0%). We performed a descriptive analysis of responses, using survey sampling weights. RESULTS Among the 526 physicians in this analysis, most were male, white, urban, and practiced in community-based practices. Overall, 81.5% (SE = 1.9) reported that patients with significant hearing limitations get worse quality health care than others. Among participants, 49.8% (2.4) reported never using an in-person sign language interpreter hired by the practice, and 63.2% (2.4) never use video remote interpreting. In contrast, 30.7% (2.1) always and 29.8% (2.2) usually speak louder and slower to patients with significant hearing limitations. None of the 8 accommodations were always or usually used by 8.9% (1.3) of participants. CONCLUSIONS More than 32 years after the Americans with Disabilities Act, most physicians do not offer accommodations sufficient to ensure effective communication with adult outpatients with significant hearing limitations.
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Acheampong AK, Marfo M, Aziato L. Experiencing motherhood as a blind mother in the Greater Accra Region of Ghana; a qualitative study. BMC Pregnancy Childbirth 2022; 22:900. [PMID: 36464685 PMCID: PMC9721001 DOI: 10.1186/s12884-022-05153-5] [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: 03/15/2022] [Accepted: 10/25/2022] [Indexed: 12/07/2022] Open
Abstract
BACKGROUND Females in developing countries are likely to suffer from visual impairment more than their male counterparts. People living with blindness or any other form of disability also have the right to reproduce and care for their children like all other humans. There is paucity of literature in the experiences of blind mothers in Ghana. Therefore, this study explored the experiences of blind mothers as they navigated the process of motherhood. METHODS Qualitative exploratory descriptive design was used to conduct the study. Nineteen blind mothers were interviewed individually. Permission was sought for data to be audiotaped, transcribed and content analyzed inductively. RESULTS Three main themes emerged from the data: mothering role and difficulties (sub-themes; feeding, disciplining and protection), mothering challenges (sub-themes; discrimination and prejudice, financial distress and psychological distress) and coping strategies (prayer, children and self-motivation). Most of the mothers reported difficulties in playing their roles in the areas of feeding, disciplining and protection. Challenges were poverty, discrimination, prejudices on their ability to be mothers and psychological distresses such as depression. They coped with their challenges with prayers, self motivation and the hope they had in their children. CONCLUSION A lot of public education is needed to make the lives of people living with disability better. Health professionals must be trained to treat blind mothers with dignity and respect.
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Affiliation(s)
| | - Margaret Marfo
- School of Nursing and Midwifery, Wisconsin International University College-Ghana, Accra, Ghana
| | - Lydia Aziato
- University of Health and Allied Sciences, Ho, Ghana
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Kaundinya T, Yang K, Watson AJ. Disability inclusion in dermatologic research: Response to "Lifetime history of total body skin examinations in patients with disabilities: Examining for differences in skin cancer screening". J Am Acad Dermatol 2022; 87:e153-e154. [PMID: 35598728 DOI: 10.1016/j.jaad.2022.04.065] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 04/11/2022] [Accepted: 04/13/2022] [Indexed: 11/20/2022]
Affiliation(s)
- Trisha Kaundinya
- Northwestern University Feinberg School of Medicine, Chicago, Illinois; Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts.
| | - Kevin Yang
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts; Tufts University School of Medicine, Boston, Massachusetts
| | - Alice J Watson
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
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Michael R, Ran G, Gali Cinamon R. Thinking About the Future: Perceived Barriers and Supports Among Israeli Young Adults With Physical Disabilities. REHABILITATION COUNSELING BULLETIN 2022. [DOI: 10.1177/00343552221124564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Young adults with disabilities tend to have lower rates of employment and career indicators as compared with youth without disabilities. Therefore, understanding the factors that may influence such outcomes is crucial. This study examined the future perceptions of 18 young adults with physical disabilities while focusing on the barriers and supports that may impact their transition into adult life. All participants were living in a rehabilitative student community in southern Israel. They participated in an in-depth semi-structured interview. Data analysis, which was conducted according to an adaptation of the Consensual Qualitative Research method, revealed four major domains: emotions, future life roles, barriers, and supports. Findings emphasized that the participants’ disability was extremely dominant in their future perceptions. In general, they expressed caution and concern about their future. They also tended not to express detailed long-term planning. Their perceptions focused on their future work, future intimate relationships, and the need to manage simultaneously different roles. When addressing their possible barriers and supports, they related both to environmental (e.g., social stigma and community support) and to personal (e.g., low self-esteem and high motivation) factors. Implications for research and practice are discussed.
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Affiliation(s)
| | - Galia Ran
- Kibbutzim College of Education, Tel Aviv, Israel
- Tel-Aviv University, Israel
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20
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Kazembe A, Simwaka A, Dougherty K, Petross C, Kafulafula U, Chakhame B, Chodzaza E, Chisuse I, Kamanga M, Sun C, George M. Experiences of women with physical disabilities accessing prenatal care in low- and middle-income countries. Public Health Nurs 2022; 39:1156-1166. [PMID: 35512242 DOI: 10.1111/phn.13087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 04/15/2022] [Accepted: 04/16/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Women with physical disabilities experience barriers to accessing patient-centered and accommodative care during the prenatal and childbirth periods. While there is a growing body of work in high-income countries to address these needs, there is little research detailing specific challenges in low- and middle-income countries (LMICs) where a woman's' burden- and need-is greatest. METHODS We conducted an integrative review to synthesize the experiences of women with physical disabilities accessing prenatal care and childbirth services in LMICs. Five databases were searched for systematic reviews, retrospective cohort studies, cross-sectional studies, narrative literature reviews, as well as other evidence types. We used Ediom's EvidenceEngine™, a machine-assisted search engine that uses artificial intelligence to conduct this search using pertinent keywords to identify original research published between January 2009 - September 2018. These results were augmented by hand searching of reference lists. Forty articles were identified using this method and 11 retained after duplicates were removed and inclusion and exclusion criteria applied. RESULTS Four types of experiences are described in these 11 studies: (1) limited physical and material resources; (2) health care worker knowledge, attitudes, and skills; (3) pregnant people's knowledge; and (4) public stigma and ignorance. DISCUSSION People with physical disabilities face specific challenges during pregnancy and childbirth. Importantly, these findings offer targets for enhanced clinical training for nurses, midwives, traditional birth attendants and public health workers, as well as opportunities for the improved delivery of prenatal care and childbirth services to these vulnerable women.
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Affiliation(s)
- Abigail Kazembe
- Kamuzu College of Nursing, University of Malawi, Lilongwe, Malawi
| | - Andrew Simwaka
- Kamuzu College of Nursing, University of Malawi, Lilongwe, Malawi
| | - Kylie Dougherty
- Columbia University School of Nursing, New York, New York, USA
| | - Chisomo Petross
- Kamuzu College of Nursing, University of Malawi, Lilongwe, Malawi
| | | | - Bertha Chakhame
- Kamuzu College of Nursing, University of Malawi, Lilongwe, Malawi
| | | | - Isabella Chisuse
- Kamuzu College of Nursing, University of Malawi, Lilongwe, Malawi
| | - Martha Kamanga
- Kamuzu College of Nursing, University of Malawi, Lilongwe, Malawi
| | - Carolyn Sun
- Hunter College School of Nursing, New York, New York, USA
| | - Maureen George
- Columbia University School of Nursing, New York, New York, USA
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Nthenge S, Smith L, Ho S, Mitra M. Experiences of Women of Short Stature During the Perinatal Period. J Obstet Gynecol Neonatal Nurs 2022; 51:418-427. [PMID: 35550125 DOI: 10.1016/j.jogn.2022.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2022] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To explore the experiences of women of short stature, including women with dwarfism and osteogenesis imperfecta (OI), during the perinatal period. DESIGN Qualitative descriptive. SETTING Telephone interviews with women of short stature from across the United States. PARTICIPANTS Nine women of short stature, including five with dwarfism and four with osteogenesis imperfecta, between the ages of 18 and 55 years who gave birth within the last 10 years. METHODS We used reflexive thematic analysis to analyze interview data. RESULTS Four themes represented the participants' experiences during maternity care: Clinicians' Lack of Knowledge, Sources of Information and EmotionalSupport, Clinical Considerations: Effects of Pregnancy and Disability, and Accessibility Barriers and Adaptations. Participants experienced respiratory difficulties and preterm birth. They expressed concerns regarding the lack of clinician knowledge and experience in administering epidural anesthesia to women of short stature and highlighted the important role of disability organizations in disseminating information about childbirth for women with disabilities. CONCLUSION Childbearing women of short stature require disability-specific maternity care. Our findings highlight the need for disability education programs for nurse-midwives, nurses, physicians, and other clinicians who provide maternity care to women of short stature.
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Smeltzer SC, Tina Maldonado L, McKeever A, Amorim F, Arcamone A, Nthenge S. Qualitative Descriptive Study of Childbirth Educators' Perspectives on Prenatal Education for Women With Physical Disability. J Obstet Gynecol Neonatal Nurs 2022; 51:302-312. [PMID: 35331670 DOI: 10.1016/j.jogn.2022.02.002] [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] [Accepted: 02/02/2022] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To explore the knowledge, experiences, and perceptions of childbirth educators about providing childbirth education to women with physical disability. DESIGN Qualitative descriptive design. SETTING Telephone interviews. PARTICIPANTS Seventeen childbirth educators. METHODS We used a semistructured interview guide to explore participants' knowledge, experiences, and perceptions of providing childbirth education to women with physical disability. We audio recorded, transcribed, and analyzed the interviews using content analysis. RESULTS We identified four themes: Importance of Childbirth Education for All Women, Inadequate Knowledge About Physical Disability, Willingness to Learn About Physical Disability, and Misconceptions and Assumptions About Women With Physical Disability. CONCLUSION Participants reported little knowledge about the needs of pregnant women with physical disability and limited experience with them in childbirth education classes. They reported eagerness to learn about disability and its effect on pregnancy to help provide meaningful education to women with physical disability. Childbirth educators need to develop and implement innovative approaches to reach women with physical disability, provide information relevant to their needs, and address the misconceptions and assumptions they may have about women with physical disability and pregnancy.
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Blair A, Cao J, Wilson A, Homer C. Access to, and experiences of, maternity care for women with physical disabilities: a scoping review. Midwifery 2022; 107:103273. [DOI: 10.1016/j.midw.2022.103273] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 02/02/2022] [Accepted: 02/03/2022] [Indexed: 01/02/2023]
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Iezzoni LI, Rao SR, Ressalam J, Bolcic-Jankovic D, Agaronnik ND, Lagu T, Pendo E, Campbell EG. US Physicians' Knowledge About The Americans With Disabilities Act And Accommodation Of Patients With Disability. Health Aff (Millwood) 2022; 41:96-104. [PMID: 34982624 PMCID: PMC8740697 DOI: 10.1377/hlthaff.2021.01136] [Citation(s) in RCA: 42] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
More than thirty years since the enactment of the Americans with Disabilities Act (ADA), people with disability continue to experience health care disparities. The ADA mandates that patients with disability receive reasonable accommodations. In our survey of 714 US physicians in outpatient practices, 35.8 percent reported knowing little or nothing about their legal responsibilities under the ADA, 71.2 percent answered incorrectly about who determines reasonable accommodations, 20.5 percent did not correctly identify who pays for these accommodations, and 68.4 felt that they were at risk for ADA lawsuits. Physicians who felt that lack of formal education or training was a moderate or large barrier to caring for patients with disability were more likely to report little or no knowledge of their responsibilities under the law and were more likely to believe that they were at risk for an ADA lawsuit. To achieve equitable care and social justice for patients with disability, considerable improvements are needed to educate physicians and make health care delivery systems more accessible and accommodating.
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Affiliation(s)
- Lisa I Iezzoni
- Lisa I. Iezzoni , Harvard Medical School and Massachusetts General Hospital, Boston, Massachusetts
| | - Sowmya R Rao
- Sowmya R. Rao, Massachusetts General Hospital and Boston University School of Public Health, Boston, Massachusetts
| | - Julie Ressalam
- Julie Ressalam, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | | | | | - Tara Lagu
- Tara Lagu, Northwestern Feinberg School of Medicine, Chicago, Illinois
| | - Elizabeth Pendo
- Elizabeth Pendo, Saint Louis University, St. Louis, Missouri
| | - Eric G Campbell
- Eric G. Campbell, University of Colorado Anschutz Medical Campus
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Prenatal Care Adequacy Among Women With Disabilities: A Population-Based Study. Am J Prev Med 2022; 62:39-49. [PMID: 34426058 PMCID: PMC9762461 DOI: 10.1016/j.amepre.2021.05.037] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 04/30/2021] [Accepted: 05/28/2021] [Indexed: 01/03/2023]
Abstract
INTRODUCTION This study examines prenatal care adequacy among women with physical, sensory, and intellectual/developmental disabilities, compared with that among women without disabilities. METHODS A population-based cohort study using linked health administrative data in Ontario, Canada was completed. The study population comprised women with physical (n=83,752), sensory (n=25,685), intellectual/developmental (n=1,219), and multiple (n=4,966) disabilities and women without disabilities (n=953,766), with a birth in 2003-2017. Analyses were conducted in 2020. Women with disabilities were identified using algorithms applied to healthcare encounters before conception. The main outcome was prenatal care adequacy, measured using the Revised Graduated Prenatal Care Utilization Index. Multivariable nominal logistic regression was used to compute the AORs and 95% CIs for no, inadequate, and intensive (versus adequate) care comparing each disability group with women without disabilities, adjusting for sociodemographic and health characteristics. RESULTS Women with physical disabilities, compared with those without disabilities, had increased odds of intensive prenatal care (AOR=1.22, 95% CI=1.19, 1.24) and decreased odds of no prenatal care (AOR=0.94, 95% CI=0.89, 0.99) versus adequate care. Women with sensory disabilities had increased odds of intensive (AOR=1.11, 95% CI=1.08, 1.14), inadequate (AOR=1.06, 95% CI=1.02, 1.09), and no (AOR=1.24, 95% CI=1.14, 1.35) prenatal care. Women with intellectual/developmental disabilities had increased odds of inadequate (AOR=1.25, 95% CI=1.08, 1.44) and no (AOR=1.64, 95% CI=1.16, 2.34) prenatal care. Women with multiple disabilities had increased odds of intensive (AOR=1.41, 95% CI=1.32, 1.51) and inadequate (AOR=1.14, 95% CI=1.05, 1.22) prenatal care. CONCLUSIONS There are variations in prenatal care adequacy by maternal disability status. Disparities in prenatal care access for women with disabilities, particularly those with intellectual/developmental disabilities, need to be addressed.
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Hughes RB, Beers L, Robinson-Whelen S. Health Information Seeking by Women with Physical Disabilities: A Qualitative Analysis. Disabil Health J 2022; 15:101268. [PMID: 35123921 PMCID: PMC8983536 DOI: 10.1016/j.dhjo.2022.101268] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 11/21/2021] [Accepted: 12/30/2021] [Indexed: 01/07/2023]
Abstract
BACKGROUND Health information seeking is critical to medical decision-making and optimal health. Although researchers have begun to explore how people with disabilities search for health information, no studies have investigated health information seeking by women with physical disabilities. OBJECTIVE The purpose of this qualitative study was to examine the health information seeking experiences of women with physical disabilities. METHOD We conducted a series of semi-structured, online focus group meetings with 21 women with disabilities. Sessions were recorded and transcribed, and data were analyzed using conventional content analysis. RESULTS Two broad themes emerged: 1) pathways to information on general health; sexual and reproductive health; as well as bowel, bladder, and other pelvic health issues; and 2) perceived facilitators and barriers to obtaining health information. Information pathways differed by the type of information sought. Internet was a commonly used resource, with a high value placed on social media interaction among peers. Self-advocacy emerged as a prominent facilitator of health information seeking. Barriers identified were lack of disability-related education, limited accessibility, and providers' negative attitudes. CONCLUSION This is the first known in-depth qualitative exploration of health information seeking by women with disabilities. Study findings revealed pathways to information commonly used by women with disabilities. The study also identified notable gaps and challenges to health information seeking including the need for improved provider education and training. Findings highlight the importance of the availability and accessibility of high quality, health-related information essential for the health and well-being of women with disabilities.
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Affiliation(s)
- Rosemary B Hughes
- University of Montana, Rural Institute for Inclusive Communities, Missoula, MT 59812, USA.
| | - Leanne Beers
- University of Montana, Rural Institute for Inclusive Communities, Missoula, MT 59812, USA
| | - Susan Robinson-Whelen
- Baylor College of Medicine, Department of Physical Medicine and Rehabilitation, Center for Research on Women with Disabilities, One Baylor Plaza, Houston, TX 77030, USA; TIRR Memorial Hermann, Spinal Cord Injury and Disability Research Center, 1333 Moursund St., Houston, TX 77030, USA
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Gleason JL, Grewal J, Chen Z, Cernich AN, Grantz KL. Risk of Adverse Maternal Outcomes in Pregnant Women With Disabilities. JAMA Netw Open 2021; 4:e2138414. [PMID: 34910153 PMCID: PMC8674748 DOI: 10.1001/jamanetworkopen.2021.38414] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
IMPORTANCE Women with disabilities have a higher risk of preterm birth, gestational diabetes, preeclampsia, and cesarean delivery; however, their risk of other obstetric interventions, adverse maternal outcomes, and clinical indications for increased cesarean delivery is unclear. OBJECTIVE To evaluate risk of a range of obstetric interventions and adverse maternal outcomes, including severe maternal morbidities (SMM) and mortality, among women with and without disabilities. DESIGN, SETTING, AND PARTICIPANTS The Consortium on Safe Labor was a retrospective cohort that included comprehensive medical chart review for deliveries between January 2002 and January 2008. Data were collected from 12 clinical sites, which included 19 hospitals across the United States. This secondary analysis was conducted in February to July 2021. EXPOSURES Using International Classification of Diseases, Ninth Revision, codes and a validated algorithm to define disability, participants were classified as having physical, intellectual, sensory, or any disability, and compared with women with no documented disability. MAIN OUTCOMES AND MEASURES The relative risk (RR) of 23 obstetric interventions and adverse maternal outcomes, including SMM and mortality, was evaluated. RESULTS Of the 223 385 women in the study, 9206 (4.1%) were Asian or Pacific Islander, 50 235 (22.5%) were Black, 39 039 (17.5%) were Hispanic, and 110 443 (49.4%) were White, with a mean (SD) age of 27.6 (6.2) years. There were 2074 (0.9%) women with disability and 221 311 (99.1%) without. Among women with disabilities, 1733 (83.5%) were physical, 91 (4.4%) were intellectual, and 250 (12.1%) were sensory. Compared with women with no disability, women with disabilities had higher risk of gestational diabetes, placenta previa, premature rupture of membranes, preterm premature rupture of membranes, and postpartum fever as well as maternal death (adjusted relative risk [aRR], 11.19; 95% CI, 2.40-52.19) and individual SMMs: severe preeclampsia/eclampsia (aRR, 2.15; 95% CI, 1.80-2.56), hemorrhage (aRR, 1.27; 95% CI, 1.09-1.49), and fever (aRR, 1.32; 95% CI, 1.03-1.67), with the highest risk observed for thromboembolism (aRR, 6.08; 95% CI, 4.03-9.16), cardiovascular events (aRR, 4.02; 95% CI, 2.87-5.63), and infection (aRR, 2.69; 95% CI, 1.97-3.67). Women with any disability also had higher risk of interventions, including oxytocin augmentation, operative vaginal delivery, and cesarean delivery (aRR, 1.33; 95% CI, 1.25-1.42), with the cesarean indication less likely to be medically indicated (aRR, 0.79; 95% CI, 0.70-0.89). Risk of adverse outcomes and interventions remained consistent across disability categories. CONCLUSIONS AND RELEVANCE In this study, women with physical, intellectual, and sensory disability during pregnancy were at higher risk of adverse outcomes, including a broad range of SMM and maternal mortality.
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Affiliation(s)
- Jessica L. Gleason
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
| | - Jagteshwar Grewal
- Office of the Director, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
| | - Zhen Chen
- Biostatistics and Bioinformatics Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
| | - Alison N. Cernich
- Office of the Director, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
| | - Katherine L. Grantz
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
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Deierlein AL, Antoniak K, Chan M, Sassano C, Stein CR. Pregnancy-related outcomes among women with physical disabilities: A systematic review. Paediatr Perinat Epidemiol 2021; 35:758-778. [PMID: 34431112 DOI: 10.1111/ppe.12781] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 04/21/2021] [Accepted: 05/02/2021] [Indexed: 01/26/2023]
Abstract
BACKGROUND Disability among women of reproductive age is common; many of these women desire children and do not have impaired fertility. OBJECTIVES To examine the epidemiological literature on perinatal health outcomes among women with physical disabilities. DATA SOURCES We searched Medline and CINAHL for articles published January 2009-April 2020 following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. STUDY SELECTION AND DATA EXTRACTION Eligible studies were observational, quantitative, and reported on physical disabilities in association with prenatal, perinatal, postpartum, and/or infant health outcomes. We included studies that grouped physical and non-physical disabilities, such as surveys that queried only about general daily life limitations. We excluded case reports, descriptive studies without comparison groups, and studies conducted in low- or middle-income countries. Data extraction was done using predefined data fields. SYNTHESIS All authors were involved in screening activities, data extraction, and/or quality assessment (rating and areas for bias). RESULTS A total of 2650 articles were evaluated, of which sixteen met inclusion criteria (8 cross-sectional studies and 8 retrospective cohort studies). Assessments of disability status and perinatal outcomes widely varied across studies. Studies were rated as poor (n = 8) or fair quality (n = 8). Findings suggested that women with physical disabilities were at risk of several adverse outcomes, including caesarean delivery, infections, preterm complications, and maternal post-delivery hospitalisations, while their infants may be at risk of low birthweight and small-for-gestational age. Women classified as having complex/severe disabilities were often observed to be at higher risk of adverse outcomes compared to women with less severe disabilities. CONCLUSIONS Research assessing how physical, functional, and medical restrictions influence health outcomes among women with physical disabilities, from preconception through postpartum, is limited. Longitudinal studies with comprehensive data collection that accurately identify women with physical disabilities are critical to understanding their reproductive health risks and outcomes.
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Affiliation(s)
| | | | - Melany Chan
- School of Global Public Health, New York University, New York, NY, USA
| | - Caprice Sassano
- School of Global Public Health, New York University, New York, NY, USA
| | - Cheryl R Stein
- Department of Child and Adolescent Psychiatry, Hassenfeld Children's Hospital at New York University, New York, NY, USA
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Iezzoni LI, Rao SR, Ressalam J, Bolcic-Jankovic D, Donelan K, Agaronnik N, Lagu T, Campbell EG. Use of Accessible Weight Scales and Examination Tables/Chairs for Patients with Significant Mobility Limitations by Physicians Nationwide. Jt Comm J Qual Patient Saf 2021; 47:615-626. [PMID: 34364797 PMCID: PMC8464497 DOI: 10.1016/j.jcjq.2021.06.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 06/14/2021] [Accepted: 06/15/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Mobility limitations are the most common disability type among the 61 million Americans with disability. Studies of patients with mobility limitations suggest that inaccessible medical diagnostic equipment poses significant barriers to care. METHODS The study team surveyed randomly selected US physicians nationwide representing seven specialties about their reported use of accessible weight scales and exam tables/chairs when caring for patients with mobility limitations. A descriptive analysis of responses was performed, and multivariable logistic regression was used to examine associations between accessible equipment and participants' characteristics. RESULTS The 714 participants (survey response rate = 61.0%) were primarily male, White, and urban, and had practiced for 20 or more years. Among those reporting routinely recording patients' weights (n = 399), only 22.6% (standard error [SE] = 2.2) reported always or usually using accessible weight scales for patients with significant mobility limitations. To determine weights of patients with mobility limitations, 8.1% always, 24.3% usually, and 40.0% sometimes asked patients. Physicians practicing ≥ 20 years were much less likely than other physicians to use accessible weight scales: odds ratio (OR) = 0.51 (95% confidence interval [CI] = 0.26-0.99). Among participants seeing patients with significant mobility limitations (n = 584), only 40.3% (SE = 2.2) always or usually used accessible exam tables or chairs. Specialists were much more likely than primary care physicians to use accessible exam tables/chairs: OR = 1.96 (95% CI = 1.29-2.99). CONCLUSION More than 30 years after enactment of the Americans with Disabilities Act, most physicians surveyed do not use accessible equipment for routine care of patients with chronic significant mobility limitations.
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Dommergues M, Candilis D, Becerra L, Thoueille E, Cohen D, Viaux-Savelon S. Childbirth and motherhood in women with motor disability due to a rare condition: an exploratory study. Orphanet J Rare Dis 2021; 16:176. [PMID: 33849607 PMCID: PMC8045243 DOI: 10.1186/s13023-021-01810-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 03/31/2021] [Indexed: 11/28/2022] Open
Abstract
Background Rare diseases may result in motor impairment, which in turn may affect parenthood. Our purpose was to evaluate perinatal outcomes, parenting needs, mother-infant interactions and infant development in a set of volunteer women with motor impairment due to a rare disease. In a parenting support institution, we recruited a consecutive series of 22 volunteer pregnant women or young mothers, recorded perinatal outcomes, and followed mother-infant interaction and relationship and infant development up to 14 months postpartum. Cases with intellectual or psychic disability were not included. Results There were 11 genetic diseases (2 Spinal Muscular Atrophy, 1 Charcot-Marie-Tooth, 1 autosomal dominants myopathy, 1 mitochondrial disease, 2 Elhers-Danlos, 1 Friedreich ataxia, 1 spinocerebellar ataxia, 1 tetrahydrobiopterine deficiency,1 Ectrodactyly), and 11 rare non-genetic conditions (2 spine tumors, 2 strokes, 1 juvenile chronic arthritis, 3 birth injuries, 1 inflammatory myopathy, 1 congenital amputation, and 1 traumatic amputation). These resulted in 10 impairments of four limbs, 4 impairments of both lower limbs, 7 unilateral impairments, and one distal tremor. Social deprivation Epices score, Cutrona social support scale, Edinburg Postnatal Depression scale, and Spielberger State/Trait Anxiety Inventory were unremarkable. Perinatal outcome: 4 gestational diabetes, 1 pre-eclampsia, 9 caesareans, 6 assisted and 7 spontaneous vaginal deliveries, 20 term live-births and 2 premature deliveries (35–36 weeks). Twelve women declared they were self-sufficient for daily activities; six declared they were self-sufficient to provide basic care to their baby. Distribution of the Brunet-Lezine child development score was normal. The parent-infant relationship global assessment scale (PIR-GAS) was well adapted in 2 cases, adapted in 8, perturbed in 7, significantly perturbed in 2, and distressed in 3 (mean 71.8; 95% CI 49.6–93.9). This was unrelated to any somatic or emotional characteristics of the participants. Coding interactive behavior revealed that infant engagement was lower and infant avoidance greater than in controls (p < 0.05). Conclusion Infant development was normal, but mother-infant interactions were altered in half of the participants independently from the degree of motor impairment, underscoring the need for parenting support, even for parents who are self-sufficient in daily activities.
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Affiliation(s)
- Marc Dommergues
- Department of Obstetrics and Gynecology, Hopital Pitié Salpêtrière APHP and Sorbonne Université, 83 Boulevard de l'Hopital, 75013, Paris, France.
| | | | - Ludivine Becerra
- Service d'Aide à la Parentalité des Personnes en Situation de Handicap, Paris, France
| | - Edith Thoueille
- Service d'Aide à la Parentalité des Personnes en Situation de Handicap, Paris, France
| | - David Cohen
- Child Psychiatry, Hopital Pitié Salpêtrière APHP and Sorbonne Université, Paris, France
| | - Sylvie Viaux-Savelon
- Child Psychiatry, Hopital Pitié Salpêtrière APHP and Sorbonne Université, Paris, France
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Iezzoni LI, Rao SR, Ressalam J, Bolcic-Jankovic D, Agaronnik ND, Donelan K, Lagu T, Campbell EG. Physicians' Perceptions Of People With Disability And Their Health Care. Health Aff (Millwood) 2021; 40:297-306. [PMID: 33523739 PMCID: PMC8722582 DOI: 10.1377/hlthaff.2020.01452] [Citation(s) in RCA: 213] [Impact Index Per Article: 71.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
More than sixty-one million Americans have disabilities, and increasing evidence documents that they experience health care disparities. Although many factors likely contribute to these disparities, one little-studied but potential cause involves physicians' perceptions of people with disability. In our survey of 714 practicing US physicians nationwide, 82.4 percent reported that people with significant disability have worse quality of life than nondisabled people. Only 40.7 percent of physicians were very confident about their ability to provide the same quality of care to patients with disability, just 56.5 percent strongly agreed that they welcomed patients with disability into their practices, and 18.1 percent strongly agreed that the health care system often treats these patients unfairly. More than thirty years after the Americans with Disabilities Act of 1990 was enacted, these findings about physicians' perceptions of this population raise questions about ensuring equitable care to people with disability. Potentially biased views among physicians could contribute to persistent health care disparities affecting people with disability.
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Affiliation(s)
- Lisa I Iezzoni
- Lisa I. Iezzoni is a professor of medicine at Harvard Medical School, based at the Health Policy Research Center, Mongan Institute, Massachusetts General Hospital, in Boston, Massachusetts
| | - Sowmya R Rao
- Sowmya R. Rao is a statistician in the Biostatistics Center at Massachusetts General Hospital and at the Boston University School of Public Health
| | - Julie Ressalam
- Julie Ressalam is a senior research coordinator in the Center for Bioethics and Humanities, Anschutz Medical Campus, University of Colorado, in Aurora, Colorado
| | - Dragana Bolcic-Jankovic
- Dragana Bolcic-Jankovic is the director of survey operations and a research fellow in the Center for Survey Research at the University of Massachusetts Boston, in Boston, Massachusetts
| | - Nicole D Agaronnik
- Nicole D. Agaronnik is a medical student at Harvard Medical School. When this work was performed, she was a research assistant in the Mongan Institute Health Policy Center, Massachusetts General Hospital
| | - Karen Donelan
- Karen Donelan is the Stuart H. Altman Chair in U.S. Health Policy at the Heller School for Social Policy and Management, Brandeis University, in Waltham, Massachusetts. At the time this work was performed, she was a senior scientist at the Health Policy Research Center at the Mongan Institute, Massachusetts General Hospital, and an associate professor in the Department of Medicine at Harvard Medical School
| | - Tara Lagu
- Tara Lagu is an associate professor in the Institute for Healthcare Delivery and Population Science and the Department of Medicine at Baystate Health and the University of Massachusetts Medical School, in Springfield, Massachusetts
| | - Eric G Campbell
- Eric G. Campbell is a professor and director of research in the Center for Bioethics and Humanities, Anschutz Medical Campus, University of Colorado
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Tarasoff LA, Murtaza F, Carty A, Salaeva D, Hamilton AD, Brown HK. Health of Newborns and Infants Born to Women With Disabilities: A Meta-analysis. Pediatrics 2020; 146:peds.2020-1635. [PMID: 33203648 PMCID: PMC7786829 DOI: 10.1542/peds.2020-1635] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/17/2020] [Indexed: 12/13/2022] Open
Abstract
CONTEXT Women with disabilities are at elevated risk for pregnancy, delivery, and postpartum complications. However, there has not been a synthesis of literature on the neonatal and infant health outcomes of their offspring. OBJECTIVE We examined the association between maternal disability and risk for adverse neonatal and infant health outcomes. DATA SOURCES Cumulative Index to Nursing and Allied Health Literature, Embase, Medline, and PsycINFO were searched from database inception to January 2020. STUDY SELECTION Studies were included if they reported original data on the association between maternal physical, sensory, or intellectual and/or developmental disabilities and neonatal or infant health outcomes; had a referent group of women with no disabilities; were peer-reviewed journal articles or theses; and were written in English. DATA EXTRACTION We used standardized instruments to extract data and assess study quality. DerSimonian and Laird random effects models were used for pooled analyses. RESULTS Thirty-one studies, representing 20 distinct cohorts, met our inclusion criteria. Meta-analyses revealed that newborns of women with physical, sensory, and intellectual and/or developmental disabilities were at elevated risk for low birth weight and preterm birth, with smaller numbers of studies revealing elevated risk for other adverse neonatal and infant outcomes. LIMITATIONS Most studies had moderate (n = 9) or weak quality (n = 17), with lack of control for confounding a common limitation. CONCLUSIONS In future work, researchers should explore the roles of tailored preconception and perinatal care, along with family-centered pediatric care particularly in the newborn period, in mitigating adverse outcomes among offspring of women with disabilities.
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Affiliation(s)
- Lesley A. Tarasoff
- Department of Health and Society and,Azrieli Adult Neurodevelopmental Centre, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; and
| | | | - Adele Carty
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Dinara Salaeva
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | | | - Hilary K. Brown
- Department of Health and Society and,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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D'Angelo DV, Cernich A, Harrison L, Kortsmit K, Thierry JM, Folger S, Warner L. Disability and Pregnancy: A Cross-Federal Agency Collaboration to Collect Population-Based Data About Experiences Around the Time of Pregnancy. J Womens Health (Larchmt) 2020; 29:291-296. [PMID: 32186964 DOI: 10.1089/jwh.2020.8309] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Many reproductive-aged women with a disability can achieve successful healthy pregnancies; however, they may face challenges accessing prenatal and postpartum care and finding providers who are knowledgeable about their specific condition. Depending on the nature of the disability, some women may also be at increased risk for adverse maternal and infant outcomes such as pre-eclampsia, infection, anemia, primary cesarean delivery, or preterm birth. Population-based data are needed to better understand the pregnancy and postpartum experiences of women living with disability. The National Institutes of Health and the Centers for Disease Control and Prevention (CDC) collaborated to address these data gaps by leveraging CDC's Pregnancy Risk Assessment Monitoring System (PRAMS) to gather information about disability among women who have had a recent live birth. Data collection began in 2019. Information gathered through PRAMS can be used to guide the development of clinical practices guidelines, intervention programs, and other initiatives of federal, state, and local agencies to improve services and the health of women of reproductive age living with disability.
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Affiliation(s)
- Denise V D'Angelo
- Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Atlanta, Georgia
| | - Alison Cernich
- National Institutes of Health, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland
| | - Leslie Harrison
- Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Atlanta, Georgia
| | - Katie Kortsmit
- Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Atlanta, Georgia.,Oak Ridge Institute for Science and Education Fellowship, Oak Ridge, Tennessee
| | - JoAnn M Thierry
- Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities, Atlanta, Georgia
| | - Suzanne Folger
- Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Atlanta, Georgia
| | - Lee Warner
- Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Atlanta, Georgia
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Panuccio F, Berardi A, Marquez MA, Messina MP, Valente D, Tofani M, Galeoto G. Development of the Pregnancy and Motherhood Evaluation Questionnaire (PMEQ) for evaluating and measuring the impact of physical disability on pregnancy and the management of motherhood: a pilot study. Disabil Rehabil 2020; 44:1474-1480. [PMID: 32748671 DOI: 10.1080/09638288.2020.1802520] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE The aim of this study was to develop a questionnaire that allows researchers to investigate and measure the impact of physical disability on pregnancy and the management of motherhood. Such a questionnaire requires good internal consistency. METHODS The tool was developed following a study conducted in 2013 in the United States consisting of a semi-structured interview with open-ended questions. A team of three experts drafted and refined the questions, generating 31 retrospective, self-rated, and predefined questions (answered using a 5-point Likert scale). A statistical analysis of the instrument was also included, to assess its reliability and internal consistency. RESULTS The Pregnancy and Motherhood Evaluation Questionnaire (PMEQ) was prepared. It is a self-administered questionnaire consisting of an initial section and three subscales. In this phase of the study, 35 women with different pathologies leading to physical disability were recruited and completed the questionnaire. The PMEQ was found to have a good internal consistency. Cronbach's α was 0.812 (p > 0.05). CONCLUSION The PMEQ has proven to be a valid, reliable, and rapid administrative tool useful for investigating and measuring the impact of physical disability on the management of pregnancy and motherhood.IMPLICATION FOR REHABILITATIONThis study provides researchers and clinicians a new tool for the evaluation of motherhood and pregnancy in women with physical disabilities.The PMEQ has proven to be a valid, reliable, and rapid administrative tool (10 min) useful for investigating and measuring the impact of physical disability on the management of pregnancy and motherhood.It is a new tool useful in both clinical and research practice to underline the importance of carrying out preventive and woman-centered assistance interventions.This tool is useful for promoting the autonomous management of pregnancy and motherhood in women with physical disabilities, and improving these women's quality of life and sense of satisfaction and competence in managing maternal tasks.
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Affiliation(s)
| | - Anna Berardi
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | | | - Marisa Patrizia Messina
- Department of Gynecological-Obstetric Sciences and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - Donatella Valente
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy.,IRCSS Neuromed, Pozzilli, Italy
| | - Marco Tofani
- Neurorehabilitation Unit, Department of Neurosciences and Neurorehabilitation, Bambino Gesù Children's Hospital, IRCSS, Rome, Italy
| | - Giovanni Galeoto
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
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Thomaz EBAF, Costa EM, Goiabeira YNLDA, Rocha TAH, Rocha NCS, Marques MCDO, Queiroz RCDS. Accessibility to people with motor, visual, or hearing disabilities during delivery and childbirth: the structure of SUS facilities linked to Rede Cegonha. CIENCIA & SAUDE COLETIVA 2020; 26:897-908. [PMID: 33729345 DOI: 10.1590/1413-81232021263.17582020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 07/03/2020] [Indexed: 11/22/2022] Open
Abstract
There are no nationwide studies characterizing accessibility for people with disabilities during delivery. This study aimed to describe the physical structure of hospital units regarding accessibility for pregnant and puerperae with motor (MD), visual (VD), or hearing (HD) disabilities in Brazil. This is an ecological, descriptive study conducted in all 606 health facilities linked to the "Rede Cegonha" where deliveries occurred, according to 2015 databases. We performed the descriptive and geospatial analysis and considered the presence of motor accessibility when the establishment had a handrail or elevator ramp, wheelchair-sized doors, and accessible bathroom with bars. We assumed visual accessibility when there was tactile signage on the floor (Braille system or embossed figures) and hearing accessibility when there was signage by texts, pictures, signs, posters, or symbols in the environments. In Brazil, only 26 (4.3%) of the facilities had accessibility for people with MD, 20 (3.3%) for people with VD, and none for HD. Motor accessibility was worse in the North and Northeast of Brazil, and hearing accessibility in the North region. Despite advances in the implementation of the "Rede Cegonha" in Brazil, the facilities' structure is not adapted for women with MD, VD, or HD.
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Affiliation(s)
| | - Elisa Miranda Costa
- Departamento de Saúde Pública, Universidade Federal do Maranhão. R. Barão de Itapary 155, Centro. São Luís MA Brasil.
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Agaronnik ND, Lagu T, DeJong C, Perez-Caraballo A, Reimold K, Ressalam J, Iezzoni LI. Accommodating patients with obesity and mobility difficulties: Observations from physicians. Disabil Health J 2020; 14:100951. [PMID: 32723692 DOI: 10.1016/j.dhjo.2020.100951] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 05/29/2020] [Accepted: 06/01/2020] [Indexed: 11/13/2022]
Abstract
BACKGROUND Given the growing population of U.S. adults with obesity and mobility disability, physicians will need to accommodate these patients. OBJECTIVE To explore attitudes and practices of US physicians related to caring for patients with obesity and mobility disability. METHODS Three open-ended, semi-structured, web-based focus group interviews with practicing physicians in selected specialties, which reached data saturation. Interviews were video recorded and transcribed for qualitative, conventional content analysis. Measurements included commonly expressed themes around caring for patients with obesity. RESULTS Physicians recognized obesity as a disability that poses challenges to high quality, safe, and efficient patient care. Observations coalesced around four themes: (1) difficulty routinely tracking weight; (2) reluctance to transfer obese patients to exam tables; (3) barriers to diagnostic testing; and (4) weight stigma. Physicians described difficulties accurately assessing weight, performing complete physical examinations, arranging diagnostic imaging, and providing prenatal care for obese patients. Lack of accessible medical diagnostic equipment impeded care for patients with obesity. Other participants did not contest comments of individual participants' that suggested weight stigma. CONCLUSIONS Our findings suggest that important gaps may remain in providing equitable access to care for patients with obesity, requiring additional training and accessible medical diagnostic equipment to safely accommodate these patients.
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Affiliation(s)
- Nicole D Agaronnik
- Health Policy Research Center, Mongan Institute, Massachusetts General Hospital, United States
| | - Tara Lagu
- Institute for Healthcare Delivery and Population Science and Department of Medicine, Baystate Health, Springfield, MA, United States; University of Massachusetts Medical School, United States
| | - Christene DeJong
- Institute for Healthcare Delivery and Population Science and Department of Medicine, Baystate Health, Springfield, MA, United States
| | - Aixa Perez-Caraballo
- Institute for Healthcare Delivery and Population Science and Department of Medicine, Baystate Health, Springfield, MA, United States
| | | | - Julie Ressalam
- Center for Bioethics and Humanities, University of Colorado School of Medicine, United States
| | - Lisa I Iezzoni
- Health Policy Research Center, Mongan Institute, Massachusetts General Hospital, United States; Department of Medicine, Harvard Medical School, United States.
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Casebolt MT. Barriers to reproductive health services for women with disability in low- and middle-income countries: A review of the literature. SEXUAL & REPRODUCTIVE HEALTHCARE 2020; 24:100485. [DOI: 10.1016/j.srhc.2020.100485] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Revised: 12/28/2019] [Accepted: 01/07/2020] [Indexed: 12/18/2022]
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Akobirshoev I, Mitra M, Parish SL, Valentine A, Simas TAM. Racial and Ethnic Disparities in Birth Outcomes and Labor and Delivery Charges Among Massachusetts Women With Intellectual and Developmental Disabilities. INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2020; 58:126-138. [PMID: 32240049 DOI: 10.1352/1934-9556-58.2.126] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Understanding the pregnancy experiences of racial and ethnic minority women with intellectual and developmental disabilities (IDD) is critical to ensuring that policies can effectively support these women. This research analyzed data from the 1998-2013 Massachusetts Pregnancy to Early Life Longitudinal (PELL) data system to examine the racial and ethnic disparities in birth outcomes and labor and delivery charges of U.S. women with IDD. There was significant preterm birth disparity among non-Hispanic Black women with IDD compared to their non-Hispanic White peers. There were also significant racial and ethnic differences in associated labor and delivery-related charges. Further research, examining potential mechanisms behind the observed racial and ethnic differences in labor and delivery-related charges in Massachusetts' women with IDD is needed.
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Affiliation(s)
- Ilhom Akobirshoev
- Ilhom Akobirshoev and Monika Mitra, Brandeis University; Susan L. Parish, Virginia Commonwealth University; Anne Valentine, Brandeis University; and Tiffany A. Moore Simas, University of Massachusetts Medical School
| | - Monika Mitra
- Ilhom Akobirshoev and Monika Mitra, Brandeis University; Susan L. Parish, Virginia Commonwealth University; Anne Valentine, Brandeis University; and Tiffany A. Moore Simas, University of Massachusetts Medical School
| | - Susan L Parish
- Ilhom Akobirshoev and Monika Mitra, Brandeis University; Susan L. Parish, Virginia Commonwealth University; Anne Valentine, Brandeis University; and Tiffany A. Moore Simas, University of Massachusetts Medical School
| | - Anne Valentine
- Ilhom Akobirshoev and Monika Mitra, Brandeis University; Susan L. Parish, Virginia Commonwealth University; Anne Valentine, Brandeis University; and Tiffany A. Moore Simas, University of Massachusetts Medical School
| | - Tiffany A Moore Simas
- Ilhom Akobirshoev and Monika Mitra, Brandeis University; Susan L. Parish, Virginia Commonwealth University; Anne Valentine, Brandeis University; and Tiffany A. Moore Simas, University of Massachusetts Medical School
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Streur CS, Schafer CL, Garcia VP, Quint EH, Sandberg DE, Kalpakjian CZ, Wittmann DA. "He told me it would be extremely selfish of me to even consider [having kids]": The importance of reproductive health to women with spina bifida and the lack of support from their providers. Disabil Health J 2020; 13:100815. [PMID: 31239106 PMCID: PMC6911648 DOI: 10.1016/j.dhjo.2019.06.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 05/23/2019] [Accepted: 06/04/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND As more women with spina bifida (SB) enter their reproductive years, the number having children is significantly increasing. However, little is known about their understanding of their ability to get pregnant or their experiences in considering, planning, or interacting with providers during a pregnancy. OBJECTIVE We sought to determine what women have been told and understand about their reproductive health, their attitudes towards having children, and their experiences interacting with providers when seeking reproductive health care. METHODS In this exploratory study employing qualitative research methods and following Grounded Theory, interviews with women with SB 16 years or older were transcribed verbatim and analyzed by three coders. RESULTS Interviews of 25 women with SB ages 16-52 (median 26) revealed the following themes about their reproductive health perceptions and experiences: 1) poor understanding of reproductive health and potential, 2) interest in having a family, 3) facing provider's opposition to their reproductive goals, 4) going into pregnancy and delivery unprepared, 5) the importance of provider support for reproductive goals. Five women experienced an unintended pregnancy. CONCLUSIONS Although having children is important to most women with SB in this study, they report a poor understanding of their reproductive potential with several noting unintended pregnancies. They feel uninformed and unprepared during pregnancy and face discouragement from providers. Those experiencing supportive providers report a more positive experience. This demonstrates the urgent need to educate women with SB about their reproductive health and the providers who care for them how to support and counsel these women.
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Affiliation(s)
| | | | | | - Elisabeth H Quint
- Department of Obstetrics and Gynecology, University of Michigan, United States
| | - David E Sandberg
- Department of Pediatrics and Communicable Diseases, University of Michigan, United States
| | - Claire Z Kalpakjian
- Department of Physical Medicine and Rehabilitation, University of Michigan, United States
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Horner-Johnson W, Dissanayake M, Wu JP, Caughey AB, Darney BG. Pregnancy Intendedness by Maternal Disability Status and Type in the United States. PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH 2020; 52:31-38. [PMID: 32096336 DOI: 10.1363/psrh.12130] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 07/20/2019] [Accepted: 09/24/2019] [Indexed: 05/07/2023]
Abstract
CONTEXT Societal views about sexuality and parenting among people with disabilities may limit these individuals' access to sex education and the full range of reproductive health services, and put them at increased risk for -unintended pregnancies. To date, however, no national population-based studies have examined pregnancy -intendedness among U.S. women with disabilities. METHODS Cross-sectional analyses of data from the 2011-2013 and 2013-2015 waves of the National Survey of Family Growth were conducted; the sample included 5,861 pregnancies reported by 3,089 women. The proportion of pregnancies described as unintended was calculated for women with any type of disability, women with each of five types of disabilities and women with no disabilities. Multivariate logistic regression analyses were conducted to examine the relationship of disability status and type with pregnancy intendedness while adjusting for covariates. RESULTS A higher proportion of pregnancies were unintended among women with disabilities than among women without disabilities (53% vs. 36%). Women with independent living disability had the highest proportion of unintended pregnancies (62%). In regression analyses, the odds that a pregnancy was unintended were greater among women with any type of disability than among women without disabilities (odds ratio, 1.4), and were also elevated among women with hearing disability, cognitive disability or independent living disability (1.5-1.9). CONCLUSIONS Further research is needed to understand differences in unintended pregnancy by type and extent of disability. People with disabilities should be fully included in sex education, and their routine care should incorporate discussion of reproductive planning.
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Affiliation(s)
- Willi Horner-Johnson
- Institute on Development and Disability, Oregon Health & Science University, Portland
| | - Mekhala Dissanayake
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland
| | - Justine P Wu
- Department of Family Medicine, University of Michigan Medical School, Ann Arbor
| | - Aaron B Caughey
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland
| | - Blair G Darney
- Department of Obstetrics and Gynecology-all at the Oregon Health & Science University, Portland
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Dissanayake MV, Darney BG, Caughey AB, Horner-Johnson W. Miscarriage Occurrence and Prevention Efforts by Disability Status and Type in the United States. J Womens Health (Larchmt) 2019; 29:345-352. [PMID: 31750752 DOI: 10.1089/jwh.2019.7880] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Very little is known about early pregnancy loss in women with disabilities. To address this gap, we analyzed nationally representative data on miscarriage and receipt of care focused on miscarriage prevention among women with and without disabilities. Materials and Methods: We used 2011-2015 National Survey of Family Growth data on women with at least one completed pregnancy within the past 5 years. Bivariate and multivariate analyses assessed the association of six disability categories (any, hearing, vision, cognitive, physical, independent living) with miscarriage occurrence and receipt of services intended to prevent miscarriage. Results: Our analytic sample included 3,843 women with 5,776 completed pregnancies within the past 5 years. Overall, 31.63% of women with disabilities and 21.83% of women without disabilities had had a miscarriage within the past 5 years. Compared to women without disabilities, women with any, cognitive, physical, and independent living disability had higher adjusted odds of experiencing miscarriage (any disability aOR = 1.65 [95% CI: 1.21-2.25]). These women also had higher odds of receiving services to prevent miscarriage compared with women without disabilities (any disability aOR = 1.71 [95% CI: 1.20-2.45]). Among women who received services, higher proportions of women with any, vision, physical, or independent living disability received recommendations for bed rest (e.g., 65.007% of women with independent living disability vs. 33.98% of women without disability, p = 0.018). Conclusions: In a representative sample of U.S. women, we found significant differences in the odds of miscarriage and in receipt of care to prevent miscarriage between women with and without disabilities. Further research is needed to understand why women with disabilities are more likely to experience a miscarriage. Such research is important for informing care recommendations.
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Affiliation(s)
- Mekhala V Dissanayake
- Department of Obstetrics & Gynecology, Oregon Health & Science University, Portland, Oregon
| | - Blair G Darney
- Department of Obstetrics & Gynecology, Oregon Health & Science University, Portland, Oregon.,School of Public Health, Oregon Health & Science University/Portland State University, Portland, Oregon.,National Institute of Public Health (INSP), Center for Population Health Research (CISP), Cuernavaca, Mexico
| | - Aaron B Caughey
- Department of Obstetrics & Gynecology, Oregon Health & Science University, Portland, Oregon
| | - Willi Horner-Johnson
- School of Public Health, Oregon Health & Science University/Portland State University, Portland, Oregon.,Institute on Development and Disability, Oregon Health & Health University, Portland, Oregon
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Sonalkar S, Chavez V, McClusky J, Hunter TA, Mollen CJ. Gynecologic Care for Women With Physical Disabilities: A Qualitative Study of Patients and Providers. Womens Health Issues 2019; 30:136-141. [PMID: 31722816 PMCID: PMC10093685 DOI: 10.1016/j.whi.2019.10.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 09/08/2019] [Accepted: 10/07/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND Women with physical disabilities have unmet gynecologic care needs, including disparities in cancer screening and contraceptive care, when compared with women without physical disabilities. Our objective was to qualitatively assess provider and patient perspectives regarding barriers to gynecologic health care for women with physical disabilities. METHODS We used purposive sampling to recruit women with physical disabilities and gynecology providers who had experience caring for this population at two university hospitals. Patient and provider participants completed in-depth, semistructured interviews investigating their experiences with and barriers to receiving or providing gynecologic care. Transcripts were systematically analyzed by reviewing assigned codes and performing thematic analysis. We planned a sample size of at least 20 patient and provider participants to allow for saturation of thematic content. RESULTS We interviewed 29 women with physical disabilities and 20 providers. Important themes for providers and patients centered around adequate time spent during appointments, challenges with the gynecologic examination, inadequate facilities, clinical space limitations, and lack of formal provider and staff training in caring for this population. CONCLUSIONS Providers were motivated to provide quality care for women with disabilities, but encountered systems and training barriers. Patients and providers had concordant impressions of barriers that influenced equitable and patient-centered care, with structural barriers, including a lack of accessible space, closely related to perceptions of health care inequity between women with and without physical disabilities.
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Affiliation(s)
- Sarita Sonalkar
- Department of Obstetrics and Gynecology, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania; Department of Obstetrics and Gynecology, Boston Medical Center, Boston, Massachusetts.
| | - Veronica Chavez
- Department of Obstetrics and Gynecology, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania; Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania
| | - Jessica McClusky
- Department of Obstetrics and Gynecology, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania; Department of Obstetrics and Gynecology, Boston Medical Center, Boston, Massachusetts; University of Pennsylvania, School of Nursing, Philadelphia, Pennsylvania
| | - Tegan A Hunter
- Division of Emergency Medicine, University of Miami Miller School of Medicine, Miami, Florida
| | - Cynthia J Mollen
- The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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Peterson-Besse JJ, Knoll JE, Horner-Johnson W. Internet networks as a source of social support for women with mobility disabilities during pregnancy. Disabil Health J 2019; 12:722-726. [DOI: 10.1016/j.dhjo.2019.04.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 04/12/2019] [Accepted: 04/24/2019] [Indexed: 11/25/2022]
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Powell RM, Mitra M, Smeltzer SC, Long-Bellil LM, Smith LD, Rosenthal E, Iezzoni LI. Adaptive parenting strategies used by mothers with physical disabilities caring for infants and toddlers. HEALTH & SOCIAL CARE IN THE COMMUNITY 2019; 27:889-898. [PMID: 30556199 DOI: 10.1111/hsc.12706] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 11/19/2018] [Accepted: 11/21/2018] [Indexed: 06/09/2023]
Abstract
There is a paucity of information concerning adaptive parenting strategies utilised by mothers with physical disabilities, particularly during early motherhood. The purpose of this study is to describe the adaptive strategies used by mothers with physical disabilities during early motherhood. This qualitative study included semi-structured telephone interviews between January and March 2014 with US mothers with a range of physical disabilities who had a baby within the past 10 years (N = 25). Interviews were audio-recorded, professionally transcribed, and coded using content analysis. Analysis revealed five broad themes indicating important adaptive parenting strategies for mothers with physical disabilities caring for infants and toddlers: They are as follows: (a) acquiring or modifying baby-care equipment, (b) adapting the home environment, (c) accessing information and supports, (d) developing communication strategies to facilitate safety, and (e) receiving assistance from others. This study indicates that mothers with physical disabilities employ a variety of adaptive strategies during early motherhood. The findings from the study suggest the need for more availability of supports and equipment for mothers with physical disabilities as well as information for prospective mothers with disabilities. In addition, healthcare and social work professionals must receive training about adaptive parenting strategies.
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Affiliation(s)
- Robyn M Powell
- The Lurie Institute for Disability Policy, The Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts
| | - Monika Mitra
- The Lurie Institute for Disability Policy, The Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts
| | - Suzanne C Smeltzer
- Center for Nursing Research, Villanova University, Villanova, Pennsylvania
| | - Linda M Long-Bellil
- Center for Health Policy and Research, University of Massachusetts Medical School, Shrewsbury, Massachusetts
| | - Lauren D Smith
- The Lurie Institute for Disability Policy, The Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts
| | - Eliana Rosenthal
- Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts
| | - Lisa I Iezzoni
- Mongan Institute for Health Policy, Massachusetts General Hospital, Boston, Massachusetts
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Akobirshoev I, Mitra M, Parish SL, Moore Simas TA, Dembo R, Ncube CN. Racial and ethnic disparities in birth outcomes and labour and delivery-related charges among women with intellectual and developmental disabilities. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2019; 63:313-326. [PMID: 30576027 PMCID: PMC7271252 DOI: 10.1111/jir.12577] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 10/12/2018] [Accepted: 11/16/2018] [Indexed: 06/02/2023]
Abstract
BACKGROUND Women with intellectual and developmental disabilities (IDD) in the USA are bearing children at increasing rates. However, very little is known whether racial and ethnic disparities in birth outcomes and labour and delivery-related charges exist in this population. This study investigated racial and ethnic disparities in birth outcomes and labour and delivery-related charges among women with IDD. METHODS The study employed secondary analysis of the 2004-2011 Healthcare Cost and Utilization Project National Inpatient Sample, the largest all-payer, publicly available US inpatient healthcare database. Hierarchical mixed-effect logistic and linear regression models were used to compare the study outcomes. RESULTS We identified 2110 delivery-associated hospitalisations among women with IDD including 1275 among non-Hispanic White women, 527 among non-Hispanic Black women and 308 among Hispanic women. We found significant disparities in stillbirth among non-Hispanic Black and Hispanic women with IDD compared with their non-Hispanic White peers [odds ratio = 2.50, 95% confidence interval (CI): 1.16-5.28, P < 0.01 and odds ratio = 2.53, 95% CI: 1.08-5.92, P < 0.01, respectively]. There were no racial and ethnic disparities in caesarean delivery, preterm birth and small-for-gestational-age neonates among women with IDD. The average labour and delivery-related charges for non-Hispanic Black and Hispanic Women with IDD ($18 889 and $22 481, respectively) exceeded those for non-Hispanic White women with IDD ($14 886) by $4003 and $7595 or by 27% and 51%, respectively. The significant racial and ethnic differences in charges persisted even after controlling for a range of individual-level and institutional-level characteristics and were 6% (ln(β) = 0.06, 95% CI: 0.01-0.11, P < 0.05) and 9% (ln(β) = 0.09, 95% CI: 0.03-0.14, P < 0.01) higher for non-Hispanic Black and Hispanic Women with IDD compared with non-Hispanic White women with IDD. CONCLUSIONS Our findings highlight the need for an integrated approach to the delivery of comprehensive perinatal services for racial and ethnic minority women with IDD to reduce their risk of having a stillbirth. Additionally, further research is needed to examine the causes of racial and ethnic disparities in hospital charges for labour and delivery admission among women with IDD and ascertain whether price discrimination exists based on patients' racial or ethnic identities.
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Affiliation(s)
- I Akobirshoev
- Lurie Institute for Disability Policy, Heller School for Social Policy and Management, Brandeis University, Waltham, MA, USA
| | - M Mitra
- Lurie Institute for Disability Policy, Heller School for Social Policy and Management, Brandeis University, Waltham, MA, USA
| | - S L Parish
- Bouvé College of Health Science, Northeastern University, Boston, MA, USA
| | - T A Moore Simas
- Departments of Obstetrics & Gynecology, Pediatrics, Psychiatry and Quantitative Health Sciences, University of Massachusetts Medical School/UMass Memorial Health Care, Worcester, MA, USA
| | - R Dembo
- Lurie Institute for Disability Policy, Heller School for Social Policy and Management, Brandeis University, Waltham, MA, USA
| | - C N Ncube
- Bouvé College of Health Science, Northeastern University, Boston, MA, USA
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Horner-Johnson W. Shining a Light on Reproductive Health Care Needs of Women with Disabilities. J Womens Health (Larchmt) 2019; 28:888-889. [PMID: 30864879 DOI: 10.1089/jwh.2018.7629] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Willi Horner-Johnson
- Institute on Development and Disability, Oregon Health & Science University, Portland, Oregon
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Differences in Prenatal Care by Presence and Type of Maternal Disability. Am J Prev Med 2019; 56:376-382. [PMID: 30777157 PMCID: PMC6402767 DOI: 10.1016/j.amepre.2018.10.021] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 10/09/2018] [Accepted: 10/10/2018] [Indexed: 01/24/2023]
Abstract
INTRODUCTION Prior studies have found that women with disabilities are less likely to receive adequate prenatal care than women without disabilities. However, little is known about differences in patterns of prenatal care by type of disability. Therefore, this study examined timing and frequency of prenatal care among women with physical, sensory, or intellectual/developmental disabilities compared with women without disabilities. METHODS This was a retrospective cohort study using linked maternal and infant hospital discharge and birth certificate data for all births in California in 2000-2012 (N=6,745,201). Analyses were conducted in 2017-2018. Modified Poisson regression analyses compared women with each type of disability with women without disabilities on trimester of prenatal care initiation and number of prenatal care visits. RESULTS Women with intellectual/developmental disabilities or with limited hearing had significantly higher RR of delaying prenatal care initiation until the second or third trimester (intellectual/developmental disabilities: adjusted RR=1.21, 95% CI=1.09, 1.33; hearing: adjusted RR=1.11, 95% CI=1.02, 1.21), whereas women with physical disabilities and limited vision had lower risk of delaying care (physical: adjusted RR=0.91, 95% CI=0.88, 0.94; vision: adjusted RR=0.85, 95% CI=0.73, 0.99). Women with limited hearing or vision or intellectual/developmental disabilities had higher risk of receiving fewer prenatal visits than recommended, compared with women without disabilities. Women with physical disabilities or intellectual/developmental disabilities had higher RR of receiving more than the typical number of visits. CONCLUSIONS There were key differences in prenatal care utilization by disability type, reflective of particularly pronounced disparities for women with intellectual/developmental disabilities and women with limited hearing. Delays in receipt of prenatal care and low numbers of prenatal care visits may contribute to the poorer birth outcomes that have been observed previously in these groups. Targeted interventions are needed to improve uptake of prenatal care in these vulnerable populations.
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Mazurkiewicz B, Stefaniak M, Dmoch-Gajzlerska E. Perinatal care needs and expectations of women with low vision or total blindness in Warsaw, Poland. Disabil Health J 2018; 11:618-623. [DOI: 10.1016/j.dhjo.2018.05.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 05/15/2018] [Accepted: 05/31/2018] [Indexed: 12/01/2022]
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