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Faulks F, Shafiei T, Mogren I, Edvardsson K. "It's just too far…": A qualitative exploration of the barriers and enablers to accessing perinatal care for rural Australian women. Women Birth 2024; 37:101809. [PMID: 39260077 DOI: 10.1016/j.wombi.2024.101809] [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: 03/02/2024] [Revised: 08/15/2024] [Accepted: 08/25/2024] [Indexed: 09/13/2024]
Abstract
PURPOSE Rural women and their babies experience poorer perinatal outcomes than their urban counterparts and this inequity has existed for decades. This study explored the barriers and enablers that exist for rural women in Australia in accessing perinatal care. METHODS A qualitative descriptive design, using reflexive thematic analysis, was employed. Semi-structured interviews were conducted in 2023 with women who had recently given birth in rural Victoria, Australia (n=19). A purposive sampling strategy was used, recruiting women via social media platforms from rural communities across the state. The Socioecological Model (SEM) was used as a framework to organise the findings. RESULTS Study participants reported multilevel barriers and enablers to accessing perinatal care in their own communities. Intrapersonal factors included financial resources, transportation, self-advocacy, health literacy, rural stoicism, personal agency, and cost of care. Interpersonal factors included factors such as ineffective relationships, poor communication, and care provider accessibility. Organisational factors included inequitable distribution of services, under-resourcing of perinatal services in rural areas, technology-enabled care models and access to continuity of care. Community factors included effective or ineffective interprofessional or interorganisational collaboration. Policy factors included centralisation of perinatal care, lack of funded homebirth and midwifery care pathways and access to free perinatal care. CONCLUSION Participants in this study articulated several key barriers influencing access to perinatal care in rural areas. These factors impede help-seeking behaviour and engagement with care providers, compounding the impact of rurality and isolation on perinatal outcomes and experience of care. Key enablers to accessing perinatal care in rural communities were also identified and included personal agency, health literacy, social capital, effective collaboration and communication between clinicians and services, technology enabled care and free perinatal care.
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Affiliation(s)
- Fiona Faulks
- Judith Lumley Centre, School of Nursing & Midwifery, La Trobe University, Bundoora, VIC, Australia.
| | - Touran Shafiei
- Judith Lumley Centre, School of Nursing & Midwifery, La Trobe University, Bundoora, VIC, Australia.
| | - Ingrid Mogren
- Department of Clinical Sciences, Obstetrics and Gynaecology, Umeå University, Umeå SE-90187, Sweden.
| | - Kristina Edvardsson
- Judith Lumley Centre, School of Nursing & Midwifery, La Trobe University, Bundoora, VIC, Australia.
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Jiang H, Wang Y, Cheng Y, Zhang M, Feng L, Wang S. Transport accessibility and hospital attributes: A nonlinear analysis of their impact on Women's prenatal care seeking behavior. Health Place 2024; 87:103250. [PMID: 38696875 DOI: 10.1016/j.healthplace.2024.103250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 04/06/2024] [Accepted: 04/14/2024] [Indexed: 05/04/2024]
Abstract
Ensuring women receive vital prenatal care is crucial for maternal and newborn health. Limited research explores factors influencing prenatal care-seeking from a geospatial perspective. This study, based on a substantial Wuhan dataset (23,947 samples), investigates factors influencing prenatal care-seeking, focusing on transport accessibility and hospital attributes. Findings indicate a nuanced relationship: (1) A non-linear trend, resembling an inverted "U," reveals the complex interplay between transport accessibility, hospital attributes, and prenatal care visits. Hospital attributes have a more pronounced impact than transport accessibility. (2) Interaction analysis underscores that lower prenatal care visits relate to low-income and education levels, despite reasonable public transport accessibility. (3) Spatial disparities are significant, with suburban areas facing increased obstacles compared to urban areas, particularly for those in suburban rural areas. This study enhances understanding by emphasizing threshold effects and spatial heterogeneity, offering valuable perspectives for refining prenatal care policies and practices.
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Affiliation(s)
- Huaxiong Jiang
- Faculty of Geographical Science, Beijing Normal University, 100875, Beijing, China.
| | - Yuxiao Wang
- Faculty of Geographical Science, Beijing Normal University, 100875, Beijing, China.
| | - Yang Cheng
- Faculty of Geographical Science, Beijing Normal University, 100875, Beijing, China.
| | - Mengmeng Zhang
- Faculty of Geographical Science, Beijing Normal University, 100875, Beijing, China.
| | - Ling Feng
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
| | - Shaoshuai Wang
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
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Bernier E, Plante AS, Lemieux P, Robitaille J, Lemieux S, Desroches S, Bélanger-Gravel A, Maheux-Lacroix S, Weisnagel SJ, Demers S, Camirand Lemyre F, Boulet M, Baillargeon JP, Morisset AS. Promoting healthy eating in early pregnancy in individuals at risk of gestational diabetes mellitus: does it improve glucose homeostasis? A study protocol for a randomized control trial. Front Nutr 2024; 10:1336509. [PMID: 38312142 PMCID: PMC10834641 DOI: 10.3389/fnut.2023.1336509] [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: 11/10/2023] [Accepted: 12/26/2023] [Indexed: 02/06/2024] Open
Abstract
Background Healthy eating during pregnancy has favorable effects on glycemic control and is associated with a lower risk of gestational diabetes mellitus (GDM). According to Diabetes Canada, there is a need for an effective and acceptable intervention that could improve glucose homeostasis and support pregnant individuals at risk for GDM. Aims This unicentric randomized controlled trial (RCT) aims to evaluate the effects of a nutritional intervention initiated early in pregnancy, on glucose homeostasis in 150 pregnant individuals at risk for GDM, compared to usual care. Methods Population: 150 pregnant individuals ≥18 years old, at ≤14 weeks of pregnancy, and presenting ≥1 risk factor for GDM according to Diabetes Canada guidelines. Intervention: The nutritional intervention initiated in the first trimester is based on the health behavior change theory during pregnancy and on Canada's Food Guide recommendations. It includes (1) four individual counseling sessions with a registered dietitian using motivational interviewing (12, 18, 24, and 30 weeks), with post-interview phone call follow-ups, aiming to develop and achieve S.M.A.R.T. nutritional objectives (specific, measurable, attainable, relevant, and time-bound); (2) 10 informative video clips on healthy eating during pregnancy developed by our team and based on national guidelines, and (3) a virtual support community via a Facebook group. Control: Usual prenatal care. Protocol: This RCT includes three on-site visits (10-14, 24-26, and 34-36 weeks) during which a 2-h oral glucose tolerance test is done and blood samples are taken. At each trimester and 3 months postpartum, participants complete web-based questionnaires, including three validated 24-h dietary recalls to assess their diet quality using the Healthy Eating Food Index 2019. Primary outcome: Difference in the change in fasting blood glucose (from the first to the third trimester) between groups. This study has been approved by the Ethics Committee of the Centre de recherche du CHU de Québec-Université Laval. Discussion This RCT will determine whether a nutritional intervention initiated early in pregnancy can improve glucose homeostasis in individuals at risk for GDM and inform Canadian stakeholders on improving care trajectories and policies for pregnant individuals at risk for GDM. Clinical trial registration https://clinicaltrials.gov/study/NCT05299502, NCT05299502.
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Affiliation(s)
- Emilie Bernier
- École de Nutrition, Université Laval, Québec, QC, Canada
- Centre de Recherche du CHU de Québec-Université Laval, Québec, QC, Canada
- Centre de Recherche Nutrition, Santé et Société (NUTRISS) de l'Institut sur la Nutrition et des Aliments Fonctionnels (INAF), Université Laval, Québec, QC, Canada
| | - Anne-Sophie Plante
- Centre de Recherche du CHU de Québec-Université Laval, Québec, QC, Canada
- Centre de Recherche Nutrition, Santé et Société (NUTRISS) de l'Institut sur la Nutrition et des Aliments Fonctionnels (INAF), Université Laval, Québec, QC, Canada
| | - Patricia Lemieux
- Centre de Recherche du CHU de Québec-Université Laval, Québec, QC, Canada
- Faculté de Médecine, Université Laval, Québec, QC, Canada
| | - Julie Robitaille
- École de Nutrition, Université Laval, Québec, QC, Canada
- Centre de Recherche du CHU de Québec-Université Laval, Québec, QC, Canada
- Centre de Recherche Nutrition, Santé et Société (NUTRISS) de l'Institut sur la Nutrition et des Aliments Fonctionnels (INAF), Université Laval, Québec, QC, Canada
| | - Simone Lemieux
- École de Nutrition, Université Laval, Québec, QC, Canada
- Centre de Recherche Nutrition, Santé et Société (NUTRISS) de l'Institut sur la Nutrition et des Aliments Fonctionnels (INAF), Université Laval, Québec, QC, Canada
| | - Sophie Desroches
- École de Nutrition, Université Laval, Québec, QC, Canada
- Centre de Recherche Nutrition, Santé et Société (NUTRISS) de l'Institut sur la Nutrition et des Aliments Fonctionnels (INAF), Université Laval, Québec, QC, Canada
| | - Ariane Bélanger-Gravel
- Centre de Recherche Nutrition, Santé et Société (NUTRISS) de l'Institut sur la Nutrition et des Aliments Fonctionnels (INAF), Université Laval, Québec, QC, Canada
- Département de Communication, Université Laval, Québec, QC, Canada
- Centre de Recherche de l'Institut Universitaire de Cardiologie de Pneumologie de Québec, Québec, QC, Canada
| | - Sarah Maheux-Lacroix
- Centre de Recherche du CHU de Québec-Université Laval, Québec, QC, Canada
- Faculté de Médecine, Université Laval, Québec, QC, Canada
| | - S John Weisnagel
- Centre de Recherche du CHU de Québec-Université Laval, Québec, QC, Canada
- Faculté de Médecine, Université Laval, Québec, QC, Canada
| | - Suzanne Demers
- Faculté de Médecine, Université Laval, Québec, QC, Canada
| | - Félix Camirand Lemyre
- Département de Mathématiques, Université de Sherbrooke, Sherbrooke, QC, Canada
- Centre de Recherche du CHU de Sherbrooke, Sherbrooke, QC, Canada
| | - Mélanie Boulet
- Centre Intégré Universitaire de Santé et de Service Sociaux de l'Estrie-CHU de Sherbrooke, Sherbrooke, QC, Canada
| | - Jean-Patrice Baillargeon
- Centre de Recherche du CHU de Sherbrooke, Sherbrooke, QC, Canada
- Département de Médecine, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Anne-Sophie Morisset
- École de Nutrition, Université Laval, Québec, QC, Canada
- Centre de Recherche du CHU de Québec-Université Laval, Québec, QC, Canada
- Centre de Recherche Nutrition, Santé et Société (NUTRISS) de l'Institut sur la Nutrition et des Aliments Fonctionnels (INAF), Université Laval, Québec, QC, Canada
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