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Ellehave SM, Thomsen LLH, Frederiksen MS, Overgaard C. Initial programme theory development: The first step in a realist evaluation of a cross-sectoral intervention for expectant Danish parents living with psychosocial risks. PLoS One 2023; 18:e0295378. [PMID: 38117815 PMCID: PMC10732377 DOI: 10.1371/journal.pone.0295378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 11/21/2023] [Indexed: 12/22/2023] Open
Abstract
A distinct inequality in maternity care exists, and women with psychosocial risks are at a greater risk of adverse birth outcomes. In several high-income countries, a psychosocial risk assessment early in pregnancy is recommended so that expectant parents are offered an appropriate level of care which facilitates relevant, tailored interventions for those in need. In 2017, a cross-sectoral and interdisciplinary intervention for expectant parents with psychosocial risks was developed and implemented in the North Denmark Region. The development process of the intervention has not been reported and theory-based knowledge about how supportive interventions bring about change for expectant parents with psychosocial risks is scarce. Through the initial phase of a realist evaluation, we aimed to elicit key contexts and mechanisms of change regarding the intervention for expectant parents with psychosocial risks. Through an initial programme theory, this article illustrates how, for whom and in which contexts the intervention is intended to work. Data is comprised of intervention documents, 14 pilot observations and 29 realist interviews with key stakeholders. A thematic analytical approach inspired by retroductive thinking was applied to identify and analyse patterns related to the incentive of the intervention, its structure, intended outcomes, generative mechanisms and contextual matters. Generative mechanisms responsible for bringing about change in the intervention were identified as healthcare professionals' approach, continuity, trust, early intervention and social network. Cross-sectoral collaboration and healthcare professionals' competencies were assumed to be central stimulating contextual factors. The initial programme theory developed in this study will serve as the basis for further refinement via empirical testing in a later phase of the realist evaluation.
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Affiliation(s)
- Sara Mandahl Ellehave
- Public Health and Epidemiology Group, Department of Health Science and Technology, Aalborg University, Aalborg East, Denmark
- Clinical Nursing Research Unit, Aalborg University Hospital, Aalborg, Denmark
| | - Louise Lund Holm Thomsen
- Public Health and Epidemiology Group, Department of Health Science and Technology, Aalborg University, Aalborg East, Denmark
| | - Marianne Stistrup Frederiksen
- Public Health and Epidemiology Group, Department of Health Science and Technology, Aalborg University, Aalborg East, Denmark
| | - Charlotte Overgaard
- The Unit of Health Promotion, Department of Public Health, University of Southern Denmark, Esbjerg, Denmark
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Walløe S, Bogh SB, Birkeland SF, Pedersen LK, Lykkebo AW, Andersen LLT, Frederiksen-Møller B, Morsø L. Using complaints from obstetric care for improving women's birth experiences - a cross sectional study. BMC Pregnancy Childbirth 2023; 23:705. [PMID: 37789282 PMCID: PMC10546670 DOI: 10.1186/s12884-023-06022-5] [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: 05/22/2023] [Accepted: 09/23/2023] [Indexed: 10/05/2023] Open
Abstract
INTRODUCTION Staff shortages and quality in obstetric care is a concern in most healthcare systems and a hot topic in the public debate that has centred on complaints about deficient care. However there has been a lack of empirical data to back the debate. The aim of this study was to analyse and describe complaints in obstetric care. Further, to compare the obstetric complaint pattern to complaints from women about other hospital services. MATERIALS AND METHODS We used the Healthcare Complaints Analysis Tool to code, analyse and extract contents of obstetric complaint cases in a region of Denmark between 2016 and 2021. We compared the obstetric complaint pattern to all other hospital complaint cases in the same period regarding female patients at a large University Hospital in a cross-sectional study. RESULTS Complaints regarding obstetric care differed from women's complaints regarding other healthcare services. Women from obstetric care raised more problems per complaint, and tended to complain more about relational issues indicated by odds for complaints about staff shortage four times higher in the obstetric care group. Women from obstetric care had a lower proportion of compensation claims. CONCLUSION Systematic complaint analysis acknowledged women's experience in obstetric care and may point to areas that potentially need further attention. Complaints from obstetric care show that women experience deficiencies related to relational problems like recognition and individualized support compared to complaints from women receiving other hospital healthcare services.
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Affiliation(s)
- Sisse Walløe
- OPEN Research Unit, Odense University Hospital, J. B. Winsløws Vej 9 a, 3rd floor, Odense C, 5000, Denmark.
- The Research and Implementation Unit PROgrez, Physio- and Occupational Therapy Unit, Naestved-Slagelse- Ringsted Hospitals, Faelledvej 2c, Slagelse, 4200, Denmark.
- Department of Clinical Research, University of Southern Denmark, J. B. Winsløws Vej 15, 3, Odense C, 5000, Denmark.
| | - Søren Bie Bogh
- OPEN Research Unit, Odense University Hospital, J. B. Winsløws Vej 9 a, 3rd floor, Odense C, 5000, Denmark
- Department of Clinical Research, University of Southern Denmark, J. B. Winsløws Vej 15, 3, Odense C, 5000, Denmark
| | - Søren Fryd Birkeland
- OPEN Research Unit, Odense University Hospital, J. B. Winsløws Vej 9 a, 3rd floor, Odense C, 5000, Denmark
- Department of Clinical Research, University of Southern Denmark, J. B. Winsløws Vej 15, 3, Odense C, 5000, Denmark
- Department of Regional Health Research, University of Southern Denmark, J. B. Winsløws Vej 15, 2, Odense C, 5000, Denmark
| | - Lone Kjeld Pedersen
- OPEN Research Unit, Odense University Hospital, J. B. Winsløws Vej 9 a, 3rd floor, Odense C, 5000, Denmark
- Department of Clinical Research, University of Southern Denmark, J. B. Winsløws Vej 15, 3, Odense C, 5000, Denmark
- Gynecological Obstetric Unit D, Odense University Hospital, Kløvervaenget 5, Odense C, 5000, Denmark
| | | | | | - Britta Frederiksen-Møller
- Women's Health and Labour, Hospital of Southern Jutland, Kresten Phillipsens Vej 15, Aabenraa, 6200, Denmark
| | - Lars Morsø
- OPEN Research Unit, Odense University Hospital, J. B. Winsløws Vej 9 a, 3rd floor, Odense C, 5000, Denmark
- Department of Clinical Research, University of Southern Denmark, J. B. Winsløws Vej 15, 3, Odense C, 5000, Denmark
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Andersen CG, Thomsen LLH, Gram P, Overgaard C. ‘It's about developing a trustful relationship’: A Realist Evaluation of midwives’ relational competencies and confidence in a Danish antenatal psychosocial screening programme. Midwifery 2023; 122:103675. [PMID: 37043942 DOI: 10.1016/j.midw.2023.103675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 12/27/2022] [Accepted: 03/27/2023] [Indexed: 04/04/2023]
Abstract
OBJECTIVE to explore how contextual conditions influence midwives' relational competencies, ability and confidence to undertake psychosocial assessment of pregnant women and their partners during the first antenatal consultation that identifies expectant parents in vulnerable positions. DESIGN a realist evaluation carried out through three phases: 1) development 2) testing and 3) refinement of programme theories. Data was generated through realist interviews and observations. SETTING nine community-based and hospital-based midwife clinics in the North Region of Denmark. INTERVENTION a dialogue-based psychosocial assessment programme in the the North Region of Denmark was evaluated. PARTICIPANTS AND DATA 15 midwives were interviewed and 16 observations of midwives undertaking psychosocial assessment during the first antenatal consultation were conducted. FINDINGS contextual conditions at multiple levels which supported midwives' relational competencies, autonomy and the power of peer reflection-and thus facilitation of a woman-centred approach and trust-were identified, i.e., being experienced, having interest, organisational prioritisation of peer reflection and flexibility. Where midwives lacked experience, competency development regarding psychosocial assessment, opportunities for peer reflection and autonomy to individualise care for expectant parents in vulnerable positions, the approach to assessment tended to become institution-centred which caused a distant dialogue and instrumental assessment which potentially harmed the midwife-woman/couple relationship. CONCLUSION midwives' ability and confidence to undertake psychosocial assessment were affected by whether individual and organisational contextual conditions empowered them to assess and care for expectant parents within a philosophy of woman-centred care. Accordingly, development of trustful midwife-woman/couple relationships - which is essential for disclosure - was achievable. These conditions become fundamental for securing quality of antenatal care for expectant parents in vulnerable positions.
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Gram P, Thomsen LLH, Andersen CG, Overgaard C. Trusting parent-professional relationships in interprofessional interventions for expectant and new parents in vulnerable positions: A realist evaluation. J Interprof Care 2023:1-11. [PMID: 36883786 DOI: 10.1080/13561820.2023.2183185] [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: 08/30/2022] [Revised: 01/10/2023] [Accepted: 01/11/2023] [Indexed: 03/09/2023]
Abstract
Interprofessional collaboration and trusting parent-professional relationships can be key to delivering interprofessional care to meet the needs of expectant and new parents in vulnerable positions. This, however, presents challenges. This study aimed to gain deeper understanding of how and under what circumstances trusting parent-professional relationships develop and work within interprofessional team-based care for this group, from the professionals' perspectives. Realist evaluation was undertaken based on 14 semi-structured, realist interviews with midwives and health visitors and 11 observations. Multiple interrelated mechanisms were identified including patient/family-centered care, timely and relevant interprofessional involvement in care, gentle interprofessional bridging, transparency of intervention roles and purposes, and relational continuity. Good interprofessional collaboration was a primary condition for these mechanisms. Developed, trusting relationships supported parents' engagements with interprofessional care and constituted a supportive safety net that promoted parenting skills and coping abilities. We identified harmful mechanisms: distanced encounters, uncertainty of interprofessional involvement, and compromising the safe space. These mechanisms caused distrust and disengagement. Ensuring trusting parent-professional relationships within interprofessional team-based care demands each professional involved competently engages in relational work and interprofessional collaboration. Uncontrollability is thus influenced regarding interpersonal connection and potentially gives an explanation when trust-building efforts fail.
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Affiliation(s)
- Pernille Gram
- Department of Health Science and Technology, The Research Team for Women's, Child & Family Health, Aalborg University, Gistrup, Denmark
| | - Louise Lund Holm Thomsen
- Department of Health Science and Technology, The Research Team for Women's, Child & Family Health, Aalborg University, Gistrup, Denmark
| | - Clara Graugaard Andersen
- Department of Health Science and Technology, The Research Team for Women's, Child & Family Health, Aalborg University, Gistrup, Denmark
| | - Charlotte Overgaard
- Department of Health Science and Technology, The Research Team for Women's, Child & Family Health, Aalborg University, Gistrup, Denmark
- Unit of Health Promotion, Department of Public Health, University of Southern Denmark, Esbjerg, Denmark
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Creating coherent perinatal care journeys: An ethnographic study of the role of continuity of care for Danish parents in a vulnerable position. Women Birth 2023; 36:117-126. [PMID: 35430187 DOI: 10.1016/j.wombi.2022.03.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 03/04/2022] [Accepted: 03/20/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND While continuity of care is a core element of high-quality maternity care, it is potentially even more important for pregnant women and their partners who are at risk of adverse health outcomes because of psychosocial vulnerability. However, little is known about how a coherent care journey can be ensured for women and families who may require interdisciplinary and inter-sectoral services during pregnancy and the postnatal period. AIM To explore the role of continuity of care in creating a coherent care journey for vulnerable parents during pregnancy and the postnatal period. METHODS An ethnographic study conducted in Denmark based on interviews with, and field observations, of 26 mothers and 13 fathers receiving services due to mental health problems, young age, past substance abuse and/or adverse childhood experiences. FINDINGS Three key findings emerged: 1). Developing relationships allowed parents to know and feel known by care providers, which helped them feel secure and reach out for support. 2). Handover of information allowed parents to feel secure as their need for support was recognised by care providers; some parents, however, felt exposed when information was shared 3). Receiving relevant services allowed parents to have their needs for support addressed, which requires easy referral pathways and coordination of services. CONCLUSION All forms of continuity of care should be prioritised in the organisation of maternity care services for women and families in vulnerable positions. While relational continuity is important, continuity of care must also reach across providers, sectors and services to ensure coherent care journeys.
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Preis H, Whitney C, Kocis C, Lobel M. Saving time, signaling trust: Using the PROMOTE self-report screening instrument to enhance prenatal care quality and therapeutic relationships. PEC INNOVATION 2022; 1:100030. [PMID: 35465253 PMCID: PMC9020232 DOI: 10.1016/j.pecinn.2022.100030] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 02/25/2022] [Accepted: 03/17/2022] [Indexed: 05/29/2023]
Abstract
OBJECTIVES Comprehensive screening of psychosocial vulnerabilities and substance use in prenatal care is critical to promote the health and well-being of pregnant patients. Effective implementation of new screening procedures and instruments should be accompanied by an in-depth investigation to assess their feasibility and impact on care delivery. METHODS In 2020, following implementation of the Profile for Maternal and Obstetric Treatment Effectiveness (PROMOTE) an innovative self-report screening instrument developed for outpatient prenatal clinics in the U.S., we conducted individual interviews and focus groups with twenty-two midwives, nurse practitioners, and obstetric residents focused on the PROMOTE and its impacts on care delivery. We used interpretive description for the qualitative analysis of the interviews. RESULTS Five themes were identified: Guiding Time Efficiently: "The Time I Don't Have," Preventing Missed Care, Signaling Trustworthiness, Establishing Trauma-Informed Foundations, and Promoting "Honest" Patient Disclosure. CONCLUSION Interviews suggest that patient completion of the PROMOTE before the medical encounter helps reduce previously reported barriers, is more time-effective, and makes history-taking easier. It also facilitates the patient-provider relationship. INNOVATION Findings offer insight into the breadth and depth of clinical impact resulting from the PROMOTE, and provide guidance for the implementation of such tools to optimize health outcomes.
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Affiliation(s)
- Heidi Preis
- Department of Psychology, Stony Brook University, Stony Brook, NY 11794, USA
- Department of Obstetrics and Gynecology, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY 11794, USA
| | - Clare Whitney
- School of Nursing, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY 11794, USA
| | - Christina Kocis
- Department of Obstetrics and Gynecology, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY 11794, USA
| | - Marci Lobel
- Department of Psychology, Stony Brook University, Stony Brook, NY 11794, USA
- Department of Obstetrics and Gynecology, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY 11794, USA
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