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Rice AR, Durowaye TD, Konkle ATM, Phillips KP. Exploring online reproductive health promotion in Canada: a focus on behavioral and environmental influences from a sex and gender perspective. BMC Public Health 2024; 24:1647. [PMID: 38902656 PMCID: PMC11188500 DOI: 10.1186/s12889-024-19159-5] [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: 01/12/2024] [Accepted: 06/14/2024] [Indexed: 06/22/2024] Open
Abstract
BACKGROUND Reproductive health promotion can enable early mitigation of behavioral and environmental risk factors associated with adverse pregnancy outcomes, while optimizing health of women + (all genders that can gestate a fetus) and babies. Although the biological and social influences of partners on pregnancy are well established, it is unknown whether online Canadian government reproductive health promotion also targets men and partners throughout the reproductive lifespan. METHODS Reproductive health promotion, designed for the general public, was assessed in a multi-jurisdictional sample of Canadian government (federal, provincial/territorial, and municipal) and select non-governmental organization (NGO) websites. For each website, information related to environmental and behavioral influences on reproductive health (preconception, pregnancy, postpartum) was evaluated based on comprehensiveness, audience-specificity, and scientific quality. RESULTS Government and NGO websites provided sparse reproductive health promotion for partners which was generally limited to preconception behavior topics with little coverage of environmental hazard topics. For women + , environmental and behavioral influences on reproductive health were well promoted for pregnancy, with content gaps for preconception and postpartum stages. CONCLUSION Although it is well established that partners influence pregnancy outcomes and fetal/infant health, Canadian government website promotion of partner-specific environmental and behavioral risks was limited. Most websites across jurisdictions promoted behavioral influences on pregnancy, however gaps were apparent in the provision of health information related to environmental hazards. As all reproductive stages, including preconception and postpartum, may be susceptible to environmental and behavioral influences, online health promotion should use a sex- and gender-lens to address biological contributions to embryo, fetal and infant development, as well as contributions of partners to the physical and social environments of the home.
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Affiliation(s)
- Alexandra R Rice
- Interdisciplinary School of Health Sciences, Faculty of Health Sciences, University of Ottawa, 25 Université Private, Ottawa, ON, K1N 6N5, Canada
| | - Toluwanimi D Durowaye
- Interdisciplinary School of Health Sciences, Faculty of Health Sciences, University of Ottawa, 25 Université Private, Ottawa, ON, K1N 6N5, Canada
| | - Anne T M Konkle
- Interdisciplinary School of Health Sciences, Faculty of Health Sciences, University of Ottawa, 25 Université Private, Ottawa, ON, K1N 6N5, Canada
- University of Ottawa Brain and Mind Research Institute, University of Ottawa, Ottawa, ON, K1H 8M5, Canada
| | - Karen P Phillips
- Interdisciplinary School of Health Sciences, Faculty of Health Sciences, University of Ottawa, 25 Université Private, Ottawa, ON, K1N 6N5, Canada.
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Soucy NL, Terrell RM, Chedid RA, Phillips KP. Best practices in prenatal health promotion: Perceptions, experiences, and recommendations of Ottawa, Canada, prenatal key informants. WOMEN'S HEALTH (LONDON, ENGLAND) 2023; 19:17455057231158223. [PMID: 36869650 PMCID: PMC9989378 DOI: 10.1177/17455057231158223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/05/2023]
Abstract
BACKGROUND Prenatal health promotion includes the provision of evidence-based information and practical skills to optimize maternal-fetal outcomes. Increasingly, prenatal education is delivered by both healthcare professionals and allied childbirth educators, in community- or hospital-based group classes, targeted outreach programs, and online modules. OBJECTIVES To better understand how prenatal health promotion relates to a diverse urban community, we assessed the perspectives of Ottawa, Canada prenatal key informants. DESIGN This is a qualitative research with key informant interviews. METHODS Semi-structured interviews were conducted with 11 prenatal key informants, responsible for the design, delivery, or promotion of publicly available prenatal health services. Interviews explored concepts and delivery of prenatal health promotion, strategies to address existing and emerging prenatal topics, identification of barriers to prenatal health services, and recommendations. RESULTS Key informants recommended a lifespan approach to prenatal health promotion, with an emphasis on healthy behaviors, emotional health, labor and delivery, and postpartum/early parenting. Recognizing community health disparities, key informants used community outreach, and intersectoral collaborations for Indigenous and other at-risk communities to mitigate barriers to prenatal service uptake. CONCLUSIONS Ottawa key informants conceptualized prenatal health promotion as inclusive, comprehensive, and as an extension of preconception, school-based sexual education. Respondents recommended the design and delivery of prenatal interventions as culturally safe and trauma informed, using online modalities to complement in-person activities. The experience and intersectoral networks of community-based prenatal health promotion programs represent potential capacity to address emergent public health risks to pregnancy, particularly among at-risk populations. PLAIN LANGUAGE SUMMARY A broad and diverse community of professionals deliver prenatal education to help people have healthy babies. We interviewed Ottawa, Canada experts in prenatal care/education to learn about the design and delivery of reproductive health promotion. We found that Ottawa experts emphasized healthy behaviors beginning before conception and through pregnancy. Community outreach was identified as a successful strategy to promote prenatal education to marginalized groups.
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Affiliation(s)
- Nura L Soucy
- Interdisciplinary School of Health Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Rowan M Terrell
- Interdisciplinary School of Health Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Rebecca A Chedid
- Interdisciplinary School of Health Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Karen P Phillips
- Interdisciplinary School of Health Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
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Sheahan KL, Kroll-Desrosiers A, Goldstein KM, Sheahan MM, Oumarou A, Mattocks K. Sufficiency of Health Information During Pregnancy: What's Missing and for Whom? A Cross-Sectional Analysis Among Veterans. J Womens Health (Larchmt) 2022; 31:1557-1566. [PMID: 35404136 DOI: 10.1089/jwh.2021.0462] [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] [Indexed: 11/13/2022] Open
Abstract
Background: Women Veterans often experience trauma and physical and mental health conditions that increase risk of adverse pregnancy outcomes. Information provision during pregnancy may facilitate improved outcomes. However, little evidence exists about information women Veterans receive during pregnancy, and their perceptions of it. Materials and Methods: We recruited pregnant Veterans from 15 Veterans Affairs medical centers. Through telephone surveys, women (N = 851) provided information about sociodemographic characteristics, military service, health, and pregnancy experiences. We asked postpartum women whether, during pregnancy, they received sufficient information about nine health topics. We calculated a composite score (range: 0-9) that reflected sufficiency of information received. Multivariable logistic regression models identified determinants of perceived sufficiency of information. Results: Mean age was 32.1 years. Most reported being White (56.3%), non-Hispanic (80.3%), married/living with a partner (85.1%), and employed (54.4%). Most (54.6%) had been diagnosed with depression (54.6%); one-quarter reported current depressive symptoms. Mean sufficiency of information score was 6.9. Topics that women most reported they did not receive sufficient information on included, what to expect during delivery (32.3%) and how their spouse/partner might support them during labor (40.3%). History of depression (β = -0.35, p = 0.03), current depressive symptoms (β = -0.66, p = 0.001), military sexual trauma (β = 0.37, p = 0.03), and experience of violence (β = 0.66, p = 0.03) were associated with lower sufficiency of information scores. Conclusion: Results indicate need for enhanced and tailored provision of information for Veterans during pregnancy, particularly among those with experience of trauma, past depression diagnoses, and current depressive symptoms. This may include optimizing care coordination and increasing access to childbirth education classes and doula support.
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Affiliation(s)
- Kate L Sheahan
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Health Services Research and Development, Durham VA Health Care System, Durham, North Carolina, USA
| | - Aimee Kroll-Desrosiers
- VA Central Western Massachusetts Healthcare System, Leeds, Massachusetts, USA
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Karen M Goldstein
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Health Services Research and Development, Durham VA Health Care System, Durham, North Carolina, USA
- Division of General Internal Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | | | - Annie Oumarou
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Health Services Research and Development, Durham VA Health Care System, Durham, North Carolina, USA
| | - Kristin Mattocks
- VA Central Western Massachusetts Healthcare System, Leeds, Massachusetts, USA
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA
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Associations between Prenatal Education, Breastfeeding and Autistic-Like Behaviors in Pre-Schoolers. CHILDREN-BASEL 2021; 8:children8020124. [PMID: 33572414 PMCID: PMC7916179 DOI: 10.3390/children8020124] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 02/05/2021] [Accepted: 02/05/2021] [Indexed: 12/17/2022]
Abstract
This study aimed to investigate the association between prenatal education and autistic-like behaviors of preschoolers as well as the mediating role of breastfeeding in their associations. A cross-sectional study via a structured questionnaire was conducted with 67,578 preschool children and parents from Longhua District of Shenzhen, China. Hierarchical logistic regression models were performed to explore the associations between maternal participation in prenatal education and autistic-like behaviors in preschoolers, as well as the mediating effect of breastfeeding in the associations. After controlling for potential confounders, logistic regression analysis indicated that maternal participation in prenatal education could significantly increase the prevalence of breastfeeding, and the strength of the association was enhanced with the increase frequency of prenatal education visits (ORs ranging from 1.191 to 1.899). While both maternal participation in prenatal education (ORs ranging from 0.732 to 0.798) and breastfeeding (OR = 0.773) were significantly associated with the lower presence of autistic-like behaviors in preschoolers. The crossover analysis indicated that children with both maternal prenatal education and breastfeeding had the lower risk of presence of autistics-like behaviors (OR = 0.569). Furthermore, mediation analysis illustrated that breastfeeding mediated the association between maternal participation in prenatal education and the presence of autistic-like behaviors in preschoolers, with a mediating effect of approximately 14.3%. Our findings suggest that maternal participation in prenatal education is significantly associated with a decreased risk of autistic-like behaviors in preschool children through increased breastfeeding in the mothers who attended prenatal education.
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Chedid RA, Phillips KP. Best Practices for the Design, Implementation and Evaluation of Prenatal Health Programs. Matern Child Health J 2019; 23:109-119. [PMID: 30066301 DOI: 10.1007/s10995-018-2600-4] [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: 10/28/2022]
Abstract
Introduction Prenatal health programs provide health education, reproductive care and related services to women. Programs may be administered individually or collaboratively by agencies including public health units, hospitals, health clinics, community and non-governmental organizations. Prenatal health disparities among populations at-risk may be reduced through the provision of accessible health education, services and resources to help women mitigate modifiable risks to pregnancy. Although standardized guidelines inform clinical screening, testing and maternity care, gaps exist regarding the design, implementation and evaluation for comprehensive prenatal health programs. Methods Using a multijurisdictional approach, prenatal health guidance documents released by clinical associations and regional governments across Canada, Australia, the United States, the United Kingdom and Ireland were systematically evaluated to identify standards and practices regarding the design, implementation and evaluation of prenatal health programs. Results Evidence-based, surveillance/monitoring, and expert/stakeholder collaborations were principles affirmed by guidance documents across all jurisdictions. Each jurisdiction described tailored strategies to optimize prenatal health in their respective communities. Divergence between jurisdictions was noted for patient care models and promotion of providers and companions of choice. Discussion A best practices model is proposed describing recommendations as follows: prenatal health programs should be grounded in a theoretical approach, fundamentally woman-centered and designed to address interacting prenatal health determinants across the lifespan. Accessible and inclusive prenatal health care can be achieved through provider training and community stakeholder collaborations. Identification of best practices for prenatal health program design, implementation and evaluation ensures that service standards are harmonized across communities, thereby optimizing maternal and child health.
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Affiliation(s)
- Rebecca A Chedid
- Interdisciplinary School of Health Sciences, Faculty of Health Sciences, University of Ottawa, 25 Universite Priv, Ottawa, ON, K1N 6N5, Canada
| | - Karen P Phillips
- Interdisciplinary School of Health Sciences, Faculty of Health Sciences, University of Ottawa, 25 Universite Priv, Ottawa, ON, K1N 6N5, Canada.
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Bagley SM, Cabral H, Saia K, Brown A, Lloyd-Travaglini C, Walley AY, Rose-Jacobs R. Frequency and associated risk factors of non-fatal overdose reported by pregnant women with opioid use disorder. Addict Sci Clin Pract 2018; 13:26. [PMID: 30547833 PMCID: PMC6295054 DOI: 10.1186/s13722-018-0126-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 11/29/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Little is known about opioid overdose or naloxone access among pregnant women. OBJECTIVES The objectives of this study were to determine the prevalence of non-fatal overdose, risk factors for overdose, and naloxone access among third trimester women in treatment for opioid use disorder. METHODS We collected baseline data from a case management parental-support intervention study. To explore the association of variables with past year overdose, we used Wilcoxon rank-sum test, Chi square or Fisher's exact tests. RESULTS Among 99 participants, 14% (95% CI 7-21%) reported past year overdose and 67% (95% CI 57-76%) had received overdose education and a naloxone kit. Younger age was the only variable associated with past year overdose. CONCLUSIONS In this sample, past year non-fatal overdose was common, younger age was a risk factor, and most participants had received a naloxone kit. Further work is needed to understand whether younger age is a risk factor in the general population of pregnant women with opioid use disorder and to identify other potential risk factors for overdose in this population.
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Affiliation(s)
- Sarah M Bagley
- Department of Medicine, Boston University School of Medicine, Boston Medical Center, Boston, MA, 02118, USA. .,Department of Pediatrics, Boston University School of Medicine, Boston Medical Center, Boston, MA, 02118, USA.
| | - Howard Cabral
- School of Public Health, Boston University, Boston, USA
| | - Kelley Saia
- Department of Obstetrics and Gynecology, Boston University School of Medicine, Boston Medical Center, Boston, USA
| | - Alyssa Brown
- Northeastern University School of Public Health, Boston, USA
| | | | - Alexander Y Walley
- Department of Medicine, Boston University School of Medicine, Boston Medical Center, Boston, MA, 02118, USA
| | - Ruth Rose-Jacobs
- Department of Pediatrics, Boston University School of Medicine, Boston Medical Center, Boston, MA, 02118, USA
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Soltani F, Shafaati S, Aghababaei S, Samiei V, Roshanaei G. The effectiveness of group counseling on prenatal care knowledge and performance of pregnant adolescents in a Kurdish region of Iran. Int J Adolesc Med Health 2018; 33:/j/ijamh.ahead-of-print/ijamh-2018-0108/ijamh-2018-0108.xml. [PMID: 30511931 DOI: 10.1515/ijamh-2018-0108] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 07/12/2018] [Indexed: 11/15/2022]
Abstract
BACKGROUND Prenatal care in adolescents is one of the most important challenges worldwide, especially in the regions with a specific culture and traditions. The purpose of this study was to investigate the effectiveness of group counseling on knowledge and performance of pregnant adolescents in prenatal care in a Kurdish region in Iran. METHODS This quasi-experimental study was conducted on pregnant adolescents attending in the health centers of Mahabad, a Kurdish city in Iran. Using a multi-stage cluster sampling method, after random selection of four health centers as the intervention and the control, primigravida adolescents with gestational age of 16-20 weeks filled out the demographic and midwifery characteristics questionnaire, as well as a prenatal care knowledge and performance of pregnant adolescents' questionnaire. Then 102 pregnant adolescents (51 people in the control centers and 51 people in the intervention centers), who responded correctly to <50% of the questionnaire items were included in the study. Six sessions of group counseling about prenatal care were held for the intervention group. The control group received the routine prenatal care. Knowledge and performance of pregnant adolescents about prenatal care were compared inter and intra two groups 1 month after the end of the sessions through descriptive-analytic tests including chi-square, independent T and paired T tests. RESULTS In contrast to the control group, the mean scores of adolescents' knowledge about prenatal care increased after the intervention (from 17.51 ± 5.93 to 24.67 ± 5.79) and showed significant difference to the control group (p < 0.05). In addition, the mean scores of adolescent care performance in the intervention group increased (from 5.80 ± 2.19 to 10.33 ± 2.55) and showed significant difference to the control group (p < 0.05). CONCLUSION The results of the present study show the positive effects of prenatal care counseling on increasing knowledge and improving the performance of pregnant adolescents.
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Affiliation(s)
- Farzaneh Soltani
- Mother and Child Care Research Center, Hamadan University of Medical Sciences, Hamadan, Iran (Islamic Republic of)
| | - Shahla Shafaati
- Hamadan University of Medical Sciences, Student Research Center, Hamadan, Iran (Islamic Republic of)
| | - Soodabeh Aghababaei
- Mother and Child Care Research Center, Hamadan University of Medical Sciences, Fahmideh Ave,Hamadan, Iran (Islamic Republic of)
| | - Vida Samiei
- Hamadan University of Medical Sciences, Deputy of Education, Hamadan, Iran (Islamic Republic of)
| | - Ghodratollah Roshanaei
- Hamadan University of Medical Sciences, Modeling of Noncommunicable Diseases Research Center, Hamadan, Iran (Islamic Republic of)
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Eluwa GI, Adebajo SB, Torpey K, Shittu O, Abdu-Aguye S, Pearlman D, Bawa U, Olorukooba A, Khamofu H, Chiegli R. The effects of centering pregnancy on maternal and fetal outcomes in northern Nigeria; a prospective cohort analysis. BMC Pregnancy Childbirth 2018; 18:158. [PMID: 29751797 PMCID: PMC5948874 DOI: 10.1186/s12884-018-1805-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 04/30/2018] [Indexed: 11/26/2022] Open
Abstract
Background Maternal and infant mortality remains high in Nigeria primarily due to low use of skilled birth attendants. Huge disparities exist between southern and northen Nigeria on use of skilled birth attendants with south significantly higher than the north. We assessed the effect of centering pregnancy group (CPG) antenatal care on the uptake of antenatal care (ANC), facility delivery and immunization rates for infants in Kano state. Methods Between December 2012 and May 2014, pregnant women with similar sociodemographics and obstetric history were enrolled into intervention (CPG) and control groups and followed up prospectively. Chi-square tests were conducted to compare the differences between the intervention and the control groups with respect to background characteristics and intervention outcomes. Logistic regression was used to measure the associations between CPG and uptake of services for mother-baby pairs in care. Results A total of 517 (260 in the control group and 257 in the CPG) pregnant women enrolled and participated in the study. Thirty-six percent of women in the control group attended ANC at least once in 2nd and 3nd trimester compared to 49% of respondents in the CPG (p < 0.01). Health facility delivery was higher among CPG (13% vs. 8%; p < 0.01). When controlled for age, number of previous pregnancies, number of term deliveries, number of children alive and occupation of respondent or their spouses, respondents who participated in the CPGs compared to those who did not, were more likely to attend at least one antenatal care (ANC) session in the third trimester [adjusted risk ratio (ARR):1.52; 95% CI:1.36–1.69], more likely to immunize their babies at six weeks [ARR: 2.23; 95% CI: 1.16–4.29] and fourteen weeks [ARR: 3.46; 95% CI: 1.19–10.01] and more likely to use health services [ARR: 1.50; 95% CI: 1.06–2.13]. Conclusion Centering or group pregnancy showed a positive effect on the use of antenatal services, facility delivery and postnatal services and thus is a promising intervention to increase uptake of maternal health care services in northern Nigeria. The low facility delivery remains a cause for alarm and requires further investigation to improve facility delivery in northern Nigeria.
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Affiliation(s)
- George I Eluwa
- Population Council, No. 16, Mafemi Crescent, Utako, Abuja, Nigeria.
| | - Sylvia B Adebajo
- Population Council, No. 16, Mafemi Crescent, Utako, Abuja, Nigeria
| | - Kwasi Torpey
- University of Ghana College of Health Sciences, Accra, Ghana
| | - Oladapo Shittu
- Department of Obstetrics & Gynaecology, Ahmadu Bello University Teaching Hospital, Zaria, Kaduna, Nigeria
| | | | - Daniel Pearlman
- Bixby School of Public Health, University of California, Berkeley, USA
| | - Umma Bawa
- Department of Obstetrics & Gynaecology, Ahmadu Bello University Teaching Hospital, Zaria, Kaduna, Nigeria
| | - Aira Olorukooba
- Department of Paediatrics, Ahmadu Bello University Teaching Hospital, Zaria, Kaduna, Nigeria
| | - Hadiza Khamofu
- University of Ghana College of Health Sciences, Accra, Ghana
| | - Robert Chiegli
- University of Ghana College of Health Sciences, Accra, Ghana
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Best practices for online Canadian prenatal health promotion: A public health approach. Women Birth 2017; 31:e223-e231. [PMID: 29113753 DOI: 10.1016/j.wombi.2017.10.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 10/09/2017] [Indexed: 11/22/2022]
Abstract
BACKGROUND Prenatal health promotion provides information regarding pregnancy risks, protective behaviours and clinical and community resources. Typically, women obtain prenatal health information from health care providers, prenatal classes, peers/family, media and increasingly, Internet sites and mobile apps. Barriers to prenatal health promotion and related services include language, rural/remote location, citizenship and disability. Online public health platforms represent the capacity to reach underserved women and can be customised to address the needs of a heterogeneous population of pregnant women. AIM Canadian government-hosted websites and online prenatal e-classes were evaluated to determine if accessible, inclusive, comprehensive and evidence-based prenatal health promotion was provided. METHODS Using a multijurisdictional approach, federal, provincial/territorial, municipal and public health region-hosted websites, along with affiliated prenatal e-classes, were evaluated based on four criteria: comprehensiveness, evidence-based information, accessibility and inclusivity. FINDINGS Online prenatal e-classes, federal, provincial/territorial and public health-hosted websites generally provided comprehensive and evidence-based promotion of essential prenatal topics, in contrast to municipal-hosted websites which provided very limited prenatal health information. Gaps in online prenatal health promotion were identified as lack of French and multilingual content, targeted information and representations of Indigenous peoples, immigrants and women with disabilities. CONCLUSION Canadian online prenatal health promotion is broadly comprehensive and evidence-based, but fails to address the needs of non-Anglophones and represent the diverse population of Canadian pregnant women. It is recommended that agencies enhance the organisation of website pregnancy portals/pages and collaborate with other jurisdictions and community groups to ensure linguistically accessible, culturally-competent and inclusive prenatal online resources.
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Nicoloro-SantaBarbara J, Rosenthal L, Auerbach MV, Kocis C, Busso C, Lobel M. Patient-provider communication, maternal anxiety, and self-care in pregnancy. Soc Sci Med 2017; 190:133-140. [PMID: 28863336 DOI: 10.1016/j.socscimed.2017.08.011] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 08/03/2017] [Accepted: 08/12/2017] [Indexed: 12/16/2022]
Abstract
RATIONALE Favorable relationships with health care providers predict greater patient satisfaction and adherence to provider recommendations. However, the specific components of patient-provider relationships that account for these benefits have not been identified. The potential benefits of strong patient-provider relationships in pregnancy may be especially important, as care providers have frequent, intimate interactions with pregnant women that can affect their emotions and behaviors. In turn, prenatal emotions and health behaviors have potent effects on birth outcomes. OBJECTIVE This study investigated whether pregnant women's relationships with their midwives predicted better self-care. Specific components of the patient-provider relationship (communication, integration, collaboration, and empowerment) were examined. We also investigated a mechanism through which these relationship components may be associated with salutary health behaviors: by alleviating women's anxiety. METHODS In total, 139 low-risk patients of a university-affiliated midwifery practice in the northeastern United States completed well-validated measures assessing their relationship with midwives, state anxiety, and prenatal health behaviors in late pregnancy; state anxiety was also assessed in mid-pregnancy. RESULTS Women's perceptions of better communication, collaboration, and empowerment from their midwives were associated with more frequent salutary health behavior practices in late pregnancy. Controlling for mid-pregnancy anxiety, lower anxiety in late pregnancy mediated associations of communication and collaboration with health behavior practices, indicating that these associations were attributable to reductions in anxiety from mid- to late pregnancy. CONCLUSION Results substantiate that benefits of patient-provider relationships in pregnancy may extend beyond providing medical expertise. Some aspects of patient-provider relationships may offer direct benefits to pregnant women in promoting better health practices; other aspects of these relationships may indirectly contribute to better health practices by alleviating negative emotions. The benefits of strong midwife relationships may derive from the reassurance, comfort, and warmth these relationships offer, as well as the information and education that midwives provide to their patients.
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Affiliation(s)
| | - Lisa Rosenthal
- Department of Psychology, Pace University, New York, USA
| | | | - Christina Kocis
- Department of Obstetrics, Gynecology, and Reproductive Medicine, Stony Brook University, Stony Brook, NY, USA
| | - Cheyanne Busso
- Department of Psychiatry, Stony Brook University, Stony Brook, NY, USA
| | - Marci Lobel
- Department of Psychology, Stony Brook University, Stony Brook, NY, USA.
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11
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Cannella BL, Yarcheski A, Mahon NE. Meta-Analyses of Predictors of Health Practices in Pregnant Women. West J Nurs Res 2016; 40:425-446. [PMID: 28322644 DOI: 10.1177/0193945916682212] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The aims of this study were to identify predictors of health practices of pregnant women in the literature reviewed, to use meta-analysis to ascertain the mean effect size (ES) across studies between each predictor and health practices, and to examine four moderators on each predictor-health practices relationship. Using preferred reporting items for systematic reviews and meta-analyses guidelines for the literature assessed, 32 published studies or doctoral dissertations completed between 1992 and 2015 met the inclusion criteria. Twelve predictors were identified, and each predictor in relation to health practices was subjected to meta-analysis. One predictor (maternal-fetal attachment) of health practices had a large ES, two predictors (depression and stress) had medium ESs, six predictors (income, education, parity, social support, employment, and age) had small ESs, and three predictors (gestational age, marital status, and race) had trivial ESs. Findings are interpreted relative to health practices in pregnant women.
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Affiliation(s)
| | - Adela Yarcheski
- 1 Rutgers, The State University of New Jersey, Newark, NJ, USA
| | - Noreen E Mahon
- 1 Rutgers, The State University of New Jersey, Newark, NJ, USA
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12
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Waller A, Bryant J, Cameron E, Galal M, Quay J, Sanson-Fisher R. Women's perceptions of antenatal care: are we following guideline recommended care? BMC Pregnancy Childbirth 2016; 16:191. [PMID: 27464567 PMCID: PMC4963960 DOI: 10.1186/s12884-016-0984-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 07/20/2016] [Indexed: 12/20/2022] Open
Abstract
Background Detection and management of antenatal risk factors is critical for improved maternal and infant outcomes. This study describes the proportion of pregnant women who self-reported being screened for and offered advice to manage antenatal risk factors in line with antenatal care recommendations; and the characteristics associated with rates of screening. Methods A survey was undertaken with 223 (64 % of eligible) pregnant women recruited from an outpatient obstetrics clinic at a public hospital. Participants self-reported whether they were: (i) screened for 23 guideline-recommended risk factors during their antenatal visit; (ii) offered assistance to manage identified risk factor(s); and (iii) received assistance that was of benefit. Association between rate of screening and participant characteristics was examined using multivariate quantile regression. Results Overall, 23 % of women reported that they were asked about every risk factor. Weight gain (48 %), diet (60 %) and oral health (31 %) were least frequently screened risk factors. The number of women who reported they were offered advice to manage identified risks and the value of that advice was perceived by women as suboptimal. Those women receiving shared care between a midwife and general practitioner, of Aboriginal or Torres Strait Islander descent, and without private health insurance reported being screened for a greater number of risk factors. Conclusions Pregnant women report suboptimal rates of screening and management of antenatal risk factors. Initiatives to improve consistency in detection of antenatal risk factors and the application of appropriate interventions to manage those risk factors that are detected are required.
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Affiliation(s)
- Amy Waller
- Priority Research Centre for Health Behaviour, University of Newcastle & Hunter Medical Research Institute, HMRI Building, Callaghan, NSW, 2308, Australia. .,School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia.
| | - Jamie Bryant
- Priority Research Centre for Health Behaviour, University of Newcastle & Hunter Medical Research Institute, HMRI Building, Callaghan, NSW, 2308, Australia.,School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
| | - Emilie Cameron
- Priority Research Centre for Health Behaviour, University of Newcastle & Hunter Medical Research Institute, HMRI Building, Callaghan, NSW, 2308, Australia.,School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
| | - Mohamed Galal
- Department of Obstetrics and Gynaecology, Hunter New England Local Health District, Newcastle, NSW, Australia.,Priority Research Centre for Reproductive Science, University of Newcastle, Callaghan, NSW, Australia
| | - Juliana Quay
- Department of Obstetrics and Gynaecology, Hunter New England Local Health District, Newcastle, NSW, Australia
| | - Rob Sanson-Fisher
- Priority Research Centre for Health Behaviour, University of Newcastle & Hunter Medical Research Institute, HMRI Building, Callaghan, NSW, 2308, Australia.,School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
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Yeoh PL, Hornetz K, Dahlui M. Antenatal Care Utilisation and Content between Low-Risk and High-Risk Pregnant Women. PLoS One 2016; 11:e0152167. [PMID: 27010482 PMCID: PMC4807004 DOI: 10.1371/journal.pone.0152167] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Accepted: 03/09/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The purpose of antenatal care is to monitor and improve the wellbeing of the mother and foetus. The World Health Organization recommends risk-oriented strategy that includes: (i) routine care to all women, (ii) additional care for women with moderately severe diseases and complications, (iii) specialised obstetrical and neonatal care for women with severe diseases and complications. Antenatal care is concerned with adequate care in order to be effective. Measurement for adequacy of antenatal care often applies indexes that assess initiation of care and number of visits. In addition, adequacy of care content should also be assessed. Results of studies in developed settings demonstrate that women without risk factors use antenatal services more frequently than recommended. Such over-utilisation is problematic for low-resourced settings. Moreover, studies show that a substantial proportion of high-risk women had utilisation or content of care below the recommended standard. Yet studies in developing countries have seldom included a comparison between low-risk and high-risk women. The purpose of the study was therefore to assess adequacy of care and pregnancy outcomes for the different risk groups. METHODS A retrospective study using a multistage sampling technique, at public-funded primary health care clinics was conducted. Antenatal utilisation level was assessed using a modified Adequacy of Prenatal Care Utilisation index that measures the timing for initiation of care and observed-to-expected visits ratio. Adequacy of antenatal care content assessed compliance to routine care based on the local guidelines. RESULTS Intensive or "adequate-plus" antenatal care utilisation as defined by the modified index was noted in over half of the low-risk women. On the other hand, there were 26% of the high-risk women without the expected intensive utilisation. Primary- or non-educated high-risk women were less likely to have a higher antenatal care utilisation level compared with tertiary educated ones (OR = 0.20, P = 0.003). Half of all women had <80% of the recommended antenatal care content. A higher proportion of high-risk than low-risk women scored <80% of the routine care content (p<0.015). The majority of the additional laboratory tests were performed on high-risk women. Provision of antenatal education showed comparatively poor compliance to guidelines, more than half of the antenatal advice topics assessed were rarely provided to the women. High-risk women were associated with a higher prevalence of adverse pregnancy outcome. CONCLUSIONS Disproportionate utilisation of antenatal care according to risk level of pregnancy indicates the need for better scheduling of care. The risk-oriented approach often results in a tendency to focus on the risk conditions of the women. Training interventions are recommended to improve communication and to help healthcare professionals understand the priorities of the women. Further studies are required to assess the reason for disproportionate utilisation of antenatal care according to risk level and how delivery of antenatal advice can be improved, reviewing both user and provider perspectives.
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Affiliation(s)
- Ping Ling Yeoh
- Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- Mediconsult Sdn. Bhd., Ampang, Malaysia
| | | | - Maznah Dahlui
- Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Heberlein EC, Picklesimer AH, Billings DL, Covington-Kolb S, Farber N, Frongillo EA. Qualitative Comparison of Women's Perspectives on the Functions and Benefits of Group and Individual Prenatal Care. J Midwifery Womens Health 2016; 61:224-34. [DOI: 10.1111/jmwh.12379] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
Group prenatal care is an emerging trend in obstetrics, and for medically low-risk women has been shown to result in lower rates of preterm birth, higher rates of breastfeeding, and higher rates of participation in postpartum family planning. Significant cost savings to the health care system are seen when the lower rates of preterm birth and neonatal intensive care unit admissions are considered. More research is needed about patients' health outcomes as well as the economic and workforce implications to outpatient obstetric practices before widely transitioning prenatal care into group settings.
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Da Costa D, Zelkowitz P, Bailey K, Cruz R, Bernard JC, Dasgupta K, Lowensteyn I, Khalifé S. Results of a Needs Assessment to Guide the Development of a Website to Enhance Emotional Wellness and Healthy Behaviors During Pregnancy. J Perinat Educ 2016; 24:213-24. [PMID: 26834443 DOI: 10.1891/1058-1243.24.4.213] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
In preparation for developing a website to enhance emotional wellness and healthy lifestyle during the perinatal period, this study examined women's informational needs and barriers. Seventy-four women who were pregnant or had given birth completed an online survey inquiring about information needs and preferred sources related to psychosocial aspects and lifestyle behaviors. Information related to healthy diet choices and weight management, followed by exercise, was rated highly as a need. Information related to depression, stress, and anxiety was also rated as important. Health-care providers and the Internet were found to be preferred sources of information. Evidence-based websites can serve as a powerful low-cost educational resource to support and reinforce the health promotion advice received from their health-care providers.
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Sword W, Heaman M, Biro MA, Homer C, Yelland J, Akhtar-Danesh N, Bradford-Janke A. Quality of prenatal care questionnaire: psychometric testing in an Australia population. BMC Pregnancy Childbirth 2015; 15:214. [PMID: 26357847 PMCID: PMC4566370 DOI: 10.1186/s12884-015-0644-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Accepted: 09/02/2015] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The quality of antenatal care is recognized as critical to the effectiveness of care in optimizing maternal and child health outcomes. However, research has been hindered by the lack of a theoretically-grounded and psychometrically sound instrument to assess the quality of antenatal care. In response to this need, the 46-item Quality of Prenatal Care Questionnaire (QPCQ) was developed and tested in a Canadian context. The objective of this study was to validate the QPCQ and to establish its internal consistency reliability in an Australian population. METHODS Study participants were recruited from two public maternity services in two Australian states: Monash Health, Victoria and Wollongong Hospital, New South Wales. Women were eligible to participate if they had given birth to a single live infant, were 18 years or older, had at least three antenatal visits during the pregnancy, and could speak, read and write English. Study questionnaires were completed in hospital. A confirmatory factor analysis (CFA) was conducted. Construct validity, including convergent validity, was further assessed against existing questionnaires: the Patient Expectations and Satisfaction with Prenatal Care (PESPC) and the Prenatal Interpersonal Processes of Care (PIPC). Internal consistency reliability of the QPCQ and each of its six subscales was assessed using Cronbach's alpha. RESULTS Two hundred and ninety-nine women participated in the study. CFA verified and confirmed the six factors (subscales) of the QPCQ. A hypothesis-testing approach and an assessment of convergent validity further supported construct validity of the instrument. The QPCQ had acceptable internal consistency reliability (Cronbach's alpha = 0.97), as did each of the six factors (Cronbach's alpha = 0.74 to 0.95). CONCLUSIONS The QPCQ is a valid and reliable self-report measure of antenatal care quality. This instrument fills a scientific gap and can be used in research to examine relationships between the quality of antenatal care and outcomes of interest, and to examine variations in antenatal care quality. It also will be useful in quality assurance and improvement initiatives.
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Affiliation(s)
- Wendy Sword
- School of Nursing, Faculty of Health Sciences, University of Ottawa, 451 Smyth Road, Ottawa, ON, K1H 8M5, Canada.
| | - Maureen Heaman
- College of Nursing and Departments of Community Health Sciences and Obstetrics, Gynecology and Reproductive Sciences, College of Medicine, Faculty of Health Sciences, University of Manitoba, 89 Curry Place, Winnipeg, MB, R3T 2N2, Canada.
| | - Mary Anne Biro
- School of Nursing and Midwifery, Faculty of Medicine, Nursing and Health Sciences, Monash University, Frankston, VIC, 3800, Australia.
| | - Caroline Homer
- Centre for Midwifery, Child and Family Health, Faculty of Health, University of Technology Sydney, 15 Broadway, Ultimo, NSW, 2007, Australia.
| | - Jane Yelland
- Healthy Mothers Healthy Families Research Group, Murdoch Childrens Research Institute and General Practice and Primary Health Care Academic Centre, University of Melbourne, Parkville, 3052, Australia.
| | - Noori Akhtar-Danesh
- School of Nursing and Department of Clinical Epidemiology & Biostatics, Faculty of Health Sciences, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada.
| | - Amanda Bradford-Janke
- Gilbrea Centre for Studies in Aging, Faculty of Social Sciences, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4M4, Canada.
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A survey of health behaviors in minority women in pregnancy: the influence of body mass index. Womens Health Issues 2014; 24:e291-5. [PMID: 24794542 DOI: 10.1016/j.whi.2014.02.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2013] [Revised: 01/28/2014] [Accepted: 02/13/2014] [Indexed: 01/13/2023]
Abstract
BACKGROUND An effective behavioral intervention for gestational weight gain in minority obese women needs to incorporate their baseline health behaviors and nutrition patterns. The objective of this study was to compare racial/ethnic differences in health behaviors and nutrition in pregnant obese and non-obese minorities. METHODS A face-to-face, 75-item survey was administered to 94 women (46% non-obese, 54% obese; 71% Black, 29% Hispanic) at a prenatal visit to an inner-city clinic. Television watching, exercise, and nutrition were compared between obese and non-obese women and racial/ethnic differences were compared within each body mass index (BMI) category using chi-square and Fisher's exact tests. Interactions between BMI category and race/ethnicity for each health behavior were examined. FINDINGS More obese women described their nutrition as "fair" or "poor" (36% vs. 15%; p = .02) and missed more meals per day (21% vs. 6%; p = .03) compared with non-obese women. Obese Blacks were less likely to improve their nutrition during pregnancy compared with obese Hispanics (28% vs. 58%; p = .08). Non-obese Blacks watched more television (p = .03) and exercised less during pregnancy (p = .04) than non-obese Hispanics. Except for dairy products, there were no differences in daily nutrition (fruit, soda, vegetables, chips) among the BMI categories and racial/ethnic groups; however, fewer than 50% of all participants consumed fruits and vegetables every day. There was an interaction between BMI category and race/ethnicity: Obese Hispanics exercised less before pregnancy (p = .02), but exercised more during pregnancy (p = .01) compared with non-obese Hispanics. CONCLUSIONS Interventions for gestational weight gain in obese women may have greater success if they considered racial/ethnic differences in health behaviors, especially related to exercise.
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Using focus groups and social marketing to strengthen promotion of group prenatal care. ANS Adv Nurs Sci 2013; 36:320-35. [PMID: 24169111 DOI: 10.1097/ans.0000000000000005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Centering Pregnancy, an innovative group model of prenatal care, shows promise to reduce persistent adverse maternal-infant outcomes and contain costs. Because this innovation requires systemwide change, clinics reported needing support enrolling women into groups and obtaining organizational buy-in. This study used the 3-step social marketing communication strategy to help clinic staff identify key customers and customer-specific barriers to adopting or supporting Centering Pregnancy. They developed targeted information to reduce barriers and built skills in communicating with different customers through role-playing. Findings provide practical information for others to use this communication strategy to improve implementation of Centering Pregnancy.
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Bell SA, Seng J. Childhood maltreatment history, posttraumatic relational sequelae, and prenatal care utilization. J Obstet Gynecol Neonatal Nurs 2013; 42:404-15. [PMID: 23772546 PMCID: PMC4331183 DOI: 10.1111/1552-6909.12223] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To test the hypothesis that childhood maltreatment history would be associated with inadequate prenatal care utilization. DESIGN A post-hoc analysis of a prospective cohort study of the effects of post traumatic stress disorder (PTSD) on pregnancy outcomes. SETTING Recruitment took place via prenatal clinics from three academic health systems in southeast Michigan. PARTICIPANTS This analysis included 467 diverse, nulliparous, English-speaking adult women expecting their first infants. METHODS Data were gathered from structured telephone interviews at two time points in pregnancy and from prenatal medical records. RESULTS Contrary to our hypothesis, history of childhood maltreatment was associated with better likelihood of using adequate prenatal care. Risk for inadequate prenatal care occurred in association with the posttraumatic stress and interpersonal sensitivity that can result from maltreatment, with low alliance with the maternity care provider, and with public insurance coverage. Prior mental health treatment was associated with using adequate prenatal care. CONCLUSION When childhood maltreatment survivors were resilient or had used mental health treatment, they were more likely to utilize adequate prenatal care. The maternity care relationship or service delivery model (e.g., no continuity of care) as well as structural factors may adversely affect utilization among PTSD-affected survivors. Since inadequate care was associated with adverse outcomes, further studies of these modifiable factors are warranted.
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Affiliation(s)
- Sue Anne Bell
- University of Michigan School of Nursing. Her research focuses on the intersection of reproductive health and mental health
| | - Julia Seng
- University of Michigan School of Nursing where she studies the effects of posttraumatic stress disorder on women's health and childbearing outcomes. 204 South State Street G120 Lane Hall Ann Arbor, MI 48109 734-647-4291
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Zhou H, Zhao CX, Wang XL, Xv YC, Shi L, Wang Y. Effectiveness of an intervention on uptake of maternal care in four counties in Ningxia, China. Trop Med Int Health 2012; 17:1441-8. [PMID: 22994293 DOI: 10.1111/j.1365-3156.2012.03092.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To understand the utilisation of prenatal care and hospitalised delivery among pregnant Muslim women in Ningxia, China, and to explore the effectiveness of the integrated interventions to reduce maternal mortality. METHODS Cross-sectional surveys before and after the intervention were carried out. Using multistage sampling, 1215 mothers of children <5 years old were recruited: 583 in the pre-intervention survey and 632 in the post-intervention study. Data on prenatal care and delivery were collected from face-to-face interviews. Maternal mortality ratio (MMR) data were obtained from the local Maternal and Child Mortality Report System. RESULTS After the intervention, the MMR significantly decreased (45.5 deaths per 100,000 live births to 32.7 deaths). Fewer children were born at home after the intervention than before the intervention (OR, 0.11; 95% CI, 0.08-0.15). The proportion of women who attended prenatal care at least once increased from 78.2% to 98.9% (OR, 24.55; 95% CI, 11.37-53.12). The proportion of women who had prenatal visit(s) in the first trimester of pregnancy increased from 35.1% to 82.6% (OR, 8.77; 95% CI, 6.58-11.69). The quality of prenatal care was greatly improved. Effects of the intervention on the utilisation of maternal care remained significant after adjusting for education level and household possessions. CONCLUSIONS The findings suggest that integrated strategies can effectively reduce maternal mortality.
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Affiliation(s)
- Hong Zhou
- Department of Child, Adolescent and Women's Health, Peking University, Beijing, China United Nations Children's Fund China Office, Beijing, China Department of Nursing, College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, MA, USA
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Sword W, Heaman MI, Brooks S, Tough S, Janssen PA, Young D, Kingston D, Helewa ME, Akhtar-Danesh N, Hutton E. Women's and care providers' perspectives of quality prenatal care: a qualitative descriptive study. BMC Pregnancy Childbirth 2012; 12:29. [PMID: 22502640 PMCID: PMC3352181 DOI: 10.1186/1471-2393-12-29] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2011] [Accepted: 04/13/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Much attention has been given to the adequacy of prenatal care use in promoting healthy outcomes for women and their infants. Adequacy of use takes into account the timing of initiation of prenatal care and the number of visits. However, there is emerging evidence that the quality of prenatal care may be more important than adequacy of use. The purpose of our study was to explore women's and care providers' perspectives of quality prenatal care to inform the development of items for a new instrument, the Quality of Prenatal Care Questionnaire. We report on the derivation of themes resulting from this first step of questionnaire development. METHODS A qualitative descriptive approach was used. Semi-structured interviews were conducted with 40 pregnant women and 40 prenatal care providers recruited from five urban centres across Canada. Data were analyzed using inductive open and then pattern coding. The final step of analysis used a deductive approach to assign the emergent themes to broader categories reflective of the study's conceptual framework. RESULTS The three main categories informed by Donabedian's model of quality health care were structure of care, clinical care processes, and interpersonal care processes. Structure of care themes included access, physical setting, and staff and care provider characteristics. Themes under clinical care processes were health promotion and illness prevention, screening and assessment, information sharing, continuity of care, non-medicalization of pregnancy, and women-centredness. Interpersonal care processes themes were respectful attitude, emotional support, approachable interaction style, and taking time. A recurrent theme woven throughout the data reflected the importance of a meaningful relationship between a woman and her prenatal care provider that was characterized by trust. CONCLUSIONS While certain aspects of structure of care were identified as being key dimensions of quality prenatal care, clinical and interpersonal care processes emerged as being most essential to quality care. These processes are important as they have a role in mitigating adverse outcomes, promoting involvement of women in their own care, and keeping women engaged in care. The findings suggest key considerations for the planning, delivery, and evaluation of prenatal care. Most notably, care should be woman-centred and embrace shared decision making as an essential element.
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Affiliation(s)
- Wendy Sword
- School of Nursing and Department of Clinical Epidemiology and Biostatistics, Faculty of Health Sciences, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada
| | - Maureen I Heaman
- Faculty of Nursing, University of Manitoba, 89 Curry Place, Winnipeg, Manitoba R3T 2N2, Canada
| | - Sandy Brooks
- School of Nursing, Faculty of Health Sciences, McMaster University, 1200 Main Street West, Hamilton, Ontario L8N 3Z5, Canada
| | - Suzanne Tough
- Department of Paediatrics and Community Health Sciences, Faculty of Medicine, University of Calgary and Alberta Centre for Child, Family and Community Research, 2888 Shaganappi Trail NW, Calgary, Alberta T3B 6A8, Canada
| | - Patricia A Janssen
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, British Columbia V6T 3Z1, Canada
| | - David Young
- IWK Health Centre and Department of Obstetrics and Gynecology, Faculty of Medicine, Dalhousie University, 5980 University Avenue, P.O. Box 9700, Halifax, Nova Scotia B3K 6R8, Canada
| | - Dawn Kingston
- Faculty of Nursing, University of Alberta, 5-258 Edmonton Clinic Health Academy, 11405-87th Avenue, Edmonton, Alberta T6G 1C9, Canada
| | - Michael E Helewa
- St. Boniface General Hospital and Department of Obstetrics, Gynecology and Reproductive Sciences, Faculty of Medicine, University of Manitoba, 409 Tache Avenue, Winnipeg, Manitoba R2H 2A6, Canada
| | - Noori Akhtar-Danesh
- School of Nursing and Department of Clinical Epidemiology and Biostatistics, Faculty of Health Sciences, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada
| | - Eileen Hutton
- Department of Obstetrics and Gynecology and Department of Clinical Epidemiology and Biostatistics, Faculty of Health Sciences, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada
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An analysis of the meanings of pre-eclampsia for pregnant and postpartum women and health professionals in Rio Grande do Norte, Brazil. Midwifery 2011; 27:e182-7. [DOI: 10.1016/j.midw.2010.06.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2009] [Revised: 02/21/2010] [Accepted: 06/22/2010] [Indexed: 11/17/2022]
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Hanson JD. Understanding prenatal health care for American Indian women in a Northern Plains tribe. J Transcult Nurs 2011; 23:29-37. [PMID: 22052090 DOI: 10.1177/1043659611423826] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Early and regular prenatal care appointments are imperative for the health of both the mother and baby to help prevent complications associated with pregnancy and birth. American Indian women are especially at risk for health disparities related to pregnancy and lack of prenatal health care. Previous research has outlined a basic understanding of the reasons for lack of prenatal care for women in general; however, little is known about care received by pregnant women at Indian Health Service hospitals. Qualitative interviews were carried out with 58 women to better understand the prenatal health experiences of American Indian women from one tribe in the Northern Plains. Several themes related to American Indian women's prenatal health care experiences were noted, including communication barriers with physicians, institutional barriers such as lack of continuity of care, and sociodemographic barriers. Solutions to these barriers, such as a nurse midwife program, are discussed.
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Affiliation(s)
- Jessica D Hanson
- Health Disparities Research Center, Sanford Research/USD, 2301 East 60th Street North, Sioux Falls, SD 57104, USA.
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Whitehead D. Before the cradle and beyond the grave: a lifespan/settings-based framework for health promotion. J Clin Nurs 2011; 20:2183-94. [DOI: 10.1111/j.1365-2702.2010.03674.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Mauriello L, Dyment S, Prochaska J, Gagliardi A, Weingrad-Smith J. Acceptability and Feasibility of a Multiple-Behavior, Computer-Tailored Intervention for Underserved Pregnant Women. J Midwifery Womens Health 2011; 56:75-80. [DOI: 10.1111/j.1542-2011.2010.00007.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Jafari F, Eftekhar H, Fotouhi A, Mohammad K, Hantoushzadeh S. Comparison of Maternal and Neonatal Outcomes of Group Versus Individual Prenatal Care: A New Experience in Iran. Health Care Women Int 2010; 31:571-84. [DOI: 10.1080/07399331003646323] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Hanson L, VandeVusse L, Roberts J, Forristal A. A critical appraisal of guidelines for antenatal care: components of care and priorities in prenatal education. J Midwifery Womens Health 2010; 54:458-68. [PMID: 19879518 DOI: 10.1016/j.jmwh.2009.08.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2008] [Revised: 08/05/2009] [Accepted: 08/05/2009] [Indexed: 10/20/2022]
Abstract
There are a variety of published prenatal care (PNC) guidelines that claim a scientific basis for the information included. Four sets of PNC guidelines published between 2005 and 2009 were examined and critiqued. The recommendations for assessment procedures, laboratory testing, and education/counseling topics were analyzed within and between these guidelines. The PNC components were synthesized to provide an organized, comprehensive appendix that can guide providers of antepartum care. The appendix may be used to locate which guidelines addressed which topics to assist practitioners to identify evidence sources. The suggested timing for introducing and reinforcing specific topics is also presented in the appendix. Although education is often assumed to be a vital component of PNC, it was inconsistently included in the guidelines that were reviewed. Even when education was included, important detail was lacking. Addressing each woman's needs as the first priority was suggested historically and remains relevant in current practice to systematically provide care while maintaining the woman as the central player. More attention to gaps in current research is important for the development of comprehensive prenatal guidelines that contribute effectively to the long-term health and well-being of women, families, and their communities.
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Affiliation(s)
- Lisa Hanson
- Marquette University College of Nursing, Clark Hall, 363, PO Box 1881, Milwaukee, WI 53201-1881, USA.
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Shieh C, McDaniel A, Ke I. Information-seeking and its predictors in low-income pregnant women. J Midwifery Womens Health 2009; 54:364-372. [PMID: 19720337 DOI: 10.1016/j.jmwh.2008.12.017] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2008] [Revised: 12/23/2008] [Accepted: 12/23/2008] [Indexed: 10/20/2022]
Abstract
This study examined information-seeking and its predictors (information needs and barriers) in low-income pregnant women. Eighty-four pregnant women from a prenatal clinic were interviewed using three scales that measured the frequency of information-seeking from eight different sources, information needs for 20 pregnancy health topics, and 15 barriers to seeking information, respectively. Most women were black, unmarried, between 20 and 29 years of age, high school educated or less, multigravidas, and in their third trimester of pregnancy. Information needs and barriers were significant predictors of information-seeking. Together, they explained 26% of the variance in the seeking outcome. High information needs and low barriers predicted more frequent information-seeking. First pregnancy and asthma during pregnancy were significant covariates for information-seeking. Information needs and barriers are related to information-seeking among low-income pregnant women. To facilitate pregnant women's information-seeking, health care providers may assess a woman's need for information and barriers that the woman experiences when seeking information, and factors such as first pregnancy and asthma.
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Affiliation(s)
- Carol Shieh
- Carol Shieh, RNC, MPH, DNSc, is an Assistant Professor at the Indiana University School of Nursing, Department of Environments for Health, Indianapolis, IN.Anna McDaniel, RN, DNS, FAAN, is Professor of Nursing and Informatics at the Indiana University Schools of Nursing and Informatics, Indianapolis, IN.Irene Ke, MS, MLS, is the Director of Library Instruction and Information Literacy Program at the MD Anderson Library, University of Houston, Houston, TX
| | - Anna McDaniel
- Carol Shieh, RNC, MPH, DNSc, is an Assistant Professor at the Indiana University School of Nursing, Department of Environments for Health, Indianapolis, IN.Anna McDaniel, RN, DNS, FAAN, is Professor of Nursing and Informatics at the Indiana University Schools of Nursing and Informatics, Indianapolis, IN.Irene Ke, MS, MLS, is the Director of Library Instruction and Information Literacy Program at the MD Anderson Library, University of Houston, Houston, TX
| | - Irene Ke
- Carol Shieh, RNC, MPH, DNSc, is an Assistant Professor at the Indiana University School of Nursing, Department of Environments for Health, Indianapolis, IN.Anna McDaniel, RN, DNS, FAAN, is Professor of Nursing and Informatics at the Indiana University Schools of Nursing and Informatics, Indianapolis, IN.Irene Ke, MS, MLS, is the Director of Library Instruction and Information Literacy Program at the MD Anderson Library, University of Houston, Houston, TX
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Reconciling the differences between health promotion in nursing and ‘general’ health promotion. Int J Nurs Stud 2009; 46:865-74. [DOI: 10.1016/j.ijnurstu.2008.12.014] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2008] [Revised: 11/26/2008] [Accepted: 12/28/2008] [Indexed: 11/30/2022]
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Shakespear K, Waite PJ, Gast J. A Comparison of Health Behaviors of Women in Centering Pregnancy and Traditional Prenatal Care. Matern Child Health J 2009; 14:202-8. [DOI: 10.1007/s10995-009-0448-3] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2008] [Accepted: 01/15/2009] [Indexed: 11/28/2022]
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Klima C, Norr K, Vonderheid S, Handler A. Introduction of CenteringPregnancy in a public health clinic. J Midwifery Womens Health 2009; 54:27-34. [PMID: 19114236 DOI: 10.1016/j.jmwh.2008.05.008] [Citation(s) in RCA: 110] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2007] [Revised: 05/26/2008] [Accepted: 05/26/2008] [Indexed: 10/21/2022]
Abstract
CenteringPregnancy is a promising group visit prenatal care innovation that provides substantial health promotion content. Elements unique to group care include peer support and self-management training and activities. CenteringPregnancy was introduced at a large public health clinic serving predominantly low-income African American pregnant women. All prenatal care at this clinic was provided by certified nurse-midwives, and all providers were trained in the CenteringPregnancy model. One hundred and ten women received prenatal care in CenteringPregnancy groups. Focus groups of pregnant women, providers, and health center staff reported that the program benefited women despite implementation challenges such as scheduling changes. Compared to women in individual care, women in CenteringPregnancy had significantly more prenatal visits, increased weight gain, increased breast feeding rates, and higher overall satisfaction. This pilot project demonstrated that CenteringPregnancy can be implemented in a busy public health clinic serving predominantly low-income pregnant women and is associated with positive health outcomes.
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Affiliation(s)
- Carrie Klima
- University of Illinois at Chicago, Centering Pregnancy and Parenting Board of Directors, USA.
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