Experiences of Austrian mothers with mobility or sensory impairments during pregnancy, childbirth and the puerperium: a qualitative study

Women with disabilities, body image, and wellbeing: Assessing the effectiveness of dance sessions

INTRODUCTION

There is growing research evidence on bodily discourses and body image issues of women with disabilities. Within the art-based intervention repertoire for persons with disabilities, dance and movement-based therapies and interventions are gaining prominence. The aim of this study was to examine the impact of dance sessions (delivered online) on body image, body satisfaction/dissatisfaction, and wellbeing of women with disabilities.

METHOD

A quasi-experimental waitlist control design study was conducted with data collected at two time points: baseline or pre-test and five-months later or post-test. Outcomes were measured using the Body Image Scale and the WHO-5-Wellbeing Index.

RESULTS

The dance sessions were effective (Hedges' g = -0.56 -0.88; p < 0.01) and post-test body dissatisfaction scores were lower and wellbeing scores were higher for participants with a college degree or postgraduate degree, self-employed or students, and whose intervention compliance was above threshold (>50% dance sessions attended and corresponding homework sessions completed). Tobit regression models indicated that it was possible to estimate post-test outcomes due to dance sessions alone, controlling for significant socio-demographics.

DISCUSSION

The domain knowledge of non-pharmacological art-based interventions for persons with disabilities, particularly women, is supported.

CONCLUSIONS

Findings commend dance sessions as effective psychotherapeutic mechanisms to mitigate body dissatisfaction, improve body image and wellbeing of women with disabilities. Future research may focus on large-scale cross-sectional trials, variations in the repertoire for women with different disability types and histories, and qualitative narratives.

Women with disabilities and their motherhood: scoping review

This review aims to disclose the gaps and needs for acknowledging the rights to experience motherhood of women with disabilities. To do so, we map how much is known about these women's experience with motherhood, shedding light on their sexual and reproductive rights. The present work followed the scoping review by the Joanna Briggs Institute (JBI). This research is structured by elaborating the question, identifying the relevant studies, selecting the studies, extracting the data, sorting, summarizing, and creating reports based on the results. Results: we found 1050 articles, of which 53 were selected for the analysis. considering the different themes, we generated three axes: (1) infantilization, dehumanization, and discredit in the experience of motherhood; (2) obstetric ableism - an expression of violence in obstetrics; (3) reproductive justice - politicize motherhood and care. The study showed the urgent need to regard women with disabilities as people having the right to make sexual and reproductive health choices. Health professionals need permanent education to acknowledge and guarantee such a need as interweaving relationships to reach decision-making and autonomy.

Health equity for persons with disabilities: a global scoping review on barriers and interventions in healthcare services

BACKGROUND

Persons with disabilities experience health inequities in terms of increased mortality, morbidity, and limitations in functioning when compared to the rest of the population. Many of the poor health outcomes experienced by persons with disabilities cannot be explained by the underlying health condition or impairment, but are health inequities driven by unfair societal and health system factors. A synthesis of the global evidence is needed to identify the factors that hinder equitable access to healthcare services for persons with disabilities, and the interventions to remove these barriers and promote disability inclusion.

METHODS

We conducted a scoping review following the methodological framework proposed by Arksey and O'Malley, Int J Soc Res Methodol 8:19-32. We searched two scholarly databases, namely MEDLINE (Ovid) and Web of Science, the websites of Organizations of Persons with Disabilities and governments, and reviewed evidence shared during WHO-led consultations on the topic of health equity for persons with disabilities. We included articles published after 2011 with no restriction to geographical location, the type of underlying impairments or healthcare services. A charting form was developed and used to extract the relevant information for each included article.

RESULTS

Of 11,884 articles identified in the search, we included 182 articles in this review. The majority of sources originated from high-income countries. Barriers were identified worldwide across different levels of the health system (such as healthcare costs, untrained healthcare workforces, issues of inclusive and coordinated services delivery), and through wider contributing factors of health inequities that expand beyond the health system (such as societal stigma or health literacy). However, the interventions to promote equitable access to healthcare services for persons with disabilities were not readily mapped onto those needs, their sources of funding and projected sustainability were often unclear, and few offered targeted approaches to address issues faced by marginalized groups of persons with disabilities with intersectional identities.

CONCLUSION

Persons with disabilities continue to face considerable barriers when accessing healthcare services, which negatively affects their chances of achieving their highest attainable standard of health. It is encouraging to note the increasing evidence on interventions targeting equitable access to healthcare services, but they remain too few and sparce to meet the populations' needs. Profound systemic changes and action-oriented strategies are warranted to promote health equity for persons with disabilities, and advance global health priorities.

Maternal Health Experiences of Black Deaf and Hard of Hearing Women in the United States

INTRODUCTION

Deaf and hard of hearing (DHH) women are faced with numerous health inequities, including adverse pregnancy and birth outcomes. These outcomes are likely exacerbated for Black DHH women because of the intersection of disability and race. This study aimed to explore the pregnancy and birth experiences of Black DHH women to identify factors that influence their pregnancy outcomes.

METHODS

Semistructured interviews were conducted between 2018 and 2019 with 67 DHH women who gave birth in the past five years. The present study represents a subgroup analysis of eight of the 67 women who self-identified as Black. Interviews were recorded, transcribed, and analyzed for emerging themes.

RESULTS

Primary themes centered on unmet needs, barriers, and facilitators. Barriers included limited access to health information owing to communication difficulties and challenges obtaining accommodations. Key facilitators included the availability of sign language interpreters, familial support, and cultural understanding from providers. Participants emphasized these facilitators in their recommendations to providers and DHH women. Findings also underscored the critical role of recognizing cultural identity in perinatal health care delivery.

CONCLUSIONS

This study outlines themes that affect pregnancy and birthing experiences among Black DHH women in the United States. Study implications include a call to action for providers to prioritize communication accommodations, accessible information, and compassionate care for all Black DHH women. Furthermore, future work should explore the impact of cultural and racial concordance between patients and their health care providers and staff. Understanding how intersectional identities affect perinatal health care access is crucial for reducing disparities among Black DHH women.

Experiences of Women with Disabilities in Accessing Maternal Healthcare Services: A South African Case Study

Access to maternal healthcare services is a challenge in most low- and middle-income countries. South Africa is one of the countries striving to improve the accessibility of maternal healthcare services. Although South Africa has put some interventions in place to improve the accessibility of maternal healthcare services, vulnerable women including women with disabilities are still facing numerous challenges when trying to access these services. The aim of this study was to explore the experiences of women with disabilities in the province of KwaZulu-Natal in South Africa in accessing public maternal healthcare services. The objectives of this study were to describe the experiences of women with disabilities in accessing maternal healthcare services during pregnancy, childbirth and post-partum care; explore the inhibitors of access to maternal healthcare services for women with disabilities; and explore the facilitators of access to maternal healthcare services for women with disabilities. Twelve women with disabilities (four with physical impairments, four with hearing impairments and four with visual impairments) were interviewed for this study. Data were transcribed verbatim and analysed utilising the Framework of Assessing Access to Maternal Healthcare Services by Peters et al., 2008. Our study found that narrow passages and information in inaccessible formats were a challenge for women with visual impairments. Women with hearing impairments faced communication difficulties due to the lack of sign language interpreters in most facilities. Moreover, healthcare professionals displayed unfavourable attitudes toward women with hearing impairments, and these women were often overlooked when seeking help. The women with physical impairments encountered inaccessible buildings, narrow passages, small consultation rooms and equipment that is not adjustable, such as beds and scales.

Experiences of women with impaired physical mobility during pregnancy, childbirth and postpartum: A case study

INTRODUCTION

The research deals with a little-studied topic in Estonia: the experiences of women with impaired physical mobility (IPM) during pregnancy, childbirth, and in the postpartum period. Women with IPM, a vulnerable group, have a higher risk of complications and a higher probability of missing out on comprehensive maternity care.

METHODS

The method of the present research is qualitative. It is a case study of three women with IPM with whom semi-structured interviews were conducted.

RESULTS

It was found that women with IPM encountered several obstacles and problems during pregnancy, childbirth, and the postpartum period; despite this, women's experiences with maternity care were mostly positive. Furthermore, there are several areas for improvement to ensure more comprehensive maternity care. Women with IPM need more support and help, and midwives are expected to have additional knowledge regarding the specifics or limitations resulting from mobility impairments.

CONCLUSIONS

In the future, the topic needs greater attention and improvement in the Estonian context to ensure more comprehensive maternity care for women with IPM. It is important to provide midwives the knowledge and skills to assist women with IPM during pregnancy, childbirth, and the postpartum period.

Experiencing motherhood as a blind mother in the Greater Accra Region of Ghana; a qualitative study

BACKGROUND

Females in developing countries are likely to suffer from visual impairment more than their male counterparts. People living with blindness or any other form of disability also have the right to reproduce and care for their children like all other humans. There is paucity of literature in the experiences of blind mothers in Ghana. Therefore, this study explored the experiences of blind mothers as they navigated the process of motherhood.

METHODS

Qualitative exploratory descriptive design was used to conduct the study. Nineteen blind mothers were interviewed individually. Permission was sought for data to be audiotaped, transcribed and content analyzed inductively.

RESULTS

Three main themes emerged from the data: mothering role and difficulties (sub-themes; feeding, disciplining and protection), mothering challenges (sub-themes; discrimination and prejudice, financial distress and psychological distress) and coping strategies (prayer, children and self-motivation). Most of the mothers reported difficulties in playing their roles in the areas of feeding, disciplining and protection. Challenges were poverty, discrimination, prejudices on their ability to be mothers and psychological distresses such as depression. They coped with their challenges with prayers, self motivation and the hope they had in their children.

CONCLUSION

A lot of public education is needed to make the lives of people living with disability better. Health professionals must be trained to treat blind mothers with dignity and respect.

Parenting with a physical disability: A scoping review of assessment methods

INTRODUCTION

Daily childcare can be challenging for parents with a physical disability who have young children. Occupational therapists are valuable facilitators to family participation. However, occupational therapists have reported significant gaps in knowledge when documenting the parenting role of parents with a physical disability in occupational therapy practice. This study explored and described the parenting assessment methods used with parents with a physical disability in the scientific literature.

METHODS

A scoping review was conducted, and search results were reviewed by two separate reviewers. The search strategy was applied to five databases (Embase, CINAHL, MEDLINE, HaPI, PsycInfo). Numerical and thematic analyses were conducted.

RESULTS

Four thousand one hundred fifty articles were screened, and 73 relevant scientific articles were included. Seventy-six assessment methods were identified, including 20 assessment instruments with few reported population-specific psychometric studies. Most assessments were conducted via interviews (n = 45), followed by questionnaires (n = 27), and only six were performance based. Parenting practices and experience were the two dimensions most assessed, with little attention given to parenting responsibility. Mothers with multiple sclerosis, spinal cord injury, rheumatoid arthritis, and cerebral palsy were the most assessed.

CONCLUSION

Further research is needed to develop specific, multidimensional, and validated parenting assessments for all parents with a physical disability, including performance-based assessments. Formal assessments should be conducted by professionals, including occupational therapists, who have the necessary training.

Pregnancy, Motherhood and Partner Support in Visually Impaired Women: A Qualitative Study

Background: This qualitative study aimed to explore the experiences of women with vision impairments regarding the meaning of motherhood and their mothering-related issues and priorities. Methods: In-depth individual, semi-structured interviews were conducted between July and December 2020 with a group of visually impaired mothers residing in Italy. The interviews explored experiences related to pregnancy, childbirth, and motherhood; support received from partners, family, and friends; ways of interacting and communicating with the child; and the participants’ sense of personal self-efficacy and self-awareness. Results: Fifteen women participated in this study, ten with a congenital visual impairment and five with an acquired disability. The mean age of the sample was 49 years. The qualitative content analysis of the transcripts of the interviews pointed out four main themes or categories: (1) pregnancy and motherhood experiences, (2) family and social support, (3) relationship and communication with the child, and (4) self-efficacy and self-awareness. Conclusions: This study underlined that mothers with visual impairments show a strong desire to be recognized and accepted as women and mothers by their social environment. Adequate social and family support is associated with a better sense of personal self-efficacy and greater confidence in one’s skills as a mother.

"Under great anxiety": Pregnancy experiences of Vietnamese women with physical disabilities seen through an intersectional lens

BACKGROUND

There is scant research on pregnancy experiences of women with physical disabilities in low and middle-income countries. This qualitative study used an intersectional lens to explore pregnancy experiences of women with physical disabilities in northern Vietnam. Specifically, socio-cultural, economic, and environmental influences were analysed, drawing upon their lived experiences.

METHODS

Two in-depth interviews were conducted at different time-points in 2018 with women with physical disabilities who had given birth in the previous three years. Twenty-nine women participated in the first interview and 27 in the follow-up interview. The interviews were thematically analysed.

RESULTS

The women were happy and excited when discovering their pregnancy but they also experienced anxiety, fear, and distress. Their ambivalence related to concerns around having a child with disabilities, their capability to carry a pregnancy, and their mothering abilities. Negative community views of disability were internalised by the women. These socio-culturally constructed beliefs led to lack of confidence in their pregnancy journey. This was exacerbated by inaccessible environments that contributed to increased risk of falls, and women who used wheelchairs experienced particular difficulties. Other powerful influences included poverty, lost income, and costs associated with pregnancy. Single mothers with disabilities experienced additional stigma and discrimination as Vietnamese society judged their pregnancies as socially unacceptable.

CONCLUSION

This study contributes to knowledge and understanding about women with physical disabilities, specifically how the intersection of gender, disability, socio-economic, and marital status shaped their pregnancy experiences in Vietnam. Multiple challenges were encountered by the women in their pregnancy journey, including negative community views, inaccessible environments, and poverty. The findings highlight the necessity for Vietnamese women with physical disabilities to be actively engaged in talking about their experiences to ensure maternal and child health providers become more sensitive to their pregnancy and motherhood needs.

Barriers in access to healthcare for women with disabilities: a systematic review in qualitative studies

Background

Studies show that different socio-economic and structural factors can limit access to healthcare for women with disabilities. The aim of the current study was to review barriers in access to healthcare services for women with disabilities (WWD) internationally.

Methods

We conducted a systematic review of relevant qualitative articles in PubMed, Web of Science and Scopus databases from January 2009 to December 2017. The search strategy was based on two main topics: (1) access to healthcare; and (2) disability. In this review, women (older than 18) with different kinds of disabilities (physical, sensory and intellectual disabilities) were included. Studies were excluded if they were not peer-reviewed, and had a focus on men with disabilities.

Results

Twenty four articles met the inclusion criteria for the final review. In each study, participants noted various barriers to accessing healthcare. Findings revealed that WWD faced different sociocultural (erroneous assumptions, negative attitudes, being ignored, being judged, violence, abuse, insult, impoliteness, and low health literacy), financial (poverty, unemployment, high transportation costs) and structural (lack of insurance coverage, inaccessible equipment and transportation facilities, lack of knowledge, lack of information, lack of transparency, and communicative problems) factors which impacted their access healthcare.

Conclusions

Healthcare systems need to train the healthcare workforce to respect WWD, pay attention to their preferences and choices, provide non-discriminatory and respectful treatment, and address stigmatizing attitudinal towards WWD. In addition, families and communities need to participate in advocacy efforts to promote WWD’s access to health care.

Parenting with a physical disability and cognitive impairments: a scoping review of the needs expressed by parents

PURPOSE

Parents, whose daily activities are limited by a disability, account for 6.2% of the American population with minor children. Considering the prevailing knowledge gaps concerning parents with a physical disability and cognitive impairments, there is an urgency to instigate an investigation of their unmet needs. In this study, we will examine the scope of literature relating to the specific needs of parents with a physical disability and cognitive impairments in early child rearing occupations.

METHODS

A scoping review of peer-reviewed literature was conducted by two independent raters in four databases (CINAHL, EMBASE, Medline, PsycINFO). Data were extracted and analyzed numerically and thematically using the International Classification of Functioning, Disability and Health (ICF).

RESULTS

Twenty-nine studies were included for review representing the needs of 113 parents. Emerging needs related to 15 ICF categories and three corresponding themes: parents' (1) needs when engaging with their young children, (2) personal needs in and outside the home, and (3) needs navigating the health system.

CONCLUSIONS

The unmet needs of parents with a physical disability and cognitive impairments legitimize the development of clinical services for this population. Future research should focus on developing assessments and interventions specific to parental needs in child rearing occupations.IMPLICATIONS FOR REHABILITATIONAdults with a physical disability and cognitive impairments who parent young children have unmet needs with regards to engaging in child rearing, meeting their personal needs, and navigating the health system.Studies reporting on the impact of impairments on parenting mostly focus on elucidating physical impairments and less so cognitive impairments.Developing a more comprehensive understanding of parental needs will inform further development of targeted assessments and interventions for parents with a physical disability and cognitive impairments.

Development of the Pregnancy and Motherhood Evaluation Questionnaire (PMEQ) for evaluating and measuring the impact of physical disability on pregnancy and the management of motherhood: a pilot study

PURPOSE

The aim of this study was to develop a questionnaire that allows researchers to investigate and measure the impact of physical disability on pregnancy and the management of motherhood. Such a questionnaire requires good internal consistency.

METHODS

The tool was developed following a study conducted in 2013 in the United States consisting of a semi-structured interview with open-ended questions. A team of three experts drafted and refined the questions, generating 31 retrospective, self-rated, and predefined questions (answered using a 5-point Likert scale). A statistical analysis of the instrument was also included, to assess its reliability and internal consistency.

RESULTS

The Pregnancy and Motherhood Evaluation Questionnaire (PMEQ) was prepared. It is a self-administered questionnaire consisting of an initial section and three subscales. In this phase of the study, 35 women with different pathologies leading to physical disability were recruited and completed the questionnaire. The PMEQ was found to have a good internal consistency. Cronbach's α was 0.812 (p > 0.05).

CONCLUSION

The PMEQ has proven to be a valid, reliable, and rapid administrative tool useful for investigating and measuring the impact of physical disability on the management of pregnancy and motherhood.IMPLICATION FOR REHABILITATIONThis study provides researchers and clinicians a new tool for the evaluation of motherhood and pregnancy in women with physical disabilities.The PMEQ has proven to be a valid, reliable, and rapid administrative tool (10 min) useful for investigating and measuring the impact of physical disability on the management of pregnancy and motherhood.It is a new tool useful in both clinical and research practice to underline the importance of carrying out preventive and woman-centered assistance interventions.This tool is useful for promoting the autonomous management of pregnancy and motherhood in women with physical disabilities, and improving these women's quality of life and sense of satisfaction and competence in managing maternal tasks.

Pregnancy and neonatal outcomes of women with disabilities: a nationwide population-based study in South Korea

We investigated (1) pregnancy and neonatal outcomes in women with and without disabilities, (2) time trends in deliveries, and (3) risks of pregnancy and neonatal complications among women with various disability types and severity. This was a nationwide population-based study merging the database of the Korea National Health Insurance claims, National Health Screening Program for Infants and Children, and Disability Registration System to compare perinatal outcomes in women with and without disabilities. Pregnancy and neonatal outcomes were analyzed during 2007 and 2015, as were time trends of deliveries. Multivariate logistic regression was used to evaluate risk of perinatal outcomes among women with various disability types and severities. Women with disabilities showed higher rates of cesarean section (aOR, 1.73; 95% CI, 1.69–1.77), hypertensive disorders (aOR, 1.74; 95% CI, 1.63–1.86), placenta abruption (aOR, 1.27; 95% CI, 1.12–1.45), placenta previa (aOR, 1.14; 95% CI, 1.05–1.24), stillbirths (aOR, 1.30; 95% CI, 1.17–1.45), preterm births (aOR, 1.67; 95% CI, 1.57–1.78), and LBW (aOR, 1.87; 95% CI, 1.78–1.97) than those without disabilities. From 2007 to 2015, although delivery rate in women with disabilities decreased steeply compared with that in women without disabilities, the rate of cesarean section increased in women with disabilities. Women with intellectual disability and those with vision impairment had the highest number of perinatal complications among women with various types of disabilities. Women with disability had more adverse pregnancy and neonatal outcomes than those without disabilities. Specific disability types & severities are more vulnerable to specific perinatal complications.

Confronting the culture of care: a call to end disrespect, discrimination, and detainment of women and newborns in health facilities everywhere

Quality and respect are increasingly recognized as critical aspects of the provision of health care, and poor quality may be an essential driver of low health care utilization, especially for maternal and neonatal care. Beyond differential access to care, unequal levels of quality exacerbate inequity, and those who need services most, including displaced, migrant, and conflict-affected populations, may be receiving poorer quality care, or may be deterred from seeking care at all.Examples from around the world show that mothers and their children are often judged and mistreated for presenting to facilities without clean or "modern" clothing, without soap or clean sheets to use in the hospital, or without gifts like sweets or candies for providers. Underfunded facilities may rely on income from those seeking care, but denying and shaming the poor further discriminates against vulnerable women and newborns, by placing additional financial burden on those already marginalized.The culture of care needs to shift to create welcoming environments for all care-seekers, regardless of socio-economic status. No one should fear mistreatment, denial of services, or detainment due to lack of gifts or payments. There is an urgent need to ensure that health care centers are safe, friendly, respectful, and hospitable spaces for women, their newborns, and their families.

Optimizing Organ Donation: Expert Opinion from Austria, Germany, Spain and the U.K

Background

Organ donation-rates using deceased donors and organizational approaches to organ donation differ drastically between countries at a similar level of health care as measured by the Euro Health Consumer Index (EHCI).

Material/Methods

Expert opinions from intensive care nurses, physicians, transplant coordinators and transplant surgeons from Austria, Germany, Spain, and the U.K. were obtained in semi-structured interviews followed by qualitative content analysis. Results were reported back to all interview partners to identify potential controversies and consensus recommendations.

Results

No controversies could be detected. On a variety of beneficial factors an interprofessional consensus between interview partners could be reached: A) The relevance of standardization of the screening for potential donors, the family approach and training; B) standards and best-practice procedures should be regulated and supervised by state authorities; C) full transparency and the prevention of scandals is essential; D) overburdened intensive care unit (ICU) doctors need to be supported by full-time in-house special nurses who organize donor evaluation, transport logistics and pastoral care, if required; E) public awareness campaigns are helpful; F) a broad public consensus on the concept of donation after brain and cardiac death is essential; G) incentives for the reporting of potential organ donors are inappropriate; H) an opt-out system alone is not sufficient.

Conclusions

Expert opinions from different professional backgrounds from different European health care systems reach a broad consensus on the most relevant issues for the improvement of organ donation.

Health professionals' views on maternity care for women with physical disabilities: a qualitative study

BACKGROUND

During pregnancy, childbirth and puerperium, women receive care from a range of health professionals, particularly midwives. To assess the current situation of maternity care for women with physical disabilities in Austria, this study investigated the perceptions and experiences of health professionals who have provided care for women with disabilities during pregnancy, childbirth and postpartum.

METHODS

The viewpoints of the participating health professionals were evaluated by means of semistructured interviews followed by an inductive qualitative content analysis of the interview transcripts, as proposed by Mayring.

RESULTS

Four main categories emerged from the inductive content analysis: (i) structural conditions and accessibility, (ii) interprofessional teamwork and cooperation, (iii) action competence, and (iv) diversity-sensitive attitudes. According to the participating health professionals, the structural conditions were frequently not suitable for providing targeted group-oriented care services. Additionally, a shortage of time and staff resources also limited the necessary flexibility of treatment measures in the care of mothers with physical disabilities. The importance of interprofessional teamwork for providing adequate care was highlighted. The health professionals regarded interprofessionalism as an instrument of quality assurance and team meetings as an elementary component of high-quality care. On the other hand, the interviewees perceived a lack of action competence that was attributed to a low number of cases and a corresponding lack of experience and routine. Regarding diversity-sensitive attitudes, it became apparent that the topic of mothers with physical disabilities in care posed challenges to health professionals that influenced their natural handling of the interactions.

CONCLUSION

The awareness of one's own attitudes towards diversity, in the perinatal context in particular, influences professional security and sovereignty as well as the quality of care of women with disabilities. There is a need for optimization in the support and care of women with physical disabilities during pregnancy, childbirth and puerperium.