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Runesha L, Yordan NT, Everett A, Mueller A, Patel E, Bisson C, Silasi M, Duncan C, Rana S. Patient perceptions of remote patient monitoring program for hypertensive disorders of pregnancy. Arch Gynecol Obstet 2024:10.1007/s00404-024-07580-5. [PMID: 38977439 DOI: 10.1007/s00404-024-07580-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2024] [Accepted: 06/04/2024] [Indexed: 07/10/2024]
Abstract
PURPOSE The utilization of remote patient monitoring (RPM) with home blood pressure monitoring has shown improvement in blood pressure control and adherence with follow-up visits. Patient perceptions regarding its use in the obstetric population have not been widely studied. The aim of this study was to assess patients' knowledge about hypertensive disorders of pregnancy and perceptions and satisfaction of the RPM program. METHODS Descriptive analysis of survey responses of patients with PPHTN enrolled into the RPM program for 6 weeks after delivery between October 2021 and April 2022. Surveys were automatically administered at 1-, 3-, and 6-week postpartum. Responses were further compared between Black and non-Black patient-reported race. RESULTS 545 patients received the RPM program. Of these, 306 patients consented to data collection. At 1 week, 88% of patients that responded reported appropriately that a blood pressure greater than 160/110 is abnormal. At 3 weeks, 87.4% of patients responded reported they were "very" or "somewhat" likely to attend their postpartum follow-up visits because of RPM. At 6 weeks, 85.5% of the patients that responded were "very" or "somewhat" satisfied with the RPM program. Responses were not statistically different between races. CONCLUSIONS Majority of postpartum patients enrolled in the RPM program had correct knowledge about hypertension. In addition, patients were highly satisfied with the RPM program and likely to attend postpartum follow-up based on responses. Further research is warranted to validate these findings and to address any barriers for patients who did not utilize the program.
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Affiliation(s)
- Lea Runesha
- Section of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Chicago Medicine, MC 2050, 5841 S. Maryland Avenue, Chicago, IL, 60637, USA
| | - Nora Torres Yordan
- Section of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Chicago Medicine, MC 2050, 5841 S. Maryland Avenue, Chicago, IL, 60637, USA
| | - Arin Everett
- Section of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Chicago Medicine, MC 2050, 5841 S. Maryland Avenue, Chicago, IL, 60637, USA
| | - Ariel Mueller
- Section of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Chicago Medicine, MC 2050, 5841 S. Maryland Avenue, Chicago, IL, 60637, USA
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Easha Patel
- Section of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Chicago Medicine, MC 2050, 5841 S. Maryland Avenue, Chicago, IL, 60637, USA
| | - Courtney Bisson
- Section of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Chicago Medicine, MC 2050, 5841 S. Maryland Avenue, Chicago, IL, 60637, USA
| | | | - Colleen Duncan
- Section of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Chicago Medicine, MC 2050, 5841 S. Maryland Avenue, Chicago, IL, 60637, USA
| | - Sarosh Rana
- Section of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Chicago Medicine, MC 2050, 5841 S. Maryland Avenue, Chicago, IL, 60637, USA.
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Fadhil PS, Mahmmod MB. Evaluation of Pregnant Women's Knowledge About Preeclampsia in the Kurdistan Region of Iraq: A Cross-Sectional Study. Cureus 2024; 16:e64134. [PMID: 39119423 PMCID: PMC11307491 DOI: 10.7759/cureus.64134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2024] [Indexed: 08/10/2024] Open
Abstract
INTRODUCTION Iraqi pregnant women have a higher prevalence of preeclampsia (PE) compared to pregnant women in neighboring developing nations. Several maternal characteristics, such as gestational weight gain (GWG), mode of delivery, and neonatal complications, have been linked to PE. The aim of this study is to evaluate the level of knowledge of pregnant women about PE. METHODS This cross-sectional study was conducted in the Kurdistan region in Iraq from 2022 to 2023. Data on women's knowledge was collected using a structured questionnaire consisting of 12 questions. The collected data was then analyzed using statistical methods such as the Mann-Whitney U test, Kruskal-Wallis test, and linear regression. RESULTS A total of 200 pregnant women diagnosed with PE and hypertension were included in the present study. The majority of participants (n=85; 42.5%) were between the ages of 28 and 37. Additionally, most participants (n=129; 64.5%) were from urban areas, with 45% (n=90) of them being obese. As for the participants' knowledge about PE, only 24.55% (n=49) were unaware of the correct answer, while 61% (n=122) stated that family history is not a risk factor for PE. On the other hand, 60% (n=120) of the participants were aware that previous PE is a risk factor for the current pregnancy, and 58.5% (n=117) indicated the importance of urine tests for pregnant women. Overall, the majority (n=144; 72%) had a low level of knowledge, while a small proportion (n=21; 10.5%) had good and high knowledge about PE. CONCLUSION The present study provides a comprehensive assessment of the knowledge of PE among Kurdish women, highlighting specific areas where intervention and education could potentially yield significant impact.
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Affiliation(s)
- Paywand S Fadhil
- Department of Maternity and Neonate Nursing, College of Nursing, University of Sulaimani, Sulaimani, IRQ
- Department of Midwifery, Erbil Medical Technical Institute, Erbil Polytechnic University, Erbil, IRQ
| | - Maryam B Mahmmod
- Department of Medical Education, College of Medicine, University of Sulaimani, Sulaimani, IRQ
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Cowan A, Haverty C, MacDonald R, Khodursky A. Impact of early preeclampsia prediction on medication adherence and behavior change: a survey of pregnant and recently-delivered individuals. BMC Pregnancy Childbirth 2024; 24:196. [PMID: 38481154 PMCID: PMC10935975 DOI: 10.1186/s12884-024-06397-z] [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: 08/15/2023] [Accepted: 03/07/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND Behavior change and medication adherence represent potential barriers to optimal prevention of pregnancy complications including preeclampsia. We sought to evaluate baseline sentiments on pregnancy care and medication amenability, and how these measures would be impacted by early predictive testing for preeclampsia. METHODS We developed a digital survey to query participants' baseline sentiments on pregnancy care, knowledge about pregnancy complications, and views on a hypothetical test to predict preeclampsia. The survey was administered online to pregnant and recently-delivered individuals in the United States. Survey data were analyzed using pooled two-sample proportion z-tests with adjustment for multiple comparisons. RESULTS One thousand and twenty-two people completed the survey. 84% reported they were satisfied with their pregnancy care. Self-assessed knowledge about preeclampsia was high, with 75% of respondents reporting they have a "good understanding" of preeclampsia, but measured knowledge was low, with only 10% able to identify five common signs/symptoms of preeclampsia. Notably, 40% of participants with prior preeclampsia believed they were at average or below-average risk for recurrence. 91% of participants desired early pregnancy predictive testing for preeclampsia. If found to be at high risk for preeclampsia, 88% reported they would be more motivated to follow their provider's medication recommendations and 94% reported they would desire home blood pressure monitoring. Increased motivation to follow clinicians' medication and monitoring recommendations was observed across the full spectrum of medication amenability. Individuals who are more medication-hesitant still reported high rates of motivation to change behavior and adhere to medication recommendations if predictive testing showed a high risk of preeclampsia. Importantly, a high proportion of medication-hesitant individuals reported that if a predictive test demonstrated they were at high risk of preeclampsia, they would feel more motivated to take medications (83.0%) and aspirin (75.9%) if recommended. CONCLUSION While satisfaction with care is high, participants desire more information about their pregnancy health, would value predictive testing for preeclampsia, and report they would act on this information. Improved detection of at-risk individuals through objective testing combined with increased adherence to their recommended care plan may be an important step to remedy the growing gap in prevention.
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Affiliation(s)
- Alison Cowan
- Mirvie, Inc., 820 Dubuque Ave, South San Francisco, CA, 94080, USA.
| | - Carrie Haverty
- Mirvie, Inc., 820 Dubuque Ave, South San Francisco, CA, 94080, USA
| | - Reece MacDonald
- Mirvie, Inc., 820 Dubuque Ave, South San Francisco, CA, 94080, USA
| | - Arkady Khodursky
- Mirvie, Inc., 820 Dubuque Ave, South San Francisco, CA, 94080, USA
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Bohsas H, Alibrahim H, Swed S, Abouainain Y, Aljabali A, Masoud S, Saleh HH, Aldawoud T, Taleb F, Alsheikh RA, Fawaz H, Mourad D, Mohamed WF, Aboushady R, Hafez W. Assessing pre-eclampsia awareness among pregnant women in Syria: a cross-sectional study on knowledge and perceptions. BMC Pregnancy Childbirth 2024; 24:185. [PMID: 38454336 PMCID: PMC10921594 DOI: 10.1186/s12884-024-06368-4] [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: 09/14/2023] [Accepted: 02/23/2024] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND Pre-eclampsia (PE) is a major contributor to morbidity and mortality in mothers worldwide. Adequate understanding of this condition improves treatment, control, and prevention. This study evaluated preeclampsia awareness among pregnant women in Syria, and the characteristics related to awareness adequacy. METHODS This national cross-sectional study was conducted in Syria between 25 October and November 19, 2022. We included pregnant females of all age groups from all Syrian governorates. The questionnaire consisted of sociodemographic characteristics and knowledge of pre-eclampsia and its associated factors, symptoms, and complications. RESULTS Overall, 706 participants were involved in this research, with a mean age of 38.22. Only 52.1% of them reported that they had heard of preeclampsia. Among the participants, 56.5% stated that they would not terminate a pregnancy if they were determined to be likely to develop preeclampsia, while nearly 55.2% agreed to continue the pregnancy rather than deliver prematurely even if their where a potential risk on their health risks. Participants who reported a family history of PE or had already experienced PE were more likely to have appropriate preeclampsia knowledge than those who did not (OR = 2.27, OR = 3.18, respectively). Respondents aged 25 to 35 years had the highest knowledge scores, and participants living in cities scored higher knowledge than rural residents. CONCLUSION According to our findings, pregnant women in Syria have a awareness gaps regarding the PE topic. This highlights the need to enhance women's preeclampsia understanding for better pregnancy outcomes. Education through organizations, the media, and national programs is a significant aspect that promotes an adequate understanding of preeclampsia.
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Affiliation(s)
| | | | - Sarya Swed
- Faculty of Medicine, Aleppo University, Aleppo, Syria.
| | | | | | - Samaa Masoud
- Faculty of medicine, Damascus university, Damascus, Syria
| | | | - Tony Aldawoud
- Faculty of medicine, Damascus university, Damascus, Syria
| | - Fahima Taleb
- Faculty of Medicine, Aleppo University, Aleppo, Syria
| | | | - Hassan Fawaz
- Faculty of medicine, Damascus university, Damascus, Syria
| | - Danya Mourad
- Al-hawash private university, Al-Mouzeina, Syria
| | | | - Reham Aboushady
- NMC Royal Hospital, 16th Street, Khalifa City, Abu Dhabi, UAE
| | - Wael Hafez
- NMC Royal Hospital, 16th Street, Khalifa City, Abu Dhabi, UAE
- Medical Research Division, Department of Internal Medicine, The National Research Centre, Cairo, Egypt
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Cramer EM, Babalola B, Agosto Maldonado LE, Chung JE. Health-related needs of survivors of hypertensive disorders of pregnancy: implications for health communication interventions. JOURNAL OF COMMUNICATION IN HEALTHCARE 2024; 17:101-110. [PMID: 38165210 DOI: 10.1080/17538068.2023.2298522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
BACKGROUND Hypertensive disorders of pregnancy (HDP) are key contributors to maternal morbidity, mortality, and future risk of cardiovascular disease. This exploratory study aimed to unearth the health-related needs of women with a reported history of HDP by inquiring about preferences for care. METHOD Deductive, qualitative analysis was conducted of HDP survivors' retrospective 'wishes' about the care received. RESULTS In analyzing 244 open-ended, online survey responses, we identified a taxonomy of health-related needs arising across the trajectory of HDP: clinical information, needs requiring clinical knowledge, such as information about the etiology or prognosis of HDP; medical, needs associated with HDP intervention and management; logistical, needs regarding practical information, such as how to contact a provider or obtain the correct medical device; emotional, needs involving a desire for support or validation; and communication, needs for improved explanations and recognition of HDP. CONCLUSIONS A taxonomy of diverse health-related needs may assist clinicians in approaching HDP patients more holistically. Additionally, opportunities exist for health communication research to inform standard approaches to HDP-related communication flowing from provider to patient.
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Affiliation(s)
- Emily M Cramer
- Department of Strategic, Legal and Management Communication, Howard University, Washington, DC, USA
| | - Bukky Babalola
- Department of Communication Studies, Howard University, Washington, DC, USA
| | | | - Jae Eun Chung
- Department of Strategic, Legal and Management Communication, Howard University, Washington, DC, USA
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Elbarazi I, Alam Z, Ali N, Loney T, Al-Rifai RH, Al-Maskari F, Ahmed LA. Health literacy among pregnant women in the United Arab Emirates: The Mutaba'ah study. WOMEN'S HEALTH (LONDON, ENGLAND) 2024; 20:17455057231224179. [PMID: 38279806 PMCID: PMC10822065 DOI: 10.1177/17455057231224179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 10/09/2023] [Accepted: 12/12/2023] [Indexed: 01/29/2024]
Abstract
BACKGROUND Health literacy is the degree to which individuals can obtain, process, understand, and communicate health-related information. Health literacy among pregnant women, in particular, may have a significant impact on maternal and child health. In the United Arab Emirates, no previous studies have been carried out to investigate the health literacy levels of pregnant women. OBJECTIVE This study aimed to investigate antenatal health literacy levels and identify associated factors among pregnant Emirati women in the United Arab Emirates. DESIGN This analysis was based on the baseline cross-sectional data for pregnant women participating in the prospective cohort Mutaba'ah Study, recruited between May 2017 and August 2022. METHODS Participants completed a self-administered questionnaire during their antenatal visits that collected sociodemographic and pregnancy-related information. Adequacy of health literacy was assessed using the BRIEF health literacy screening tool with adequate health literacy defined as a score ⩾ 17. Regression modeling investigated the association between the pregnant women characteristics with having adequate health literacy level (ability to read and comprehend most patient education materials). RESULTS A total of 2694 responses to the BRIEF health literacy screening tool were analyzed. Approximately, three-quarters (71.6%) of respondents showed adequate health literacy, followed by marginal (22.8%), and limited (5.6%) health literacy levels, respectively. Higher education levels (adjusted odds ratio (aOR) = 1.74, 95% confidence interval = 1.46-2.08), employment (adjusted odds ratio = 1.35, 95% confidence interval = 1.10-1.65), and adequate social support (adjusted odds ratio = 1.69, 95% confidence interval = 1.26-2.28) were associated with adequate health literacy levels. Participants who expressed worry about birth were less likely to have adequate literacy levels (adjusted odds ratio = 0.70, 95% confidence interval = 0.58-0.85). CONCLUSION Nearly three-quarters of pregnant women have adequate health literacy. Nevertheless, measures including policies to sustain and enhance health literacy levels among all expectant mothers are required, with a specific focus on those having limited health literacy.
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Affiliation(s)
- Iffat Elbarazi
- Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Zufishan Alam
- Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Nasloon Ali
- Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Tom Loney
- College of Medicine, Mohammed Bin Rashid University, Dubai, United Arab Emirates
| | - Rami H Al-Rifai
- Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Fatma Al-Maskari
- Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Luai A Ahmed
- Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
- Zayed Bin Sultan Center for Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
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Radwan A, Al Naji M, Alyoubi N, Alsallat I, Alsulaimani Z, Ali Albeladi S, Sabban H, Abdou A, Alsamry A. Awareness and Knowledge of Pre-eclampsia Among Saudi Women of Reproductive Age. Cureus 2023; 15:e49233. [PMID: 38143610 PMCID: PMC10739410 DOI: 10.7759/cureus.49233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/22/2023] [Indexed: 12/26/2023] Open
Abstract
BACKGROUND Pre-eclampsia has emerged as a significant concern in maternal healthcare worldwide, impacting the health and well-being of expectant mothers and their unborn children. This study examines the extent of pre-eclampsia knowledge and awareness among Saudi women aged 18 to 49. Recognising informed and proactive healthcare decisions is pivotal in managing and preventing pre-eclampsia. METHODS It is a prospective cross-sectional community-based study design. We calculated a minimum sample size of 385 participants using the Raosoft online calculator, aiming for a 5% margin of error and a 95% confidence interval. The structured questionnaire was distributed via various social media platforms to collect the data. The questionnaire consisted of two sections, namely demographics and medical history. Additionally, the questionnaire explored pre-eclampsia risk factors, symptoms, and complications. We analysed data using the Statistical Package for the Social Sciences (SPSS) version 26 (IBM Corp., Armonk, NY). We applied statistical tests, including the Chi-squared test (χ2) and the Mann-Whitney test for non-parametric variables. RESULTS Most of our participants were young, with a mean age of 25.94 and single (69.5%). Moreover, many (68.8%) had a bachelor's degree. A notable portion of participants stated they had no family history (86.1%) of pre-eclampsia and (98.1%) no previous experience with pre-eclampsia. Approximately 50% recognised hypertension as a symptom, while 44.1% identified persistent headaches. However, complications such as fetal and maternal death were better-known consequences of pre-eclampsia. 11.3% of participants had adequate knowledge about pre-eclampsia, 39.3% had moderate knowledge, and 49.4% had inadequate knowledge. It is a fact that higher levels of knowledge are positively correlated with advanced age, prior pregnancy experience, and a family history of pre-eclampsia. CONCLUSION This study highlights the limited knowledge and awareness of pre-eclampsia among Saudi women of reproductive age. Addressing this knowledge gap is crucial for preventing pre-eclampsia-related maternal and fetal complications. Policymakers and healthcare providers should consider implementing educational programs to raise awareness and improve outcomes for pregnant women in Saudi Arabia and similar regions.
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Affiliation(s)
- Ashraf Radwan
- Obstetrics and Gynaecology, King Abdulaziz University Faculty of Medicine, Jeddah, SAU
| | - Manar Al Naji
- Medicine, King Abdulaziz University Faculty of Medicine, Jeddah, SAU
| | - Nourah Alyoubi
- Medicine and Surgery, King Abdulaziz University Faculty of Medicine, Jeddah, SAU
| | - Iram Alsallat
- Obstetrics and Gynaecology, King Abdulaziz University Faculty of Medicine, Jeddah, SAU
| | | | | | - Hussein Sabban
- Obstetrics and Gynaecology, King Abdulaziz University Faculty of Medicine, Jeddah, SAU
| | - Abdulmageed Abdou
- Obstetrics and Gynaecology, King Abdulaziz University Faculty of Medicine, Jeddah, SAU
| | - Ali Alsamry
- Obstetrics and Gynaecology, King Abdulaziz University Faculty of Medicine, Jeddah, SAU
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Osman T, Keshk EA, Alghamdi AAS, Alghamdi MAA, Alghamdi MAA, Alzahrani AA, Alghamdi KN, Alzahrani YA, Alghamdi AA, Alghamdi RA. Awareness of Preeclampsia and Its Associated Factors Among Women in Al Baha Region, Saudi Arabia. Cureus 2023; 15:e49038. [PMID: 38116365 PMCID: PMC10729291 DOI: 10.7759/cureus.49038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/19/2023] [Indexed: 12/21/2023] Open
Abstract
BACKGROUND Preeclampsia is associated with the incidence of common fetal problems including intra-uterine growth restriction (IUGR), premature delivery oligohydramnios, placental abruption, fetal discomfort, and intrauterine fetal death. Pregnant women are not well-informed about preeclampsia, including its symptoms, risk factors, and consequences. The aim of the current study is to evaluate the awareness of preeclampsia and its associated factors among women in the Al Baha region, Saudi Arabia. METHODOLOGY An observational cross-sectional design was employed to assess the awareness of preeclampsia and its associated factors among women in the Al Baha region of Saudi Arabia. Data was collected from April 2023 to September 2023. A questionnaire was designed to gather information on participants' sociodemographic characteristics (such as age, educational level, and residency) and their awareness of preeclampsia, including knowledge about signs/symptoms, risk factors, and complications. RESULTS In the current study, we included 485 pregnant women. The majority of participants were aged 40 years or older (37.5%), followed by those aged 35-39 (20.4%). Among the participants, 70.9% confirmed that they had heard about pre-eclampsia before. The most common signs and symptoms were high blood pressure (47.4%), increased protein in urine (40.2%), continuous headache (39.2%), and vomiting/nausea (40.0%). Participants demonstrated awareness of obesity (29.7%), diabetes mellitus (35.5%), chronic hypertension (47.0%), and chronic kidney disease (31.3%) as major risk factors. Participants were aware of potential risks such as kidney disorders (34.6%), heart disorders (23.7%), and preterm delivery (50.9%). The analysis reveals that younger participants below 20 years old (3.3%) and lower educational levels (5.6%) had lower awareness of preeclampsia compared to older age groups. CONCLUSION The findings of this study highlight a reasonable level of preeclampsia awareness and knowledge among Saudi Arabian women residing in the Al Baha region. While the majority of participants were familiar with preeclampsia, there were significant knowledge gaps regarding the precise symptoms, risk factors, and consequences of the condition.
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Affiliation(s)
- Tajelsir Osman
- Obstetrics & Gynecology, Al Baha University, Al Baha, SAU
| | - Eman A Keshk
- Obstetrics & Gynecology, Al Baha University, Al Baha, SAU
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Fuller S, Kuenstler M, Snipes M, Miller M, Lutgendorf MA. Obstetrical health care inequities in a universally insured health care system. AJOG GLOBAL REPORTS 2023; 3:100256. [PMID: 37638226 PMCID: PMC10458343 DOI: 10.1016/j.xagr.2023.100256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2023] Open
Abstract
BACKGROUND Racial and ethnic disparities in health care exist and are rooted in long-standing systemic inequities. These disparities result in significant excess health care expenditures and are due to complex interactions between patients, health care providers and systems, and social and environmental factors. In perinatal care, these inequities also exist, with Black patients being 3 to 4 times more likely to die of childbirth compared with White patients. Similar health care inequities may also exist in the Military Health System despite universal health care coverage, stable employment, and social programs that benefit military families. OBJECTIVE This study aimed to evaluate racial disparities in obstetrical outcomes in the Military Health System. STUDY DESIGN This is a retrospective cohort study of deliveries from 2019 to 2021 in the Military Health System, which provides obstetrical care for approximately 35,000 annual deliveries. The study was conducted using National Perinatal Information Center data on cesarean delivery, postpartum hemorrhage, and severe maternal morbidity by race and ethnicity from direct-care military hospitals representing tertiary care medical centers and community hospitals in the United States and abroad. Chi-square analyses and binary logistic regression were used to compare groups. RESULTS The cohort included 68,918 deliveries. Of these, 32,358 (47%) were White, 9594 (13.9%) Black, 3120 (4.5%) Asian Pacific Islander, 456 (0.7%) American Indian/Alaska Native, 19,543 (28.4%) other, 3976 (5.8%) unknown, 7096 (10.3%) Hispanic, 58,009 (84.2%) non-Hispanic, and 4399 (6.4%) other ethnicity. Rates of cesarean delivery were significantly higher for Black (30%; odds ratio, 1.44; 95% confidence interval, 1.37-1.52), Asian Pacific Islander (27%; odds ratio, 1.24; 95% confidence interval, 1.14-1.35), and other (26%; odds ratio, 1.20; 95% confidence interval, 1.15-1.25) compared with White race (23%) (P<.001). Postpartum hemorrhage rates were higher for Black (5.9%; odds ratio, 1.11; 95% confidence interval, 1.00-1.24) and Asian Pacific Islander (7.7%; odds ratio, 1.49; 95% confidence interval, 1.29-1.72) compared with White race (5.3%) (P<.001). Severe maternal morbidity was higher for Black (2.9%; odds ratio, 1.44; 95% confidence interval, 1.24-1.67), Asian Pacific Islander (2.9%; odds ratio, 1.45; 95% confidence interval, 1.15-1.82), and other (2.8%; odds ratio, 1.36; 95% confidence interval, 1.21-1.54) compared with White race (2.1%) (P<.001). For severe maternal morbidity excluding blood transfusions, rates were also significantly higher for Black (1%; odds ratio, 1.68; 95% confidence interval, 1.30-2.17) than for White race (0.6%) (P<.002). Hispanic ethnicity was associated with a lower rate of severe maternal morbidity excluding transfusions (0.5%; odds ratio, 0.68; 95% confidence interval, 0.48-0.98) compared with non-Hispanic ethnicity (0.7%) (P=.04). CONCLUSION Racial disparities in obstetrical outcomes exist in the Military Health System despite universal health care coverage, with significantly higher rates of cesarean delivery and severe maternal morbidity in Black, Asian Pacific Islander, and other races compared with White race. These findings suggest that these disparities are likely related to other factors or social determinants of health rather than availability of health care and insurance coverage. Further work should include investigation into such social determinants of health to address their causes, including systemic and structural barriers.
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Affiliation(s)
- Shara Fuller
- Department of Gynecologic Surgery and Obstetrics, Naval Medical Center San Diego, San Diego, CA (Drs Fuller and Miller)
| | - Molly Kuenstler
- Department of Gynecologic Surgery and Obstetrics, Uniformed Services University of the Health Sciences, Bethesda, MD (Dr Kuenstler and Dr Lutgendorf)
| | - Marie Snipes
- Department of Mathematics and Statistics, Kenyon College, Gambier, OH (Dr Snipes)
| | - Michael Miller
- Department of Gynecologic Surgery and Obstetrics, Naval Medical Center San Diego, San Diego, CA (Drs Fuller and Miller)
| | - Monica A. Lutgendorf
- Department of Gynecologic Surgery and Obstetrics, Uniformed Services University of the Health Sciences, Bethesda, MD (Dr Kuenstler and Dr Lutgendorf)
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Püschl IC, de Wolff MG, Broberg L, Macklon N, Hegaard HK. Pregnant women's attitudes to and experiences with a smartphone-based self-test for prediction of pre-eclampsia: a qualitative descriptive study. BMJ Open 2023; 13:e065575. [PMID: 37221028 DOI: 10.1136/bmjopen-2022-065575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/25/2023] Open
Abstract
OBJECTIVES To explore attitudes to and experiences using a smartphone-based self-test for prediction of pre-eclampsia among pregnant women. DESIGN A qualitative, descriptive study. SETTING An obstetrical care unit at a university hospital in Denmark. PARTICIPANTS Twenty women who had participated in the Salurate trial, a clinical trial testing the efficacy of a smartphone-based self-test for prediction of pre-eclampsia, were purposefully chosen for the study, using maximum variation sampling. DATA COLLECTION AND ANALYSIS Data were collected by semistructured, individual, face-to-face interviews conducted from 4 October 2018 to 8 November 2018. Data were transcribed verbatim and analysed by means of thematic analysis. RESULTS Qualitative thematic analysis resulted in the identification of three main themes: Raising awareness, self-testing has the potential to be an integrated part of pregnancy and trusting in technology. Two subthemes were identified under each main theme. CONCLUSIONS The smartphone-based self-test for prediction of pre-eclampsia has potential to be integrated into antenatal care, and women found it feasible to use. However, testing affected the participating women psychologically, leading to feelings of worry as well as safety. Therefore, if self-testing is implemented, it is important to take actions to handle adverse psychological side effects, including increasing knowledge on pre-eclampsia and having healthcare professionals ongoingly address the psychological state of women throughout pregnancy. In addition, it is essential to emphasise the importance of subjective bodily sensations during pregnancy, including fetal movements. Further studies on the experience of being labelled low risk versus high risk for pre-eclampsia are warranted since this was not investigated in this trial.
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Affiliation(s)
- Ida Catharina Püschl
- Department of Gyneacology and Obstetrics, Zealand University Hospital, Roskilde, Denmark
- Department of Clinical Medicine, University of Copenhagen, Faculty of Health and Medical Sciences, Kobenhavn, Denmark
| | - Mie Gaarskjaer de Wolff
- The Research Unit for Women's, Children's and Families' Health, Juliane Marie Centre, Kobenhavn, Denmark
- Department of Gynaecology and Obstetrics, Hvidovre Hospital, Hvidovre, Denmark
| | - Lotte Broberg
- Department of Obstetrics, Copenhagen University Hospital, Rigshospitalet, Kobenhavn, Denmark
- Center for Clinical Research and Prevention, Frederiksberg University Hospital, Frederiksberg, Denmark
| | - Nick Macklon
- London Womens Clinic, London, UK
- Department of Gynecology and Obstetrics and ReproHealth Consortium, Zealand University Hospital Koge, Koge, Denmark
| | - Hanne Kristine Hegaard
- Department of Clinical Medicine, University of Copenhagen, Faculty of Health and Medical Sciences, Kobenhavn, Denmark
- Department of Obstetrics, Copenhagen University Hospital, Rigshospitalet, Kobenhavn, Denmark
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Adu-Bonsaffoh K, Tamma E, Nwameme A, Dako-Gyeke P, Srofenyoh E, Ansah EK, Grobbee DE, Franx A, Browne JL. Provision and experience of care among women with hypertension in pregnancy: a multi-center qualitative study in Ghana. Reprod Health 2023; 20:49. [PMID: 36966326 PMCID: PMC10039538 DOI: 10.1186/s12978-023-01593-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 03/05/2023] [Indexed: 03/27/2023] Open
Abstract
BACKGROUND Hypertensive disorders of pregnancy (HDP) remain a leading global health problem with complex clinical presentations and potentially grim birth outcomes for both mother and fetus. Improvement in the quality of maternal care provision and positive women's experiences are indispensable measures to reduce maternal and perinatal adverse outcomes. OBJECTIVE To explore the perspectives and lived experiences of healthcare provision among women with HDP and the associated challenges. METHODS A multi-center qualitative study using in-depth interviews (IDIs) and focus group discussions (FGDs) was conducted in five major referral hospitals in the Greater Accra Region of Ghana between June 2018 and March 2019. Women between 26 and 34 weeks' gestation with confirmed HDP who received maternity care services were eligible to participate. Thematic content analysis was performed using the inductive analytic framework approach. RESULTS Fifty IDIs and three FGDs (with 22 participants) were conducted. Most women were between 20 and 30 years, Akans (ethnicity), married/cohabiting, self-employed and secondary school graduates. Women reported mixed (positive and negative) experiences of maternal care. Positive experiences reported include receiving optimal quality of care, satisfaction with care and good counselling and reassurance from the health professionals. Negative experiences of care comprised ineffective provider-client communication, inappropriate attitudes by the health professionals and disrespectful treatment including verbal and physical abuse. Major health system factors influencing women's experiences of care included lack of logistics, substandard professionalism, inefficient national health insurance system and unexplained delays at health facilities. Patient-related factors that influenced provision of care enumerated were financial limitations, chronic psychosocial stress and inadequate awareness about HDP. CONCLUSION Women with HDP reported both positive and negative experiences of care stemming from the healthcare system, health providers and individual factors. Given the importance of positive women's experiences and respectful maternal care, dedicated multidisciplinary women-centered care is recommended to optimize the care for pregnant women with HDP.
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Affiliation(s)
- Kwame Adu-Bonsaffoh
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
- Department of Obstetrics and Gynaecology, University of Ghana Medical School, Korle-Bu, P.O. Box 77, Accra, Ghana.
- Holy Care Specialist Hospital, Accra, Ghana.
| | | | - Adanna Nwameme
- Department of Social and Behavioural Sciences, School of Public Health, University of Ghana, Accra, Ghana
| | - Phyllis Dako-Gyeke
- Department of Social and Behavioural Sciences, School of Public Health, University of Ghana, Accra, Ghana
| | - Emmanuel Srofenyoh
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Department of Obstetrics and Gynaecology, Greater Accra Regional Hospital (Ridge), Accra, Ghana
| | - Evelyn K Ansah
- Institute for Health Research, University of Health and Allied Sciences, Ho, Ghana
| | - Diederick E Grobbee
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Arie Franx
- Department of Obstetrics and Gynecology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Joyce L Browne
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
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12
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Geissler KH, Evans V, Cooper MI, Shaw SJ, Yarrington C, Attanasio LB. Content Analysis of Patient-Facing Information Related to Preeclampsia. Womens Health Issues 2023; 33:77-86. [PMID: 36328927 PMCID: PMC9772133 DOI: 10.1016/j.whi.2022.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 08/30/2022] [Accepted: 09/21/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND Previous research has shown pregnant people are not knowledgeable about preeclampsia, a significant cause of maternal morbidity and mortality. This lack of knowledge may impact their ability to report symptoms, comply with recommendations, and receive appropriate follow-up care. Pregnant people commonly seek information from sources outside their treating clinician, including pregnancy-specific books and online sources. We examined commonly used preeclampsia information sources to evaluate whether pregnant people are receiving up-to-date, guideline-based information. METHODS We conducted a content analysis of preeclampsia-related information in top-ranking websites and bestselling pregnancy books. We used American College of Obstetricians and Gynecologists preeclampsia guidelines to construct a codebook, which we used to examine source content completeness and accuracy. For each source, we analyzed information about preeclampsia diagnosis, patient-reported symptoms, risk factors, prevention, treatment, and complications. RESULTS Across 19 included sources (13 websites and 6 books), we found substantial variation in completeness and accuracy of preeclampsia information. We found high rates of mentions for preeclampsia symptoms. Risk factors were more commonly included in online sources than book sources. Most sources mentioned treatment options, including blood pressure medication and giving birth; however, one-third of online sources positively mentioned the nonrecommended treatment of bed rest. Prevention methods, including prenatal aspirin for high-risk pregnancies, and long-term complications of preeclampsia were infrequently mentioned. CONCLUSIONS Varying rates of accuracy in patient-facing preeclampsia information mean there is substantial room for improvement in these sources. Ensuring pregnant people receive current guideline-based information is critical for improving outcomes and implementing shared decision-making.
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Affiliation(s)
- Kimberley H Geissler
- Department of Health Promotion and Policy, University of Massachusetts School of Public Health and Health Sciences, Amherst, Massachusetts.
| | - Valerie Evans
- Department of Health Promotion and Policy, University of Massachusetts School of Public Health and Health Sciences, Amherst, Massachusetts
| | - Michael I Cooper
- Department of Health Promotion and Policy, University of Massachusetts School of Public Health and Health Sciences, Amherst, Massachusetts; Tufts University School of Medicine, Boston, Massachusetts
| | - Susan J Shaw
- Department of Health Promotion and Policy, University of Massachusetts School of Public Health and Health Sciences, Amherst, Massachusetts
| | - Christina Yarrington
- Boston Medical Center and Boston University School of Medicine, Boston, Massachusetts
| | - Laura B Attanasio
- Department of Health Promotion and Policy, University of Massachusetts School of Public Health and Health Sciences, Amherst, Massachusetts
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13
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Sakurai S, Mwilike B, Horiuchi S. Women's experiences with hypertensive disorders of pregnancy from a national referral hospital in Tanzania: A qualitative study. Jpn J Nurs Sci 2023; 20:e12513. [PMID: 36116438 DOI: 10.1111/jjns.12513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 07/22/2022] [Accepted: 08/22/2022] [Indexed: 01/05/2023]
Abstract
AIM This study aimed to explore the experiences among postpartum women with hypertensive disorders of pregnancy, from pregnancy to admission at a referral hospital in Tanzania. METHODS This was a descriptive cross-sectional design with purposive sampling. Data were collected from semi-structured in-depth interviews with postpartum women diagnosed with hypertensive disorders and who were admitted to the maternity ward of Muhimbili National Hospital. Data were analyzed using NVivo software for qualitative content analysis. RESULTS Fourteen women participated in interviews. Half were primipara and two-thirds had over four antenatal visits. Data analysis yielded four categories and 27 sub-categories. The four categories were: "I'm shocked; I thought I was normal," "The treatment journey," "What health care providers did and did not teach me," "I have a risky future; I hope health care providers can help me." CONCLUSION Women regarded themselves going from being normal to having a risk through the process of experiencing their treatments. They did not expect to be admitted or referred to a major hospital and while they demanded more information and education, they also expressed appreciation for their health care providers. Education during pregnancy addressing their needs and level of understanding is recommended for improvement of early detection and access to the health service.
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Affiliation(s)
| | - Beatrice Mwilike
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
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14
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Cramer EM, Chung JE, Li J. #Preeclampsiasurvivor and symbolic interactionism in women's maternal health. Health Care Women Int 2022; 45:852-871. [PMID: 36542786 DOI: 10.1080/07399332.2022.2142226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 10/27/2022] [Accepted: 10/27/2022] [Indexed: 12/24/2022]
Abstract
A hypertensive disorder of pregnancy and leading cause of maternal mortality worldwide, preeclampsia (PE) impacts approximately one in 25 pregnancies. Biomedical researchers continue to look for concrete causes and effective treatments for PE, but the experience of PE-the personal and socially constructed meanings surrounding the condition-remains under-researched. Using a symbolic interactionism approach, we examined Instagram posts accompanying the #preeclampsiasurvivor hashtag during Preeclampsia Awareness Month. Themes emerging from interpretive analysis of 98 posts (160 images) included the role of PE in redefining a woman's relationship to her body, reifying a woman's connection to her child, and illuminating the transitive aspects of a childbearing woman's identity. Additionally, PE survivors turned to Instagram to speak to an imagined, 'generalized sisterhood' of women sharing a common set of experiences. Our study is unique in its examination of the lived experiences of PE survivors.
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Affiliation(s)
- Emily M Cramer
- Department of Strategic, Legal and Management Communication, Howard University, Washington, DC, USA
| | - Jae Eun Chung
- Department of Strategic, Legal and Management Communication, Howard University, Washington, DC, USA
| | - Jiang Li
- Department of Electrical Engineering and Computer Science, Howard University, Washington, DC, USA
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15
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Robbins T, Musiyiwa M, Gidiri MF, Mambo V, Hill C, Sandall J, Hanlon C, Shennan AH. Developing shared understanding of pre-eclampsia in Haiti and Zimbabwe using Theory of Change. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0001352. [PMID: 36962848 PMCID: PMC10021157 DOI: 10.1371/journal.pgph.0001352] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 11/09/2022] [Indexed: 12/23/2022]
Abstract
Pre-eclampsia, a complex and multi-system disorder specific to pregnancy, is a leading cause of preventable maternal and perinatal deaths in low-resource settings. Early detection and appropriate intervention with management of hypertension, prevention of eclampsia and timely delivery are effective at reducing mortality and morbidity. Outcomes can be greatly improved with the provision and uptake of good quality care. Cultural contexts of maternal care, social practices and expectations around pregnancy and childbirth profoundly shape understanding and prioritisation when it comes to seeking out care. Few studies have addressed health education specifically targeting pre-eclampsia in low resource settings. The existing literature has limited descriptions of contextual barriers to care or of the intervention development processes employed. More engaging, holistic approaches to pre-eclampsia education for women and families that recognise the challenges they face and that support a shared understanding of the disorder, are needed. We describe our experience of developing a Theory of Change (ToC) as part of the co-production of educational resources for pre-eclampsia in Haiti and Zimbabwe.
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Affiliation(s)
- Tanya Robbins
- Department of Women & Children’s Health, School of Life Course and Population Science, King’s College London, St Thomas’ Hospital, London, United Kingdom
| | - Mickias Musiyiwa
- Department of History, Heritage and Knowledge Systems, Faculty of Arts and Humanities, University of Zimbabwe, Harare, Zimbabwe
| | - Muchabayiwa Francis Gidiri
- Department of Obstetrics and Gynaecology, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Violet Mambo
- Department of Obstetrics and Gynaecology, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | | | - Jane Sandall
- Department of Women & Children’s Health, School of Life Course and Population Science, King’s College London, St Thomas’ Hospital, London, United Kingdom
| | - Charlotte Hanlon
- Centre for Global Mental Health, Health Service and Population Research Department, and WHO Collaborating Centre for Mental Health Research and Training, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
- Department of Psychiatry, WHO Collaborating Centre for Mental Health Research and Capacity-Building, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Andrew H. Shennan
- Department of Women & Children’s Health, School of Life Course and Population Science, King’s College London, St Thomas’ Hospital, London, United Kingdom
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Nielsen LM, Hauge MG, Ersbøll AS, Johansen M, Linde JJ, Damm P, Nielsen KK. Women’s perceptions of cardiovascular risk after preeclampsia: a qualitative study. BMC Pregnancy Childbirth 2022; 22:832. [DOI: 10.1186/s12884-022-05179-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 10/13/2022] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Preeclampsia is associated with increased risk of cardiovascular disease later in life, but studies suggest that women with previous preeclampsia are not aware of this. Little is known about how these women perceive the condition and the associated long-term risks. We examined the experiences and perceptions of preeclampsia and the increased risk of cardiovascular disease (CVD) later in life among Danish women with previous preeclampsia and their attitudes towards CVD risk screening.
Methods
Ten individual semi-structured interviews were conducted with women with previous preeclampsia. Data were analysed using thematic analysis.
Results
We identified six themes: 1) Experiences and perceptions of being diagnosed with preeclampsia, 2) Awareness about increased risk of CVD later in life, 3) Knowledge as a precondition for action, 4) The perception of CVD risk as being modifiable, 5) Motivators for and barriers to a healthy lifestyle, and 6) Screening for CVD. Awareness of the severity of preeclampsia was limited prior to being diagnosed. Particularly among those with few or no symptoms, preeclampsia was perceived as a non-severe condition, which was further reinforced by the experience of having received very little information. Nonetheless, some women were shocked by the diagnosis and feared for the health of the offspring. Many women also experienced physical and psychological consequences of preeclampsia. Awareness of the increased risk of later CVD was lacking; yet, when informed, the women considered this to be essential knowledge to be able to act accordingly. The risk of future CVD was perceived to be partly modifiable with a healthy lifestyle, and the women expressed a need for counselling on appropriate lifestyle changes to reduce CVD risk. Other factors were also mentioned as imperative for lifestyle changes, including social support. The women were generally positive towards potential future screening for CVD because it could provide them with information about their health condition.
Conclusions
After preeclampsia, women experienced a lack of knowledge on preeclampsia and the increased risk of CVD later in life. Improved information and follow-up after preeclampsia, including guidance on CVD risk reduction and support from health professionals and family, are warranted.
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Adu-Bonsaffoh K, Tamma E, Nwameme AU, Browne JL. Health professionals' perspectives on clinical challenges in managing hypertensive disorders of pregnancy and recommendations for improving care: A multi-center qualitative study. Front Glob Womens Health 2022; 3:968914. [PMID: 36440321 PMCID: PMC9686376 DOI: 10.3389/fgwh.2022.968914] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 10/18/2022] [Indexed: 09/15/2023] Open
Abstract
Background Hypertensive disorders of pregnancy (HDP) are a leading cause of maternal mortality and morbidity globally despite the intensive international effort to improving maternal care. Substandard clinical care has emerged as a major contributing factor to the high maternal deaths associated with maternal hypertension globally and the impact is severer in low- and middle-income countries (LMICs). Context specific challenges impact negatively on the quality of maternity care and health providers play a crucial role in achieving positive pregnancy experiences for women. This study explored the perspectives of health professionals on the clinical challenges associated with the management of HDP in Ghana and recommendations for improving care. Methods A multi-center qualitative study using in-depth interviews (IDIs) was conducted in five major hospitals in the Greater Accra Region of Ghana between June 2018 and March 2019. Health professionals (midwives/nurses and medical doctors) who have worked at the study sites for at least three months were included. Data were analysed based on thematic content using Nvivo software. Results We included 62 health professionals comprising 40 midwives/nurses (64.5%) with a median age of 32.5 years (range 26 to 59) and 22 medical doctors (34.5%) with a median age of 34 years (range 25 to 55). Health providers highlighted major challenges associated with clinical management of hypertension in pregnancy: (1) patient-related factors (inadequate understanding and misconceptions about hypertension in pregnancy, women's non-compliance with clinical advice, financial constraints); (2) health system-related challenges (frequent unavailability of logistics, medications and laboratory support, delays in provision of care and limitations in the health insurance coverage); (3) health provider associated factors (inadequate number of health professionals and poor attitudes). Context-specific recommendations suggested for improving the quality of care in managing maternal hypertension include restructuring of the health system to reduce delays in providing care, improving financial coverage of medical insurance, encouraging social/family support, enhancing education on HDP and strengthening the health workers' numbers and working conditions. Conclusion Major challenges in the clinical management of HDP relate to the health system, health professionals and pregnant women themselves. Context-specific interventions are required to improve the quality of care for hypertensive mothers including regular health education, re-structuring of the health systems, refresher courses for health providers, improvement in health insurance coverage and government subsidy for hypertensive women.
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Affiliation(s)
- Kwame Adu-Bonsaffoh
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
- Department of Obstetrics and Gynaecology, University of Ghana Medical School, Accra, Ghana
- Holy Care Specialist Hospital, Accra, Ghana
| | | | - Adanna Uloaku Nwameme
- Department of Social and Behavioural Sciences, School of Public Health, University of Ghana, Accra, Ghana
| | - Joyce L. Browne
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
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18
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Meldgaard M, Gamborg M, Terkildsen Maindal H. Health literacy in the prenatal phase: a systematic review. SEXUAL & REPRODUCTIVE HEALTHCARE 2022; 34:100796. [DOI: 10.1016/j.srhc.2022.100796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 08/15/2022] [Accepted: 11/08/2022] [Indexed: 11/17/2022]
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Needs and preferences of women with prior severe preeclampsia regarding app-based cardiovascular health promotion. BMC Womens Health 2022; 22:427. [PMID: 36309668 PMCID: PMC9618195 DOI: 10.1186/s12905-022-02004-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 09/29/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Women with prior severe preeclampsia are at an increased risk for cardiovascular diseases later in life compared to women who had a normotensive pregnancy. The objective of this study was to assess their needs and preferences regarding app-based cardiovascular health promotion. METHODS Patients (n = 35) of the Follow-Up PreEClampsia Outpatient Clinic (FUPEC), Erasmus MC, the Netherlands, participated in an anonymous online survey. The main outcomes under study were women's needs for health behavior promotion, and their preferences with respect to intervention delivery. Descriptive statistics were used to evaluate needs, and thematic analysis was used to analyze preferences. RESULTS Women's primary need for health behavior promotion pertained to their fat and sugar intake and physical activity; for some, to their mental health (practices), fruit and vegetable intake, salt intake, and water intake; and for a few, to their alcohol and tobacco use. Most women preferred an app-based intervention to include, in descending order: the tracking of health-related metrics, an interactive platform, the use of behavior change strategies, the provision of information, and personalization. CONCLUSION Cardiovascular health promotion targeting women with prior severe preeclampsia should feel relevant to its audience. App-based interventions are likely to be well received if they target fat and sugar intake and physical activity. These interventions should preferably track health-related metrics, be interactive, contain behavior change strategies, provide information, and be personalized. Adopting these findings during intervention design could potentially increase uptake, behavior change, and behavior change maintenance in this population.
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Meldgaard M, Jensen AL, Johansen AD, Maimburg RD, Maindal HT. Health literacy and related behaviour among pregnant women with obesity: a qualitative interpretive description study. BMC Pregnancy Childbirth 2022; 22:712. [PMID: 36123636 PMCID: PMC9483451 DOI: 10.1186/s12884-022-05023-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 09/02/2022] [Indexed: 11/29/2022] Open
Abstract
Background Obesity in pregnant women is increasing worldwide, affecting the health of both mother and baby. Obesity may be associated with inadequate health literacy, a central competence when navigating antenatal health information and services. This study explores women’s health literacy by examining their knowledge, motivation and skills to access, understand and evaluate health information and the related behaviour among a sample of pregnant women with a prepregnant body mass index (BMI) > 25 kg/m2. Methods An inductive, qualitative study using an interpretive description methodology. Data was collected through ten semi-structured interviews with pregnant women with a prepregnancy BMI > 25 kg/m2 attending antenatal care at the midwifery clinic at Aarhus University Hospital in the Central Denmark Region. Results Pregnant women with obesity understand general health information provided by health professionals, but translating this knowledge into specific healthy behaviours presents a challenge. Although difficulties navigating booking systems and available digital services contribute to this problem, apps can help facilitate navigation. However, successful navigation may depend on adequate e-health literacy. Conflicting information from health professionals, social media and families also present a challenge for pregnant women, requiring a broad skillset for critical evaluation and resolution. Conclusions Adequate health literacy is necessary for pregnant women receiving antenatal care to (i) translate general health information into personalised healthy behaviour, (ii) access and navigate complex and digitalised systems, and (iii) critically evaluate conflicting information. Person-centred differentiation in the organisation of antenatal care may benefit vulnerable pregnant women with inadequate health literacy. Trial registration The study was registered cf. General Data Protection Regulation, Aarhus University Journal number 2016–051-000001, serial number 1934. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-022-05023-0.
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Affiliation(s)
- Maiken Meldgaard
- Department of Public Health, Aarhus University, Aarhus, Denmark.
| | | | | | - Rikke Damkjær Maimburg
- Department of Clinical Medicine & Department of Obstetrics and Gynaecology, Aarhus University Hospital, Aarhus, Denmark.,School of Nursing and Midwifery, Western Sydney University, Sydney, Australia
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Sauvegrain P, Camilleri C, Tessier V, Deneux C. [Women's Opinions on Information about Preeclampsia: An Online Survey]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2022; 50:499-501. [PMID: 35085714 DOI: 10.1016/j.gofs.2022.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 11/19/2021] [Accepted: 01/18/2022] [Indexed: 06/14/2023]
Affiliation(s)
- P Sauvegrain
- Équipe de recherche en épidémiologie obstétricale, périnatale et pédiatrique (Epopé), université de Paris, CRESS, Inserm, INRA, Paris, France; Service de maternité, AP-HP Pitié-Salpêtrière, DMU Origyne, France.
| | - C Camilleri
- Association Grossesse Santé contre la Prééclampsie, Paris, France
| | | | - C Deneux
- Équipe de recherche en épidémiologie obstétricale, périnatale et pédiatrique (Epopé), université de Paris, CRESS, Inserm, INRA, Paris, France
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22
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Bijl RC, Bangert SE, Shree R, Brewer AN, Abrenica-Keffer N, Tsigas EZ, Koster MPH, Seely EW. Patient journey during and after a pre-eclampsia-complicated pregnancy: a cross-sectional patient registry study. BMJ Open 2022; 12:e057795. [PMID: 35241475 PMCID: PMC8896051 DOI: 10.1136/bmjopen-2021-057795] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To gain insight into the patient journey through a pre-eclampsia-complicated pregnancy. DESIGN Cross-sectional patient registry study. SETTING Online patient registry initiated by the Preeclampsia Foundation. PARTICIPANTS Women with a history of pre-eclampsia enrolled in The Preeclampsia Registry (TPR). PRIMARY AND SECONDARY OUTCOME MEASURES Retrospective patient-reported experience measures concerning awareness of pre-eclampsia, timing and type of information on pre-eclampsia received, involvement in decision making regarding medical care, mental/emotional impact of the pre-eclampsia-complicated pregnancy and impact on future pregnancy planning. RESULTS Of 3618 TPR-participants invited to complete the Patient Journey questionnaire, data from 833 (23%) responders were available for analysis. Most responders were white (n=795, 95.4%) and lived in the USA (n=728, 87.4%). Before their pre-eclampsia diagnosis, 599 (73.9%) responders were aware of the term 'pre-eclampsia', but only 348 (43.7%) were aware of its associated symptoms. Women with a lower level of education were less likely to have heard of pre-eclampsia (OR 0.36, 95% CI 0.21 to 0.62). Around the time of diagnosis, 29.2% of responders did not feel involved in the decision making, which was associated with reporting a serious mental/emotional impact of the pre-eclampsia experience (OR 2.46, 95% CI 1.58 to 3.84). Over time, there was an increase in the proportion of women who were aware of the symptoms of pre-eclampsia (32.2% before 2011 to 52.5% after 2016; p<0.001) and in the proportion of responders stating they received counselling about the later-life health risks associated with pre-eclampsia (14.2% before 2011 to 25.6% after 2016; p=0.005). CONCLUSIONS This study demonstrates that improved patient education regarding pre-eclampsia is needed, that shared decision making is of great importance to patients to enhance their healthcare experience, and that healthcare providers should make efforts to routinely incorporate counselling about the later-life health risks associated with pre-eclampsia. TRIAL REGISTRATION NUMBER NCT02020174.
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Affiliation(s)
- Rianne C Bijl
- Department of Obstetrics and Gynaecology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Sophie E Bangert
- Department of Obstetrics and Gynaecology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Raj Shree
- Department of Obstetrics and Gynecology, University of Washington, Seattle, Washington, USA
| | - Alina N Brewer
- Preeclampsia Foundation, Melbourne, Florida, USA
- Juneau Biosciences LLC, Salt Lake City, Utah, USA
| | | | | | - Maria P H Koster
- Department of Obstetrics and Gynaecology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Ellen W Seely
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
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Fraser A, Markovitz AR, Haug EB, Horn J, Romundstad PR, Dalen H, Rich-Edwards J, Åsvold BO. Ten-Year Cardiovascular Disease Risk Trajectories by Obstetric History: A Longitudinal Study in the Norwegian HUNT Study. J Am Heart Assoc 2022; 11:e021733. [PMID: 35014852 PMCID: PMC9238539 DOI: 10.1161/jaha.121.021733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Women with a history of obstetric complications are at increased risk of cardiovascular disease, but whether they should be specifically targeted for cardiovascular disease (CVD) risk screening is unknown. Methods and Results We used linked data from the Norwegian HUNT (Trøndelag Health) Study and the Medical Birth Registry of Norway to create a population‐based, prospective cohort of parous women. Using an established CVD risk prediction model (A Norwegian risk model for cardiovascular disease), we predicted 10‐year risk of CVD (nonfatal myocardial infarction, fatal coronary heart disease, and nonfatal or fatal stroke) based on established risk factors (age, systolic blood pressure, total and high‐density lipoprotein cholesterol, smoking, antihypertensive use, and family history of myocardial infarction). Predicted 10‐year CVD risk scores in women aged between 40 and 60 years were consistently higher in those with a history of obstetric complications. For example, when aged 40 years, women with a history of preeclampsia had a 0.06 percentage point higher mean risk score than women with all normotensive deliveries, and when aged 60 years this difference was 0.86. However, the differences in the proportion of women crossing established clinical thresholds for counseling and treatment in women with and without a complication were modest. Conclusions Findings do not support targeting parous women with a history of pregnancy complications for CVD screening. However, pregnancy complications identify women who would benefit from primordial and primary prevention efforts such as encouraging and supporting behavioral changes to reduce CVD risk in later life.
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Affiliation(s)
- Abigail Fraser
- Population Health Sciences Bristol Medical School University of Bristol Bristol UK.,Medical Research Council Integrative Epidemiology Unit at the University of Bristol Bristol UK
| | - Amanda R Markovitz
- Department of Epidemiology Harvard T.H. Chan School of Public Health Boston MA.,Division of Women's Health Brigham and Women's Hospital Boston MA.,Connors Center for Women's Health and Gender BiologyBrigham and Women's Hospital Boston MA.,Mathematica Cambridge MA
| | - Eirin B Haug
- Population Health Sciences Bristol Medical School University of Bristol Bristol UK.,Medical Research Council Integrative Epidemiology Unit at the University of Bristol Bristol UK.,K.G. Jebsen Center for Genetic Epidemiology Department of Public Health and Nursing NTNUNorwegian University of Science and Technology Trondheim Norway
| | - Julie Horn
- HUNT Research Center Department of Public Health and Nursing NTNUNorwegian University of Science and Technology Levanger Norway.,Department of Obstetrics and Gynecology Levanger HospitalNord-Trøndelag Hospital Trust Levanger Norway
| | - Pål Richard Romundstad
- Department of Public Health and Nursing NTNUNorwegian University of Science and Technology Trondheim Norway
| | - Håvard Dalen
- Department of Medicine Levanger HospitalNord-Trøndelag Hospital Trust Levanger Norway.,Department of Circulation and Medical Imaging NTNUNorwegian University of Science and Technology Trondheim Norway.,Cardiac Clinic St Olavs HospitalTrondheim University Hospital Trondheim Norway
| | - Janet Rich-Edwards
- Department of Epidemiology Harvard T.H. Chan School of Public Health Boston MA.,Division of Women's Health Brigham and Women's Hospital Boston MA.,Connors Center for Women's Health and Gender BiologyBrigham and Women's Hospital Boston MA
| | - Bjørn Olav Åsvold
- K.G. Jebsen Center for Genetic Epidemiology Department of Public Health and Nursing NTNUNorwegian University of Science and Technology Trondheim Norway.,HUNT Research Center Department of Public Health and Nursing NTNUNorwegian University of Science and Technology Levanger Norway.,Department of Endocrinology Clinic of Medicine St. Olavs HospitalTrondheim University HospitalNorwegian University of Science and TechnologyNorwegian University of Science and Technology Trondheim Norway
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24
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Petersen CCM, Bilbo REQ, Damsted Rasmussen T, Ekstrøm CT, Villadsen SF. Knowledge About How to Manage Warning Signs of Pregnancy Complications Among Immigrants and Their Descendants Compared to Women of Danish Origin. Matern Child Health J 2022; 26:1367-1374. [PMID: 35000071 DOI: 10.1007/s10995-021-03298-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Ethnic differences in perinatal morbidity and mortality are starting points for social inequality in health. Increased incidence and severity of some pregnancy complications are found among immigrant women compared to ethnic majority women in high-income settings. However, little is known about immigrant women's assessment and management of warning signs. We aimed to assess women's knowledge about how to manage warning signs of pregnancy complications among immigrants and their descendants compared to women of Danish origin. METHODS A cross-sectional study including phone-based interviews with 1899 women. Women were interviewed during gestational week 30-37 in one of six languages. Maternal ethnicity was categorized as; immigrants, their descendants and ethnic Danes. The outcomes were yes or no to; do you know what to do if you experience 1) sudden swelling, redness, and heat in one leg 2) severe headache and 3) vaginal bleeding. RESULTS Immigrant women had lower levels of knowledge about how to manage all three types of warning signs of pregnancy complications compared to women of Danish origin. Adjusted OR for vaginal bleeding for women of European (4.33, 95% CI: 2.24-8.37), Asian (9.26, 95% CI: 5.10-16.83) and African (8.66, 95% CI: 3.26-23.05) origin. CONCLUSIONS FOR PRACTICE Immigrant women had lower levels of knowledge about how to manage warning signs of pregnancy complications compared to women of Danish origin. Improved needs-based health education in pregnancy complications and body symptoms during antenatal care is needed to address delays in the management of complications and could potentially improve the health of women and children.
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Affiliation(s)
- Clara Christine Mosborg Petersen
- Section of Social Medicine, Department of Public Health, University of Copenhagen, Oester Farimagsgade 5, Post box 2099, 1014, Copenhagen K, Denmark
| | - Rebecca Elisabeth Qwist Bilbo
- Section of Social Medicine, Department of Public Health, University of Copenhagen, Oester Farimagsgade 5, Post box 2099, 1014, Copenhagen K, Denmark
| | - Trine Damsted Rasmussen
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Oester Farimagsgade 5, Post box 2099, 1014, Copenhagen K, Denmark
| | - Claus Thorn Ekstrøm
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Oester Farimagsgade 5, Post box 2099, 1014, Copenhagen K, Denmark
| | - Sarah Fredsted Villadsen
- Section of Social Medicine, Department of Public Health, University of Copenhagen, Oester Farimagsgade 5, Post box 2099, 1014, Copenhagen K, Denmark.
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25
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Joshi A, Beyuo TK, Oppong SA, Moyer CA, Lawrence ER. 'I don't really understand this BP': Women's knowledge, attitudes, and experiences with preeclampsia in Ghana. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000121. [PMID: 36962267 PMCID: PMC10022332 DOI: 10.1371/journal.pgph.0000121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 06/13/2022] [Indexed: 11/18/2022]
Abstract
Preeclampsia and eclampsia are common and serious complications of pregnancies, often presenting as obstetric emergencies. In low- and middle-income countries, limited numbers of healthcare providers and a high volume of critically ill patients can negatively impact provider communication and counseling. Lack of knowledge or awareness of preeclampsia and eclampsia among pregnant women can lead to delays in health seeking behavior. Our study uses grounded theory to explore patients' experience of preeclampsia and eclampsia in a low-resource setting. Participants were postpartum women diagnosed with preeclampsia or eclampsia at Korle Bu Teaching Hospital in Ghana. Interviews consisted of semi-structured, open-ended questions regarding participant understanding of their diagnosis of preeclampsia and eclampsia; counseling from their healthcare providers; and experiences with their delivery, monitoring, and treatment. Qualitative thematic analysis was performed according to the Attride-Sterling analytical framework, using NVivo 12. A total of 45 women were interviewed, 88.9% with preeclampsia and 11.1% with eclampsia. Major themes identified include participants' low general knowledge of their diagnosis, inadequate counseling from healthcare providers, and resulting emotional distress. Women desire more information regarding their diagnosis and associate their health-seeking behaviors with counseling they receive from healthcare providers. Women also acknowledge the systemic barriers that make patient care and counseling challenging for providers, especially in low- and middle-income countries. These findings highlight the need for improved models of counseling and health education for women with pregnancies complicated by preeclampsia and eclampsia.
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Affiliation(s)
- Avina Joshi
- University of Massachusetts Medical School, Worcester, Massachusetts, United States of America
| | - Titus K Beyuo
- University of Ghana School of Medicine and Dentistry, Accra, Ghana
- Department of Obstetrics & Gynaecology, Korle Bu Teaching Hospital, Accra, Ghana
| | - Samuel A Oppong
- University of Ghana School of Medicine and Dentistry, Accra, Ghana
- Department of Obstetrics & Gynaecology, Korle Bu Teaching Hospital, Accra, Ghana
| | - Cheryl A Moyer
- Global REACH, University of Michigan Medical School, Ann Arbor, Michigan, United States of America
- Department of Obstetrics & Gynecology, University of Michigan Medical School, Ann Arbor, Michigan, United States of America
| | - Emma R Lawrence
- Department of Obstetrics & Gynecology, University of Michigan Medical School, Ann Arbor, Michigan, United States of America
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Helou A, Stewart K, Ryan K, George J. Pregnant women's experiences with the management of hypertensive disorders of pregnancy: a qualitative study. BMC Health Serv Res 2021; 21:1292. [PMID: 34856992 PMCID: PMC8638107 DOI: 10.1186/s12913-021-07320-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 11/08/2021] [Indexed: 11/26/2022] Open
Abstract
Background Hypertensive disorders are a leading cause of mortality and morbidity during pregnancy. Despite multiple national and international clinical guidelines and a plethora of research in the field of optimising management, there has been limited research describing the perspectives and experiences of pregnant women with the management of hypertensive disorders of pregnancy (HDP). Understanding these perceptions and experiences is imperative to the optimisation of HDP management. Methods A qualitative study involving face-to-face, in-depth interviews were undertaken with 27 pregnant women diagnosed with and being treated for HDP to explore their perspectives of and experiences with clinical management. Written consent was obtained individually from each participant, and the interviews ranged from 16 to 54 min. Inductive codes were generated systematically for the entire data set. Line-by-line analysis was then performed and nodes were created within NVivo, a qualitative data management software. Data collection was continued until thematic saturation was reached. Thematic analysis was employed to interpret the data. Results Three major descriptive themes were discerned regarding the women’s perspectives on and experiences with the management of HDP: attitudes towards monitoring of HDP, attitudes and perceptions towards development and management of complications, and perceptions of pregnant women with chronic hypertension. Trust in the hospital system, positive attitudes towards close blood pressure monitoring as well as self-monitoring of blood pressure, and a realistic approach to emergency antenatal hospital admissions contributed to a positive attitude towards monitoring of HDP. Women with prior experiences of HDP complications, including pre-eclampsia, were more confident in their clinical management and knew what to expect. Those without prior experience were often in shock when they developed pre-eclampsia. Some women with chronic hypertension displayed limited understanding of the potential risks that they may experience during pregnancy and thus lacked comprehension of the seriousness of the condition. Conclusions The clinical management experiences of pregnant women with HDP were varied. Many women did not feel that they were well informed of management decisions and had a desire to be more informed and involved in decision-making. Clear, concise information about various facets of HDP management including blood pressure monitoring, prescription of the appropriate antihypertensive agent, and planning for potential early delivery are required.
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Affiliation(s)
- Amyna Helou
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, 381 Royal Parade, Parkville, Melbourne, Victoria, Australia
| | - Kay Stewart
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, 381 Royal Parade, Parkville, Melbourne, Victoria, Australia
| | - Kath Ryan
- Reading School of Pharmacy, University of Reading, Whiteknights, Reading, RG6 6AP, UK
| | - Johnson George
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, 381 Royal Parade, Parkville, Melbourne, Victoria, Australia.
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27
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Shree R, Hatfield-Timajchy K, Brewer A, Tsigas E, Vidler M. Information needs and experiences from pregnancies complicated by hypertensive disorders: a qualitative analysis of narrative responses. BMC Pregnancy Childbirth 2021; 21:743. [PMID: 34724906 PMCID: PMC8561882 DOI: 10.1186/s12884-021-04219-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 10/06/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Incorporation of the patient voice is urgently needed in a broad array of health care settings, but it is particularly lacking in the obstetrical literature. Systematically derived information about patients' experience with hypertensive disorders of pregnancy (HDP), most notably preeclampsia, is necessary to improve patient-provider communication and ultimately inform patient-centered care and research. We sought to examine the information needs and experiences of individuals with pregnancies complicated by hypertensive disorders. METHODS We conducted a qualitative content analysis of narrative-responses to an open-ended question from the Preeclampsia Registry (TPR), an online registry hosted by the Preeclampsia Foundation. Individuals were invited to enroll in TPR via social media, web searches, and newsletters. We restricted our analysis to participants who self-reported a history of HDP and responded to the open-ended question, "Is there any information that you could have had at the time of this pregnancy that would have been helpful?". Available responses from July 2013 to March 2017 were included. Narrative responses were coded, reconciled, and thematically analyzed by multiple coders using an inductive approach. Our main outcome measures included participants' expressed needs and additional concerns with respect to their HDP pregnancy. RESULTS Of 3202 enrolled participants, 1850 completed the survey and self-reported having at least one pregnancy complicated by HDP, of which 895 (48.4%) responded to the open-ended question. Participants delivered in the United States (83%) and 27 other countries. Compared to non-responders, responders reported more severe HDP phenotypes and adverse offspring outcomes. We identified three principal themes from responses: patient-identified needs, management and counseling, and potential action. Responses revealed that participants' baseline understanding of HDP, including symptoms, management, therapeutic strategies, and postpartum complications, was demonstrably lacking. Responders strongly desired improved counseling so that both they and their providers could collaboratively diagnose, appropriately manage, and robustly and continuously communicate to facilitate a partnership to address any HDP complications. CONCLUSIONS Participants' responses regarding their HDP experience provide indispensable insight into the patient's perspectives. Our study suggests that improved education regarding possible HDP complications and transparency about the consideration of HDP and its associated outcomes during an evaluation are needed, and efforts to implement these strategies should be sought. TRIAL REGISTRATION The Preeclampsia Registry: NCT02020174.
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Affiliation(s)
- Raj Shree
- Division of Maternal Fetal Medicine, Department of Obstetrics & Gynecology, University of Washington, 1959 NE Pacific Street, Box 356460, Seattle, WA 98195 USA
| | - Kendra Hatfield-Timajchy
- Health Scientist, Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA USA
| | - Alina Brewer
- Preeclampsia Foundation, Predictive Laboratories, Inc., Melbourne, FL USA
| | | | - Marianne Vidler
- Department of Obstetrics & Gynecology, British Columbia Children’s Hospital Research Institute, University of British Columbia, Vancouver, BC Canada
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28
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Yee LM, Silver R, Haas DM, Parry S, Mercer BM, Wing DA, Reddy U, Saade GR, Simhan H, Grobman WA. Association of Health Literacy Among Nulliparous Individuals and Maternal and Neonatal Outcomes. JAMA Netw Open 2021; 4:e2122576. [PMID: 34468757 PMCID: PMC8411280 DOI: 10.1001/jamanetworkopen.2021.22576] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
IMPORTANCE Health literacy is considered an important social determinant of health that may underlie many health disparities, but it is unclear whether inadequate health literacy among pregnant individuals is associated with adverse maternal and neonatal outcomes. OBJECTIVE To assess the association between maternal health literacy and maternal and neonatal outcomes among nulliparous individuals. DESIGN, SETTING, AND PARTICIPANTS This was a secondary analysis of a large, multicenter cohort study of 10 038 nulliparous individuals in the US (2010-2013). Participants underwent 3 antenatal study visits and had detailed maternal and neonatal data abstracted. Data analysis was performed from July to December 2019. EXPOSURES Between 16 and 21 weeks of gestation, health literacy was assessed using the Rapid Estimate of Adult Literacy in Medicine-Short Form, a validated 7-item word recognition test. In accordance with standard scoring, results were dichotomized as inadequate vs adequate health literacy. MAIN OUTCOMES AND MEASURES On the basis of theoretical causal pathways between health literacy and health outcomes, a priori maternal and neonatal outcomes (determined via medical records) were selected for this analysis. Multivariable Poisson regression models were constructed to estimate the associations between health literacy and outcomes. Sensitivity analyses in which education was removed from models and that excluded individuals who spoke English as a second language were performed. RESULTS Of 9341 participants who completed the Rapid Estimate of Adult Literacy in Medicine-Short Form, the mean (SD) age was 27.0 (5.6) years, and 2540 (27.4%) had publicly funded prenatal care. Overall, 1638 participants (17.5%) had scores indicative of inadequate health literacy. Participants with inadequate health literacy were more likely to be younger (mean [SD] age, 22.9 [5.0] vs 27.9 [5.3] years), have less educational attainment (some college education or greater, 1149 participants [73.9%] vs 5279 participants [94.5%]), have publicly funded insurance (1008 participants [62.2%] vs 1532 participants [20.0%]), and report they were a member of an underrepresented racial or ethnic group (non-Hispanic Black, 506 participants [30.9%] vs 780 participants [10.1%]; Hispanic, 516 participants [31.5%] vs 948 participants [12.3%]) compared with those with adequate health literacy. Participants who had inadequate health literacy had greater risk of cesarean delivery (adjusted risk ratio [aRR], 1.11; 95% CI, 1.01-1.23) and major perineal laceration (aRR, 1.44; 95% CI, 1.03-2.01). The adjusted risks of small-for-gestational-age status (aRR, 1.34; 95% CI, 1.14-1.58), low birth weight (aRR, 1.33; 95% CI, 1.07-1.65), and 5-minute Apgar score less than 4 (aRR, 2.78; 95% CI, 1.16-6.65) were greater for neonates born to participants with inadequate health literacy. Sensitivity analyses confirmed these findings. CONCLUSIONS AND RELEVANCE These findings suggest that inadequate maternal health literacy is associated with a variety of adverse maternal and neonatal outcomes.
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Affiliation(s)
- Lynn M. Yee
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Robert Silver
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The University of Utah, Salt Lake City
| | - David M. Haas
- Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis
| | - Samuel Parry
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Brian M. Mercer
- Department of Obstetrics and Gynecology, The MetroHealth System, Case Western Reserve University, Cleveland, Ohio
| | - Deborah A. Wing
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of California, Irvine
| | - Uma Reddy
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Science, Yale University, New Haven, Connecticut
| | - George R. Saade
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston
| | - Hyagriv Simhan
- Department of Obstetrics, Gynecology, and Reproductive Science, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - William A. Grobman
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Helou A, Stewart K, Ryan K, George J. 'I wish my body was stronger': A qualitative study of attitudes and behaviours regarding treatment of hypertensive disorders of pregnancy. SAGE Open Med 2021; 9:20503121211032480. [PMID: 34349997 PMCID: PMC8287341 DOI: 10.1177/20503121211032480] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 06/24/2021] [Indexed: 11/17/2022] Open
Abstract
Objectives: To investigate pregnant women’s attitudes and behaviours towards hypertensive
disorders of pregnancy and their treatment. Methods: Face-to-face, in-depth interviews were undertaken with 27 pregnant women
diagnosed with and being treated for hypertensive disorders of pregnancy to
investigate attitudes and behaviours regarding the conditions and their
treatment. Written consent was obtained individually from each participant,
and the interviews ranged from 16 to 54 minutes. Data collection was
continued until thematic saturation was reached. Thematic analysis was
employed to interpret the data. Results: Four major themes emerged around beliefs and behaviours of pregnant women
regarding treatment of their hypertension: understanding of hypertensive
disorders of pregnancy and their implications, risks versus benefits of
antihypertensive medication during pregnancy, trust in medical professionals
and adherence to medication. The women’s level of understanding of
hypertensive disorders of pregnancy and their implications determined
whether they were able to make informed decisions about their treatment.
Prior experiences and concern for preservation of the pregnancy played major
roles in the perception of the risk/benefit balance of using
antihypertensive medication during pregnancy. The degree of trust in the
treating medical professionals varied according to the perception of their
confidence and knowledge. Conclusions: Sound understanding of the condition, a positive risk/benefit balance
regarding antihypertensive medication use during pregnancy, and trust in
medical professionals contributed to adherence to medication. Good
communication with healthcare professionals is important to achieve optimal
treatment.
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Affiliation(s)
- Amyna Helou
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, VIC, Australia
| | - Kay Stewart
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, VIC, Australia
| | - Kath Ryan
- School of Pharmacy, University of Reading, Reading, UK
| | - Johnson George
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, VIC, Australia
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Health Literacy in Pregnant Women: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18073847. [PMID: 33917631 PMCID: PMC8038834 DOI: 10.3390/ijerph18073847] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 03/30/2021] [Accepted: 04/01/2021] [Indexed: 02/06/2023]
Abstract
Health literacy plays a crucial role during pregnancy, as the mother’s health behavior influences both her own health and that of her child. To the authors’ best knowledge, no comprehensive overview on evidence of the health literacy of pregnant women and its impact on health outcomes during pregnancy exists. Therefore, this review aims to assess health literacy levels in pregnant women, whether health literacy is associated with outcomes during pregnancy and whether effective interventions exist to improve the health literacy of pregnant women. A systematic literature search was conducted in PubMed and EBSCO, resulting in 14 studies. The results show mixed levels of health literacy in pregnant women. Limited health literacy is associated with unhealthy behaviors during pregnancy. Mixed health literacy levels can be attributed to the recruitment site, the number of participants and the measurement tool used. Quality assessment reveals that the quality of the included studies is moderate to good. The review revealed that randomized controlled trials and interventions to improve health literacy in pregnant women are rare or do not exist. This is crucial in the light of the mixed health literacy levels found among pregnant women. Healthcare providers play a key role in this context, as pregnant women with limited health literacy rely on them as sources of health information.
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Joshi A, Beyuo T, Oppong SA, Moyer CA, Lawrence ER. Preeclampsia knowledge among postpartum women treated for preeclampsia and eclampsia at Korle Bu Teaching Hospital in Accra, Ghana. BMC Pregnancy Childbirth 2020; 20:625. [PMID: 33059625 PMCID: PMC7566025 DOI: 10.1186/s12884-020-03316-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 10/06/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Preeclampsia/eclampsia is a major cause of maternal morbidity and mortality worldwide, yet patients' perspectives about their diagnosis are not well understood. Our study examines patient knowledge among women with preeclampsia/eclampsia in a large urban hospital in Ghana. METHODS Postpartum women diagnosed with preeclampsia or eclampsia were asked to complete a survey 2-5 days after delivery that assessed demographic information, key obstetric factors, and questions regarding provider counseling. Provider counseling on diagnosis, causes, complications, and future health effects of preeclampsia/eclampsia was quantified on a 4-point scale ('Counseling Composite Score'). Participants also completed an objective knowledge assessment regarding preeclampsia/eclampsia, scored from 0 to 22 points ('Preeclampsia/Eclampsia Knowledge Score' (PEKS)). Linear regression was used to identify predictors of knowledge score. RESULTS A total of 150 participants were recruited, 88.7% (133) with preeclampsia and 11.3% (17) with eclampsia. Participants had a median age of 32 years, median parity of 2, and mean number of 5.4 antenatal visits. Approximately half of participants reported primary education as their highest level of education. While 74% of women reported having a complication during pregnancy, only 32% of participants with preeclampsia were able to correctly identify their diagnosis, and no participants diagnosed with eclampsia could correctly identify their diagnosis. Thirty-one percent of participants reported receiving no counseling from providers, and only 11% received counseling in all four categories. Even when counseled, 40-50% of participants reported incomplete understanding. Out of 22 possible points on a cumulative knowledge assessment scale, participants had a mean score of 12.9 ± 0.38. Adjusting for age, parity, and the number of antenatal visits, higher scores on the knowledge assessment are associated with more provider counseling (β 1.4, SE 0.3, p < 0.001) and higher level of education (β 1.3, SE 0.48, p = 0.008). CONCLUSIONS Counseling by healthcare providers is associated with higher performance on a knowledge assessment about preeclampsia/eclampsia. Patient knowledge about preeclampsia/eclampsia is important for efforts to encourage informed healthcare decisions, promote early antenatal care, and improve self-recognition of warning signs-ultimately improving morbidity and reducing mortality.
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Affiliation(s)
- Avina Joshi
- University of Massachusetts Medical School, 55 N. Lake Ave, Worcester, MA, 01655, USA
| | - Titus Beyuo
- University of Ghana School of Medicine and Dentistry, Slater Avenue, Accra, Ghana.
- Department of Obstetrics & Gynaecology, Korle Bu Teaching Hospital, Guggisberg Avenue, Accra, Ghana.
| | - Samuel A Oppong
- University of Ghana School of Medicine and Dentistry, Slater Avenue, Accra, Ghana
- Department of Obstetrics & Gynaecology, Korle Bu Teaching Hospital, Guggisberg Avenue, Accra, Ghana
| | - Cheryl A Moyer
- Global REACH, University of Michigan Medical School, 1301 Catherine St, Ann Arbor, MI, 48109, USA
- Department of Obstetrics & Gynecology, University of Michigan Medical School, 1500 E. Medical Center Dr, Ann Arbor, MI, 48109, USA
| | - Emma R Lawrence
- Department of Obstetrics & Gynecology, University of Michigan Medical School, 1500 E. Medical Center Dr, Ann Arbor, MI, 48109, USA
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Alnuaimi K, Abuidhail J, Abuzaid H. The effects of an educational programme about preeclampsia on women's awareness: a randomised control trial. Int Nurs Rev 2020; 67:501-511. [DOI: 10.1111/inr.12626] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 08/24/2020] [Accepted: 08/25/2020] [Indexed: 12/27/2022]
Affiliation(s)
- K. Alnuaimi
- Maternal and Child Health Nursing Department Faculty of Nursing Jordan University of Science and Technology IrbidJordan
| | - J. Abuidhail
- Department of Maternal, Child and Family Health Nursing Faculty of Nursing Hashemite University ZarqaJordan
| | - H. Abuzaid
- Jordan University of Science and Technology Irbid Jordan
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Strassberg ER, Fisher S, Mackeen AD, Sun H, Paglia MJ. Comparison of different methods of patient education on preeclampsia: a randomized controlled trial. J Matern Fetal Neonatal Med 2020; 35:2507-2511. [PMID: 32627621 DOI: 10.1080/14767058.2020.1786524] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Preeclampsia is a life-threatening condition unique to pregnancy that contributes to maternal mortality worldwide. Delays in diagnosis and treatment are contributing factors for most maternal deaths from preeclampsia. Patients who are educated and knowledgeable regarding this disease process may present earlier for care. OBJECTIVE To assess whether two different visual aids are effective methods to educate patients about preeclampsia, and to evaluate the potential impact of these visual aids on patient anxiety. STUDY DESIGN Primigravid participants at a tertiary care center were given a survey regarding preeclampsia knowledge 18-25 weeks gestation. Participants were then randomized to preeclampsia education with a graphic card, an educational video, or through routine prenatal care. Participants completed the survey again at 32-37 weeks gestation. We compared the follow-up preeclampsia knowledge score for each type of education as well as the level of anxiety after viewing the video or graphic card. RESULTS Recruitment began 9 May 2016 and ceased 18 January 2017. A total of 179 patients were randomized and 150 participants completed the study, with 56 shown the graphic card, 45 shown the educational video, and 49 who had only routine prenatal counseling. The remaining 28 patients were lost to follow up and 1 was withdrawn. There was no significant difference in preeclampsia knowledge score at follow-up. There was no significant difference in anxiety score before and after viewing either educational tool for those randomized to either the graphic card (p = .64) or the video (p = .63). CONCLUSIONS There is no additional improvement of patient knowledge retention when patients receive education with a graphic card versus an educational video over routine prenatal counseling. Patient anxiety does not appear to be impacted by preeclampsia education with a graphic card or an educational video.
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Affiliation(s)
| | - Sarah Fisher
- Department of Maternal-Fetal Medicine, Geisinger, Danville, PA, USA
| | - A Dhanya Mackeen
- Department of Maternal-Fetal Medicine, Geisinger, Danville, PA, USA
| | - Haiyan Sun
- Biostatistics Core, Geisinger, Danville, PA, USA
| | - Michael J Paglia
- Department of Maternal-Fetal Medicine, Geisinger, Danville, PA, USA
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Fondjo LA, Boamah VE, Fierti A, Gyesi D, Owiredu EW. Knowledge of preeclampsia and its associated factors among pregnant women: a possible link to reduce related adverse outcomes. BMC Pregnancy Childbirth 2019; 19:456. [PMID: 31791264 PMCID: PMC6888941 DOI: 10.1186/s12884-019-2623-x] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 11/22/2019] [Indexed: 12/20/2022] Open
Abstract
Background Pre-eclampsia (PE) is one of the leading causes of maternal morbidity and mortality globally. Adequate knowledge about a disorder contributes greatly to its prevention, control and management. This study assessed the level of knowledge of PE and evaluated the factors associated with knowledge adequacy among pregnant women attending antenatal care at a University Hospital in Kumasi-Ghana. Methods This cross-sectional study was conducted at the University Hospital in Kumasi, Ghana. A validated closed-ended questionnaire was used to collect socio-demographic information and history of PE. Knowledge of PE was assessed based on a series of questions regarding the awareness, signs/symptoms, risk factors and complications of PE. Responses were scored percentage-wise and grouped into low (< 60%), moderate (60–80%) and high (80–100%). Knowledge score was then re-stratified into adequate (% score of ≥60%) and inadequate knowledge of PE (% score of < 60%). Results The prevalence of inadequate and adequate knowledge of PE was 88.6% (mean score = 55.5 ± 4.3%) and 11.4% (mean score = 76.3 ± 5.9%), respectively. For participants with adequate knowledge of PE, 9.1% (mean score = 67.4 ± 6.9%) and 2.3% (mean score = 85.2 ± 5.1%) had moderate and high knowledge, respectively. Using univariate logistic regression models, being older (> 35 years old) [cOR = 3.09, 95%CI (0.88–10.88), p = 0.049] and having a higher level of education (> SHS education) [cOR = 4.45, 95%CI (2.18–9.10), p < 0.0001] were significantly associated with greater odds of having adequate knowledge of PE. After controlling for potential confounders in multivariate logistic regression analysis, we found higher level of education to be independently associated with adequate knowledge of PE [aOR = 2.87, 95%CI (1.31–6.30), p = 0.008]. Conclusion The knowledge of PE among pregnant women in Ghana is low. The prominent factor that facilitates adequacy of knowledge of PE is higher level of education.
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Affiliation(s)
- Linda A Fondjo
- Department of Molecular Medicine, SMS, KNUST, Kumasi, Ghana.
| | - Vivian E Boamah
- Department of Pharmaceutical Chemistry, KNUST, Kumasi, Ghana
| | - Adelaide Fierti
- Department of Biochemistry, University of Ghana, Accra, Ghana
| | - Dorcas Gyesi
- Department of Pharmaceutical Chemistry, KNUST, Kumasi, Ghana
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Pre-eclampsia Educational Tool Impact on Knowledge, Anxiety, and Satisfaction in Pregnant Women: A Randomized Trial. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2019; 41:960-970. [DOI: 10.1016/j.jogc.2018.10.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 08/27/2018] [Accepted: 10/20/2018] [Indexed: 11/22/2022]
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Parsa S, Khajouei R, Baneshi MR, Aali BS. Improving the knowledge of pregnant women using a pre-eclampsia app: A controlled before and after study. Int J Med Inform 2019; 125:86-90. [PMID: 30914185 DOI: 10.1016/j.ijmedinf.2019.03.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Revised: 02/11/2019] [Accepted: 03/04/2019] [Indexed: 01/23/2023]
Abstract
OBJECTIVE The objective of this study was to investigate the effect of a pre-eclampsia mobile application on the knowledge of pregnant women. METHODS Following development of a pre-eclampsia mobile application, we conducted a controlled before and after study during a three-month period in 2018. The study population consisted of pregnant women attended to obstetrician clinics and offices in Kerman, Iran of whom, 110 sample participants were divided into two intervention and control groups. The participants completed a questionnaire of pre-eclampsia knowledge at baseline and 1-month follow up. Data were analyzed using inferential statistics including chi-square, independent sample t-test, paired t-test and linear regression. RESULTS A total of 108 pregnant women with an average age of 28 years participated in this study. There was no significant difference between the scores of the two groups before the intervention (p=0.94). Their difference after the intervention was highly significant (p<0.001). The difference between the knowledge of the participants before and after the intervention was significant in the both groups (p<0.05). The results showed that the knowledge score of the participants after the intervention was significantly associated with their group and assessment score before the intervention (p<0.001). CONCLUSION The results showed that the use of a mobile-based educational application improves the knowledge of pregnant women about pre-eclampsia. Increasing women's knowledge about pre-eclampsia may enables them to identify its signs and symptoms, resulting in the early detection and management of this condition, and likely reduction of its adverse consequences. TRIAL REGISTRATION IRCT2017050633837N1.
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Affiliation(s)
- Sara Parsa
- Health Service Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Reza Khajouei
- Medical Informatics Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.
| | - Mohammad Reza Baneshi
- Modeling in Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Bibi Shahnaz Aali
- Physiology Research Center, Department of Obstetrics and Gynecology, Afzalipour Hospital, Kerman University of Medical Sciences, Kerman, Iran
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Malik A, Jee B, Gupta SK. Preeclampsia: Disease biology and burden, its management strategies with reference to India. Pregnancy Hypertens 2018; 15:23-31. [PMID: 30825923 DOI: 10.1016/j.preghy.2018.10.011] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 10/29/2018] [Accepted: 10/31/2018] [Indexed: 11/19/2022]
Abstract
Preeclampsia is the cause of significant maternal and fetal mortality and morbidity. It is characterized by new-onset hypertension and proteinuria after 20 weeks of gestation. Preeclamptic women and children born from preeclamptic pregnancies are at greater risk to develop severe cardiovascular complications and metabolic syndromes later in life. The incidence of preeclampsia is estimated to be seven times higher in developing countries as compared to the developed countries. This review summarizes the pathophysiology of preeclampsia, emerging new hypothesis of its origin, risk factors that make women susceptible to developing preeclampsia and the potential of various biomarkers being studied to predict preeclampsia. The health care of developing countries is continuously challenged by substantial burden of maternal and fetal mortality. India despite being a fast developing country, is still far behind in achieving the required maternal mortality rates as per Millennium Development Goals set by the World Health Organization. Further, this review discusses the prevalence of preeclampsia in India, health facilities to manage preeclampsia, current guidelines and protocols followed and government policies to combat this complication in Indian condition.
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Affiliation(s)
- Ankita Malik
- Reproductive Cell Biology Lab, National Institute of Immunology, Aruna Asaf Ali Marg, New Delhi 110 067, India.
| | - Babban Jee
- Department of Health Research, Ministry of Health and Family Welfare, Government of India, New Delhi 110 001, India
| | - Satish Kumar Gupta
- Reproductive Cell Biology Lab, National Institute of Immunology, Aruna Asaf Ali Marg, New Delhi 110 067, India.
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Ouasmani F, Engeltjes B, Haddou Rahou B, Belayachi O, Verhoeven C. Knowledge of hypertensive disorders in pregnancy of Moroccan women in Morocco and in the Netherlands: a qualitative interview study. BMC Pregnancy Childbirth 2018; 18:344. [PMID: 30134940 PMCID: PMC6106822 DOI: 10.1186/s12884-018-1980-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 08/14/2018] [Indexed: 11/10/2022] Open
Abstract
Background Hypertensive disorders in pregnancy (HDP) are the most common medical disorders in pregnancy and the greatest single cause of maternal mortality worldwide. Ethnicity appears to be a significant risk factor for pregnancy related mortality and for severe maternal morbidity. Most of the complications caused by HDP may be reduced by early detection and proper management. Health education during antenatal care attendance may play an important role in preventing the disease to aggravate. The purpose of this study was to investigate the status of knowledge that Moroccan pregnant women, both in Morocco and in the Netherlands, have of HDP in terms of symptoms, complications, treatment and management. Methods A qualitative research design was used to explore and describe the knowledge of HDP of pregnant Moroccan women. Interviews were held on the basis of a topic list. The interviews were recorded, transcribed, coded and analysed. Results Nineteen Moroccan women were interviewed, nine in the Netherlands and ten in Morocco. Half of them never heard about hypertension in pregnancy and had no knowledge of symptoms or alarm signals related to HDP. All women acknowledged the importance of knowledge of HDP because of the possibly dangerous complications. The interviewees stated that information on symptoms, alarm signs and complications is the most important information. Nearly all women stated that communicating information via movies was the most appropriate tool to inform Moroccan pregnant women about HDP. Conclusions The knowledge of Moroccan women, living in Morocco or in the Netherlands, of symptoms and alarm signs related to hypertensive disorders of pregnancy was very limited, if not absent. Since early detection provides the opportunity for follow-up management and/or treatment, this may reduce complications of HDP. Therefore, it is important to inform pregnant women about the signs and symptoms of HDP. Electronic supplementary material The online version of this article (10.1186/s12884-018-1980-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Fatima Ouasmani
- Laboratory of Genetic, Neuroendocrinology and Biotechnology, Faculty of Sciences, Ibn Tofail University, Kenitra, Morocco.,High Institute of Nursing Professions and Technical Health, Rabat, Morocco
| | | | - Bouchra Haddou Rahou
- Laboratory of Genetic, Neuroendocrinology and Biotechnology, Faculty of Sciences, Ibn Tofail University, Kenitra, Morocco.,High Institute of Nursing Professions and Technical Health, Rabat, Morocco
| | - Ouafae Belayachi
- School of Public Health, University of Montreal, Montreal, Canada
| | - Corine Verhoeven
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Midwifery Science, AVAG, Amsterdam Public Health research institute, Amsterdam, the Netherlands. .,Department of Obstetrics and Gynecology, Maxima Medical Centre, Veldhoven, The Netherlands.
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Rivera-Romero O, Olmo A, Muñoz R, Stiefel P, Miranda ML, Beltrán LM. Mobile Health Solutions for Hypertensive Disorders in Pregnancy: Scoping Literature Review. JMIR Mhealth Uhealth 2018; 6:e130. [PMID: 29848473 PMCID: PMC6000483 DOI: 10.2196/mhealth.9671] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Revised: 03/08/2018] [Accepted: 03/09/2018] [Indexed: 02/07/2023] Open
Abstract
Background Hypertensive disorders are the most common complications during pregnancy, occurring in 5% to 11% of pregnancies; gestational hypertension and preeclampsia are the leading causes of perinatal and maternal morbidity and mortality, especially in low- and middle-income countries (LMIC) where maternal and perinatal mortality ratios are still high. Pregnant women with hypertensive disorders could greatly benefit from mobile health (mHealth) solutions as a novel way to identify and control early symptoms, as shown in an increasing number of publications in the field. Such digital health solutions may overcome access limiting factors and the lack of skilled medical professionals and finances commonly presented in resource-poor environments. Objective The aim of this study was to conduct a literature review of mHealth solutions used as support in hypertensive disorders during pregnancy, with the objective to identify the most relevant protocols and prototypes that could influence and improve current clinical practice. Methods A methodological review following a scoping methodology was conducted. Manuscripts published in research journals reporting technical information of mHealth solutions for hypertensive disorders in pregnancy were included, categorizing articles in different groups: Diagnosis and Monitoring, mHealth Decision Support System, Education, and Health Promotion, and seven research questions were posed to study the manuscripts. Results The search in electronic research databases yielded 327 articles. After removing duplicates, 230 articles were selected for screening. Finally, 11 articles met the inclusion criteria, and data were extracted from them. Very positive results in the improvement of maternal health and acceptability of solutions were found, although most of the studies involved a small number of participants, and none were complete clinical studies. Accordingly, none of the reported prototypes were integrated in the different health care systems. Only 4 studies used sensors for physiological measurements, and only 2 used blood pressure sensors despite the importance of this physiological parameter in the control of hypertension. The reported mHealth solutions have great potential to improve clinical practice in areas lacking skilled medical professionals or with a low health care budget, of special relevance in LMIC, although again, no extensive clinical validation has been carried out in these environments. Conclusions mHealth solutions hold enormous potential to support hypertensive disorders during pregnancy and improve current clinical practice. Although very positive results have been reported in terms of usability and the improvement of maternal health, rigorous complete clinical trials are still necessary to support integration in health care systems. There is a clear need for simple mHealth solutions specifically developed for resource-poor environments that meet the United Nations Sustainable Development Goal (SDG); of enormous interest in LMIC.
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Affiliation(s)
| | - Alberto Olmo
- Department of Electronic Technology, Universidad de Sevilla, Sevilla, Spain
| | - Rocío Muñoz
- Instituto de Biomedicina de Sevilla (IBiS), Laboratorio de Hipertensión Arterial e Hipercolesterolemia, Servicio Andaluz de Salud / Consejo Superior de Investigaciones Científicas / Universidad de Sevilla, Seville, Spain
| | - Pablo Stiefel
- Instituto de Biomedicina de Sevilla (IBiS), Laboratorio de Hipertensión Arterial e Hipercolesterolemia, Servicio Andaluz de Salud / Consejo Superior de Investigaciones Científicas / Universidad de Sevilla, Seville, Spain.,Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - María Luisa Miranda
- Instituto de Biomedicina de Sevilla (IBiS), Laboratorio de Hipertensión Arterial e Hipercolesterolemia, Servicio Andaluz de Salud / Consejo Superior de Investigaciones Científicas / Universidad de Sevilla, Seville, Spain.,Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Luis M Beltrán
- Instituto de Biomedicina de Sevilla (IBiS), Laboratorio de Hipertensión Arterial e Hipercolesterolemia, Servicio Andaluz de Salud / Consejo Superior de Investigaciones Científicas / Universidad de Sevilla, Seville, Spain.,Hospital Universitario Virgen del Rocío, Sevilla, Spain
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Howell EA, Brown H, Brumley J, Bryant AS, Caughey AB, Cornell AM, Grant JH, Gregory KD, Gullo SM, Kozhimannil KB, Mhyre JM, Toledo P, D'Oria R, Ngoh M, Grobman WA. Reduction of Peripartum Racial and Ethnic Disparities: A Conceptual Framework and Maternal Safety Consensus Bundle. J Midwifery Womens Health 2018; 63:366-376. [PMID: 29684258 DOI: 10.1111/jmwh.12756] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 03/13/2018] [Indexed: 11/29/2022]
Abstract
Racial and ethnic disparities exist in both perinatal outcomes and health care quality. For example, black women are 3 to 4 times more likely to die from pregnancy-related causes and have more than a 2-fold greater risk of severe maternal morbidity than white women. In an effort to achieve health equity in maternal morbidity and mortality, a multidisciplinary workgroup of the National Partnership for Maternal Safety, within the Council on Patient Safety in Women's Health Care, developed a concept article for the bundle on reduction of peripartum disparities. We aimed to provide health care providers and health systems with insight into racial and ethnic disparities in maternal outcomes, the etiologies that are modifiable within a health care system, and resources that can be used to address these etiologies and achieve the desired end of safe and equitable health care for all childbearing women.
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Howell EA, Brown H, Brumley J, Bryant AS, Caughey AB, Cornell AM, Grant JH, Gregory KD, Gullo SM, Kozhimannil KB, Mhyre JM, Toledo P, D’Oria R, Ngoh M, Grobman WA. Reduction of Peripartum Racial and Ethnic Disparities: A Conceptual Framework and Maternal Safety Consensus Bundle. J Obstet Gynecol Neonatal Nurs 2018; 47:275-289. [DOI: 10.1016/j.jogn.2018.03.004] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Ejike DE, Ambrose B, Moses DA, Karimah MR, Iliya E, Sheu OS, Nganda P. Determination, knowledge and prevalence of pregnancy-induced hypertension/eclampsia among women of childbearing age at Same District Hospital in Tanzania. ACTA ACUST UNITED AC 2018. [DOI: 10.5897/ijmms2017.1343] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Affiliation(s)
| | - Gene Cole
- Health Science, Brigham Young University, Provo, USA
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National Partnership for Maternal Safety: Consensus Bundle on Severe Hypertension During Pregnancy and the Postpartum Period. Anesth Analg 2017; 125:540-547. [PMID: 28696959 DOI: 10.1213/ane.0000000000002304] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Complications arising from hypertensive disorders of pregnancy are among the leading causes of preventable severe maternal morbidity and mortality. Timely and appropriate treatment has the potential to significantly reduce hypertension-related complications. To assist health care providers in achieving this goal, this patient safety bundle provides guidance to coordinate and standardize the care provided to women with severe hypertension during pregnancy and the postpartum period. This is one of several patient safety bundles developed by multidisciplinary work groups of the National Partnership for Maternal Safety under the guidance of the Council on Patient Safety in Women's Health Care. These safety bundles outline critical clinical practices that should be implemented in every maternity care setting. Similar to other bundles that have been developed and promoted by the Partnership, the hypertension safety bundle is organized into four domains: Readiness, Recognition and Prevention, Response, and Reporting and Systems Learning. Although the bundle components may be adapted to meet the resources available in individual facilities, standardization within an institution is strongly encouraged. This commentary provides information to assist with bundle implementation.
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Bernstein PS, Martin JN, Barton JR, Shields LE, Druzin ML, Scavone BM, Frost J, Morton CH, Ruhl C, Slager J, Tsigas EZ, Jaffer S, Menard MK. Consensus Bundle on Severe Hypertension During Pregnancy and the Postpartum Period. J Midwifery Womens Health 2017; 62:493-501. [PMID: 28697534 DOI: 10.1111/jmwh.12647] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Accepted: 05/26/2017] [Indexed: 11/29/2022]
Abstract
Complications arising from hypertensive disorders of pregnancy are among the leading causes of preventable severe maternal morbidity and mortality. Timely and appropriate treatment has the potential to significantly reduce hypertension-related complications. To assist health care providers in achieving this goal, this patient safety bundle provides guidance to coordinate and standardize the care provided to women with severe hypertension during pregnancy and the postpartum period. This is one of several patient safety bundles developed by multidisciplinary work groups of the National Partnership for Maternal Safety under the guidance of the Council on Patient Safety in Women's Health Care. These safety bundles outline critical clinical practices that should be implemented in every maternity care setting. Similar to other bundles that have been developed and promoted by the Partnership, the hypertension safety bundle is organized into four domains: Readiness, Recognition and Prevention, Response, and Reporting and Systems Learning. Although the bundle components may be adapted to meet the resources available in individual facilities, standardization within an institution is strongly encouraged. This commentary provides information to assist with bundle implementation.
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Bernstein PS, Martin JN, Barton JR, Shields LE, Druzin ML, Scavone BM, Frost J, Morton CH, Ruhl C, Slager J, Tsigas EZ, Jaffer S, Menard MK. Consensus Bundle on Severe Hypertension During Pregnancy and the Postpartum Period. J Obstet Gynecol Neonatal Nurs 2017; 46:776-787. [PMID: 28709727 DOI: 10.1016/j.jogn.2017.05.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Complications arising from hypertensive disorders of pregnancy are among the leading causes of preventable severe maternal morbidity and mortality. Timely and appropriate treatment has the potential to significantly reduce hypertension-related complications. To assist health care providers in achieving this goal, this patient safety bundle provides guidance to coordinate and standardize the care provided to women with severe hypertension during pregnancy and the postpartum period. This is one of several patient safety bundles developed by multidisciplinary work groups of the National Partnership for Maternal Safety under the guidance of the Council on Patient Safety in Women's Health Care. These safety bundles outline critical clinical practices that should be implemented in every maternity care setting. Similar to other bundles that have been developed and promoted by the Partnership, the hypertension safety bundle is organized into four domains: Readiness, Recognition and Prevention, Response, and Reporting and Systems Learning. Although the bundle components may be adapted to meet the resources available in individual facilities, standardization within an institution is strongly encouraged. This commentary provides information to assist with bundle implementation.
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Wotherspoon AC, Young IS, McCance DR, Holmes VA. Exploring knowledge of pre-eclampsia and views on a potential screening test in women with type 1 diabetes. Midwifery 2017; 50:99-105. [PMID: 28399474 DOI: 10.1016/j.midw.2017.03.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Revised: 03/20/2017] [Accepted: 03/29/2017] [Indexed: 11/19/2022]
Abstract
OBJECTIVE to explore knowledge of pre-eclampsia and opinions on potential screening tests for pre-eclampsia in women with type 1 diabetes. DESIGN a qualitative study using semi-structured interviews of women planning a pregnancy, currently pregnant or post-partum with experience of pre-eclampsia. SETTING, PARTICIPANTS AND METHODS: eleven women with type 1 diabetes were recruited from a pre-pregnancy planning clinic or antenatal clinic. Semi-structured interviews were conducted with the women, asking a series of open-ended questions about their current knowledge of pre-eclampsia and their views on screening for pre-eclampsia. Data analysis was conducted using inductive thematic analysis. FINDINGS four main themes were identified: Information, sources of stress, awareness and acceptability of screening. Generally, women's knowledge of pre-eclampsia was limited. Most did not appear to be aware of their increased risk of developing the disease. Similarly, the majority of women were unaware as to why their blood pressure and urine were checked regularly. The introduction of a screening test for pre-eclampsia was favoured, with only a small number of women raising concerns related to the screening tests. CONCLUSIONS health care professionals need to raise awareness of pre-eclampsia in this high risk group. The introduction of a screening test for pre-eclampsia appears to be acceptable in this population, however, further research is required to validate these findings and also to explore the views of women in other high risk groups.
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Affiliation(s)
- Amy C Wotherspoon
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - Ian S Young
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - David R McCance
- Regional Centre for Endocrinology and Diabetes, Royal Victoria Hospital, Belfast, UK
| | - Valerie A Holmes
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK.
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Carter W, Bick D, Mackintosh N, Sandall J. A narrative synthesis of factors that affect women speaking up about early warning signs and symptoms of pre-eclampsia and responses of healthcare staff. BMC Pregnancy Childbirth 2017; 17:63. [PMID: 28193255 PMCID: PMC5309733 DOI: 10.1186/s12884-017-1245-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2016] [Accepted: 02/04/2017] [Indexed: 11/10/2022] Open
Abstract
Background One of the challenges for treating pre-eclampsia and preventing further deterioration is determining how best to enable early detection. If women or their partners and families are able to raise early warnings about potential signs and symptoms of pre-eclampsia in pregnancy, birth and in the postnatal period, women may be able to receive earlier intervention to prevent severe pre-eclampsia from developing. The aim of this study was to improve understanding of factors affecting the ability of women to recognise symptoms and signs of pre-eclampsia/eclampsia and seek appropriate medical help and factors affecting health care professionals’ responses to women and their families who ‘speak up’ about early warning signs and symptoms. Methods A narrative synthesis was conducted of evidence relevant to address the research question. The following electronic data bases were searched for qualitative studies which met inclusion criteria from January 1980 to April 2016; Medline, CINAHL, HMIC, PsycINFO, Embase, BNI, ASSIA, Scopus, Maternity and Infant Care, Web of Science, Google Scholar, Cochrane, JBI and IBSS with the support of an Information Service Consultant. Results Following thematic analysis, three themes were identified; 1: Women’s understanding and knowledge of pre-eclampsia/eclampsia; 2: Factors affecting help seeking behaviour from perspectives of women and their families’; 3: Factors affecting staff response. There was widespread lack of knowledge and understanding of signs and symptoms of pre-eclampsia/eclampsia among women and their families, with some women not exhibiting signs and symptoms of pre-eclampsia or unable to distinguish them from ‘normal’ pregnancy changes. Conclusions Women and their families not only need to be made aware of signs and symptoms of pre-eclampsia/eclampsia but also require information on the most effective ways to seek urgent medical assessment and care. Some women did not experience prodromal signs and symptoms, which raises concerns about how women and families can detect early onset, and is an issue which needs further exploration. There is very limited research exploring clinical staff response to women who raise concerns about their health when experiencing symptoms and signs of pre-eclampsia/eclampsia with further research needed if safety and quality of care are to be improved.
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Affiliation(s)
- Wendy Carter
- King's College London, Division of Women's Health, Faculty of Life Sciences and Medicine, London, UK. .,King's College London, Women's Health Academic Centre, King's Health Partners, 10th Floor North Wing, St Thomas' Hospital, Westminster Bridge Road, SE1 7EH, London, UK.
| | - Debra Bick
- King's College London, Florence Nightingale Faculty of Nursing and Midwifery, London, UK
| | - Nicola Mackintosh
- King's College London, Division of Women's Health, Faculty of Life Sciences and Medicine, London, UK
| | - Jane Sandall
- King's College London, Division of Women's Health, Faculty of Life Sciences and Medicine, London, UK
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