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Symon A, Lightly K, Howard R, Mundle S, Faragher B, Hanley M, Durocher J, Winikoff B, Weeks A. Introducing the participant-generated experience and satisfaction (PaGES) index: a novel, longitudinal mixed-methods evaluation tool. BMC Med Res Methodol 2023; 23:214. [PMID: 37759174 PMCID: PMC10537543 DOI: 10.1186/s12874-023-02016-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 08/09/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Patient-Reported Outcomes or Experience Measures (PROMS / PREMS) are routinely used in clinical studies to assess participants' views and experiences of trial interventions and related quality of life. Purely quantitative approaches lack the necessary detail and flexibility to understand the real-world impact of study interventions on participants, according to their own priorities. Conversely, purely qualitative assessments are time consuming and usually restricted to a small, possibly unrepresentative, sub-sample. This paper, which reports a pilot study within a randomised controlled trial of induction of labour, reports the feasibility, and acceptability of the Participant-Generated Experience and Satisfaction (PaGES) Index, a new mixed qualitative / quantitative PREM tool. METHODS The single-sheet PaGES Index was completed by hypertensive pregnant women in two hospitals in Nagpur, India before and after taking part in the 'Misoprostol or Oxytocin for Labour Induction' (MOLI) randomised controlled trial. Participants recorded aspects of the impending birth they considered most important, and then ranked them. After the birth, participants completed the PaGES Index again, this time also scoring their satisfaction with each item. Forms were completed on paper in the local language or in English, supported by Research Assistants. Following translation (when needed), responses were uploaded to a REDCap database, coded in Excel and analysed thematically. A formal qualitative evaluation (qMOLI) was also conducted to obtain stakeholder perspectives of the PaGES Index and the wider trial. Semi-structured interviews were conducted with participants, and focus groups with researchers and clinicians. Data were managed using NVivo 12 software and analysed using the framework approach. RESULTS Participants and researchers found the PaGES Index easy to complete and administer; mothers valued the opportunity to speak about their experience. Qualitative analysis of the initial 68 PaGES Index responses identified areas of commonality and difference among participants and also when comparing antenatal and postnatal responses. Theme citations and associated comments scores were fairly stable before and after the birth. The qMOLI phase, comprising 53 one-to-one interviews with participants and eight focus groups involving 83 researchers and clinicians, provided support that the PaGES Index was an acceptable and even helpful means of capturing participant perspectives. CONCLUSIONS Subjective participant experiences are an important aspect of clinical trials. The PaGES Index was found to be a feasible and acceptable measure that unites qualitative research's explanatory power with the comparative power of quantitative designs. It also offers the opportunity to conduct a before-and-after evaluation, allowing researchers to examine the expectations and actual experiences of all clinical trial participants, not just a small sub-sample. This study also shows that, with appropriate research assistant input, the PaGES Index can be used in different languages by participants with varying literacy levels. TRIAL REGISTRATION Clinical Trials.gov (21/11/2018) (NCT03749902).
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Affiliation(s)
- Andrew Symon
- Mother and Infant Research Unit, University of Dundee, 11 Airlie Place, Dundee, DD1 4HJ, UK
| | - Kate Lightly
- Clinical Research Fellow, University of Liverpool, Liverpool Women's Hospital, Crown Street, Liverpool, L8 7SS, UK.
| | - Rachel Howard
- Medical Student, University of Liverpool, Liverpool, L69 3BX, UK
| | - Shuchita Mundle
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, Nagpur, India
| | - Brian Faragher
- Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
| | - Molly Hanley
- Medical Student, University of Liverpool, Liverpool, L69 3BX, UK
| | - Jill Durocher
- Gynuity Health Projects (GHP), MOLI Trial Manager, 220 East 42nd Street, New York, NY, 10017, USA
| | - Beverly Winikoff
- Gynuity Health Projects (GHP), MOLI Trial Manager, 220 East 42nd Street, New York, NY, 10017, USA
| | - Andrew Weeks
- Sanyu Research Department, University of Liverpool, Liverpool Women's Hospital, Crown Street, Liverpool, L8 7SS, UK
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Cummins A, Symon A. Transforming the Quality Maternal Newborn Care Framework into an index to measure the quality of maternity care. Birth 2023; 50:192-204. [PMID: 36468251 DOI: 10.1111/birt.12694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 10/25/2022] [Accepted: 10/28/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND The Quality Maternal and Newborn Care (QMNC) Framework describes the care that childbearing women and newborn infants need in all settings. It comprises five components and was designed for use in planning, workforce development, and resource allocation, aimed at improving the quality and cost effectiveness of maternal and newborn care globally. The purpose of this paper is to describe the first phase of a project designed to transform the Framework into a quantitative tool for service user assessment of the quality of maternity care. METHODS Each component of the original Framework content was developed into a draft service user questionnaire and distributed to an expert panel, drawn from a range of low-, middle-, and high-resource countries. The panel consisted of five Framework authors, nine midwife researchers, six midwives, and five service user (consumer) advocates. Two rounds of discussion and revision were undertaken with the expert panel who commented on the importance, relevance and clarity of questions, and then on their necessity, wording, and order. A third round involved two experts in survey design. RESULTS Following 24 responses in the first round, the questions were refined and returned to the panel. After incorporating the second-round comments from 16 experts, the survey was then sent to two experts in questionnaire design and construction. Face validity was affirmed through this consultative process. CONCLUSIONS Despite Covid-19 pandemic-related restrictions, this robust iterative consultative process with an international expert panel has resulted in the prototype QMNC Framework index (QMNCFi)-a questionnaire designed for use in diverse settings to assess the quality of maternity care. The QMNCFi's psychometric properties are now being tested in an international online survey.
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Affiliation(s)
- Allison Cummins
- College of Health, Medicine and Wellbeing, School of Nursing and Midwifery, University of Newcastle, Callaghan, New South Wales, Australia
| | - Andrew Symon
- Maternal Infant Health Research Unit, University of Dundee, Dundee, UK
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Barozet E, Valenzuela CY, Cifuentes L, Verdugo RA, Herrera L, Acuña M, Llop E, Moraga M, Berríos S, Di Genova A, Digman D, Symon A, Asenjo S, López P, Bustamante ML, Pezo-Valderrama P, Suazo J, Caba F, Villalón M, Alvarado S, Cáceres D, Salgado K, Portales P, Loira N, Maas A. The Chilean socio-ethno-genomic cline. Biodemography Soc Biol 2021; 66:156-171. [PMID: 34182852 DOI: 10.1080/19485565.2021.1879626] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Studies of the current Chilean population performed using classical genetic markers have established that the Chilean population originated primarily from the admixture of European people, particularly Spaniards, and Amerindians. A socioeconomic-ethno-genetic cline was established soon after the conquest. Spaniards born in Spain or Chile occupied the highest Socioeconomic Strata, while Amerindians belonged to the lowest. The intermediate strata consisted of people with different degrees of ethnic admixture; the larger the European admixture, the higher the Socioeconomic Level. The present study of molecular genomic markers sought to calculate the percentage of Amerindian admixture and revealed a finer distribution of this cline, as well as differences between two Amerindian groups: Aymara and Mapuche. The use of two socioeconomic classifications - Class and Socioeconomic Level - reveals important differences. Furthermore, Self-reported Ethnicity (self-assignment to an ethnic group) and Self-reported Ancestry (self-recognition of Amerindian ancestors) show variations and differing relationships between socioeconomic classifications and genomic Amerindian Admixture. These data constitute a valuable input for the formulation of public healthcare policy and show that the notions of Ethnicity, Socioeconomic Strata and Class should always be a consideration in policy development.
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Affiliation(s)
- E Barozet
- Departamento de Sociología, Facultad de Ciencias Sociales, Universidad de Chile, Centro de Estudios de Conflicto y Cohesión, Social, Santiago, Chile
| | - C Y Valenzuela
- Programa de Genética Humana del ICBM, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - L Cifuentes
- Programa de Genética Humana del ICBM, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - R A Verdugo
- Programa de Genética Humana del ICBM, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - L Herrera
- Programa de Genética Humana del ICBM, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - M Acuña
- Programa de Genética Humana del ICBM, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - E Llop
- Programa de Genética Humana del ICBM, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - M Moraga
- Programa de Genética Humana del ICBM, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - S Berríos
- Programa de Genética Humana del ICBM, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - A Di Genova
- Mathomics, Centro de Modelamiento Matemático y Centro Para la Regulación del Genoma, Facultad de Ciencias Físicas y Matemáticas, Universidad de Chile, Santiago, Chile
| | - D Digman
- Programa de Genética Humana del ICBM, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - A Symon
- Programa de Genética Humana del ICBM, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - S Asenjo
- Programa de Genética Humana del ICBM, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - P López
- Programa de Genética Humana del ICBM, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - M L Bustamante
- Programa de Genética Humana del ICBM, Facultad de Medicina, Universidad de Chile, Santiago, Chile
- Departamento de Psiquiatría y Salud Mental Norte, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - P Pezo-Valderrama
- Programa de Genética Humana del ICBM, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - J Suazo
- Instituto de Investigación en Ciencias Odontológicas, Facultad de Odontología, Universidad de Chile, Santiago, Chile
| | - F Caba
- Escuela de Puericultura, Facultad de Ciencias Médicas, Universidad Bernardo O'Higgins, Chile
| | - M Villalón
- Instituto de Salud Poblacional "Escuela de Salud Pública", Universidad de Chile, Santiago, Chile
| | - S Alvarado
- Instituto de Salud Poblacional "Escuela de Salud Pública", Universidad de Chile, Santiago, Chile
| | - D Cáceres
- Instituto de Salud Poblacional "Escuela de Salud Pública", Universidad de Chile, Santiago, Chile
| | - K Salgado
- Escuela de Puericultura, Facultad de Ciencias Médicas, Universidad Bernardo O'Higgins, Chile
| | - P Portales
- Corporación Municipal de Desarrollo Social, Iquique, Chile
| | - N Loira
- Mathomics, Centro de Modelamiento Matemático y Centro Para la Regulación del Genoma, Facultad de Ciencias Físicas y Matemáticas, Universidad de Chile, Santiago, Chile
| | - A Maas
- Mathomics, Centro de Modelamiento Matemático y Centro Para la Regulación del Genoma, Facultad de Ciencias Físicas y Matemáticas, Universidad de Chile, Santiago, Chile
- Departamento de Ingeniería Matemática, Facultad de Ciencias Físicas y Matemáticas, Universidad de Chile, Santiago, Chile
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Murad A, Renfrew MJ, Symon A, Whitford H. Understanding factors affecting breastfeeding practices in one city in the Kingdom of Saudi Arabia: an interpretative phenomenological study. Int Breastfeed J 2021; 16:9. [PMID: 33407636 PMCID: PMC7789192 DOI: 10.1186/s13006-020-00350-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 12/09/2020] [Indexed: 11/29/2022] Open
Abstract
Background Breastfeeding duration has declined in the Kingdom of Saudi Arabia (KSA) in recent decades, although accurate national data about different breastfeeding indicators by infant age are lacking. This qualitative study, the first in KSA, aimed to understand the factors affecting mothers’ decisions and experiences regarding any breastfeeding practices. Methods A qualitative phenomenological approach was used to investigate mothers’ experiences of breastfeeding. Non-probability convenience sampling and snowballing strategies were designed to recruit participants. Semi-structured interviews were conducted with 16 mothers, from two hospitals and three primary health clinics in Al-Madinah city, from December 2017 to March 2018. Interpretative phenomenological analysis was the analysis framework. Results Three themes were identified: 1) ‘Up against the system’: policies, staff and systems were the main barriers to exclusive breastfeeding; 2) ‘Social support and negativity’: family support in the first 40 postpartum days protected breastfeeding continuation and was highly appreciated, but negative comments limited breastfeeding practices thereafter; and 3) ‘Managing tensions’: mothers’ religious beliefs about breastfeeding boosted their decisions; however, the challenge of managing tensions influenced mothers to stop breastfeeding earlier than they wished. The study revealed that mothers had no doubts about wanting to breastfeed their babies; but continuation was adversely affected by unhelpful hospital policies and staff actions, the lack of ongoing social support, and by others people’s negativity, rather than by the mothers’ own views. Stopping breastfeeding earlier than planned was a complex decision for most mothers. However, mothers said that they intended to breastfeed their next baby successfully. Conclusions Healthcare professionals (maternity staff, paediatricians and pharmacists) need education and training to support exclusive breastfeeding effectively. Increasing the number of hospitals with Baby Friendly Hospital Initiative accreditation, which includes staff practice changes, is needed to protect and support exclusive breastfeeding. Ongoing professional and peer support, and improving conditions at workplaces and universities, are needed to help mothers to continue breastfeeding successfully. Effective, coordinated national policies can support mothers’ decisions in relation to breastfeeding. Such changes will reduce the tensions experienced by women and help them to achieve their breastfeeding goals and to breastfeed for longer.
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Affiliation(s)
- Amal Murad
- Maternity and Childhood Department, College of Nursing, Taibah University, Al-Madinah, Saudi Arabia.
| | - Mary J Renfrew
- Mother and Infant Research Unit (MIRU), School of Health Sciences, University of Dundee, Dundee, Scotland, UK
| | - Andrew Symon
- Mother and Infant Research Unit (MIRU), School of Health Sciences, University of Dundee, Dundee, Scotland, UK
| | - Heather Whitford
- Mother and Infant Research Unit (MIRU), School of Health Sciences, University of Dundee, Dundee, Scotland, UK
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Symon A, Shinwell S. Qualitative evaluation of an innovative midwifery continuity scheme: Lessons from using a quality care framework. Birth 2020; 47:378-388. [PMID: 33263206 DOI: 10.1111/birt.12512] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 11/03/2020] [Accepted: 11/03/2020] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Innovative midwifery schemes must be robustly evaluated to establish whether they should be modified or can be replicated. Assessing quality of care can help to ascertain a scheme's acceptability and effectiveness. We used an established quality care framework as a benchmark in our qualitative evaluation of a combined continuity of caregiver and planned home birth scheme in Scotland. METHODS Qualitative evaluation of stakeholder perceptions using the Quality Maternal and Newborn Care Framework was the basis for six focus groups and two one-to-one interviews with stakeholders (new mothers, partners, midwives). A thematic analytical approach was used. RESULTS The qualitative evaluation found universal approval among participants. Flexible working patterns helped to nurture positive relationships, and information and support were highly valued. The principal themes-Organization of Care/Work Culture; Information and Support; Relationships-were strongly inter-related. They shared several subthemes, notably continuity of caregiver, flexible family-centered care, and the benefits of being at home. Flexibility and mutual respect helped women to express autonomy and develop agency. Women related their birth experiences to friends, family, and colleagues, thereby helping to normalize home birth. CONCLUSIONS This qualitative evaluation of an innovative scheme used an established quality framework as a benchmark against which to assess stakeholder experiences. This approach helped to identify the critical codependence of factors involved in care delivery, which in turn helps to identify lessons for others considering similar schemes. Although our evaluation relates to one specific scheme, identifying the scheme's critical quality care aspects may assist others when planning similar schemes.
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Affiliation(s)
- Andrew Symon
- Mother and Infant Research Unit, School of Nursing and Health Sciences, University of Dundee, Dundee, UK
| | - Shona Shinwell
- Maternity Services, Ninewells Hospital, NHS Tayside, Dundee, UK
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Symon A, Shinwell S, Craig J. Process lessons from evaluating a combined continuity of carer and home birth scheme. Birth 2020; 47:389-396. [PMID: 33289141 DOI: 10.1111/birt.12514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 10/30/2020] [Accepted: 11/02/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Continuity of midwifery carer improves outcomes, but there is significant variation in how such schemes are implemented and evaluated cross-culturally. The Angus home birth scheme in Scotland incorporates continuity of carer throughout pregnancy, labor, birth, and the postnatal period. METHODS Manual maternity case note review to evaluate the 80% continuity of carer and 3% planned home birth rate targets. RESULTS Of 1466 women booking for maternity care, 69 joined the scheme. Forty-four had a planned home birth (3% overall), of whom seven were originally deemed ineligible. Of the 44, eight (18%) also achieved 80% continuity of carer with the primary midwife; by including a home birth team colleague, the continuity rate rose to 73%. Women whose care achieved home birth and continuity targets had lower deprivation scores. Eligibility issues, women's changing circumstances, and data recording lapses were complicating issues. CONCLUSIONS Targets must be both feasible and meaningful and should be complemented by assessing a broad range of outcomes while viewing the scheme holistically. By expanding eligibility criteria, the home birth rate target was met; including input from a home birth team colleague in the calculation meant the continuity target was nearly met. With dedicated and competent staff, adequate resource and political support, and when considered in the round, the scheme's viability within local services was confirmed. Other generalizable learning points included the need to standardize definitions and data recording methods. Comparability across schemes helps grow the evidence base so that the links between processes and outcomes can be identified.
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Affiliation(s)
- Andrew Symon
- Mother and Infant Research Unit, School of Nursing and Health Sciences, University of Dundee, UK
| | - Shona Shinwell
- Maternity Services, Ninewells Hospital, NHS Tayside, Dundee, UK
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McFadden A, Siebelt L, Marshall JL, Gavine A, Girard LC, Symon A, MacGillivray S. Counselling interventions to enable women to initiate and continue breastfeeding: a systematic review and meta-analysis. Int Breastfeed J 2019; 14:42. [PMID: 31649743 PMCID: PMC6805348 DOI: 10.1186/s13006-019-0235-8] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 09/04/2019] [Indexed: 11/10/2022] Open
Abstract
Background Many infants worldwide are not breastfeeding according to WHO recommendations and this impacts on the health of women and children. Increasing breastfeeding is identified as a priority area supported by current policy targets. However, interventions are complex and multi-component and it is unclear which elements of interventions are most effective to increase breastfeeding in which settings. Breastfeeding counselling is often part of complex interventions but evidence is lacking on the specific effect of counselling interventions on breastfeeding practices. The aim of this systematic review is to examine evidence on effectiveness of breastfeeding counselling to inform global guidelines. Methods A systematic search was conducted of six electronic databases in January 2018. Randomised controlled trials comparing breastfeeding counselling with no breastfeeding counselling or different formulations of counselling were included if they measured breastfeeding practices between birth and 24 months after birth. Results From the 5180 records identified in searches and a further 11 records found by hand searching, 63 studies were included. Of these, 48 were individually-randomised trials and 15 were cluster-randomised trials. A total of 69 relevant comparisons were reported involving 33,073 women. There was a significant effect of counselling interventions on any breastfeeding at 4 to 6 weeks (Relative risk [RR] 0.85, 95% CI 0.77, 0.94) and 6 months (RR 0.92, 95% CI 0.87, 0.94). Greater effects were found on exclusive breastfeeding at 4 to 6 weeks (RR 0.79, 95% CI 0.72, 0.87) and 6 months (RR 0.84, 95% CI 0.78, 0.91). Counselling delivered at least four times postnatally is more effective than counselling delivered antenatally only and/or fewer than four times. Evidence was mostly of low quality due to high or unclear risk of bias of the included trials and high heterogeneity. Conclusions Breastfeeding counselling is an effective public health intervention to increase rates of any and exclusive breastfeeding. Breastfeeding counselling should be provided face-to-face, and in addition, may be provided by telephone, both antenatally and postnatally, to all pregnant women and mothers with young children. To inform scale-up globally there is a need to further understand the elements of breastfeeding interventions such as counselling and their effectiveness in different contexts and circumstances. Study registration This systematic review was registered in Prospero (CRD42018086494).
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Affiliation(s)
- Alison McFadden
- 1School of Nursing and Health Sciences, University of Dundee, 11 Airlie Place, Dundee, DD1 4HJ Scotland
| | - Lindsay Siebelt
- 1School of Nursing and Health Sciences, University of Dundee, 11 Airlie Place, Dundee, DD1 4HJ Scotland
| | - Joyce L Marshall
- 2School of Human and Health Sciences, Harold Wilson Building, University of Huddersfield, Queensgate, Huddersfield, HD1 3DH Scotland
| | - Anna Gavine
- 1School of Nursing and Health Sciences, University of Dundee, 11 Airlie Place, Dundee, DD1 4HJ Scotland
| | - Lisa-Christine Girard
- 3School of Health in Social Science, The University of Edinburgh, Doorway 6, Room 1m04, Old Medical School, Edinburgh, EH8 9AG Scotland
| | - Andrew Symon
- 1School of Nursing and Health Sciences, University of Dundee, 11 Airlie Place, Dundee, DD1 4HJ Scotland
| | - Stephen MacGillivray
- 1School of Nursing and Health Sciences, University of Dundee, 11 Airlie Place, Dundee, DD1 4HJ Scotland
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Cummins A, Coddington R, Fox D, Symon A. Exploring the qualities of midwifery-led continuity of care in Australia (MiLCCA) using the quality maternal and newborn care framework. Women Birth 2019. [DOI: 10.1016/j.wombi.2019.07.231] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Allan HT, van den Akker O, Culley L, Mounce G, Odelius A, Symon A. An integrative literature review of psychosocial factors in the transition to parenthood following non-donor-assisted reproduction compared with spontaneously conceiving couples. HUM FERTIL 2019; 24:249-266. [PMID: 31328586 DOI: 10.1080/14647273.2019.1640901] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The paper reports an integrative literature review of research into the psychosocial factors which shape the transition to parenthood in couples following non-donor in vitro fertilization in comparison with those conceiving spontaneously. Nineteen papers of non-donor IVF and SC mothers and fathers were included. Differences between groups were reported for a range of psychosocial measures during the transition from pregnancy to parenthood including: the control couples feel they have over their lives (locus of control), parental adjustment and child behaviour, parental stress, parental investment in the child, self-esteem and self-efficacy, greater levels of protectiveness (separation anxiety) towards child, marital and family functioning, family alliance, marital satisfaction and communication, as well as anxiety, indirect aggression and lowered respect for the child. We have conceptualised these differences as three substantive themes which reflect psychosocial factors shaping transition to parenthood in parents after non-donor AR: namely social support, relationships and emotional well-being, which are in turn influenced by gender differences. These findings have implications for health care professionals' assessment of individual couples' support needs.
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Affiliation(s)
- Helen T Allan
- a Faculty of Health and Education, Middlesex University , London , UK
| | - O van den Akker
- b Faculty of Science and Technology, Middlesex University , London , UK
| | - Lorraine Culley
- c School of Applied Social Sciences, Health and Life Sciences, De Montfort, University , Leicester , UK
| | - Ginny Mounce
- d Nuffield Department of Women's & Reproductive Health, Institute of Reproductive Sciences, University of Oxford , Oxford , UK
| | - Anki Odelius
- a Faculty of Health and Education, Middlesex University , London , UK
| | - Andrew Symon
- e School of Nursing & Health Sciences, University of Dundee , Dundee , UK
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Symon A, McFadden A, White M, Fraser K, Cummins A. Using the Quality Maternal and Newborn Care Framework to evaluate women's experiences of different models of care: A qualitative study. Midwifery 2019; 73:26-34. [DOI: 10.1016/j.midw.2019.03.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 02/25/2019] [Accepted: 03/03/2019] [Indexed: 11/30/2022]
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Symon A, McFadden A, White M, Fraser K, Cummins A. Using a quality care framework to evaluate user and provider experiences of maternity care: A comparative study. Midwifery 2019; 73:17-25. [PMID: 30856527 DOI: 10.1016/j.midw.2019.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 02/25/2019] [Accepted: 03/03/2019] [Indexed: 01/22/2023]
Abstract
OBJECTIVE The Quality Maternal and Newborn Care Framework describes the components and characteristics of quality care and emphasises relational and continuity elements. Continuity of care is increasingly a focus of maternity care policy in the United Kingdom. While some outcomes have been shown to be improved, there is uncertainty about why certain models of care are more effective. Our overall objective is to develop a maternity care evaluation toolkit which incorporates this Framework along with other outcome evaluations. An initial step in developing this toolkit was to use the adapted Framework to evaluate perceptions and experiences of maternity care. Our specific objective in this study was to test this adapted Framework in a series of focus groups with key stakeholders, and to compare findings between different groups. Findings related to service users (pregnant women and new mothers) are reported in our accompanying paper; this paper presents findings from focus groups with service providers (midwives and obstetricians), and then compares user and provider perspectives. DESIGN A qualitative comparative enquiry involving three focus groups with 26 midwives (eight newly qualified; eight working in a community midwifery unit; and ten senior tertiary-based) and two focus groups with twelve obstetricians of all grades. We used a six-phase thematic analysis to derive then compare the focus groups' principal sub-themes; we then mapped these to the original Quality Maternal and Newborn Care Framework and compared these service providers' responses with those from the pregnant women and new mothers. SETTING Two health boards in Scotland. PARTICIPANTS Midwives and obstetricians who had experience of various models of maternity care. FINDINGS There were significant areas of overlap in their perceptions of providing maternity care. All groups reported 'limited resources and time'; the community midwifery unit and senior midwives and one group of obstetricians provided a critique of the system. Achieving tailored care was acknowledged as a problem by the senior midwives and one group of obstetricians. Only obstetricians discussed strategies for improvement. The newly qualified midwives were most positive in their responses. There was both overlap and contrast when comparing the views of service users and providers. We found most agreement when participants discussed some of the Framework's characteristics of care in negative terms, such as (in) accessible care, (lack of) adequate resources, and (absence of) tailored care. KEY CONCLUSIONS Being able firstly to map the participants' responses to the Quality Maternal and Newborn Care Framework, and then to identify strengths and gaps in the provision of quality maternity care, suggests to us that the Framework, derived as it is from a comprehensive analysis of the global evidence on quality care, can indeed be used to inform an evaluation toolkit. While aware that we cannot generalise from this limited qualitative study, we are currently undertaking similar work in other countries by which we hope to confirm our findings and further develop the toolkit.
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Affiliation(s)
- Andrew Symon
- Mother and Infant Research Unit, School of Nursing and Health Sciences, University of Dundee, DD1 4HJ United Kingdom.
| | - Alison McFadden
- Mother and Infant Research Unit, School of Nursing and Health Sciences, University of Dundee, DD1 4HJ United Kingdom
| | - Marianne White
- Maternity Services, Ninewells Hospital, NHS Tayside, Dundee, United Kingdom
| | - Katrina Fraser
- Maternity Unit, Victoria Hospital, NHS Fife, Kirkcaldy, United Kingdom
| | - Allison Cummins
- Centre for Midwifery, Child and Family Health, University of Technology Sydney, Australia
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Symon A, McFadden A, White M, Fraser K, Cummins A. Adapting the Quality Maternal and Newborn Care (QMNC) Framework to evaluate models of antenatal care: A pilot study. PLoS One 2018; 13:e0200640. [PMID: 30106961 PMCID: PMC6091915 DOI: 10.1371/journal.pone.0200640] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 06/30/2018] [Indexed: 11/18/2022] Open
Abstract
Background Recent evidence indicates that continuity models of maternity care result in improved clinical and psychosocial outcomes, but their causal mechanisms are poorly understood. The recent Lancet Series on Midwifery’s Quality Maternal and Newborn Care Framework describes five components of quality care and their associated characteristics. As an initial step in developing this Framework into an evaluation toolkit, we transformed its components and characteristics into a topic guide to assess stakeholder perceptions and experiences of care provided and received. The main purpose of this study was to assess the feasibility of this process. Methods We conducted twelve focus groups in two Scottish health board areas with 13 pregnant women, 18 new mothers, 26 midwives and 12 obstetricians who had experience of a range of different models of maternity care. Transcripts were analysed using a six-phase approach of thematic analysis. We mapped the identified themes and sub-themes back to the Framework. Results The emerging themes and sub-themes demonstrated the feasibility of using the QMNC framework as a data collection tool, and as a lens for analysing the data. Of the four emerging themes, only Organisation Culture / Work Structure’ mapped directly to a single Framework component. The others—‘Relationships’; ‘Information and support’; and ‘Uncertainty’–mapped to between two and five components, illustrating the interconnectedness of the Framework’s components. Some negative sub-themes mirrored positive Framework characteristics of care. Some re-phrasing and re-ordering of the topic guides in later focus groups ensured we could cover all aspects of the Framework adequately. Conclusion Adapting the Quality Maternal and Newborn Care Framework enabled us to focus on aspects of care which worked well and which didn’t work well for these key stakeholders. Identifying ‘what works for whom and why’ in different models of care is a necessary step in reinforcing and replicating the most effective models of care.
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Affiliation(s)
- Andrew Symon
- Mother and Infant Research Unit, School of Nursing and Health Sciences, University of Dundee, Dundee, United Kingdom
- * E-mail:
| | - Alison McFadden
- Mother and Infant Research Unit, School of Nursing and Health Sciences, University of Dundee, Dundee, United Kingdom
| | - Marianne White
- Maternity Services, Ninewells Hospital, NHS Tayside, Dundee, United Kingdom
| | - Katrina Fraser
- Maternity Unit, Victoria Hospital, NHS Fife, Kirkcaldy, United Kingdom
| | - Allison Cummins
- Centre for Midwifery, Child and Family Health, University of Technology Sydney, Sydney, Australia
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Lagan BM, Symon A, Dalzell J, Whitford H. Corrigendum to 'The midwives aren't allowed to tell you: Perceived infant feeding policy restrictions in a formula feeding culture - the Feeding Your Baby study' [Midwifery 30/3 (2014) e49-e55]. Midwifery 2017; 42:100. [PMID: 28314433 DOI: 10.1016/j.midw.2016.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Briege M Lagan
- School of Nursing, Institute of Nursing and Health Research, Ulster University, Jordanstown, N. Ireland BT37 0QB, UK.
| | - Andrew Symon
- School of Nursing and Midwifery, University of Dundee, Scotland 11 Airlie Pl, Dundee DD1 4HJ, UK
| | - Janet Dalzell
- Directorate of Public Health, Kings Cross, Clepington Road, Dundee DD3 8EA, UK
| | - Heather Whitford
- Directorate of Public Health, Kings Cross, Clepington Road, Dundee DD3 8EA, UK
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Symon A, Pringle J, Downe S, Hundley V, Lee E, Lynn F, McFadden A, McNeill J, Renfrew MJ, Ross-Davie M, van Teijlingen E, Whitford H, Alderdice F. Antenatal care trial interventions: a systematic scoping review and taxonomy development of care models. BMC Pregnancy Childbirth 2017; 17:8. [PMID: 28056877 PMCID: PMC5216531 DOI: 10.1186/s12884-016-1186-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2016] [Accepted: 12/07/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Antenatal care models vary widely around the world, reflecting local contexts, drivers and resources. Randomised controlled trials (RCTs) have tested the impact of multi-component antenatal care interventions on service delivery and outcomes in many countries since the 1980s. Some have applied entirely new schemes, while others have modified existing care delivery approaches. Systematic reviews (SRs) indicate that some specific antenatal interventions are more effective than others; however the causal mechanisms leading to better outcomes are poorly understood, limiting implementation and future research. As a first step in identifying what might be making the difference we conducted a scoping review of interventions tested in RCTs in order to establish a taxonomy of antenatal care models. METHODS A protocol-driven systematic search was undertaken of databases for RCTs and SRs reporting antenatal care interventions. Results were unrestricted by time or locality, but limited to English language. Key characteristics of both experimental and control interventions in the included trials were mapped using SPIO (Study design; Population; Intervention; Outcomes) criteria and the intervention and principal outcome measures were described. Commonalities and differences between the components that were being tested in each study were identified by consensus, resulting in a comprehensive description of emergent models for antenatal care interventions. RESULTS Of 13,050 articles retrieved, we identified 153 eligible articles including 130 RCTs in 34 countries. The interventions tested in these trials varied from the number of visits to the location of care provision, and from the content of care to the professional/lay group providing that care. In most studies neither intervention nor control arm was well described. Our analysis of the identified trials of antenatal care interventions produced the following taxonomy: Universal provision model (for all women irrespective of health state or complications); Restricted 'lower-risk'-based provision model (midwifery-led or reduced/flexible visit approach for healthy women); Augmented provision model (antenatal care as in Universal provision above but augmented by clinical, educational or behavioural intervention); Targeted 'higher-risk'-based provision model (for woman with defined clinical or socio-demographic risk factors). The first category was most commonly tested in low-income countries (i.e. resource-poor settings), particularly in Asia. The other categories were tested around the world. The trials included a range of care providers, including midwives, nurses, doctors, and lay workers. CONCLUSIONS Interventions can be defined and described in many ways. The intended antenatal care population group proved the simplest and most clinically relevant way of distinguishing trials which might otherwise be categorised together. Since our review excluded non-trial interventions, the taxonomy does not represent antenatal care provision worldwide. It offers a stable and reproducible approach to describing the purpose and content of models of antenatal care which have been tested in a trial. It highlights a lack of reported detail of trial interventions and usual care processes. It provides a baseline for future work to examine and test the salient characteristics of the most effective models, and could also help decision-makers and service planners in planning implementation.
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Affiliation(s)
- Andrew Symon
- Mother & Infant Research Unit, University of Dundee, DD1 4HJ, Dundee, UK.
| | - Jan Pringle
- School of Nursing & Health Sciences, University of Dundee, DD1 4HJ, Dundee, UK
| | - Soo Downe
- School of Health, Brook Building, University of Central Lancashire, Preston, PR1 2HE, UK
| | - Vanora Hundley
- Centre for Midwifery, Maternal & Perinatal Health, Faculty of Health & Social Sciences, Bournemouth University, BU1 3LH, Poole, UK
| | - Elaine Lee
- Mother & Infant Research Unit, University of Dundee, DD1 4HJ, Dundee, UK
| | - Fiona Lynn
- School of Nursing & Midwifery, Queens University, Belfast, BT9 7BL, UK
| | - Alison McFadden
- Mother & Infant Research Unit, University of Dundee, DD1 4HJ, Dundee, UK
| | - Jenny McNeill
- School of Nursing & Midwifery, Queens University, Belfast, BT9 7BL, UK
| | - Mary J Renfrew
- Mother & Infant Research Unit, University of Dundee, DD1 4HJ, Dundee, UK
| | - Mary Ross-Davie
- Maternal & Child Health, NHS Education for Scotland, Edinburgh, EH3 9DN, UK
| | - Edwin van Teijlingen
- Centre for Midwifery, Maternal & Perinatal Health, Faculty of Health & Social Sciences, Bournemouth University, BU1 3LH, Poole, UK
| | - Heather Whitford
- Mother & Infant Research Unit, University of Dundee, DD1 4HJ, Dundee, UK
| | - Fiona Alderdice
- School of Nursing & Midwifery, Queens University, Belfast, BT9 7BL, UK
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Symon A, Rankin J, Sinclair H, Butcher G, Smith L, Gordon R, Cochrane L. Peri-Conceptual and Mid-Pregnancy Alcohol Consumption: A Comparison between Areas of High and Low Deprivation in Scotland. Birth 2016; 43:320-327. [PMID: 27620000 DOI: 10.1111/birt.12252] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/04/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Alcohol-related mortality and morbidity among women has increased over recent decades, especially in areas of higher deprivation. Pre-pregnancy alcohol use is associated with continued consumption in pregnancy. We assessed whether general population alcohol consumption patterns were reflected among pregnant women in two Scottish areas with different deprivation levels. METHODS Cross-sectional study in two health boards (HB1, lower deprivation levels, n = 274; HB2, higher deprivation levels, n = 236), using face-to-face 7-day Retrospective Diary estimation of peri-conceptual and mid-pregnancy alcohol consumption. RESULTS A greater proportion of women in HB2 (higher deprivation area) sometimes drank peri-conceptually, but women in HB1 (lower deprivation area) were more likely to drink every week (49.6 vs 29.7%; p < 0.001) and to exceed daily limits (6 units) at least once each week (32.1 vs 14.8%; p < 0.001). After pregnancy recognition, consumption levels fell sharply, but women in HB2 were more likely to drink above recommended daily limits (2 units) each week (2.5 vs 0.0%; p < 0.05). However, women in HB1 were more likely to drink frequently. Women with the highest deprivation scores in each area drank on average less than women with the lowest deprivation scores. CONCLUSIONS Heavy episodic and frequent consumption was more common in the lower deprivation area, in contrast with general population data. Eliciting a detailed alcohol history at the antenatal booking visit, and not simply establishing whether the woman is currently drinking, is essential. Inconsistent messages about the effects of alcohol in pregnancy may have contributed to the mixed picture we found concerning peri-conceptual and mid-pregnancy alcohol consumption.
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Affiliation(s)
- Andrew Symon
- Mother and Infant Research Unit, University of Dundee, Dundee, UK
| | - Jean Rankin
- School of Health, Nursing and Midwifery, University of the West of Scotland, Paisley, UK
| | | | | | - Lesley Smith
- Department of Psychology, Social Work & Public Health, Oxford Brookes University, Marston, UK
| | - Rhona Gordon
- School of Nursing & Health Sciences, University of Dundee, Dundee, UK
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Symon A, Rankin J, Butcher G, Smith L, Cochrane L. Evaluation of a retrospective diary for peri-conceptual and mid-pregnancy drinking in Scotland: a cross-sectional study. Acta Obstet Gynecol Scand 2016; 96:53-60. [PMID: 27792241 DOI: 10.1111/aogs.13050] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Accepted: 10/19/2016] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Heavy episodic ("binge") drinking among women in Scotland is commonplace; prepregnancy drinking is associated with continued antenatal drinking. Evidence for effectiveness of standardized antenatal alcohol assessment is lacking. Alcohol-exposed pregnancies may be missed. We assessed peri-conceptual and mid-pregnancy consumption using a week-long retrospective diary and standard alcohol questionnaires, and evaluated the agreement between these instruments. MATERIAL AND METHODS Cross-sectional study in two Scottish health board areas involving 510 women attending mid-pregnancy ultrasound scan clinics. Face-to-face administration of alcohol retrospective diary and AUDIT or AUDIT-C assessed weekly and daily alcohol consumption levels and patterns. Depression-Anxiety-Stress Scale (DASS-21) assessed maternal wellbeing. A sub-sample (n = 30) provided hair for alcohol metabolite analysis. Pearson's correlation coefficient investigated associations between questionnaires and alcohol metabolite data. RESULTS The response rate was 73.8%. The retrospective diary correlated moderately with AUDIT-C and AUDIT but elicited reports of significantly higher peri-conceptual consumption, (median unit consumption on "drinking days" 6.8; range 0.4-63.8). Additional "special occasions" consumption ranged from 1 to 125 units per week. Correlations between DASS-21 and retrospective diary were weak. Biomarker analysis identified three instances of hazardous peri-conceptual drinking. CONCLUSIONS Women reported higher consumption levels when completing the retrospective diary, especially regarding peri-conceptual "binge" drinking. Routine clinical practice methods may not capture potentially harmful or irregular drinking patterns. Given the association between prepregnancy and antenatal drinking, and alcohol's known teratogenic effects, particularly in the first trimester, the retrospective diary may be a useful low-tech tool to gather information on alcohol intake patterns and levels.
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Affiliation(s)
- Andrew Symon
- Mother and Infant Research Unit, University of Dundee, Dundee, UK
| | - Jean Rankin
- School of Health, Nursing and Midwifery, University of the West of Scotland, Paisley, UK
| | | | - Lesley Smith
- Department of Social Work and Public Health, Oxford Brookes University, Oxford, UK
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Symon A, Rankin J, Sinclair H, Butcher G, Barclay K, Gordon R, MacDonald M, Smith L. Peri-conceptual and mid-pregnancy drinking: a cross-sectional assessment in two Scottish health board areas using a 7-day Retrospective Diary. J Adv Nurs 2016; 73:375-385. [PMID: 27555470 DOI: 10.1111/jan.13112] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/13/2016] [Indexed: 11/29/2022]
Abstract
AIMS The aim of this study was to evaluate the use of a 7-day Retrospective Diary to assess peri-conceptual and mid-pregnancy alcohol consumption. BACKGROUND Alcohol consumption among women has increased significantly and is of international concern. Heavy episodic ('binge') drinking is commonplace and is associated with unintended pregnancy. Pre-pregnancy drinking is strongly associated with continued drinking in pregnancy. Routine antenatal assessment of alcohol history and current drinking is variable; potentially harmful peri-conceptual drinking may be missed if a woman reports low or no drinking during pregnancy. DESIGN Cross-sectional study (n = 510) in two Scottish health board areas. METHODS Face-to-face Retrospective Diary administration from February to June 2015 assessing alcohol consumption in peri-conceptual and mid-pregnancy periods. Women were recruited at the mid-pregnancy ultrasound clinic. RESULTS Of 510 women, 470 (92·0%) drank alcohol before their pregnancy; 187 (39·9%) drank every week. Retrospective assessment of peri-conceptual consumption identified heavy episodic drinking (more than six units on one occasion) in 52·2% (n = 266); 19·6% (n = 100) reported drinking more than 14 units per week, mostly at the weekend; 'mixing' of drinks was associated with significantly higher consumption. While consumption tailed off following pregnancy recognition, 5·5% (n = 28) still exceeded the recommended daily two-unit limit in pregnancy. Multivariable logistic regression identified that women who 'binged' peri-conceptually were 3·2 times more likely to do this. CONCLUSION Statistically significant peri-conceptual consumption levels suggest a substantial proportion of alcohol-exposed pregnancies before pregnancy recognition. Not taking a detailed alcohol history, including patterns of consumption, will result in under-detection of alcohol-exposed pregnancies. The Retrospective Diary offers practitioners a detailed way of enquiring about alcohol history for this population.
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Affiliation(s)
- Andrew Symon
- Mother and Infant Research Unit, University of Dundee, UK
| | - Jean Rankin
- Maternal, Child and Family Health, School of Health, Nursing and Midwifery, University of the West of Scotland, Paisley, UK
| | | | | | - Kylie Barclay
- School of Nursing and Health Sciences, University of Dundee, UK
| | - Rhona Gordon
- School of Nursing and Health Sciences, University of Dundee, UK
| | | | - Lesley Smith
- Department of Psychology, Social Work and Public Health, Oxford Brookes University, Marston, UK
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Symon A, Pringle J, Cheyne H, Downe S, Hundley V, Lee E, Lynn F, McFadden A, McNeill J, Renfrew MJ, Ross-Davie M, van Teijlingen E, Whitford H, Alderdice F. Midwifery-led antenatal care models: mapping a systematic review to an evidence-based quality framework to identify key components and characteristics of care. BMC Pregnancy Childbirth 2016; 16:168. [PMID: 27430506 PMCID: PMC4949880 DOI: 10.1186/s12884-016-0944-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 06/09/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Implementing effective antenatal care models is a key global policy goal. However, the mechanisms of action of these multi-faceted models that would allow widespread implementation are seldom examined and poorly understood. In existing care model analyses there is little distinction between what is done, how it is done, and who does it. A new evidence-informed quality maternal and newborn care (QMNC) framework identifies key characteristics of quality care. This offers the opportunity to identify systematically the characteristics of care delivery that may be generalizable across contexts, thereby enhancing implementation. Our objective was to map the characteristics of antenatal care models tested in Randomised Controlled Trials (RCTs) to a new evidence-based framework for quality maternal and newborn care; thus facilitating the identification of characteristics of effective care. METHODS A systematic review of RCTs of midwifery-led antenatal care models. Mapping and evaluation of these models' characteristics to the QMNC framework using data extraction and scoring forms derived from the five framework components. Paired team members independently extracted data and conducted quality assessment using the QMNC framework and standard RCT criteria. RESULTS From 13,050 citations initially retrieved we identified 17 RCTs of midwifery-led antenatal care models from Australia (7), the UK (4), China (2), and Sweden, Ireland, Mexico and Canada (1 each). QMNC framework scores ranged from 9 to 25 (possible range 0-32), with most models reporting fewer than half the characteristics associated with quality maternity care. Description of care model characteristics was lacking in many studies, but was better reported for the intervention arms. Organisation of care was the best-described component. Underlying values and philosophy of care were poorly reported. CONCLUSIONS The QMNC framework facilitates assessment of the characteristics of antenatal care models. It is vital to understand all the characteristics of multi-faceted interventions such as care models; not only what is done but why it is done, by whom, and how this differed from the standard care package. By applying the QMNC framework we have established a foundation for future reports of intervention studies so that the characteristics of individual models can be evaluated, and the impact of any differences appraised.
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Affiliation(s)
- Andrew Symon
- />Mother and Infant Research Unit, University of Dundee, Dundee, DD1 4HJ UK
| | - Jan Pringle
- />School of Nursing & Health Sciences, University of Dundee, Dundee, DD1 4HJ UK
| | - Helen Cheyne
- />NMAHP Research Unit, University of Stirling, Stirling, UK
| | - Soo Downe
- />School of Health, Brook Building, University of Central Lancashire, Preston, PR1 2HE UK
| | - Vanora Hundley
- />Centre for Midwifery, Maternal & Perinatal Health, Faculty of Health & Social Sciences, Bournemouth University, Bournemouth, BU1 3LH UK
| | - Elaine Lee
- />Mother and Infant Research Unit, University of Dundee, Dundee, DD1 4HJ UK
| | - Fiona Lynn
- />School of Nursing and Midwifery, Queens University Belfast, Belfast, BT9 7BL UK
| | - Alison McFadden
- />Mother and Infant Research Unit, University of Dundee, Dundee, DD1 4HJ UK
| | - Jenny McNeill
- />School of Nursing and Midwifery, Queens University Belfast, Belfast, BT9 7BL UK
| | - Mary J Renfrew
- />Mother and Infant Research Unit, University of Dundee, Dundee, DD1 4HJ UK
| | - Mary Ross-Davie
- />Maternal and Child Health, NHS Education for Scotland, Edinburgh, EH3 9DN UK
| | - Edwin van Teijlingen
- />Centre for Midwifery, Maternal & Perinatal Health, Faculty of Health & Social Sciences, Bournemouth University, Bournemouth, BU1 3LH UK
| | - Heather Whitford
- />Mother and Infant Research Unit, University of Dundee, Dundee, DD1 4HJ UK
| | - Fiona Alderdice
- />School of Nursing and Midwifery, Queens University Belfast, Belfast, BT9 7BL UK
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Symon A, Downe S, Finlayson KW, Knapp R, Diggle P. The feasibility and acceptability of using the Mother-Generated Index (MGI) as a Patient Reported Outcome Measure in a randomised controlled trial of maternity care. BMC Med Res Methodol 2015; 15:100. [PMID: 26582386 PMCID: PMC4652369 DOI: 10.1186/s12874-015-0092-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Accepted: 11/02/2015] [Indexed: 11/22/2022] Open
Abstract
Background Using patient-reported outcome measures (PROMs) to assess Quality of Life (QoL) is well established, but commonly-used PROM item-sets do not necessarily capture what all respondents consider important. Measuring complex constructs is particularly difficult in randomised controlled trials (RCTs). The Mother-Generated Index (MGI) is a validated antenatal and postnatal QoL instrument in which the variables and scores are completely respondent-driven. This paper reports on the feasibility and acceptability of the MGI in an RCT, and compares the resulting variables and QoL scores with more commonly used instruments. Methods The single-page MGI was included at the end of a ten page questionnaire pack and posted to the RCT participants at baseline (28–32 weeks’ gestation) and follow-up (six weeks postnatal). Feasibility and acceptability were assessed by ease of administration, data entry and completion rates. Variables cited by women were analysed thematically. MGI QoL scores were compared with outcomes from the EQ-5D-3 L; Edinburgh Postnatal Depression Scale; Satisfaction With Life Scale; and State Trait Anxiety Inventory. Results Six hundred and seventy eight pregnant women returned the pack at baseline; 668 completed the MGI (98.5 %); 383/400 returns at follow up included a completed MGI (95.7 %). Quantitative data were scanned into SPSS using a standard data scanning system, and were largely error-free; qualitative data were entered manually. The variables recorded by participants on the MGI forms incorporated many of those in the comparison instruments, and other outcomes commonly used in intrapartum trials, but they also revealed a wider range of issues affecting their quality of life. These included financial and work-related worries; moving house; and concerns over family illness and pets. The MGI scores demonstrated low-to-moderate correlation with other tools (all r values p < .01). Conclusions Without face-to-face explanation and at the end of a long questionnaire, the MGI was feasible to use, and acceptable to RCT participants. It allowed individual participants to include issues that were important to them, but which are not well captured by existing tools. The MGI unites the explanatory power of qualitative research with the comparative power of quantitative designs, is inexpensive to administer, and requires minimal linguistic and conceptual translation. Trial registration ISRCTN27575146 (date assigned 23 March 2011)
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Affiliation(s)
- Andrew Symon
- Mother and Infant Research Unit, University of Dundee, 11 Airlie Place, Dundee, DD1 4HJ, UK.
| | - Soo Downe
- Midwifery Studies, School of Health, Brook Building, University of Central Lancashire, Preston, PR1 2HE, UK.
| | | | - Rebecca Knapp
- Sharoe Green Unit, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, PR2 9HT, UK.
| | - Peter Diggle
- Lancaster Medical School, Lancaster University, Lancaster, LA1 4YB, UK.
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Symon A, Winter C, Cochrane L. Exploration of preterm birth rates associated with different models of antenatal midwifery care in Scotland: Unmatched retrospective cohort analysis. Midwifery 2015; 31:590-6. [PMID: 25819706 DOI: 10.1016/j.midw.2015.02.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Revised: 01/27/2015] [Accepted: 02/27/2015] [Indexed: 11/27/2022]
Abstract
OBJECTIVES preterm birth represents a significant personal, clinical, organisational and financial burden. Strategies to reduce the preterm birth rate have had limited success. Limited evidence indicates that certain antenatal care models may offer some protection, although the causal mechanism is not understood. We sought to compare preterm birth rates for mixed-risk pregnant women accessing antenatal care organised at a freestanding midwifery unit (FMU) and mixed-risk pregnant women attending an obstetric unit (OU) with related community-based antenatal care. METHODS unmatched retrospective 4-year Scottish cohort analysis (2008-2011) of mixed-risk pregnant women accessing (i) FMU antenatal care (n=1107); (ii) combined community-based and OU antenatal care (n=7567). Data were accessed via the Information and Statistics Division of the NHS in Scotland. Aggregates analysis and binary logistic regression were used to compare the cohorts׳ rates of preterm birth; and of spontaneous labour onset, use of pharmacological analgesia, unassisted vertex birth, and low birth weight. Odds ratios were adjusted for age, parity, deprivation score and smoking status in pregnancy. FINDINGS after adjustment the 'mixed risk' FMU cohort had a statistically significantly reduced risk of preterm birth (5.1% [n=57] versus 7.7% [n=583]; AOR 0.73 [95% CI 0.55-0.98]; p=0.034). Differences in these secondary outcome measures were also statistically significant: spontaneous labour onset (FMU 83.9% versus OU 74.6%; AOR 1.74 [95% CI 1.46-2.08]; p<0.001); minimal intrapartum analgesia (FMU 53.7% versus OU 34.4%; AOR 2.17 [95% CI 1.90-2.49]; p<0.001); spontaneous vertex delivery (FMU 71.9% versus OU 63.5%; AOR 1.46 [95% CI 1.32-1.78]; p<0.001). Incidence of low birth weight was not statistically significant after adjustment for other variables. There was no significant difference in the rate of perinatal or neonatal death. CONCLUSIONS given this study׳s methodological limitations, we can only claim associations between the care model and or chosen outcomes. Although both cohorts were mixed risk, differences in risk levels could have contributed to these findings. Nevertheless, the significant difference in preterm birth rates in this study resonates with other research, including the recent Cochrane review of midwife-led continuity models. Because of the multiplicity of risk factors for preterm birth we need to explore the salient features of the FMU model which may be contributing to this apparent protective effect. Because a randomised controlled trial would necessarily restrict choice to pregnant women, we feel that this option is problematic in exploring this further. We therefore plan to conduct a prospective matched cohort analysis together with a survey of unit practices and experiences.
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Affiliation(s)
- Andrew Symon
- Mother and Infant Research Unit, School of Nursing & Midwifery, University of Dundee, United Kingdom.
| | - Clare Winter
- School of Nursing & Midwifery, University of Brighton, United Kingdom
| | - Lynda Cochrane
- Dundee Epidemiology and Biostatistics Unit, University of Dundee, United Kingdom
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Symon A, Williams B, Adelasoye QA, Cheyne H. Nocebo and the potential harm of ‘high risk’ labelling: a scoping review. J Adv Nurs 2015; 71:1518-29. [DOI: 10.1111/jan.12637] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/02/2015] [Indexed: 12/20/2022]
Affiliation(s)
- Andrew Symon
- Mother and Infant Research Unit; University of Dundee; UK
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Andrews EJ, Symon A, Anderson AS. ‘I didn't know why you had to wait’: an evaluation of NHS infant-feeding workshops amongst women living in areas of high deprivation. J Hum Nutr Diet 2014; 28:558-67. [DOI: 10.1111/jhn.12269] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- E. J. Andrews
- Centre for Public Health Nutrition Research; Ninewells Hospital & Medical School; University of Dundee; Dundee UK
| | - A. Symon
- School of Nursing & Midwifery; University of Dundee; Dundee UK
| | - A. S. Anderson
- Centre for Public Health Nutrition Research; Ninewells Hospital & Medical School; University of Dundee; Dundee UK
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Khabiri R, Rashidian A, Montazeri A, Symon A, Foroushani AR, Arab M, Rashidi BH. Validation of the Mother-Generated Index in Iran: A Specific Postnatal Quality-of-Life Instrument. Int J Prev Med 2013; 4:1371-9. [PMID: 24498492 PMCID: PMC3898442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2012] [Accepted: 04/25/2013] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND The mother-generated index (MGI) is one of only a few existing specific questionnaires for assessing the postnatal quality of life (QoL). MGI is a single-form questionnaire that asks postnatal mothers to specify up to eight areas of their lives which have been affected by giving birth to a baby. Using this tool, it is possible to score and rank the QoL of mothers. This study aimed to validate the questionnaire for use in Iran. METHODS Forward translation was used to translate the questionnaire from English to Farsi (Persian). The questionnaire was then administered to a sample of postnatal women attending two teaching hospitals in Tehran, Iran. Face validity and criterion validity were performed to establish the validity for the Iranian version of the MGI. Face validity was assessed by asking women to indicate whether they understood the wording of the questions, how easy the questionnaire was, and so on. Criterion validity was examined using the Short Form 36-item (SF-36) Health Survey. It was hypothesized that the MGI would significantly correlate with the SF-36. RESULTS In all, 124 women were approached. Of these, 119 women were eligible and 96 women agreed to take part in the study. Face validity was good and all of the women found the MGI straightforward to complete; as criterion validity, the MGI scores and the subscales of the SF-36 were moderately correlated (for all subscales: Pearson r > 0.4; P < 0.001). The mean MGI primary score was 5.38 (SD = 3.05). Women who had comorbidity had significantly lower MGI scores than women without comorbidity (P = 0.04). Correlation between aggregate of comments and primary score was high (r = 0.68, P < 0.01). CONCLUSIONS In general, the Iranian version of the MGI performed well and our data suggest that it is a valid measure to assess health-related QoL among postnatal women.
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Affiliation(s)
- Roghayeh Khabiri
- Department of Observatory on Health and Health System, National Institute of Health Research, Tehran University of Medical Sciences, Tehran, Iran
| | - Arash Rashidian
- Department of Health Management and Economics, School of Public Health, Knowledge Utilization Research Center, Tehran University of Medical Sciences, Tehran, Iran,Correspondence to: Dr. Arash Rashidian, National Institute of Health Research, Tehran University of Medical Sciences, No 78, Italia Ave, Tehran, Iran. E-mail:
| | - Ali Montazeri
- Mental Health Group, Health Metrics Research Center, Iranian Institute for Health Sciences Research, ACECR, Tehran, Iran
| | - Andrew Symon
- Department of Midwifery, School of Nursing & Midwifery,University of Dundee, Scotland, United Kingdom
| | - Abbas Rahimi Foroushani
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Arab
- Department of Observatory on Health and Health System, National Institute of Health Research, Tehran University of Medical Sciences, Tehran, Iran
| | - Batoul Hosein Rashidi
- Department of Gynecology-Obstetrics, Vali-e-Asr Reproductive Health Research Center, Faculty of Medicine, Tehran University of Medical Sciences, Iran
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Lagan BM, Symon A, Dalzell J, Whitford H. 'The midwives aren't allowed to tell you': perceived infant feeding policy restrictions in a formula feeding culture - the Feeding Your Baby Study. Midwifery 2013; 30:e49-55. [PMID: 24238979 DOI: 10.1016/j.midw.2013.10.017] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2013] [Revised: 09/04/2013] [Accepted: 10/20/2013] [Indexed: 11/26/2022]
Abstract
OBJECTIVE to explore the expectations and experiences of postnatal mothers in relation to infant feeding, and to identify how care could be improved. DESIGN this study used a qualitative, exploratory, descriptive design. Data were collected through one to one in-depth semi-structured interviews and focus groups. SETTING Tayside area of Eastern Scotland. PARTICIPANTS seven focus group interviews (n=38 participants) and 40 semi-structured one-to-one interviews with mothers with a range of infant feeding experiences i.e. exclusively breast fed; started breast feeding but changed to formula milk before 16 weeks; exclusively formula fed; or who concurrently breast and formula fed their infant. FINDINGS a principal theme of 'Mixed and missing messages' emerged, incorporating 'Conflicting advice', 'Information gaps' and 'Pressure to breast feed' with a secondary theme of 'Emotional costs'. Several problems were identified with how women were given information, how infant feeding discussions were held, and the type of support available after the infant is born. KEY CONCLUSIONS there was a strong perception that some midwives are not 'allowed' to discuss or provide information on formula feeding, and the women reported feeling pressurised to breast feed. Current interpretation of guidance from the UNICEF UK Baby Friendly Initiative may be restricting antenatal discussions about infant feeding. The combination of this partial preparation antenatally and postnatal support that was often inconsistent seems to incur a counter-productive emotional cost. IMPLICATIONS FOR PRACTICE at strategic, policy and practice levels the infant feeding message needs to change to encourage a more woman-centred focus including discussions about the realities of all types of infant feeding. It is important that health providers continue to promote and support breast feeding; and that effective services are provided to women who wish to breast feed to help them to do so. However provision of information about all aspects of feeding is needed as well as support for women who do not wish to breast feed.
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Affiliation(s)
- Briege M Lagan
- School of Nursing, Institute of Nursing and Health Research, University of Ulster, Jordanstown, N. Ireland BT37 0QB, UK.
| | - Andrew Symon
- School of Nursing and Midwifery, University of Dundee, Scotland 11 Airlie Pl, Dundee DD1 4HJ, UK.
| | - Janet Dalzell
- Directorate of Public Health, Kings Cross, Clepington Road, Dundee DD3 8EA, UK.
| | - Heather Whitford
- School of Nursing and Midwifery, University of Dundee, Scotland 11 Airlie Pl, Dundee DD1 4HJ, UK.
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Donnan PT, Dalzell J, Symon A, Rauchhaus P, Monteith-Hodge E, Kellett G, Wyatt JC, Whitford HM. Prediction of initiation and cessation of breastfeeding from late pregnancy to 16 weeks: the Feeding Your Baby (FYB) cohort study. BMJ Open 2013; 3:bmjopen-2013-003274. [PMID: 23906958 PMCID: PMC3733309 DOI: 10.1136/bmjopen-2013-003274] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To derive prediction models for both initiation and cessation of breastfeeding using demographic, psychological and obstetric variables. DESIGN A prospective cohort study. SETTING Women delivering at Ninewells Hospital, Dundee, UK. DATA SOURCES Demographic data and psychological measures were obtained during pregnancy by questionnaire. Birth details, feeding method at birth and at hospital discharge were obtained from the Ninewells hospital database, Dundee, UK. Breastfeeding women were followed up by text messages every 2 weeks until 16 weeks or until breastfeeding was discontinued to ascertain feeding method and feeding intentions. PARTICIPANTS Pregnant women over 30 weeks gestation aged 16 years and above, living in Dundee, booked to deliver at Ninewells Hospital, Dundee, and able to speak English. MAIN OUTCOME MEASURE Initiation and cessation of breastfeeding. RESULTS From the total cohort of women at delivery (n=344) 68% (95% CI 63% to 73%) of women had started breastfeeding at discharge. Significant predictors of initiating breastfeeding were older age, parity, greater intention to breastfeed from a Theory of Planned Behaviour (TPB)-based questionnaire, higher Iowa Infant Feeding Assessment Scale (IIFAS) score as well as living with a husband or partner. For the final model, the AUROC was 0.967. For those who initiated breastfeeding (n=233), the strongest predictors of stopping were low intention to breastfeed from TPB, low IIFAS score and non-managerial/professional occupations. CONCLUSIONS The findings from this study will be used to inform the protocol for an intervention study to encourage and support prolonged breastfeeding as intentions appear to be a key intervention focus for initiation. The predictive models could be used to identify women at high risk of not initiating and also women at high risk of stopping for interventions to improve the longevity of breastfeeding.
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Affiliation(s)
- Peter T Donnan
- Dundee Epidemiology and Biostatistics Unit, Division of Population Health Sciences, Medical Research Institute, University of Dundee, Dundee, Scotland, UK
| | - Janet Dalzell
- Directorate of Public Health, NHS, Tayside, Scotland, UK
| | - Andrew Symon
- School of Nursing and Midwifery, University of Dundee, Dundee, Scotland, UK
| | - Petra Rauchhaus
- Dundee Epidemiology and Biostatistics Unit, Division of Population Health Sciences, Medical Research Institute, University of Dundee, Dundee, Scotland, UK
| | - Ewa Monteith-Hodge
- School of Nursing and Midwifery, University of Dundee, Dundee, Scotland, UK
| | - Gillian Kellett
- School of Nursing and Midwifery, University of Dundee, Dundee, Scotland, UK
| | - Jeremy C Wyatt
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Heather M Whitford
- School of Nursing and Midwifery, University of Dundee, Dundee, Scotland, UK
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Symon A, Nagpal J, Maniecka-Bryła I, Nowakowska-Głąb A, Rashidian A, Khabiri R, Mendes I, Pinheiro AKB, de Oliveira MF, Wu L. Cross-cultural adaptation and translation of a quality of life tool for new mothers: a methodological and experiential account from six countries. J Adv Nurs 2012; 69:970-80. [PMID: 22812385 DOI: 10.1111/j.1365-2648.2012.06098.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2012] [Indexed: 11/26/2022]
Abstract
AIM To examine the challenges and solutions encountered in the translation and cross-cultural adaptation of an English language quality of life tool in India, China, Iran, Portugal, Brazil, and Poland. BACKGROUND Those embarking on research involving translation and cross-cultural adaptation must address certain practical and conceptual issues. These include instrument choice, linguistic factors, and cultural or philosophical differences, which may render an instrument inappropriate, even when expertly translated. Publication bias arises when studies encountering difficulties do not admit to these, or are not published at all. As an educative guide to the potential pitfalls involved in the cross-cultural adaptation process, this article reports the conceptual, linguistic, and methodological experiences of researchers in six countries, who translated and adapted the Mother-Generated Index, a quality of life tool originally developed in English. DATA SOURCES Principal investigator experience from six stand-alone studies (two published) ranging from postgraduate research to citywide surveys. DISCUSSION/IMPLICATIONS FOR NURSING: This analysis of a series of stand-alone cross-cultural studies provides lessons about how conceptual issues, such as the uniqueness of perceived quality of life and the experience of new motherhood, can be addressed. This original international approach highlights practical lessons relating to instrument choice, and the resources available to researchers with different levels of experience. Although researchers may be confident of effective translation, conceptual and practical difficulties may be more problematic. CONCLUSION Instrument choice is crucial. Researchers must negotiate adequate resources for cross-cultural research, including time, translation facilities, and expert advice about conceptual issues.
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Affiliation(s)
- Andrew Symon
- School of Nursing & Midwifery, University of Dundee, UK.
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Fenwick J, Hammond A, Raymond J, Smith R, Gray J, Foureur M, Homer C, Symon A. Surviving, not thriving: a qualitative study of newly qualified midwives’ experience of their transition to practice. J Clin Nurs 2012; 21:2054-63. [DOI: 10.1111/j.1365-2702.2012.04090.x] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Herrera L, Symon A, Heskia C, Lara P, Marin F, Guajardo V, Rojas G, Araya V, Fiedler J. P-493 - Relation between salivary cortisol levels and corticotrophin releasing hormone receptor 1 (CRHR1) with antidepressant response to fluoxetine in patients with major depressive disorder. Eur Psychiatry 2012. [DOI: 10.1016/s0924-9338(12)74660-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Symon A, Dobb B. Maternal quality of life assessment: the feasibility of antenatal–postnatal follow‐up using the Mother‐Generated Index. J Reprod Infant Psychol 2011. [DOI: 10.1080/02646838.2010.513049] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Byrom S, Symon A. Developing the midwife's role in public health. Pract Midwife 2011; 14:16-17. [PMID: 21323080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
There is widespread acceptance that health can be shaped by factors occurring as far back as infancy, and even before birth. In September 2010 the document Midwifery 2020: Delivering Expectations was launched in Edinburgh. The aim of the report was to establish the future direction for midwifery in the UK, and included specific reference to the midwife's public health role. The report notes that experiences from in utero development until eight years of age lay critical foundations for the entire life course. The report reiterates previous debate on the important contribution maternity services have in addressing health inequalities, and emphasises the importance of midwives striving to address the needs of the most vulnerable communities they serve.
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Abstract
BACKGROUND An earlier matched cohort study in the United Kingdom found a significantly higher perinatal mortality rate for births booked under an independent midwife compared with births in National Health Service units (1.7% [25/1,508] vs 0.6% [45/7,366]). This study examined independent midwives' management and decision making in the 15 instances of perinatal death that occurred at term. METHODS Thematic analysis of independent midwives' case notes was performed in instances of perinatal mortality. Semi-structured interviews were conducted with the midwives concerned. RESULTS Home birth was attempted in 13 of the 15 cases. Significant (often multiple) antenatal risk factors were identified in 13 cases, including twin pregnancy, planned vaginal births after cesarean section, breech presentations, and maternal illness. Several women had declined some or all routine antenatal screening. Three deaths occurred before labor onset. Postmortem results were known in only four cases; many causes of death remained unexplained. Professional consensus was that seven deaths were unpreventable; elective cesarean section may have changed the outcome in eight cases. However, the pregnant women had declined this option; some were reported to be avoiding National Health Service care because of previous bad experiences. Transfer to hospital care, when it occurred, was often problematic. Care management was judged to be clinically acceptable within the parameters set by the mothers' choices. CONCLUSIONS Information about clinical processes (and outcomes) is essential if informed decisions are to be made. The women in this review had reportedly accepted the potential consequences of their high-risk situations. If reality is to match rhetoric about "patient" autonomy, such decision making in high-risk situations must be accepted.
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Affiliation(s)
- Andrew Symon
- School of Nursing & Midwifery, University of Dundee, Dundee, UK
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Abstract
Many claims about an increase in the incidence of perinatal litigation have been made, despite a lack of comprehensive data which might confirm this. A large scale study into litigation throughout Scotland from 1980 to 1995 revealed an initial sharp rise in the number of claims, but a fall in the overall number of claims made in 1994 and 1995; a similar picture was noted in a limited cross-border examination of English files. Not every area has experienced a reduction in incidence, and the rate of litigation (measured in deliveries per legal claim) varied hugely over time and between areas. A wide variety of head of claim was noted. Twenty-one percent of Scottish claims concerned cerebral palsy; of closed claims only 15% were successful, but a large proportion are still on-going. While the 'litigation crisis' is difficult to verify from these data, costs appear to be rising.
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Affiliation(s)
- A Symon
- Department of Widwifery, Perth & Kincross NHS Trust/University of Dundee, UK
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Abstract
Claims about a rising litigation rate, particularly in obstetrics, have allegedly fuelled fears of worsening relationships between obstetricians and midwives. Interviews with a number of practitioners, and others concerned with medical litigation, provided differing views about these assertions. While the fear of litigation is one element, it is probable that other often personal-factors may play a part. The overall tone of the interviews, however, suggested a significant degree of tension between obstetric and midwifery practitioners. The changing role of the midwife in contemporary maternity care also brings fresh challenges in developing healthy inter-professional relationships. At a time when litigation is believed to be ever-increasing, the existence of poor work relationships in this multi-disciplinary field may be critical.
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Affiliation(s)
- A Symon
- Department of Widwifery, Perth & Kincross NHS Trust/University of Dundee, UK
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Abstract
OBJECTIVE To compare clinical outcomes between women employing an independent midwife and comparable pregnant women using NHS services. DESIGN Anonymised matched cohort analysis. Cases from the database of the Independent Midwives' Association (IMA) matched up to 1:5 with Scottish National Health Service (NHS) records for age, parity, year of birth, and socioeconomic status. Multivariable logistic regression models used to explore the relation between explanatory variables and outcomes; analyses controlled for potential confounding factors and adjusted for stratification. SETTING UK databases 2002-5. PARTICIPANTS Anonymised records for 8676 women (7214 NHS; 1462 IMA). MAIN OUTCOME MEASURES Unassisted vertex delivery, live birth, perinatal death, onset of labour, gestation, use of analgesia, duration of labour, perineal trauma, Apgar scores, admission to neonatal intensive care, infant feeding. RESULTS IMA cohort mothers were significantly more likely to achieve an unassisted vertex delivery than NHS cohort mothers (77.9% (1139) v 54.3% (3918); odds ratio 3.49, 95% confidence interval 2.99 to 4.07) but also significantly more likely to experience a stillbirth or a neonatal death (1.7% (25) v 0.6% (46); 5.91, 3.27 to 10.7). All odds ratios are adjusted for confounding factors. Exclusion of "high risk" cases from both cohorts showed a non-significant difference (0.5% (5) v 0.3% (18); 2.73, 0.87 to 8.55); the "low risk" IMA perinatal mortality rate is comparable with other studies of low risk births. Women in the IMA cohort had a higher incidence of pre-existing medical conditions (1.5% (22) v 1.0% (72) in the NHS cohort) and previous obstetric complications (21.0% (307) v 17.8% (1284)). The incidence of twin pregnancy was also higher (3.4% (50) v 3.1% (224)). In the IMA cohort, 66.0% of mothers (965/1462) had home births, compared with only 0.4% of NHS cohort mothers (27/7214). Spontaneous onset of labour was more common in the IMA group (96.6% (1405) v 74.5% (5365); 10.43, 7.74 to 14.0), and fewer mothers used pharmacological analgesia (40.2% (588) v 60.6% (4370); 0.42, 0.38 to 0.47). Mothers in the IMA cohort were much more likely to breast feed (88.0% (1286) v 64.0% (2759); 3.46, 2.84 to 4.20). Prematurity (4.3% (63) v 6.9% (498); 0.49, 0.35 to 0.69), low birth weight (4.0% (60) v 7.1%) (523); 0.93, 0.62 to 1.38), and rate of admission to neonatal intensive care (4.4% (65) v 9.3% (667); 0.43, 0.32 to 0.59) were all higher in the NHS dataset. CONCLUSIONS Healthcare policy tries to direct patient choice towards clinically appropriate and practicable options; nevertheless, pregnant women are free to make decisions about birth preferences, including place of delivery and staff in attendance. While clinical outcomes across a range of variables were significantly better for women accessing an independent midwife, the significantly higher perinatal mortality rates for high risk cases in this group indicate an urgent need for a review of these cases. The significantly higher prematurity and admission rates to intensive care in the NHS cohort also indicate an urgent need for review.
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Affiliation(s)
- Andrew Symon
- School of Nursing and Midwifery, University of Dundee, Dundee DD1 4HJ.
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Affiliation(s)
- Andrew Symon
- School of Nursing & Midwifery, University of Dundee
| | | | | | - Val Carr
- School of Design, University of Dundee
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Affiliation(s)
- Andrew Symon
- School of Nursing and Midwifery, University of Dundee
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Affiliation(s)
- Andrew Symon
- School of Nursing & Midwifery, University of Dundee
| | | | | | - Val Carr
- School of Design, University of Dundee
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Affiliation(s)
- Andrew Symon
- School of Nursing & Midwifery, University of Dundee
| | | | | | - Val Carr
- School of Design, University of Dundee
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Affiliation(s)
- Andrew Symon
- School of Nursing & Midwifery, University of Dundee
| | | | - Maggie Butchart
- PhD candidate, School of Nursing & Midwifery, University of Dundee
| | - Val Carr
- PhD candidate, School of Design, University of Dundee
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Symon A. Commentary on Hung C-H (2006) Revalidation of the postpartum stress scale. Journal of Clinical Nursing 15, 718?725. J Clin Nurs 2007; 16:1771-2; discussion 1773-5. [PMID: 17727602 DOI: 10.1111/j.1365-2702.2006.01609.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Andrew Symon
- School of Nursing & Midwifery, University of Dundee, Dundee, UK.
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Abstract
Postnatal morbidity is increasingly recognized, but standard assessments may not capture what is most important to the woman with such morbidity in terms of her quality of life. The Mother-Generated Index (MGI) is a proposed postnatal quality-of-life instrument which allows the mother to determine both content and scoring. In this pilot study we found that although a degree of psychological and physical morbidity (including tiredness) is common, and may be very significant, for most women these factors are low-grade, and other aspects of their lives are more important. A quality-of-life approach allows the mother to determine her own postnatal assessment, and encourages practitioners to view her more holistically.
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Affiliation(s)
- A Symon
- School of Nursing & Midwifery, University of Dundee, Dundee, Dundee DD1 9SY, Scotland, UK.
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Cheyne H, Hundley V, Symon A. Policy, practice and research: does it make a difference? RCM Midwives 2003; 6:526-8. [PMID: 14748126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
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Affiliation(s)
- Andrew Symon
- School of Nursing and Midwifery, University of Dundee
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Abstract
Background Contemporary broad descriptions of health and well-being are reflected in an increasing appreciation of quality of life issues; in turn this has led to a growing number of tools to measure this. Methods This paper reviews articles cited in MEDLINE, CINAHL and BIDS which have addressed the concept of quality of life in pregnancy and the period following childbirth. Results It describes five groups of articles: those explicitly assessing quality of life in this area; those using broader health assessments as an indicator of quality of life; those articles equating quality of life with certain pregnancy outcomes in identified groups of patients; those studies which identify the possibility of pregnancy as an outcome measure and infer from this that quality of life has been improved; and those articles which are themselves reviews or commentaries of pregnancy and childbirth and which identify quality of life as a feature. Conclusions The term 'quality of life' is used inconsistently in the literature. There are few quality of life tools specifically designed for the maternity care setting. Improved or adversely affected quality of life is frequently inferred from certain clinical conditions.
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Affiliation(s)
- Andrew Symon
- School of Nursing & Midwifery, University of Dundee, Dundee, Scotland, UK.
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Symon A, McGreavey J, Picken C. Postnatal quality of life assessment: validation of the Mother-Generated Index. BJOG 2003; 110:865-8. [PMID: 14511971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
Quality of life is multifactorial, but may not be adequately assessed using existing validated health measures. The Mother-Generated Index, a subjective tool to measure postnatal quality of life, was assessed in a study of 102 women in Tayside, Scotland. They specified the most important areas of their lives having had a baby, and scored these. The Index showed good correlation with established measures of physical and psychological wellbeing, and accurately tracked attitudes towards the baby and the partner. Face, criterion and construct validity were all demonstrated. As both content and scoring are subjectively determined, the Index encourages a holistic assessment.
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Affiliation(s)
- Andrew Symon
- School of Nursing and Midwifery, University of Dundee, Dundee DD1 9SY, Scotland, UK
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Abstract
BACKGROUND A healthy diet in pregnancy is important for both maternal and infant health but this may be difficult to achieve particularly for groups such as teenage pregnant women, many of whom are from disadvantaged backgrounds. To our knowledge this is the first report of a practical nutrition education programme for this group in the UK. METHOD An intervention was designed incorporating seven informal food preparation sessions, which allowed opportunities for discussion of nutritional, and other topics (e.g. food safety and well-being in pregnancy). Midwives in a community centre setting led the sessions. The acceptability of the package to participants and midwives was recorded and pre- and post-intervention data collected on sociodemographic details, dietary intake (using an eating-habits questionnaire and a 24-h dietary recall) and cooking skills. RESULTS The midwives found the package easy to follow and use. The 16 (of the 120 invited) women who attended found the courses helpful but objective evaluation of dietary intake was not possible because of poor compliance. CONCLUSIONS The nutrition education programme was favourably received by midwives and the women who participated. However recruitment was problematic and alternative methods of delivering and evaluating such a package should be investigated.
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Affiliation(s)
- W L Wrieden
- Centre for Public Health Nutrition Research, Department of Medicine, Ninewells Medical School, University of Dundee, UK.
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