Midwifery最新文献_第7页

Scarce perinatal social support for women with OUD: Opportunities for doula services 为患有 OUD 的妇女提供稀缺的围产期社会支持：朵拉服务的机遇

IF 2.6 3区医学 Q1 NURSING

Midwifery

Pub Date : 2024-08-30 DOI: 10.1016/j.midw.2024.104169

Meghan Gannon , Vanessa Short , Scott Keith , Dennis Hand , Leah Owen Oliner , Angela Yang , Nadia Haerizadeh-Yazdi , Aisosa Ize-Iyamu , Erin Kelly , Lara Weinstein , Neera Goyal , Ruth Jeminiwa , Diane Abatemarco

Problem

Persons with opioid use disorder (OUD) often lack social support, which is associated with improved recovery outcomes.

Background

In the last two decades, the rate of opioid use disorder (OUD) among pregnant people has quadrupled.

Question

This study aimed to describe the prenatal and postpartum social support networks and needs of persons with OUD and assess perceived acceptability of community-based social supports such as doulas.

Methods

This mixed methods study utilized quantitative and qualitative data to understand social support structures and needs. Data was collected through surveys –demographics and social mapping; Adverse Childhood Experiences (ACE) tool; Connor Davidson Resilience 25-item (CDRS-25) scale– and a semi-structured interview. A total of 34 participants from a single urban opioid treatment program consented to participate.

Findings

Participants were on average 34.9 years old, White (64.7%), and unemployed (91.2%). Participants described small perinatal social support networks, which decreased in size from the prenatal to postpartum period. Only half (52.9%) reported adequate prenatal and postpartum social support. Doulas and peer recovery support specialists were perceived as valuable in perinatal health, social support, and recovery domains, with interest in doulas seen particularly amongst those with fewer reported supports.

Discussion

: The scarcity of prenatal and postpartum social support among persons with OUD is critical to address, given the increased risk of relapse during the postpartum period which has implications for the maternal child dyad.

Conclusion

: Due to multiple disparities in prenatal and postpartum social support (small networks, inadequate support), doulas represent a trusted community-based support to be integrated into healthcare teams to address maternal morbidity/mortality associated with opioid use.

问题阿片类药物使用障碍（OUD）患者往往缺乏社会支持，而社会支持与康复效果的改善相关。背景在过去二十年中，孕妇阿片类药物使用障碍（OUD）的发病率翻了两番。数据是通过调查--人口统计学和社会分布图；童年不良经历（ACE）工具；康纳-戴维森复原力 25 项量表（CDRS-25）--和半结构化访谈收集的。共有 34 名来自一个城市阿片类药物治疗项目的参与者同意参加。研究结果参与者平均年龄 34.9 岁，白人（64.7%），失业（91.2%）。参与者描述的围产期社会支持网络规模较小，而且从产前到产后规模不断缩小。只有一半（52.9%）的受试者在产前和产后得到了足够的社会支持。朵拉和同伴康复支持专家被认为在围产期健康、社会支持和康复领域很有价值，尤其是那些报告支持较少的人群对朵拉很感兴趣：讨论：鉴于产后复发的风险增加，这对母婴关系产生了影响，因此必须解决 OUD 患者在产前和产后缺乏社会支持的问题：由于在产前和产后社会支持方面存在多种差异（网络规模小、支持不足），朵拉代表了一种值得信赖的社区支持，应将其纳入医疗保健团队，以解决与阿片类药物使用相关的孕产妇发病率/死亡率问题。

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引用次数: 0

“It's my Home away from Home:” A hermeneutic phenomenological study exploring decision-making experiences of choosing a freestanding birth centre for perinatal care "这是我的家外之家："一项诠释学现象学研究，探索选择独立分娩中心进行围产期护理的决策经验。

IF 2.6 3区医学 Q1 NURSING

Midwifery

Pub Date : 2024-08-30 DOI: 10.1016/j.midw.2024.104164

Erin K. George , Sarah Dominique , Whitney Irie , Joyce K. Edmonds

Problem

The high-value, midwifery-led birth centre (BC) model of care is underutilized in the United States, a country with high rates of obstetric intervention and maternal morbidity and mortality.

Background

Birth setting decision-making is a complex, preference-sensitive, and resource-dependent process. Understanding how people choose BCs for care may help increase the utilization of BCs and generate positive perinatal outcomes.

Aim

This study explores the decision-making experiences of people with Medicaid insurance who chose to give birth in a BC in Massachusetts by gathering interview data to interpret and provide meaning about their selection of birth setting.

Methods

We employed a hermeneutic phenomenology study to interview people about their decision to give birth in a BC. Interview data were coded using a hybrid deductive-inductive approach and analyzed using reflexive thematic analysis to interpret and provide meaning.

Findings

Twelve women participated in the study. Five themes emerged that described participants’ decision-making processes: 1) Stepping Away from “the System,” 2) Decision-Making with External Influences, 3) Accessing BC Care, 4) Finding a Home at the BC, and 5) Decision-Making as a Temporal Process.

Discussion

The decision to choose a BC was a dynamic process that occurred over time and was influenced by factors such as the quality of care, accessibility, external influences, and the physical environment.

Conclusion

Prioritizing an individual's capacity to choose their birth setting and fostering awareness about options in the context of informed decision-making are pivotal steps toward attaining equity in perinatal health. Securing public insurance coverage and equitable reimbursement for BCs represent essential policies aimed at facilitating universal access to the BC model for all people.

问题：在产科干预率、孕产妇发病率和死亡率都很高的美国，以助产士为主导的高价值分娩中心（BC）护理模式未得到充分利用：背景：选择分娩环境是一个复杂、对偏好敏感且依赖资源的过程。目的：本研究通过收集访谈数据，探讨马萨诸塞州拥有医疗补助保险并选择在 BC 分娩的人群的决策经验，以解释他们对分娩环境选择的意义：方法：我们采用诠释现象学研究方法，就人们选择在 BC 分娩的决定进行访谈。采用演绎-归纳混合法对访谈数据进行编码，并使用反思性主题分析法对其进行分析，以解释和提供意义：12 名妇女参与了研究。出现了五个主题来描述参与者的决策过程：1) 远离 "系统"；2) 在外部影响下做出决策；3) 获得 BC 护理；4) 在 BC 找到家；5) 决策是一个时间过程：讨论：选择 BC 的决定是一个动态过程，会随着时间的推移而发生，并受到护理质量、可及性、外部影响和物理环境等因素的影响：结论：优先考虑个人选择分娩环境的能力，并在知情决策的背景下提高对各种选择的认识，是实现围产期保健公平的关键步骤。确保公共保险的覆盖范围以及对产前护理的公平补偿是旨在促进所有人普遍使用产前护理模式的重要政策。

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引用次数: 0

Effect of health education provided to couples on maternal knowledge, attitude and use of maternity waiting homes in rural Ethiopia: A cluster-randomized trial 在埃塞俄比亚农村地区，向夫妇提供健康教育对孕产妇知识、态度和使用待产之家的影响：分组随机试验

IF 2.6 3区医学 Q1 NURSING

Midwifery

Pub Date : 2024-08-22 DOI: 10.1016/j.midw.2024.104153

Teklemariam Ergat Yarinbab , Hailay Abrha Gesesew , Tefera Belachew

Background

Maternity waiting home (MWH) has been advocated as an approach to improve women's access to obstetric services in low-resource settings; however, its use remains low. This study investigated the effectiveness of couple-based health education on maternal knowledge, attitudes, and use of MWHs in rural Ethiopia.

Methods

A total of 320 couples from 16 clusters were allocated to the intervention and control groups using restricted randomization. Participants in the intervention group received group health education, home visits, and information flyers along with usual care, whereas those in the control group received usual care. Statistical differences were estimated using the chi-squared test. The impact of the intervention was evaluated using generalized linear regression and difference-in-differences models.

Results

Baseline and endline data were collected from the 320 couples. The intervention increased knowledge by 37.5 % (95 % CI: 32.2 % - 42.8 %), attitude by 33.8 % (95 % CI: 28.8 %–39.2 %), and utilization of MWH by 32.9 % (95 % CI: 27.9 %–38.2 %) among women. In addition, compared to those in the control group, women in the intervention group were almost six times more likely to have increased knowledge of MWH (AOR 5.74, 95 % CI: 3.51–9.38), four times more likely to have improved attitudes of MWH (AOR 4.45, 95 % CI: 2.78 -7.13), and four times more likely to stay at MWH (AOR 4.45, 95 % CI: 2.78 -7.12).

Conclusion

Providing health education to couples can improve maternal knowledge, attitudes, and the use of MWHs. Policymakers and healthcare cadres can use the current intervention strategy to enhance maternal health services, particularly MWHs, in rural Ethiopia.

背景待产之家（MWH）一直被认为是改善低资源环境中妇女获得产科服务的一种方法，但其使用率仍然很低。本研究调查了以夫妇为基础的健康教育对埃塞俄比亚农村地区孕产妇知识、态度和待产之家使用情况的影响。方法采用限制性随机法将 16 个群组的 320 对夫妇分配到干预组和对照组。干预组的参与者在接受常规护理的同时还接受了集体健康教育、家访和信息传单，而对照组的参与者则接受常规护理。统计差异采用卡方检验进行估计。使用广义线性回归和差异模型对干预的影响进行了评估。干预措施使妇女的知识水平提高了 37.5 %（95 % CI：32.2 % - 42.8 %），态度水平提高了 33.8 %（95 % CI：28.8 % - 39.2 %），对产妇保健的利用率提高了 32.9 %（95 % CI：27.9 % - 38.2 %）。此外，与对照组相比，干预组妇女对产妇保健知识的了解增加了近六倍（AOR 5.74，95 % CI：3.51-9.38），对产妇保健态度的改善增加了四倍（AOR 4.45，95 % CI：2.78 -7.13），留在 MWH 的可能性增加了四倍（AOR 4.45，95 % CI：2.78 -7.12）。政策制定者和医疗保健人员可以利用当前的干预策略来加强埃塞俄比亚农村地区的孕产妇保健服务，尤其是产妇保健服务。

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引用次数: 0

Psychometric evaluation of the Afaan Oromo version of the exclusive breastfeeding social support scale among Ethiopian women 埃塞俄比亚妇女纯母乳喂养社会支持量表阿法安-奥罗莫语版的心理计量学评估

IF 2.6 3区医学 Q1 NURSING

Midwifery

Pub Date : 2024-08-22 DOI: 10.1016/j.midw.2024.104154

Reta Tsegaye Gayesa , Yao Jie Xie , Fei Wan Ngai

Problem

There is a lack of validated tools for assessing social support for Exclusive Breastfeeding (EBF) practice in Ethiopia.

Background

Validating instruments ensures culturally appropriate and reliable data collection for effective research and interventions.

Aim

This study aimed to translate the exclusive breastfeeding social support scale into the Afaan Oromo language (EBFSS-AO) and test its psychometric properties among Ethiopian women.

Methods

The scale was first subjected to forward and backward translation before undergoing psychometric evaluation. Then, a cross-sectional study was conducted on convenience sample of 160 postpartum women. Content validity was assessed via Content Validity Index (CVI), and construct validity was tested using confirmatory factor analysis (CFA) with maximum likelihood estimation. The scale's reliability was measured using Cronbach's alpha and intraclass correlation coefficient (ICC).

Findings

The CFA verified that the EBFSS-AO for Ethiopian women is a three-dimensional scale with satisfactory fit indices; $x^{2}$ /df: 2.76; Comparative fit index: 0.917; Tucker-Lewis Index: 0.902; Standardized Root Mean square residual: 0.061; and Root mean square error of approximation: 0.105. Item-level CVI ranged from 0.86 to 1.00, and scale-level CVI was 0.98. The overall scale had a Cronbach's alpha of 0.95 while instrumental, emotional, and informational support subscales had a Cronbach's alpha of 0.89, 0.92, and 0.93 respectively. After a 4-week re-test, the ICC yielded a value of 0.94. Partner support on EBF showed no socio-demographic differences except for income.

Conclusion

The EBFSS-AO showed satisfactory psychometric properties, suitable for assessing social support among Ethiopian women in both research and clinical contexts.

背景对工具进行验证可确保为有效的研究和干预收集到文化适宜且可靠的数据。本研究旨在将纯母乳喂养社会支持量表翻译成阿法安奥罗莫语（EBFSS-AO），并在埃塞俄比亚妇女中测试其心理测量特性。然后，对 160 名方便抽样的产后妇女进行了横断面研究。内容效度通过内容效度指数（CVI）进行评估，而构造效度则通过采用最大似然估计的确证因子分析（CFA）进行检验。研究结果：CFA 证实埃塞俄比亚妇女 EBFSS-AO 是一个三维量表，其拟合指数令人满意；x2/df：2.76；比较拟合指数：0.917；Tucker-Learn 拟合指数：0.917：0.917；Tucker-Lewis 指数0.902；标准化均方根残差：0.061；均方根近似误差：0.105：0.105.项目级 CVI 为 0.86 至 1.00，量表级 CVI 为 0.98。总量表的 Cronbach's alpha 为 0.95，而工具支持、情感支持和信息支持子量表的 Cronbach's alpha 分别为 0.89、0.92 和 0.93。经过 4 周的重新测试，ICC 值为 0.94。结论 EBFSS-AO 显示出令人满意的心理测量特性，适合在研究和临床环境中评估埃塞俄比亚妇女的社会支持。

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引用次数: 0

Birthing consciousness and the flow experience during physiological childbirth 分娩意识和生理分娩过程中的流动体验

IF 2.6 3区医学 Q1 NURSING

Midwifery

Pub Date : 2024-08-20 DOI: 10.1016/j.midw.2024.104151

Orli Dahan , Alexander Zibenberg , Alon Goldberg

Problem

It has been demonstrated that birth without medical intervention conveys significant physical and psychological benefits to the mother and her newborn baby. However, there is a need to include women's subjective experience of physiological birth to understand and promote it.

Background

The theoretical concept of “birthing consciousness” hypothesizes that women during natural childbirth sometimes experience a specific altered state of consciousness, which is a positive peak experience that resembles “flow” in many aspects.

Aim

To investigate the underexplored connection between the physiological mode of childbirth and altered states of consciousness during childbirth.

Methods

Israeli women with childbirth experience were recruited through social media (Facebook groups with a focus on childbirth and motherhood). Participants (n = 766) completed an online survey: the Flow State Scale (FSS) and a demographic questionnaire.

Findings

Differences were found between modes of birth as to flow state, as women who experienced physiological childbirth (i.e., with no epidural anesthesia or instrumental interventions) had a higher flow state during birth.

Discussion

This link empirically confirms the phenomenon of birthing consciousness. All nine dimensions of the mental state of flow apply to childbirth: challenge-skill balance, action-awareness merging, clear goals, unambiguous feedback, concentration on the task, sense of control, loss of self-consciousness, transformation of time, and autotelic experience.

Conclusion

Understanding a women's subjective experience during physiological birth can enhance clinical understanding of physiological birth thus promoting positive physiological birth experiences – which has crucial health benefits. We propose that more studies need to be done to promote experiencing flow during physiological birth.

问题事实证明，在没有医疗干预的情况下分娩，对母亲和新生儿的生理和心理都有很大好处。背景 "分娩意识 "这一理论概念假设，自然分娩过程中妇女有时会经历一种特定的意识改变状态，这是一种积极的高峰体验，在许多方面类似于 "流动"。方法通过社交媒体（以分娩和母性为主题的 Facebook 群组）招募有分娩经验的以色列女性。参与者（n = 766）完成了一项在线调查："流动状态量表"（FSS）和一份人口统计学问卷。研究结果发现不同分娩方式的流动状态存在差异，经历过生理性分娩（即没有硬膜外麻醉或器械干预）的妇女在分娩时的流动状态更高。流动心理状态的九个维度均适用于分娩：挑战-技能平衡、行动-意识融合、目标明确、反馈清晰、专注于任务、控制感、失去自我意识、时间转换和自发体验。我们建议需要开展更多研究，以促进生理分娩过程中的流动体验。

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引用次数: 0

Novel solutions to the midwifery retention crisis in England: an organisational case study of midwives’ intentions to leave the profession and the role of retention midwives 英格兰助产士留任危机的新解决方案：助产士离职意向及留任助产士作用的组织案例研究

IF 2.6 3区医学 Q1 NURSING

Midwifery

Pub Date : 2024-08-20 DOI: 10.1016/j.midw.2024.104152

Claire Feeley, Tomasina Stacey

Problem/Background

: Midwifery retention is a global issue, but less is known regarding what motivates midwives’ intention to stay or leave within individual organisations. In 2021, NHS England funded maternity organisations to employ retention midwives. To date, the impact of these roles has not been evaluated.

Aim

: To explore the views of midwives regarding their intentions to leave or stay within one English organisation and to provide insights into the perceived impact of the role of retention midwives.

Methods

: An instrumental case study was carried out in one organisation. Data a mixed methods survey (n=67/91) and interview data (n=7). Quantitative data was analysed using descriptive and inferential statistics; qualitative data using thematic analysis. All data was synthesised together.

Findings

: The three themes included ‘Values-based tensions: The eroding role of the midwife’; ‘Discerning differences: Intentions to leave or stay’; ‘Retention midwives: Activities and impact’.

Discussion

: We found that there was a clear link between midwives’ intention to leave or stay and their workplace roles; specialist midwives were more likely to stay, report satisfaction, autonomy, and feel a sense of contribution or effectiveness in their role compared to those in other roles. The retention midwives were making a positive difference to midwives’ experience of the workplace.

Conclusion

: Midwives working within the same organisation have different experiences of their role and job satisfaction. Future work should consider applying the positive elements of the specialist roles to the wider midwifery workforce to enhance retention. The retention midwife role shows promise, but further evaluation is required.

问题/背景：助产士留任是一个全球性问题，但人们对助产士在个别机构内留任或离职的动机却知之甚少。2021 年，英国国家医疗服务体系资助产科机构聘用留用助产士。目的：探讨助产士对其在一家英国机构内去留意向的看法，并深入了解留任助产士角色的感知影响：方法：在一家机构内开展工具性案例研究。数据采用混合方法调查（n=67/91）和访谈数据（n=7）。定量数据采用描述性和推论性统计进行分析；定性数据采用主题分析进行分析。对所有数据进行了综合：三个主题包括 "基于价值观的紧张关系：结果：三个主题包括 "基于价值观的紧张关系：助产士角色的侵蚀"、"辨别差异：去留意向"；"留住助产士：活动和影响"：活动和影响"：我们发现，助产士的去留意向与她们在工作场所的角色之间存在着明显的联系；与其他角色的助产士相比，专业助产士更有可能留下来，她们对自己的角色表示满意、拥有自主权，并感觉到自己的贡献或效率。留任助产士对助产士的工作场所体验产生了积极的影响：结论：在同一机构工作的助产士对其角色和工作满意度有不同的体验。未来的工作应考虑将专业角色的积极因素应用到更广泛的助产士队伍中，以提高留任率。留任助产士角色显示了前景，但还需要进一步评估。

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引用次数: 0

International News October 2024 2024 年 10 月国际新闻

IF 2.6 3区医学 Q1 NURSING

Midwifery

Pub Date : 2024-08-20 DOI: 10.1016/j.midw.2024.104135

引用次数: 0

Barriers and facilitators of screening postpartum depression by primary maternal health workers: A mixed methods study based on the normalization process theory 基层孕产妇保健工作者筛查产后抑郁症的障碍和促进因素：基于正常化过程理论的混合方法研究。

IF 2.6 3区医学 Q1 NURSING

Midwifery

Pub Date : 2024-08-18 DOI: 10.1016/j.midw.2024.104148

Zhen Zeng , Xiaoyu Li , Yanping Bai , Wenjie Gong

Background

Postpartum depression (PPD) significantly impacts mothers and children's health. China aims to incorporate PPD screening in postpartum home visits, but research on implementation barriers and facilitators is scarce. We designed and implemented a new PPD screening program in Changsha, China, requiring maternal health workers to integrate PPD screening into their postpartum home visits.

Aims

To identify real-world barriers and facilitators associated with integrating PPD screening into routine home visits from the perspective of maternal health workers.

Methods

We employed a mixed-methods approach. Maternal health workers involved in the newly introduced PPD screening program were included. Guided by Normalization Process Theory (NPT), quantitative data were collected using the NoMAD instrument, and qualitative data were obtained through semi-structured interviews. Data were analyzed using descriptive statistics for the survey and thematic analysis for the interviews.

Results

All 42 maternal health workers involved in the new PPD program completed the quantitative survey, and nine participated in qualitative interviews. The NoMAD survey revealed high scores for Coherence and Cognitive Participation, but lower scores for Collective Action, particularly regarding insufficient skills and resource adequacy. Thematic analysis identified several barriers, including workload concerns, the need for enhanced psychological healthcare capacity, and lack of economic incentives. Facilitators included the integration of structured feedback and clear referral pathways.

Conclusion

Addressing identified barriers through targeted skill training, well-defined referral pathways, and formal recognition of the screening program in performance evaluations could help achieve successful normalization.

背景：产后抑郁症（PPD）严重影响母亲和儿童的健康。中国的目标是在产后家访中纳入 PPD 筛查，但有关实施障碍和促进因素的研究却很少。我们在中国长沙设计并实施了一项新的PPD筛查项目，要求孕产妇保健工作者将PPD筛查纳入其产后家访中。目的：从孕产妇保健工作者的角度出发，找出将PPD筛查纳入常规家访的现实障碍和促进因素：我们采用了混合方法。方法：我们采用了混合方法，将参与新引入的 PPD 筛查项目的孕产妇保健工作者纳入其中。在规范化过程理论（NPT）的指导下，我们使用 NoMAD 工具收集定量数据，并通过半结构化访谈获得定性数据。调查数据采用描述性统计，访谈数据采用主题分析：所有参与新 PPD 计划的 42 名孕产妇保健工作者都完成了定量调查，9 人参加了定性访谈。NoMAD 调查显示，一致性和认知参与得分较高，但集体行动得分较低，尤其是在技能不足和资源充足方面。专题分析发现了一些障碍，包括工作量问题、加强心理保健能力的需要以及缺乏经济激励。促进因素包括整合结构化反馈和明确的转诊途径：通过有针对性的技能培训、明确的转诊途径以及在绩效评估中对筛查计划的正式认可来解决已发现的障碍，有助于成功实现正常化。

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引用次数: 0

Development and early implementation of telemonitoring of complicated pregnancies – A qualitative study with the perspectives of health professionals 复杂妊娠远程监护的开发和早期实施--从医疗专业人员的角度进行的定性研究。

IF 2.6 3区医学 Q1 NURSING

Midwifery

Pub Date : 2024-08-18 DOI: 10.1016/j.midw.2024.104149

Jane Hyldgaard Nielsen , Ingrid Jepsen , Stine Aistrup Eriksen , Rikke Damkjær Maimburg

Background

Telemonitoring may offer promising opportunities in health care. In obstetric health care, there is a need to expand and improve digitalization. Nevertheless, there is limited knowledge based on healthcare professionals' perspectives regarding the use of telemedicine and remote cardiotocography during pregnancy, as well as its implementation.

Aim

To explore the perspectives of health-care professionals who manage telemonitoring of complicated pregnancies.

Design and setting

A qualitative interview study undertaken in a hospital with a tertiary obstetric unit in Northen Denmark.

Methods

Based on a purposive sample strategy, 11 semi-structured interviews of health-care professionals involved in the management of telemonitoring in women with complicated pregnancies were conducted and analyzed using a reflexive thematic analytical approach.

Findings

The findings are assembled into two main themes. The experience of relevance to own practice: included the embedded potentials in telemonitoring providing women-centred care, but also challenges related to the implementation of a new technology. Experience of challenges and potential in day-to-day operation: included frustrations regarding the technological devices and software, working experiences increasing confidence in telemonitoring, and perspectives on the required interdependence across departments.

Conclusion

This study adds important knowledge to support awareness and reflection on how challenges impact the successful implementation of telemonitoring in obstetric and midwifery care. This includes knowledge of important processes and resources to ensure ongoing implementation and evaluation. Implementation strategies and collaborations to support a multiple-level system change, such as an interdisciplinary team, seem crucial to minimize challenges, build shared visions, and engage staff.

背景：远程监控可为医疗保健提供大有可为的机会。在产科医疗保健中，有必要扩大和改进数字化。然而，从医护人员的角度来看，他们对孕期远程医疗和远程心动图的使用及其实施的了解还很有限。目的：探讨管理复杂妊娠远程监护的医护人员的观点：在丹麦北部一家设有三级产科的医院进行的定性访谈研究：根据目的性抽样策略，对参与复杂妊娠妇女远程监护管理的专业医护人员进行了 11 次半结构化访谈，并采用反思性主题分析方法对访谈结果进行了分析：研究结果分为两大主题。与自身实践相关的经验：包括远程监护在提供以妇女为中心的护理方面所蕴含的潜力，但也包括与实施新技术相关的挑战。日常操作中的挑战和潜力：包括技术设备和软件方面的挫折、增强对远程监控信心的工作经验，以及对跨部门相互依存所需的观点：这项研究增加了重要的知识，有助于认识和思考在产科和助产护理中成功实施远程监护所面临的挑战。这包括了解确保持续实施和评估的重要流程和资源。支持多层次系统变革的实施策略和合作（如跨学科团队）对于最大限度地减少挑战、建立共同愿景和吸引员工参与似乎至关重要。

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引用次数: 0

Shared decision-making in maternity care in Saudi Arabia: A cross-sectional study 沙特阿拉伯孕产妇护理中的共同决策：横断面研究

IF 2.6 3区医学 Q1 NURSING

Midwifery

Pub Date : 2024-08-14 DOI: 10.1016/j.midw.2024.104147

Tahani Ali Alruwaili , Kimberley Crawford , Ensieh Fooladi

Background

Shared decision-making (SDM) in maternity care involves women actively in decisions, thereby reducing decisional conflicts and enhancing satisfaction with care.

Aim

To investigate SDM and the factors associated with it, and its correlation with respect in maternity care in Saudi Arabia.

Methods

A comprehensive, nationwide online questionnaire-based study was conducted between January to May 2023, involving women aged 18 years and above who were either pregnant or had experienced pregnancy/childbirth in the past 12 months. The Mothers’ Autonomy in Decision-Making (MADM) scale and the Mothers of Respect Index (MORi) were used. Low to very low SDM was defined as a score of ≤ 24 on the MADM and low to very low respected was defined as a score of ≤ 49 on the MORi.

Results

A total of 505 women completed the survey. Low to very low SDM was reported by 137 (34.1 %, 95 confidence interval (CI), 29.6 % - 38.9 %) women. Factors significantly associated with low to very low SDM included seeing different obstetricians of different gender at each visit (adjusted odds ratio (AOR) 2.0, 95 % CI, 1.0 – 3.9), not meeting the same obstetrician throughout the pregnancy (AOR 2.6, 95 % CI, 1.2 – 5.6) and having an instrumental vaginal birth (AOR 6.67, 95 % CI, 1.6 - 28.1). There was a positive association between low to very SDM and feeling of low to very low respect ((χ2 = 83.8173, p < 0.001).

Conclusion

More than one-third of women experienced low to very low SDM in maternity care. This should alert healthcare providers to the importance of continuity of care in Saudi Arabia.

背景产科护理中的共同决策（SDM）让女性积极参与决策，从而减少决策冲突并提高护理满意度。目的调查沙特阿拉伯产科护理中的 SDM 及其相关因素，以及其与尊重的相关性。方法在 2023 年 1 月至 5 月期间开展了一项基于在线问卷的全国性综合研究，研究对象为 18 岁及以上、怀孕或在过去 12 个月中经历过怀孕/分娩的女性。研究采用了母亲自主决策量表（MADM）和母亲尊重指数（MORi）。MADM评分≤24分为 "低度至极度低度SDM"，MORi评分≤49分为 "低度至极度低度受尊重"。137名（34.1%，95 置信区间 (CI)，29.6% - 38.9%）女性表示 SDM 低至很低。与低至极低 SDM 显著相关的因素包括：每次就诊时都见到不同性别的产科医生（调整后的几率比（AOR）为 2.0，95 % CI，1.0 - 3.9）；整个孕期没有见到同一位产科医生（AOR 2.6，95 % CI，1.2 - 5.6）；以及阴道助产（AOR 6.67，95 % CI，1.6 - 28.1）。低度至极度 SDM 与低度至极度受尊重感之间存在正相关（χ2 = 83.8173，p < 0.001）。在沙特阿拉伯，医疗服务提供者应警惕连续性护理的重要性。

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