Womens Health Issues最新文献_第3页

Does a Welcoming Environment Influence Women Veterans’ Primary Care Experiences? 欢迎环境是否会影响女性退伍军人的初级保健体验？

IF 2.8 2区医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Womens Health Issues

Pub Date : 2024-09-01 DOI: 10.1016/j.whi.2024.07.002

Danielle E. Rose PhD, MPH , Melissa M. Farmer PhD , Sabine M. Oishi PhD, MSPH , Ruth S. Klap PhD , Bevanne A. Bean-Mayberry MD, MHS , Ismelda Canelo MPA , Donna L. Washington MD, MPH , Elizabeth M. Yano PhD, MPH

Background

A welcoming environment may influence patient care experiences, and it may be particularly relevant for underrepresented groups, such as women veterans at Veterans Health Administration (VA) facilities where they represent only 8–10% of patients. Challenges to ensuring a welcoming environment for women veterans may include unwelcome comments from male veterans and staff or volunteers and feeling unsafe inside or outside VA facilities. We assessed associations between reports of gender-related environment of care problems and patient-reported outcomes.

Procedures

We merged national patient-reported outcomes from women veterans (n = 4,961) using Consumer Assessment of Health Plans & Systems Patient Centered Medical Home (CAHPS-PCMH) survey composite measures with Women Veteran Program Managers' reports of gender-related environment of care problems (n = 127, 2016–2017) at VA facilities. We performed multilevel bivariate logistic regressions to assess associations between Women Veteran Program Managers' reports of large/extreme problems and likelihood of women veterans’ optimal ratings of primary care experiences (access, coordination, comprehensiveness, provider communication, and overall rating of primary care provider). We adjusted for patient-, site-, and area-level characteristics, and clustering of patients within VA facilities, and we applied design weights to address nonresponse bias in the patient data. Response rates were 40% for women veterans and 90% for Women Veteran Program Managers.

Main Findings

Few (<15%) Women Veteran Program Managers reported large/extreme environment of care problems. Women veterans obtaining care at those sites were less likely to rate provider communication and comprehensiveness (psychosocial health assessed) as optimal.

Principal Conclusions

Ensuring a welcoming environment may improve women veterans' primary care experiences.

背景：温馨的环境可能会影响患者的护理体验，对于代表性不足的群体，例如退伍军人健康管理局设施中的女性退伍军人，她们仅占患者总数的 8-10%，这一点可能尤为重要。要确保为女性退伍军人营造一个温馨的环境所面临的挑战可能包括来自男性退伍军人、工作人员或志愿者的不受欢迎的评论，以及在退伍军人医疗机构内外感到不安全。我们评估了与性别相关的护理环境问题报告与患者报告结果之间的关联：我们将全国女性退伍军人（n = 4961）的患者报告结果与女性退伍军人项目经理对退伍军人事务部设施中与性别相关的护理环境问题的报告（n = 127，2016-2017 年）进行了合并。我们进行了多层次的双变量逻辑回归，以评估女性退伍军人项目管理人员报告的大型/极端问题与女性退伍军人对初级医疗体验（就医途径、协调性、全面性、提供者沟通以及对初级医疗提供者的总体评价）最佳评价的可能性之间的关联。我们对患者、医疗机构和地区层面的特征以及退伍军人医疗机构内的患者聚类进行了调整，并应用设计权重来解决患者数据中的非响应偏差。女退伍军人的回复率为 40%，女退伍军人项目经理的回复率为 90%：很少（主要结论：确保一个温馨的环境可以改善女性退伍军人的初级保健体验。

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引用次数: 0

Birth Outcomes Among First Nations Birthing Parents Incarcerated While Pregnant: A Linked Administrative Data Study From Manitoba, Canada 怀孕时被监禁的原住民生育父母的生育结果：来自加拿大马尼托巴省的关联行政数据研究。

IF 2.8 2区医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Womens Health Issues

Pub Date : 2024-09-01 DOI: 10.1016/j.whi.2024.06.001

Background

In Canada, colonial policies have resulted in health inequities between First Nations and other Canadians. These policies contribute to overrepresentation of First Nations in the criminal legal system, where incarcerated people and their infants face elevated health risks. We investigated the association between prenatal incarceration and adverse birth outcomes among First Nations and other birthing parents in Manitoba, Canada.

Methods

Using linked whole-population administrative data, we identified all live births (2004–2017) in which the birthing parent (First Nations n = 1,449; other Manitoban n = 278) was prenatally incarcerated and compared them to birthing parents who were postnatally incarcerated (First Nations n = 5,290; other Manitoban n = 790) or not incarcerated (First Nations n = 19,950; other Manitoban n = 3,203). We used generalized linear models adjusted for measured confounders with propensity score weighting to calculate risk differences and 95% confidence intervals for adverse birth outcomes among those prenatally versus postnatally incarcerated in each group.

Results

Low birthweight births were more likely among First Nations birthing parents who were prenatally (vs. postnatally) incarcerated (risk difference 1.59, 95% CI [.79, 2.38]) but less likely among other Manitoban birthing parents (risk difference −2.33, 95% CI [−4.50, −.16]) who were prenatally (vs. postnatally) incarcerated. Among First Nations, prenatal incarceration was also associated with large-for-gestational-age births, low Apgar scores, and no breastfeeding (vs. postnatal incarceration), as well as preterm births (vs. no incarceration). Among other Manitobans, prenatal incarceration was also associated with small-for-gestational-age births, low Apgar scores, and no breastfeeding (vs. postnatal incarceration), as well as preterm births (vs. no incarceration).

Conclusions

The findings suggest that incarceration may contribute to intergenerational systems of oppression by compromising birth outcomes among First Nations and other birthing parents in Canada and underscore the need to both improve care for pregnant people who are incarcerated and invest in alternatives to incarceration.

背景：在加拿大，殖民政策造成了原住民与其他加拿大人在健康方面的不平等。这些政策导致原住民在刑事法律系统中的比例过高，被监禁者及其婴儿面临着更高的健康风险。我们调查了加拿大马尼托巴省原住民和其他生育父母产前入狱与不良出生结果之间的关联：利用关联的全人口管理数据，我们确定了分娩父母（原住民 n = 1,449 人；其他马尼托巴人 n = 278 人）产前曾被监禁的所有活产婴儿（2004-2017 年），并将其与产后曾被监禁（原住民 n = 5,290 人；其他马尼托巴人 n = 790 人）或未被监禁（原住民 n = 19,950 人；其他马尼托巴人 n = 3,203 人）的分娩父母进行了比较。我们使用广义线性模型对测量的混杂因素进行调整，并采用倾向得分加权法计算各组产前和产后被监禁者不良出生结果的风险差异和 95% 的置信区间：在产前（与产后）被监禁的原住民生育父母中，低出生体重儿的发生率较高（风险差异为 1.59，95% CI [.79，2.38]），但在产前（与产后）被监禁的其他马尼托巴生育父母中，低出生体重儿的发生率较低（风险差异为-2.33，95% CI [-4.50，-.16]）。在原住民中，产前入狱还与胎龄过大、Apgar 评分过低、未进行母乳喂养（与产后入狱相比）以及早产（与未入狱相比）有关。在其他马尼托巴人中，产前监禁也与小于胎龄新生儿、低Apgar评分、无母乳喂养（与产后监禁相比）以及早产（与无监禁相比）有关：研究结果表明，监禁可能会损害加拿大原住民和其他生育父母的分娩结果，从而助长世代相传的压迫制度，并强调有必要改善对被监禁孕妇的护理，同时投资于监禁的替代措施。

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引用次数: 0

Navigating Miscarriage Management Post-Dobbs: Health Risks and Ethical Dilemmas 后多布斯流产管理导航：健康风险与伦理困境。

IF 2.8 2区医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Womens Health Issues

Pub Date : 2024-09-01 DOI: 10.1016/j.whi.2024.05.004

引用次数: 0

Twelve-Month Sustainment of IPV Screening and Response Programs in Primary Care: Contextual Factors Impacting Implementation Success. 在基层医疗机构持续开展为期 12 个月的 IPV 筛查和响应计划：影响实施成功的环境因素。

IF 2.8 2区医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Womens Health Issues

Pub Date : 2024-08-21 DOI: 10.1016/j.whi.2024.07.001

Katherine M Iverson, Julianne E Brady, Omonyêlé L Adjognon, Kelly Stolzmann, Melissa E Dichter, LeAnn E Bruce, Galina A Portnoy, Samina Iqbal, Megan R Gerber, Sally G Haskell, Christopher J Miller

Purpose: The Veterans Health Administration (VHA) employed implementation facilitation (IF) as a strategy to boost uptake of intimate partner violence (IPV) screening programs in primary care. This study examined the sustainment of screening uptake 1 year after IF and identified factors impacting sustainment success.

Methods: A mixed-methods evaluation using quantitative and qualitative data was conducted. IPV screening rates from the conclusion of the IF period (i.e., initial adoption) through the 1-year sustainment period served as the primary outcome. We categorized sites into four groups of screening adoption and sustainment success (high adoption and high sustainment, moderate adoption and moderate sustainment, low adoption and low sustainment, and no adoption and/or no sustainment). Qualitative analysis of key informant interviews was used to identify contextual factors affecting screening 12 months post-IF. A mixed sustainment analysis matrix integrated quantitative and qualitative findings and enabled the identification of cross-site patterns.

Main findings: Seven of the nine sites sustained IPV screening at the most basic level (saw static or increased screening rates). High adopting and high sustaining sites (n = 3) were marked by consistently supportive medical center leadership, ongoing training for clinicians, clear protocols for responding to positive screens, and robust referral options for women experiencing IPV. Nonsustaining sites (n = 2) were marked by a host of barriers including staffing shortages, competing priorities, and inconsistent messaging from leadership regarding the importance of IPV screening.

Conclusions: Knowing barriers and facilitators to successful IPV screening sustainment can inform health care systems to tailor IF and other implementation strategies to sustain IPV screening in primary care. Sustainment of IPV screening requires attention to a combination of facilitators (e.g., consistent leadership support and robust referral options) as well as addressing key barriers (e.g., staff turnover and competing priorities).

目的：退伍军人健康管理局（VHA）采用了实施促进（IF）策略，以提高初级保健中亲密伴侣暴力（IPV）筛查项目的接受率。本研究考察了 IF 实施 1 年后筛查吸收率的持续情况，并确定了影响持续成功的因素：方法：采用定量和定性数据进行了混合方法评估。从综合框架期结束（即初始采用）到 1 年持续期的 IPV 筛查率是主要结果。我们将筛查采用率和持续成功率的地点分为四组（高采用率和高持续成功率、中等采用率和中等持续成功率、低采用率和低持续成功率、未采用率和/或未持续成功率）。通过对关键信息提供者访谈的定性分析，确定了影响筛查 12 个月后的背景因素。混合持续性分析矩阵综合了定量和定性分析结果，并确定了跨站点模式：九个地点中有七个在最基本的水平上维持了 IPV 筛查（筛查率保持不变或有所提高）。采用率高和持续率高的医疗点（n = 3）具有以下特点：医疗中心领导始终如一的支持、对临床医生的持续培训、明确的阳性筛查应对方案，以及为遭受 IPV 的妇女提供健全的转诊选择。非持续性医疗点（n = 2）则存在一系列障碍，包括人员短缺、优先事项相互竞争、领导层对 IPV 筛查重要性的宣传不一致等：结论：了解成功维持 IPV 筛查的障碍和促进因素可为医疗保健系统提供信息，以调整综合框架和其他实施策略，从而维持初级医疗保健中的 IPV 筛查。维持 IPV 筛查需要关注促进因素（如领导层的一贯支持和强大的转诊选择）以及解决关键障碍（如人员流动和相互竞争的优先事项）的组合。

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引用次数: 0

Uncertainty in Postpartum Permanent Contraception Decision-Making: Physician and Patient Perspectives. 产后永久避孕决策的不确定性：医生和患者的观点。

IF 2.8 2区医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Womens Health Issues

Pub Date : 2024-08-01 DOI: 10.1016/j.whi.2024.06.005

Brooke W Bullington, Madeline Thornton, Madison Lyleroehr, Kristen A Berg, Kari White, Margaret Boozer, Tania Serna, Emily S Miller, Jennifer L Bailit, Kavita Shah Arora

Purpose: We sought to understand how patients and physicians conceptualize uncertainty in the permanent contraception decision-making process.

Basic procedures: In 2022-2023, we interviewed postpartum patients with a documented desire for permanent contraception (n = 81) and their delivering physicians (n = 67). Eligible patients gave birth at one of our four study hospitals in California, Ohio, Illinois, and Alabama. We used rapid content analysis and thematic content analysis to develop and refine themes related to uncertainty in permanent contraceptive decision-making.

Main findings: Most patients reported full certainty in their decision regarding permanent contraception, although some expressed doubts. After receiving permanent contraception, some patients discussed grief but overall affirmed their decision. One patient said they wished they had considered other contraceptive options. Physicians reported using a range of strategies to safeguard from patient regret, including ensuring patients were 100% certain with their decision, inferring certainty based on their characteristics, asking patients to think through all scenarios that could affect decision-making, and repeat counseling during multiple interactions.

Principal conclusions: Patient experiences reveal the depth, fluidity, and nuance of patients' contraceptive decision-making processes. Physicians sometimes failed to grapple with this nuance by centering potential regret in their counseling. Personalized and supportive contraceptive counseling that acknowledges the complexity of contraceptive decision-making is imperative. Shared decision-making can help ensure patients can make informed and autonomous decisions about their reproductive lives.

目的：我们试图了解患者和医生如何看待永久避孕决策过程中的不确定性：2022-2023 年，我们采访了有永久避孕意愿记录的产后患者（81 人）及其接生医生（67 人）。符合条件的患者在加利福尼亚州、俄亥俄州、伊利诺伊州和阿拉巴马州的四家研究医院之一分娩。我们使用快速内容分析法和主题内容分析法来制定和完善与永久避孕决策中的不确定性有关的主题：主要研究结果：大多数患者表示完全确定他们是否决定采取永久避孕措施，但也有一些患者表示怀疑。在接受永久避孕后，一些患者谈到了悲伤，但总体上肯定了他们的决定。一名患者说，他们希望自己曾考虑过其他避孕方法。医生报告说，他们使用了一系列策略来避免患者后悔，包括确保患者对自己的决定有 100% 的把握、根据患者的特点推断其确定性、要求患者考虑所有可能影响决策的情况，以及在多次互动中重复咨询：患者的经历揭示了患者避孕决策过程的深度、流动性和细微差别。医生在提供咨询时，有时会将潜在的遗憾作为中心，从而无法应对这种细微差别。个性化和支持性的避孕咨询必须承认避孕决策的复杂性。共同决策有助于确保患者在知情的情况下自主决定自己的生殖生活。

{"title":"Uncertainty in Postpartum Permanent Contraception Decision-Making: Physician and Patient Perspectives.","authors":"Brooke W Bullington, Madeline Thornton, Madison Lyleroehr, Kristen A Berg, Kari White, Margaret Boozer, Tania Serna, Emily S Miller, Jennifer L Bailit, Kavita Shah Arora","doi":"10.1016/j.whi.2024.06.005","DOIUrl":"https://doi.org/10.1016/j.whi.2024.06.005","url":null,"abstract":"<p><strong>Purpose: </strong>We sought to understand how patients and physicians conceptualize uncertainty in the permanent contraception decision-making process.</p><p><strong>Basic procedures: </strong>In 2022-2023, we interviewed postpartum patients with a documented desire for permanent contraception (n = 81) and their delivering physicians (n = 67). Eligible patients gave birth at one of our four study hospitals in California, Ohio, Illinois, and Alabama. We used rapid content analysis and thematic content analysis to develop and refine themes related to uncertainty in permanent contraceptive decision-making.</p><p><strong>Main findings: </strong>Most patients reported full certainty in their decision regarding permanent contraception, although some expressed doubts. After receiving permanent contraception, some patients discussed grief but overall affirmed their decision. One patient said they wished they had considered other contraceptive options. Physicians reported using a range of strategies to safeguard from patient regret, including ensuring patients were 100% certain with their decision, inferring certainty based on their characteristics, asking patients to think through all scenarios that could affect decision-making, and repeat counseling during multiple interactions.</p><p><strong>Principal conclusions: </strong>Patient experiences reveal the depth, fluidity, and nuance of patients' contraceptive decision-making processes. Physicians sometimes failed to grapple with this nuance by centering potential regret in their counseling. Personalized and supportive contraceptive counseling that acknowledges the complexity of contraceptive decision-making is imperative. Shared decision-making can help ensure patients can make informed and autonomous decisions about their reproductive lives.</p>","PeriodicalId":48039,"journal":{"name":"Womens Health Issues","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141879609","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

The Impact of Immigration Policy Changes on Preterm Birth Rates in Texas: An Examination of Border and Nonborder Regions 移民政策变化对得克萨斯州早产率的影响：边境地区和非边境地区的研究。

IF 2.8 2区医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Womens Health Issues

Pub Date : 2024-07-01 DOI: 10.1016/j.whi.2024.03.006

Background

Our study examined the acute and sustained impact of immigration policy changes announced in January 2017 on preterm birth (PTB) rates among Hispanic and non-Hispanic white women in Texas's border and nonborder regions.

Methods

Using Texas birth certificate data for years 2008 through 2020, we used a multiple group interrupted time series approach to explore changes in PTB rates.

Results

In the nonborder region, the PTB rate among Hispanic women of any race was 8.64% in 2008 and was stable each year before 2017 but increased by .29% (95% CI [.12, .46]) annually between 2017 and 2020. This effect remained statistically significant even when compared with that of non-Hispanic white women (p = .014). In the border areas, the PTB rate among Hispanic women of any race was 11.67% in 2008 and remained stable each year before and after 2017. No significant changes were observed when compared with that of non-Hispanic white women (p = .897). In Texas as a whole, the PTB rate among Hispanic women of any race was 10.16% in 2008 and declined by .07% (95% CI [−.16, −.03]) per year before 2017, but increased by .16% (95% CI [.05, .27]) annually between 2017 and 2020. The observed increase was not statistically significant when compared with that of non-Hispanic white women (p = .326).

Conclusions

The January 2017 immigration policies were associated with a sustained increase in PTB among Hispanic women in Texas's nonborder region, suggesting that geography plays an important role in perceptions of immigration enforcement. Future research should examine the impact of immigration policies on maternal and child health, considering geography and sociodemographic factors.

背景：我们的研究考察了 2017 年 1 月宣布的移民政策变化对德克萨斯州边境地区和非边境地区西班牙裔和非西班牙裔白人妇女早产率（PTB）的急性和持续性影响：利用德克萨斯州 2008 年至 2020 年的出生证明数据，我们采用了多组间断时间序列方法来探讨早产率的变化：在非边境地区，2008 年任何种族的西班牙裔女性的 PTB 率为 8.64%，在 2017 年之前每年都保持稳定，但在 2017 年至 2020 年期间，每年增加 0.29% (95% CI [.12, 0.46])。即使与非西班牙裔白人女性相比，这一影响仍具有统计学意义（p = .014）。在边境地区，2008 年任何种族的西班牙裔妇女的肺结核发病率为 11.67%，在 2017 年之前和之后每年都保持稳定。与非西班牙裔白人妇女相比，未观察到明显变化（p = .897）。在整个得克萨斯州，2008 年任何种族的西班牙裔妇女的 PTB 患病率为 10.16%，在 2017 年之前每年下降 0.07%（95% CI [-.16，-.03]），但在 2017 年至 2020 年期间每年上升 0.16%（95% CI [.05，.27]）。与非西班牙裔白人女性相比，观察到的增长没有统计学意义（P = .326）：2017 年 1 月的移民政策与得克萨斯州非边境地区拉美裔妇女 PTB 的持续增长有关，这表明地理因素在对移民执法的看法中起着重要作用。未来的研究应考虑地理和社会人口因素，研究移民政策对母婴健康的影响。

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引用次数: 0

Latent Profiles of Disordered Eating Among Veterans: Associations With Mental Health Concerns 退伍军人饮食失调的潜在特征：退伍军人饮食失调的潜在特征：与心理健康问题的关联。

IF 2.8 2区医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Womens Health Issues

Pub Date : 2024-07-01 DOI: 10.1016/j.whi.2024.03.002

Background

Varying patterns in eating disorder (ED) classification are evident and may impact ED treatment and prevention. However, investigations of patterns of heterogeneity in ED presentations have been limited to civilian samples, despite the high prevalence of EDs in military personnel and veterans. The present study aimed to explore ED-related symptom patterns, including emotional overeating, in women veterans.

Methods

Participants were 407 women veterans using health care services at a large Veterans Affairs health care system who completed mental health measures via surveys. Latent profile analyses were used to explore distinct ED symptom patterns (binge eating, purging, heavy exercise, positive and negative emotional overeating, dietary restraint, and shape/weight concerns). Subsequent auxiliary models explored associations with mental health concerns (depressive symptoms, posttraumatic stress disorder, anxiety, alcohol misuse, substance misuse), adjusting for age, race and ethnicity, and service branch.

Results

A four-class solution demonstrated the best model fit, characterized as follows: 1) Low ED Concerns, 2) Moderate Dietary Restraint/Negative Emotional Eating, 3) High Binge/Emotional Eating, and 4) High ED Concerns. Although all profiles had moderate or higher levels of negative emotional overeating, the High Binge/Emotional Eating and High ED Concerns profiles were distinct in levels of dietary restraint and had the highest probabilities of positive emotional overeating. The High ED Concerns profile also had the most severe mental health concerns relative to the other profiles.

Conclusions

The identification of unique ED symptom patterns in women veterans can inform prevention and intervention efforts.

背景：饮食失调症（ED）分类的不同模式显而易见，可能会影响 ED 的治疗和预防。然而，尽管进食障碍在军人和退伍军人中的发病率很高，但对进食障碍表现的异质性模式的调查却仅限于平民样本。本研究旨在探讨女退伍军人中与 ED 相关的症状模式，包括情绪性暴饮暴食：研究对象是在退伍军人事务医疗保健系统中使用医疗保健服务的 407 名女性退伍军人，她们通过调查完成了心理健康测量。我们使用潜在特征分析来探索不同的 ED 症状模式（暴饮暴食、清除、剧烈运动、积极和消极情绪性暴饮暴食、饮食节制以及对体形/体重的担忧）。随后的辅助模型探讨了与心理健康问题（抑郁症状、创伤后应激障碍、焦虑、酒精滥用、药物滥用）的关联，并对年龄、种族和民族以及服役部门进行了调整：四类解决方案显示出最佳模型拟合度，其特征如下：1）低 ED 关切，2）中度饮食限制/负面情绪化饮食，3）高暴饮暴食/情绪化饮食，4）高 ED 关切。虽然所有特征都有中等或更高程度的消极情绪暴食，但 "暴饮暴食/情绪化进食程度高 "和 "对教育的高度关注 "特征在饮食限制程度上截然不同，其积极情绪暴食的概率也最高。与其他特征相比，高ED关注特征也具有最严重的心理健康问题：结论：识别女性退伍军人的独特 ED 症状模式可为预防和干预工作提供依据。

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引用次数: 0

Experiences and Perceptions of Maternal Autonomy and Racism Among BIPOC Veterans Receiving Cesarean Sections 接受剖腹产手术的黑人退伍军人对产妇自主权和种族主义的体验和看法。

IF 2.8 2区医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Womens Health Issues

Pub Date : 2024-07-01 DOI: 10.1016/j.whi.2024.04.001

Background

Previous studies of pregnant veterans enrolled in Department of Veterans Affairs (VA) care reveal high rates of cesarean sections among racial/ethnic minoritized groups, particularly in southern states. The purpose of this study was to better understand contributors to and veteran perceptions of maternal autonomy and racism among veterans receiving cesarean sections.

Methods

We conducted semi-structured interviews to understand perceptions of maternal autonomy and racism among 27 Black, Indigenous, People of Color (BIPOC) veterans who gave birth via cesarean section using VA maternity care benefits.

Results

Our study found that a substantial proportion (67%) of veterans had previous cesarean sections, ultimately placing them at risk for subsequent cesarean sections. More than 60% of veterans with a previous cesarean section requested a labor after cesarean (LAC) but were either refused by their provider or experienced complications that led to another cesarean section. Qualitative findings revealed the following: (1) differences in treatment by veterans’ race/ethnicity may reduce maternal agency, (2) many veterans felt unheard and uninformed regarding birthing decisions, (3) access to VA-paid doula care may improve maternal agency for BIPOC veterans during labor and birth, and (4) BIPOC veterans face substantial challenges related to social determinants of health.

Conclusion

Further research should examine veterans’ perceptions of racism in obstetrical care, and the possibility of VA-financed doula care to provide additional labor support to BIPOC veterans.

背景：以前对退伍军人事务部（VA）护理的怀孕退伍军人进行的研究显示，少数种族/族裔群体的剖腹产率很高，尤其是在南部各州。本研究的目的是更好地了解在接受剖腹产手术的退伍军人中，产妇自主权和种族主义的促成因素和退伍军人的看法：我们进行了半结构化访谈，以了解 27 名使用退伍军人事务部产妇护理福利进行剖腹产的黑人、土著、有色人种（BIPOC）退伍军人对产妇自主权和种族主义的看法：我们的研究发现，很大一部分（67%）退伍军人曾进行过剖腹产，这最终使他们面临再次进行剖腹产的风险。超过 60% 曾进行过剖腹产的退伍军人要求进行剖腹产后分娩 (LAC)，但要么被医疗服务提供者拒绝，要么出现并发症，导致再次进行剖腹产。定性研究结果显示了以下几点：(1) 退伍军人种族/族裔待遇的差异可能会降低产妇的能动性，(2) 许多退伍军人在分娩决定方面感到被忽视和不知情，(3) 获得退伍军人协会支付的朵拉护理可能会提高 BIPOC 退伍军人在分娩和生产期间的产妇能动性，(4) BIPOC 退伍军人面临着与健康的社会决定因素相关的巨大挑战：进一步的研究应考察退伍军人对产科护理中的种族主义的看法，以及退伍军人事务部资助的朵拉护理为BIPOC退伍军人提供额外分娩支持的可能性。

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引用次数: 0

Florida Doulas’ Perspectives on Their Role in Reducing Maternal Morbidity and Health Disparities 佛罗里达州催乳师对其在降低产妇发病率和减少健康差异方面的作用的看法。

IF 2.8 2区医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Womens Health Issues

Pub Date : 2024-07-01 DOI: 10.1016/j.whi.2024.01.003

Background

Maternal mortality rates continue to rise in the United States. Considerable racial disparities exist, as Black women face two to three times the risks of dying from pregnancy-related complications compared with white women. Doulas have been associated with improved maternal outcomes. This study aimed to 1) investigate Florida doulas’ perspectives and influence on severe maternal morbidity/mortality and related inequities, as well as 2) identify opportunities for actionable change. The social ecological model, which acknowledges how individual, interpersonal, institutional, community, and public policy factors intersect, informed our analysis.

Methods

This qualitative study included seven online in-depth interviews and seven focus groups with doulas (N = 31) in Florida. Interview guides investigated how doulas perceive their role in the context of a) maternal morbidity and b) health disparities.

Results

Doulas associated maternal morbidity and health disparities with Black pregnant people, identifying racism as a major contributor. Doulas identified their role as one that most often intersects with the individual and interpersonal levels of the social ecological model. Doulas report providing positive social surveillance and emotional support, contributing education and resources, and championing for advocacy in health care settings. Actionable steps recommended by doulas to further mitigate health disparities include the integration of implicit bias training into doula certification programs, increasing public health funding to bolster a doula workforce that can serve racial and ethnic communities, establishing doula–hospital partnerships to improve relational communication, providing tailored resources for clients featuring representative messaging, and doulas’ continued engagement in positive social surveillance of their clients.

Conclusions

Doulas perceived their role as integral to mitigating maternal morbidity and health disparities, particularly in the context of supporting and advocating for birthing persons on all levels of the social ecological model. Equitable access to doulas for low-income and/or minoritized populations may be one key strategy to improve maternal health equity.

背景：美国的孕产妇死亡率持续上升。与白人妇女相比，黑人妇女死于与妊娠有关的并发症的风险是白人妇女的两到三倍。杜拉拉与改善产妇预后有关。本研究旨在：1）调查佛罗里达州朵拉对严重孕产妇发病率/死亡率及相关不平等现象的看法和影响；2）确定可付诸行动的变革机会。社会生态模型承认个人、人际、机构、社区和公共政策等因素如何相互交叉，为我们的分析提供了依据：这项定性研究包括对佛罗里达州的朵拉进行的七次在线深度访谈和七个焦点小组（N = 31）。访谈指南调查了朵拉如何看待她们在 a) 产妇发病率和 b) 健康差异背景下的角色：结果：朵拉将孕产妇发病率和健康差异与黑人孕妇联系起来，认为种族主义是主要原因。杜拉拉认为她们的角色通常与社会生态模型中的个人和人际层面相交叉。朵拉报告称，她们提供了积极的社会监督和情感支持，提供了教育和资源，并在医疗保健环境中倡导权益。朵拉为进一步减少健康差异而建议的可操作步骤包括：将隐性偏见培训纳入朵拉认证项目；增加公共卫生资金以加强能够为种族和民族社区服务的朵拉队伍；建立朵拉与医院的合作关系以改善关系沟通；为客户提供具有代表性信息的定制资源；以及朵拉继续参与对其客户的积极社会监督：朵拉认为她们的角色是减轻孕产妇发病率和健康差异不可或缺的，尤其是在社会生态模式的各个层面上支持和倡导分娩者。为低收入和/或少数群体提供公平的朵拉服务可能是改善孕产妇健康公平性的关键策略之一。

{"title":"Florida Doulas’ Perspectives on Their Role in Reducing Maternal Morbidity and Health Disparities","authors":"","doi":"10.1016/j.whi.2024.01.003","DOIUrl":"10.1016/j.whi.2024.01.003","url":null,"abstract":"<div><h3>Background</h3><p><span><span>Maternal mortality rates continue to rise in the United States. Considerable </span>racial disparities<span> exist, as Black women face two to three times the risks of dying from pregnancy-related complications compared with white women. </span></span>Doulas have been associated with improved maternal outcomes. This study aimed to 1) investigate Florida doulas’ perspectives and influence on severe maternal morbidity/mortality and related inequities, as well as 2) identify opportunities for actionable change. The social ecological model, which acknowledges how individual, interpersonal, institutional, community, and public policy factors intersect, informed our analysis.</p></div><div><h3>Methods</h3><p>This qualitative study included seven online in-depth interviews and seven focus groups with doulas (<em>N</em><span><span> = 31) in Florida. Interview guides investigated how doulas perceive their role in the context of a) maternal morbidity and b) </span>health disparities.</span></p></div><div><h3>Results</h3><p><span><span>Doulas<span> associated maternal morbidity and </span></span>health disparities with Black pregnant people, identifying racism as a major contributor. Doulas identified their role as one that most often intersects with the individual and interpersonal levels of the social ecological model. Doulas report providing positive social surveillance and </span>emotional support<span><span>, contributing education and resources, and championing for advocacy in health care<span> settings. Actionable steps recommended by doulas to further mitigate health disparities include the integration of implicit bias training into doula certification programs, increasing </span></span>public health funding to bolster a doula workforce that can serve racial and ethnic communities, establishing doula–hospital partnerships to improve relational communication, providing tailored resources for clients featuring representative messaging, and doulas’ continued engagement in positive social surveillance of their clients.</span></p></div><div><h3>Conclusions</h3><p><span><span>Doulas perceived their role as integral to mitigating maternal morbidity and </span>health disparities, particularly in the context of supporting and advocating for </span>birthing persons on all levels of the social ecological model. Equitable access to doulas for low-income and/or minoritized populations may be one key strategy to improve maternal health equity.</p></div>","PeriodicalId":48039,"journal":{"name":"Womens Health Issues","volume":"34 4","pages":"Pages 417-428"},"PeriodicalIF":2.8,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140177189","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Interest in and Support for Alternative Models of Medication Abortion Provision Among Patients Seeking Abortion in the United States 美国寻求人工流产的患者对药物流产替代模式的兴趣和支持。

IF 2.8 2区医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Womens Health Issues

Pub Date : 2024-07-01 DOI: 10.1016/j.whi.2024.03.003

Introduction

Medication abortion is safe and effective, but restrictions still limit patients from accessing this method. Alternative models of medication abortion provision, namely advance provision, over-the-counter (OTC), and online, could help improve access to care for some, although there is limited evidence about abortion patients’ interest in these models.

Methods

Between 2017 and 2019, we administered a cross-sectional survey to abortion patients at 45 clinics across 15 U.S. states to explore their interest in and support for advance provision, OTC, and online abortion access. We assessed relationships between sociodemographic characteristics and interest in and support for each model using bivariate logistic regressions and present perceived advantages and disadvantages of each model, as described by a subset of participants.

Results

Among 1,965 people enrolled, 1,759 (90%) initiated the survey. Interest in and support for advance provision was highest (72% and 82%, respectively), followed by OTC (63% and 72%) and online access (57% and 70%). In bivariate analyses, non-Hispanic Black and Asian/Pacific Islander respondents expressed lower interest and support for the online model and Alaska Native/Native American respondents expressed higher interest in an OTC model, as compared with white respondents. Among 439 participants naming advantages and disadvantages of each model, the most common advantages included convenience and having the abortion earlier. The most common disadvantages were not seeing a provider first and possibly taking pills incorrectly.

Conclusions

Although most abortion patients expressed interest in and support for alternative models of medication abortion provision, variation in support across race/ethnicity highlights a need to ensure that abortion care service models meet the needs and preferences of all patients, particularly people from historically underserved populations.

导言：药物流产安全有效，但各种限制仍限制了患者获得这种方法。药物流产的替代模式，即提前提供、非处方药（OTC）和在线提供，可帮助改善部分患者获得医疗服务的机会，但有关流产患者对这些模式的兴趣的证据有限：2017 年至 2019 年期间，我们对美国 15 个州 45 家诊所的堕胎患者进行了横断面调查，以了解他们对提前提供、OTC 和在线堕胎服务的兴趣和支持程度。我们使用双变量逻辑回归评估了社会人口特征与对每种模式的兴趣和支持之间的关系，并介绍了参与者子集所描述的每种模式的优势和劣势：在 1,965 名参与者中，1,759 人（90%）发起了调查。对预先提供服务的兴趣和支持率最高（分别为 72% 和 82%），其次是非处方药（63% 和 72%）和在线服务（57% 和 70%）。在双变量分析中，与白人受访者相比，非西班牙裔黑人和亚裔/太平洋岛民受访者对在线模式的兴趣和支持度较低，阿拉斯加原住民/美国本土受访者对 OTC 模式的兴趣较高。在说出每种模式优缺点的 439 名参与者中，最常见的优点包括方便和更早堕胎。最常见的缺点是没有先去看医疗服务提供者，以及可能吃错药：尽管大多数人工流产患者对药物流产的替代模式表示出兴趣和支持，但不同种族/族裔的支持率存在差异，这凸显出有必要确保人工流产护理服务模式满足所有患者的需求和偏好，尤其是历史上服务不足人群的需求和偏好。

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引用次数: 0