Turkish women's satisfaction with family planning services.

This research was designed to identify women's satisfaction with family planning services and, secondly, to establish a standardized scale of satisfaction for use in the evaluation of women's satisfaction with family planning services. The population for this study comprised Turkish women living in Erzurum, and attending one of five primary health-care centers in Erzurum for services. The study included 406 women who were selected by random sampling from the population who used current family planning methods. Data were collected using the satisfaction with family planning services scale front 1 April to 20 June 2002. Cronbach's alpha of the scale is 0.86. Alpha coefficients ranged from 0.83 to 0.77 for seven dimensions. Factor analysis on the 37 items revealed that the seven factors that resulted were the same as the seven components of intrinsic motivation. The score mean of the scale was 132.2 +/- 26.8, and the score mean per item was 3.5. In terms of both the mean overall score and the score per item, women were reasonably satisfied with family planning services. This study provided a standardized scale of women's satisfaction with family planning services. The sample of the present study was collected from only the Eastern Anatolia region of Turkey. Utilization of such methods as an interview form that would identify factors and rate their importance while women are in health-care centers and offices would be helpful.     

What women from an Islamic background in Australia say about care in pregnancy and prenatal testing

OBJECTIVE: to examine satisfaction with care and services in relation to antenatal care and prenatal testing and to present what women say about what can be done better to improve antenatal care for women from an Islamic background. DESIGN: in-depth interviews of women's perceptions and experiences of care received relating to prenatal testing and antenatal care. SETTING: Melbourne Metropolitan Area, Victoria, Australia. PARTICIPANTS: 15 women of Islamic background who are now living in Melbourne. FINDINGS: in general, women had positive experiences with care relating to antenatal care and prenatal testing in Australia. This is particularly so when they compared care in Australia with that of their own country. However, women indicated several issues of concern where they were dissatisfied and they believed need to be improved for pregnant women from an Islamic background. Firstly, there was a lack of sufficient communication between health care providers and the women. This was not only due to a language problem, but also a lack of cultural appreciation among health care providers. Secondly, women identified the issue of gender of health care providers as important; women stated clearly their need to have female doctors for their care. CONCLUSIONS: the findings of this study have implications for antenatal care and prenatal testing services in Australia and elsewhere. Women provided several suggestions for the improvement of care including the need for sufficient information of prenatal testing and antenatal care and the need for culturally sensitive services. In providing services for women of an Islamic background, it is imperative that health care providers take into account individual women's preferences and personal circumstances and go beyond an assumption based on women's religion and ethnicity.     

Impact of written information on women's use of postpartum services: a randomised controlled trial

BACKGROUND: This study evaluates the impact of providing women with written educational material on their satisfaction with care, and use of health services postpartum. METHODS: All women having a live birth at 4 private hospitals in Lebanon were eligible. The sample consisted of 187 women in the intervention and 191 in the control arms. An intervention booklet was developed following a qualitative study of women's information needs; placebo material was 2 leaflets about childproofing the house. Field workers administered a baseline questionnaire to recruit all eligible women, and conducted follow-up interviews 6-20 weeks postpartum at the women's residences. The written material was handed out to women just before discharge from hospital. At the baseline interview, interviewers and women were blinded to the nature of the written material. Outcome measures were a postpartum visit to a health professional after discharge and before the follow-up interview, and satisfaction with maternity care received during pregnancy, delivery and postpartum. RESULTS: Satisfaction with care during the postpartum period was 57.2% in the intervention and 38.9% in the control arm (p<0.001). Some 85% of women in the intervention arm had a postpartum visit compared to 55% in the control arm (p<0.001). CONCLUSION: In the context of high female literacy, the intervention is effective and requires few resources.     

Women's perspectives on maternity services in Sweden: processes, problems, and solutions

Most measures of health care quality focus on medical outcomes rather than patients' assessments of quality. Drawing on data from a national survey of Swedish women, this study describes women's opinions about what is important to them during pregnancy and birth. This qualitative study is based on responses of 827 pregnant women to an open question completed in the second trimester. In total, 2061 separate statements were analyzed. Using content analysis, these statements were clustered into 4 themes: desirable characteristics of midwife, prenatal care during pregnancy, care during labor and birth, and care after birth. Within those themes, 13 categories were found. Findings suggest areas for improvement in maternity services including: the timing and length of prenatal visits, making parent education classes available to all women, prelabor visits to the maternity ward, continuous information about the progress of labor, flexibility in time of discharge, and postpartum support for families. Women also stated that characteristics of the midwife, such as being supportive, friendly, attentive, respectful, and nonjudgemental, were important. A patient-centered and individualized approach, with women and their partners as the subjects rather than the objects of care, would increase satisfaction and the overall quality of maternity services in Sweden.     

The experience of pregnancy, labour and birth of Thai women in Australia.

OBJECTIVE: To identify the perceptions and experience of pregnancy care, labour and birth of Thai women in Melbourne, Australia. DESIGN: An ethnographic interview and participant observation with women in relation to pregnancy, labour and birth. SETTING: Melbourne Metropolitan Area, Victoria, Australia. PARTICIPANTS: 30 Thai women who are now living in Melbourne. FINDINGS: Thai women saw antenatal care as an important aspect of their pregnancy and sought care as soon as they suspected they were pregnant. They were more concerned about the well-being of their babies than their own health, therefore they attended all antenatal appointments. In general, these women were satisfied with care during labour, but some also had negative experiences with their caregivers and hospital routine. When asked to compare maternity services between Thailand and Australia, most of the women believed that services in Australia were better. However, women who had had good experiences of childbirth in Thailand, tended to have negative feelings about the Australian experience. There was also evidence in this study that most of these Thai women did not receive adequate information about care. IMPLICATIONS FOR PRACTICE: Women's perceptions and experiences of antenatal care, labour and birth deserve attention, if appropriate and sensitive care is to be provided to women in Australia and elsewhere. It is only when women's voices are heard in all aspects of health-care delivery that we may see better and appropriate health services for women in childbirth.     

The voices and concerns about prenatal testing of Cambodian,Lao and Vietnamese women in Australia

OBJECTIVES: to examine how Cambodian, Lao and Vietnamese women experience prenatal testing and to examine their knowledge and communication with health-care providers. SETTING: Melbourne Metropolitan Area, Victoria, Australia. DESIGN: an ethnographic study of childbearing and childrearing among women born in South-east Asia and now living in Melbourne, Australia reporting in-depth interviews with 67 women who had given birth in Australia. FINDINGS: nearly all the women had prenatal testing as advised by their doctors and their main concerns were about their unborn baby and the need to follow doctors' advice. The women felt 'indifferent' towards prenatal testing, perceiving it as a normal part of antenatal care in Australia. Despite agreeing to undertake prenatal testing, the women did not have adequate understanding of the tests. This may be due to lack of information per se or inadequate communication between health providers and women. IMPLICATIONS FOR PRACTICE: inevitably, the onus rests with the health-care provider to ensure that all options available to women are understood, so that women can make a positive and informed choice regardless of their social or cultural background. This will lead to women's increased satisfaction with care during pregnancy.     

Satisfaction and Use of Prenatal Care: Their Relationship Among African‐American Women in a Large Managed Care Organization

ABSTRACT:Background: Although many more mothers of almost all ethnic groups began prenatal care in the first trimester during the last decade, a significant number of low‐income and minority women still fail to obtain adequate care in the United States—a failure that may be related to their dissatisfaction with the prenatal care experience. This study sought to examine the relationship between satisfaction with care and subsequent prenatal care utilization among African‐American women using prospective methods. Methods: A sample of 125 Medicaid and 275 non‐Medicaid African‐American adult women seeking care through a large Midwest managed care organization were interviewed before or at 28 weeks’ gestation at one of two prenatal care sites. Women were interviewed about personal characteristics, prenatal care experience, and ratings of care (satisfaction). Information about subsequent use of prenatal care was obtained through retrospective medical record review after delivery. Univariate and multivariable analyses examining the relationship between women's satisfaction and prenatal care use were conducted using a dichotomous measure of satisfaction and a continuous measure of utilization. Results: Women were highly satisfied with prenatal care, with an overall mean satisfaction score of 80.3. Non‐Medicaid women were significantly (p < 0.05) less satisfied with their prenatal care (mean score, 79.1) than Medicaid women (mean score, 82.8), and the latter had significantly fewer visits on average than the former subsequent to the interview. Analyses showed no significant difference in subsequent utilization according to whether a woman had a high versus low level of satisfaction at the prenatal care interview. Conclusions: This study challenges the assumption that improving a woman's satisfaction with care will lead to an increase in the adequacy of her prenatal care utilization. Since this study was limited to African‐American women and is the first prospective study of women's satisfaction with care and prenatal care utilization, the negative findings do not yet settle this area of inquiry. Monitoring women's satisfaction with prenatal care in both managed care and fee‐for‐service settings and working to improve those aspects of care associated with decreased satisfaction is warranted. (BIRTH 30:1 March 2003)     

Interest of pregnant women in the use of SMS (short message service) text messages for the improvement of perinatal and postnatal care

ABSTRACT: BACKGROUND: Mobile health (mHealth) is emerging as a useful tool to improve healthcare access especially in the developing world, where limited access to health services is linked to poor antenatal care, and maternal and perinatal mortality. The objective of this study is to 1) understand pregnant women's access and usage of cell phones and 2) survey the health information needs and interests in a population attending public hospitals and health centers of two cities in Argentina. This information is not available and it is the basis to develop a strategy for improving maternal care via cell phones. METHODS: Questionnaires were verbally administered to pregnant women who were attending an antenatal care visit in community health centers and public hospitals in Rosario, Santa Fe and Mercedes, Corrientes. Participants were 18 years of age or older and had previously given birth. The data obtained was qualitative and analyzed using SPSS version 18. RESULTS: A total of 147 pregnant women meeting inclusion criteria (Rosario: 63; Mercedes: 84) were approached and verbally consented to participate. The average age was 29.5 years, most lived in urban areas (89%) with a mean travel time of 43.4 minutes required to get to the health center and 57.3 minutes to get the hospital. Ninety-six percent of women (n = 140) responded that they would like to receive text messages and cell phone calls with information regarding prenatal care, although the topics and period of time to receive information varied greatly. CONCLUSIONS: Considering the vast majority of the interviewed women had access to and were interested in receiving text messages and calls with educational information regarding pregnancy and infant health, pregnant women in Argentina could benefit from such an mHealth program. The low access to Internet suggests it is not an option for this population; however, this cannot be assumed as representative of the country's situation. To retain active participation, other forms of health communication, such as a 2-way text message systems or toll-free numbers, could be considered in the future. Cost of use and implementing these options should be studied.     

A comparison of data obtained from service providers and service users to assess the quality of maternity care

OBJECTIVE: to compare data obtained from two sources, service providers and service users, regarding the maternity services in Scotland. DESIGN: an audit of maternity services involving site visits, staff interviews and a cross-sectional survey of service users. PARTICIPANTS: lead professionals in every consultant-led maternity unit in Scotland and all 1639 women giving birth in Scotland during a ten-day period. DATA COLLECTION:structured group interviews with service providers and a questionnaire survey of recently delivered women. DATA ANALYSIS: professionals' and women's responses were cross-tabulated and differences in proportions were tested for statistical significance using the chi-square test. FINDINGS: a total of 1137 women completed the questionnaire (response rate 69%). Overall, there was good agreement between professionals' and women's perceptions of the aspects of care studied. However, there were disparities in some areas. For example, staff in eight units reported mechanisms to ensure early distribution of a free national pregnancy book; however, in six of these units less than 75% of women actually received this book prior to their first hospital visit. Eighteen units reported that they offer a postnatal 'reunion meeting'; in ten of these units, less than 50% of women were aware of the reunion meeting. Eighteen units reported a policy of each woman having a lead professional or care co-ordinator; in three of these units, less than 50% of women perceived that they had a care co-ordinator and for most women, the profession (midwife, general practitioner or obstetrician) of their perceived co-ordinator differed from that expected on the basis of staff reports. There was some evidence overall that unit policies had a direct influence on women's responses. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: this study demonstrates the importance of using a range of complementary methods of data collection and of ascertaining both service users' and providers' views when assessing the quality of care. Further research is required to explore differences in service provider's and women's perceptions and how this information can be used to improve the quality of maternity care. The finding that service provision may influence women's preferences has important implications for service planning, in particular the introduction of new models of care, and this needs further exploration.     

Prenatal Care Outcomes in Women with Substance Use Disorders: A Retrospective Cohort Study

ObjectiveThis study sought to examine and compare the characteristics and prenatal care and pregnancy outcomes of women with and without substance use disorder (SUD). It also examined whether there were differences in prenatal care and pregnancy outcomes within the population of substance-using women based on the stability of their SUD during pregnancy.MethodsThis retrospective cohort study involved pregnant women with and without SUD who accessed care through the Maternity Centre of Hamilton between 2015 and 2017. Cases and controls were matched 1:1 for gravidity, parity, ethnicity, smoking status, and postal code.ResultsFifty-five pregnant women with SUD were identified and matched to 55 pregnant women without SUD. When analyzed by stability of substance use, women with stable SUD had similar outcomes to those of women without SUD. Women with unstable SUD received the poorest prenatal care and were more likely to have their infants removed from their care. There was significant movement towards stability of maternal substance use over the course of pregnancy in our integrated prenatal and addiction care model.ConclusionWomen with unstable SUD had poorer prenatal care and higher rates of custody loss than those with stable substance use disorders or those without substance use disorders. The disparate outcomes among women with unstable SUD may indicate a need to identify patients requiring greater support at entry into prenatal care and to target services accordingly. This integrated prenatal and addiction care model was effective in reducing maternal substance use in pregnancy.     

Comparing women's assessment of midwifery and medical care in Québec, Canada

In 1990, the province of Québec, Canada, adopted a law that authorized the evaluation of the practice of midwifery through pilot projects before its legalization. A key objective of this evaluation, as defined by the law, was the documentation of women's assessment of maternity care, especially with regard to humanization and continuity of care. Two to 3 months after birth, 933 midwifery clients and 1,000 physicians' clients, matched on several characteristics, responded to a mailed questionnaire (response rates were 93% and 76%, respectively). Results showed that women from both groups were generally satisfied with the care they received, although women who received midwifery care were assessed as more positive on every issue surveyed. Objective measures supported impressions that were also confirmed through qualitative data analysis: midwifery clients had a greater number of and longer prenatal visits, their care was perceived to be more personalized, and a greater number of midwives' clients breastfed their infants. However, the interpretation of these results must take into account that the two groups had different personal expectations and values with regard to health and health care. These findings are enlightening in evaluating women's needs, expectations, and satisfaction with health care services and should be included in future development of maternity care, including idwifery services, in Québec and other locations.     

The attitude of pregnant women to the possibilities for the prenatal screening and diagnosis of Down's syndrome in the 2nd trimester

The aim of the study was to assess pregnant women's attitude and receptivity for second trimester prenatal screening and diagnostic tests for fetal Down syndrome [DS], factors that influence attitude formation, sufficiency of patients' information, advisability of introduction of these tests in routine prenatal care Interviews with 129 pregnant women were conducted after they had received written information concerning prenatal DS screening and diagnostic tests Five questions to the point of the matter as well as 14 related to the personal characteristics of the interviewed were included. Ultrasound screening rt]. accepted by 98.4% serum screening--by 93% and invasive prenatal testing--by 90% of the pregnant women Patients receptivity for serum screening and invasive testing Was influenced by factors like age, past obstetric history educational level, religiosity, attitude towards patient's own health For some of the factors statistically significant relationships were present while for others only some trends were outlined Regarding patients' high receptivity for prenatal DS screening and diagnostic tests the latter can be recommended as an element of the routine prenatal care in our country.     

Are counsellors' attitudes influencing pregnant women's attitudes and decisions on prenatal screening?

OBJECTIVES: It is generally recognised that choices concerning treatment or screening should be people's own, autonomous decisions. However, in the context of genetic counselling, many studies found that counsellors deviate from nondirectiveness, or that subjective norm influences behaviour. The present study aimed to investigate whether prenatal counsellors (midwives, gynaecologists) influence pregnant women's decisions and their attitudes regarding prenatal screening. It was hypothesised that uptake rates and attitudes would be associated with the counsellor's attitude toward prenatal screening. METHODS: Pregnant women attending their midwifery or gynaecology practice were asked to fill out postal questionnaires before and after they were offered prenatal screening for Down syndrome. Their prenatal counsellors also filled in a questionnaire. These questionnaires assessed attitudes toward prenatal screening and background variables. The study sample consisted of 945 pregnant women, being guided by 97 prenatal counsellors. RESULTS: Multilevel regression analyses revealed that neither uptake rates, nor attitude toward prenatal screening were significantly predicted by counsellors' attitudes toward prenatal screening. CONCLUSION: It is suggested that the advice these pregnant women were reported to have received, should rather be interpreted as an indication of shared decision-making and social support than of social pressure and undesired influence.     

Culturally Sensitive Prenatal Care for Southeast Asians

OBJECTIVE: To evaluate the success of the Southeast Asian Health Project in terms of client satisfaction with the prenatal care and other services. To obtain additional data about Southeast Asian women's health practices regarding childbearing. DESIGN: Survey through questionnaires administered as interviews. SETTING: In clients' homes or via telephone. PARTICIPANTS: 119 women from SEAHP's case files of recently delivered clients. MEASUREMENTS AND MAIN RESULTS: Interviews were conducted by four community workers fluent in Cambodian or Lao. The majority of women were satisfied with SEAHP, particularly the interpretation and education in native languages. Women were also satisfied with SEAHP, encouraging others to seek care. CONCLUSIONS: SEAHP appears to meet prenatal care needs of Southeast Asian women in Long Beach, California. More objective outcome data await analyses, but the program's approach may ensure access to and use of health services.     

An unaddressed issue: domestic violence and unplanned pregnancies among pregnant women in Turkey.

OBJECTIVE: The aim of this study was to estimate the prevalence and type of domestic violence during pregnancy in Turkey and to compare socioeconomic background factors. METHODS: A survey was carried out among a representative sample of 475 pregnant women. Data were collected on the incidence and the nature of domestic violence perpetrated by the woman's spouse or other family members during her current pregnancy and before. Sociodemographic characteristics such as age, duration of marriage, number of children, monthly income, education, occupation of the husband, domestic violence towards children, contribution to family decisions, smoking habits, sexual relations and whether the pregnancy was planned or not, were also recorded. RESULTS: Of the 475 women screened for domestic violence during pregnancy, 158 (33.3%) reported physical or sexual abuse since they had become pregnant. The source of the domestic violence was mainly the husband in 105 (66.5%) women. Types of abuse were psychological in 71 (44.9%) and physical in 87 (55.1%) women. The rate of women's satisfaction with their sexual life among abused women was 43.67% compared to 61.2% among non-abused women. Abused pregnant women were less educated, had lower income, had more children, had a longer duration of marriage, were applying violence towards their children, were not contributing to family decisions, were less satisfied with their sexual life and were more likely to have unplanned pregnancies when compared to non-abused women. CONCLUSION: Antenatal care protocols should be modified to address domestic violence and contributing factors during pregnancy so that identified women can be counseled appropriately and attempts can be made to intervene to prevent further episodes of domestic violence in primary care settings.     

Prenatal consultation after a fetal anomaly scan: videotaped exploration of physician's attitude and patient's satisfaction

The main aim of the study was to evaluate the relationship between the physician's attitude (using the non-verbal Global Affective Measure of the Roter Analaysis System and the Counselor Rating Form-short version) and the satisfaction of the pregnant women with the prenatal consultation. A secondary aim was to evaluate the women's recall of essential information (i.e. location, severity, prognosis and cause of the anomaly). To this end, 24 prenatal consultations (pregnant women, partners and physicians) were videotaped following a fetal anomaly scan, and a few days later, the pregnant women completed questionnaires to assess their perception of the physician's attitude and their satisfaction with the consultation and the extent to which they could recall the essentials of the information given about the fetal anomaly. In descending order, the physician's dominance/assertiveness (i.e. being self-confident and decisive) (assessment of the videotapes by two psychologists), trustworthiness (women's report) and expertise were significantly positively associated with the women's overall satisfaction, i.e. satisfaction with the information given and affective behaviour on the part of the physician during the prenatal consultation. All the women (n=24) recalled the essentials of the information given about the location of the fetal anomaly. The majority of them correctly reproduced the severity, the prognosis and the cause of the anomaly. Our findings indicate that women in whom a fetal anomaly has been detected derive particular benefit from a self-confident, decisive, expert and trustworthy physician.     

Postnatal care in low-income urban African American women: relationship to level of prenatal care sought.

OBJECTIVE: This study examined the relationship between level of prenatal care utilization and postnatal patterns of health care behavior among high-risk minority women. The primary hypothesis was that prenatal care utilization predicts subsequent levels of both the maternal and child health services used in the postnatal period. METHODS: The study population consisted of 297 low-income African American women who were recruited at delivery at an urban tertiary medical center in the Mid-Atlantic region. They were followed monthly for 1 year using telephone interviews to determine their use of maternal and child health services. Four levels of prenatal care were identified retrospectively based on reviews of health records and screening interviews using the Kessner Index. Data regarding pregnancy outcomes, maternal postnatal visits, and well-child and acute care child visits were collected. RESULTS: Women who sought inadequate or no prenatal care had greater infant morbidity and mortality in the postnatal period and significantly lower levels of attendance at maternal postnatal visits, well-child visits, immunization completions, and acute care visits. CONCLUSION: This study confirms that the level of prenatal care is indicative of the level of postnatal care women seek for themselves and their children in the first year after delivery.