Continuum of care and the antenatal record in rural New South Wales

Objective: The aim of the study was to determine the effect of the woman held antenatal record card (PNC2) on the continuity of maternity care received when presenting to the acute rural setting for clinical assessment. Design: Qualitative, open‐ended questionnaires. Setting: Rural New South Wales public hospital. Subjects: Maternity consumers, 50 women who were inpatients receiving antenatal or postnatal care between August and October 1998. A stratified sample of healthcare professionals employed by the service, 12 midwives and 13 general practitioners. Main outcome measure: The self reported use of the antenatal card and the viewed effects of the card on the continuity of healthcare received. Results: The study identified a significant difference between the responding professionals (93%) positive perception of the effect of the PNC2 on the women's pregnancy continuum of care and the maternity consumer (36%), who felt it bore little impact on their care. The study findings suggested a lack of compliance and standardisation in usage of the antenatal card negated any flow on effects for the women. Conclusions: The intended purposes of the PNC2 were compromised in this rural setting. The study recommends that stakeholders in rural maternity care be accountable for examining the benefits and barriers of their antenatal practices, that the rural community's expectations of ‘continuity of maternity care’ are sought and that there should be a review of the available models of rural antenatal care. What is already known: The woman held antenatal record has been reported to be an effective approach for enabling consumers to participate in their maternity care, whilst also address the concerns of continuity, safety and information sharing. This form of medical record has been strongly supported by the National Health and Medical Research Council and NSW Health as a professional and consumer friendly strategy. The usage or the effects of the antenatal record in rural New South Wales settings have yet to be widely evaluated. What this study adds: The study's questionnaire responses identified that the antenatal record may have met the needs of rural health professionals, however, the maternity care consumers were unaware of these benefits. The study suggests that the antenatal record was operationalised at the discretion and for the convenience of the rural health care professional. Identifying rural communities perceptions of continuity of care and the need to explore models of care that promote continuity in rural areas, where significant findings of the study.     

Exploring care from extended family through rural women's accounts of perinatal mental illness – a qualitative study with implications for policy and practice

Extended family often have an important role in caring for women experiencing perinatal mental illness; but rural women's perspectives are under-researched. We explored women's experiences of living in rural northern England and receiving care from extended family during periods of perinatal mental illness through 21 qualitative interviews. Key findings were that companionship, practical support - informal childcare and transport, and emotional support were important forms of care - filling gaps in formal service provision. Findings highlight women's needs for support from extended families in rural areas. The rural infrastructure and inequity in formal services can create vulnerability for women.     

GIVING BIRTH IN THE HOSPITAL: CHILDBIRTH EXPERIENCES OF THAI WOMEN IN NORTHERN THAILAND

In this article, I examine how Thai women perceive and experience childbirth in hospitals. The article is based on in-depth interviews with 30 women living in Chiang Mai, Thailand. The women's narratives reveal that childbirth was managed within the medical system. The women believed that safety was the primary reason for their choice of birth in the hospital. Women's embodied experiences with hospital birth reveal the “passivity” discourse; women accord total trust to their doctors and very rarely question the many routine procedures in hospitals. It seems that in northern Thai hospitals the involvement of women's partners or their significant others is kept to a minimum. Of interest among postpartum care provided in Thai hospitals in the north is the use of a spotlight to help heal the episiotomy wound. This is an adaptation of Thai traditional confinement practices in the era of modernity. The use of a spotlight in hospital not only provides the women with symbolic ritual but also is believed to assist them in the healing process. Women in general were satisfied with postpartum care received during their hospital stay, except for rooming-in practice. The data suggest some differences between rural poor and urban middle-class women in terms of hospitals of birth, the opportunity to have a family member at birth, and so on. It is clear that middle-class educated women are able to exercise their choices and control over their childbirth experiences much more than rural poor women. I argue that care provided to women during birth needs to take into account women's emotional and subjective experience so that sensitive birthing care can be achieved. This will only make childbirth of many women a more positive one.     

Translating Knowledge Directly to Childbearing Women: A Study of Canadian Women's Preferences

Knowledge translation has relied on research products that take years to disseminate, losing relevance for intended users. We used a mixed-methods approach to determine women's preferences for research results and format, intention to share results, and potential benefits. We sampled healthy, pregnant women who completed survey data during their third trimesters and wanted access to results. Mothers preferred results about sleep, fears, and anxieties during later pregnancy to benefit from reassurance that their experiences were shared. Women mostly intended to share results with their social networks. Organizational contacts increased dissemination of the women's preferred information to nonstudy participants.     

How Far?: Using Geographical Information Systems (GIS) to Examine Maternity Care Access for Expectant Mothers in a Rural State

Various factors have made rural access to maternity care a significant problem for rural women. The geographic distance between a mother's county of residence and the county in which she gave birth was examined in a rural state. Analyzing North Dakota county-level data using geographic information system (GIS) software, women from over half of the state's counties, making up nearly 18% of all births, were found to be over 40 miles to the hospital in which they gave birth. These findings suggest that rural women may experience significant geographic barriers as they receive health services in the prenatal, delivery, and postpartum periods of their pregnancy. We highlight the value of GIS, particularly geovisualization power, and note models of care that may be effective for rural women.     

The Old is Newer Than Ever: Showcasing Opportunities

Tanzania's health care provider shortage, especially in rural areas, makes it challenging to meet women's support needs in hospitals. We describe women's perceptions of childbirth support at a hospital in rural Tanzania. We interviewed 25 women within 24 hours after delivery using semistructured interviews. Most women sought life-saving technological support in case of complications. They also valued having family present to provide care and affection. Women's needs, however, were difficult to fulfill at this busy facility. Increasing women-centered childbirth support and recognizing family as important contributors may provide a strategy to meet the needs of both women and providers.     

Dying at home in rural residential aged care: A mixed‐methods study in the Snowy Monaro region,Australia

Residential aged care (RAC) is a significant provider of end‐of‐life care for people aged 65 years and older. Rural residents perceive themselves as different to their urban counterparts. Most studies describing place of death (PoD) in RAC are quantitative and reflect an urban voice. Using a mixed‐methods design, this paper examines the PoD of 80 RAC residents (15 short‐stay residents who died in RAC during respite or during an attempted step‐down transition from hospital to home, and 65 permanent residents), within the rural Snowy Monaro region, Australia, who died between 1 February 2015 and 31 May 2016. Death data were collected from local funeral directors, RAC facilities, one multi‐purpose heath service and obituary notices in the local media. The outcome variable was PoD: RAC, local hospital or out‐of‐region tertiary hospital. For the permanent RAC residents, the outcome of interest was dying in RAC or dying in hospital. Cross tabulations by PoD and key demographic data were performed. Pearson Chi squared tests and exact p‐values were used to determine if any of the independent variables were associated with PoD. Using an ethnographic approach, data were collected from 12 face‐to‐face, open‐ended interviews with four RAC residents, with a life expectancy of ≤6 months, and six family caregivers. Interviews were audio‐recorded, transcribed and analysed thematically. Fifty‐one (78.5%) of the permanent residents died in RAC; 21.5% died in hospital. Home was the initial preferred POD for most interviewed participants; most eventually accepted the transfer to RAC. Long‐term residents considered RAC to be their “home”—a familiar place, and an important part of their rural community. The participants did not consider a transfer to hospital to be necessary for end‐of‐life care. Further work is required to explore further the perspectives of rural RAC residents and their families, and if transfers to hospital are avoidable.     

From pillar to post: homeless women's experiences of social care

This paper reports findings from a longitudinal study of homeless women. Thirty‐eight women were recruited with a retention rate of 58% over three rounds of interviews. Interviews explored specific events in women's lives, their current living arrangements and how their experiences and needs, including for social care, changed over time. Data were analysed thematically using a priori codes. Women reported a range of complex issues, consistent with experiences of deep social exclusion and received support from both statutory and voluntary agencies. Although women appreciated the support they received, many reported that services were fragmented and rarely personalised to their needs.     

The Influence of Neighbors' Family Size Preference on Progression to High Parity Births in Rural Nepal

Large families can have a negative impact on the health and well‐being of women, children, and their communities. Seventy‐three percent of the individuals in our rural Nepalese sample report that two children is their ideal number, yet about half of the married women continue childbearing after their second child. Using longitudinal data from the Chitwan Valley Family Study, we explore the influence of women's and neighbors' family size preferences on women's progression to high parity births, comparing this influence across two cohorts. We find that neighbors' family size preferences influence women's fertility, that older cohorts of women are more influenced by their neighbors' preferences than are younger cohorts of women, and that the influence of neighbors' preferences is independent of women's own preferences.     

农村育龄妇女皮下埋植术后生殖保健需求分析

目的了解聊城市农村育龄妇女行皮下埋植剂术后人群生殖保健需求的特点。方法采用多阶段随机抽样方法,对568例农村育龄妇女行皮下埋植术避孕者进行问卷调查。结果20%有生殖系统炎症症状,90%自诉受术后有月经周期缩短、经期延长、经量增多或不规则阴道流血。调查对象对生殖健康的重视程度与文化程度相关。结论行皮下埋植术后的育龄妇女对生殖保健需求的渴望心理较强,对生殖需求的层次较高。计划生育部门应采取有效措施,提高育龄妇女生殖健康水平。     

Perceptions of Quality of Reproductive Care Services in Bolivia: Use of Photo Prompts and Surveys as an Impetus for Change

Surveys are sometimes used to assess women's perceptions of the quality of reproductive health care, but less empowered women may feel uncomfortable expressing their views in this method. We demonstrate the use of a participatory approach, combining a standard survey with an innovative photonarrative method. Women in Cochabamba, Bolivia, were asked to participate in exit surveys (n = 108). A subsample did photonarratives (n = 20). The survey showed rural women had less access to care, but photonarratives revealed the cause—fear. Women asserted quality of care was high, but photonarratives contradicted survey results. Staff used photonarratives to select action items for quality improvement.     

Perception of Humanization of Birth in a Highly Specialized Hospital: Let's Think Differently

Our goal for this article was to identify the perceptions of health care professionals, administrators, and women concerning the humanization of childbirth care in a tertiary hospital. A single-case study design and a qualitative approach were used. We collected data through semistructured interviews, participant observation, field notes, and a questionnaire. The humanization of birth in a tertiary hospital is identifiable by several key characteristics such as personalization, recognition of women's rights, human caring, women's advocacy and companionship, and a balance between medical care and comfort, safety, and humanity.     

Factors related to women's preferences for OBGYN care providers: An explanatory survey

Utilizing a framework of systems theory, this study was done to determine the preferences of a group of women for the health professional composition of ambulatory OBGYN care provider groups and to relate these preferences to a variety of client‐related factors. A random sample of 300 women employed at an insurance company received an explanatory survey developed by the researcher (N = 157). Respondents tended to utilize the OBGYN care groups that they preferred. Private OBGYN care groups composed of male OBGYN physicians tended to be the preferred and utilized groups for the majority of respondents. Women who had previously received care from women providers or nurse practitioners tended to prefer these providers, while women who had not previously received care from these practitioners tended not to include them in their preferences. Certain statistically significant relationships between selected client‐related factors and respondents’ preferences resulted in specific suggestions for nursing practice.     

中国已婚育龄妇女分娩保健服务的状况与变化研究

目的:分析我国已婚育龄妇女分娩保健服务状况及其变化。方法:对全国31个省(直辖市、自治区)抽取的调查前三年有生育史的1962名已婚育龄妇女进行问卷调查,结合1997年全国人口与生殖健康调查资料,对两次调查前三年有生育史妇女最近一次活产的分娩保健服务状况进行比较分析。结果:①与1997年调查前三年相比,2001年调查前三年育龄妇女的入院分娩率增加,家庭分娩的比例明显减少;②农村妇女家庭分娩比例明显降低,由1997年调查时的61·41%降为2001年调查时的40·78%,1998~2000年间,92·54%城镇妇女接受分娩保健服务,农村妇女家庭分娩比例高出城镇7·4倍,为40·78%;③分娩保健服务在各地区发展不平衡,东部和中部地区发展快,西部地区,尤其是西南地区发展相对较慢,1998~2000年间,西部地区妇女中,一半以上在家分娩,西部地区农村家庭分娩妇女一半以上由家人接生,约为东部和中部地区的6倍;④少数民族妇女家庭分娩和由家人接生的比例明显高于汉族妇女;⑤随着文化程度和经济收入的增加育龄妇女对分娩保健服务的利用增加,文盲、经济收入低的妇女家庭分娩比例和由家人接生的比例非常高。结论:我国分娩保健服务状况在改善,但发展极不平衡,西部地区农村的分娩保健服务急待提高。应加强对西部地区分娩保健服务的支持力度,研究制定应对策略,加强对西部农村接生人员的专业技术培训。     

Orthopedic surgery in rural American hospitals: a survey of rural hospital administrators

Rural American residents prefer to receive their medical care locally. Lack of specific medical services in the local community necessitates travel to a larger center which is less favorable. This study was done to identify how rural hospitals choose to provide orthopedic surgical services to their communities. Methods: All hospitals in 5 states located in communities that met the criteria for a rural town according to the Rural Urban Commuting Area codes were included. A survey with topics including community and hospital demographics, orthopedic surgical workforce and demand, surgical services, and the perceived benefit of orthopedic services was sent to the hospital administrators. Results: Of the 223 rural hospitals surveyed, 145 completed the survey. Of those completing the survey, 30% had at least one full‐time orthopedic surgeon, 25% did not provide any orthopedic surgical services, 65% never had an orthopedic surgeon on ER call, 33% were recruiting an orthopedic surgeon, 52% stated that it is more difficult to recruit an orthopedic surgeon vs a general surgeon, and 71% of the administrators acknowledged a need for additional orthopedic surgical services in their community. For those hospitals that did not have a full‐time orthopedic surgeon, members of those communities traveled a mean distance of 55 miles for emergency orthopedic surgical care as reported by the hospital administrators. Conclusions: There are many rural communities that have limited access to orthopedic surgical services. While many of the rural hospital administrators feel that there is a need for additional orthopedic surgical services in their communities, it is difficult to recruit orthopedic surgeons to these areas.     

Women Veterans' Pathways to and Perspectives on Veterans Affairs Health Care

BackgroundWe examined Veterans Affairs (VA) health care experiences among contemporary women veteran patients receiving care at a VA medical center. Specifically, we examined women veteran patients' satisfaction with VA care along dimensions in line with patient-centered medical home (patient-aligned care teams [PACT] in VA) priorities, and pathways through which women initially accessed VA care.MethodsWe used a mixed methods research design. First, 249 racially diverse women (ages 22–64) who were past-year users of primary care at a VA medical center completed interviewer-administered surveys in 2012 assessing ratings of satisfaction with care in the past year. We then conducted in-depth qualitative interviews of a subset of women surveyed (n = 25) to gain a deeper understanding of perspectives and experiences that shaped satisfaction with care and to explore women's initial pathways to VA care.ResultsRatings of satisfaction with VA care were generally high, with some variation by demographic characteristics. Qualitative interviews revealed perceptions of care centered on the following themes: 1) barriers to care delay needed medical care, while innovative care models facilitate access, 2) women value communication and coordination of care, and 3) personalized context of VA care, including gender sensitive care shapes women's perceptions. Pathways to VA care were characterized by initial delays, often attributable to lack of knowledge or negative perceptions of VA care. Informal social networks were instrumental in helping women to overcome barriers.ConclusionsFindings highlight convergence of women's preferences with PACT priorities of timely access to care, provider communication, and coordination of care, and suggest areas for improvement. Outreach is needed to address gaps in knowledge and negative perceptions. Initiatives to enhance women veterans' social networks may provide an information-sharing resource.     

Envisioning Women-Centered HIV Care: Perspectives from Women Living with HIV in Canada

BackgroundWomen comprise nearly one-quarter of people living with human immunodeficiency virus (HIV) in Canada. Compared with men, women living with HIV experience inequities in HIV care and health outcomes, prompting a need for gendered and tailored approaches to HIV care.MethodPeer and academic researchers from the Canadian HIV Women's Sexual and Reproductive Health Cohort Study conducted focus groups to understand women's experience of seeking care, with the purpose of identifying key characteristics that define a women-centered approach to HIV care. Eleven focus groups were conducted with 77 women living with HIV across Quebec, Ontario, and British Columbia, Canada.ResultsWomen envisioned three central characteristics of women-centered HIV care, including i) coordinated and integrated services that address both HIV and women's health care priorities, and protect against exclusion from care due to HIV-related stigma, ii) care that recognizes and responds to structural barriers that limit women's access to care, such as violence, poverty, motherhood, HIV-related stigma, and challenges to safe disclosure, and iii) care that fosters peer support and peer leadership in its design and delivery to honor the diversity of women's experiences, overcome women's isolation, and prioritize women's ownership over the decisions that affect their lives.ConclusionDespite advances in HIV treatment and care, the current care landscape is inadequate to meet women's comprehensive care needs. A women-centered approach to HIV care, as envisioned by women living with HIV, is central to guiding policy and practice to improve care and outcomes for women living with HIV in Canada.