Engagement: an indicator of difference in the perceptions of antenatal care for pregnant women from diverse socioeconomic backgrounds

Background Socioeconomically deprived women are at greater risk of adverse pregnancy outcomes. Research tends to focus on access of services. Yet access may not equate with the equity of services for women from different socioeconomic backgrounds. Objectives To determine whether pregnant women’s perceptions of antenatal provision differed in relation to their socioeconomic deprivation ranking (determined by the Scottish Index of Multiple Deprivation 2006). Design A longitudinal, qualitative study with comparative antenatal case studies between January 2007 and April 2009. Setting/Participants Cases were primigravida women from ‘least deprived’ (n = 9) and ‘most deprived’ (n = 12) geographical areas within one local authority in Scotland. Analysis Data were analysed using case study replication analysis. Results There was little difference in access to antenatal services between the ‘least’ and ‘most’ deprived groups. Perception of care differed in relation to the level of ‘engagement’ (defined using constructs of: language and personalization of care; power and relationships; and health literacy). Engagement was evidenced in most of the ‘least deprived’ cases and almost none of the ‘most deprived’ cases. Specifically, socioeconomically deprived women described less evidence of personal connection to their own care, effective communication and the opportunity for shared decision making. Conclusion In women from socioeconomically deprived areas, access may be a less useful indicator than engagement when assessing antenatal service quality. As engagement levels may be one method by which to predict and improve health outcomes, a more equitable antenatal service may need to be developed through the early identification of those women at risk of non‐engagement.     

How sharp can a screening tool be? A qualitative study of patients’ experience of completing a bowel cancer screening questionnaire

Introduction There is evidence to suggest that the Patient Consultation Questionnaire (PCQ) is a reliable tool to predict symptomatic left‐sided colorectal cancer. While previous research has examined the sensitivity and specificity of the PCQ as a tool, it has not addressed patients’ perspectives. Objective To examine qualitatively patients’ perspectives on ease of use of the PCQ, and their attitude to completing it. Method The target population were patients in North Wales between 55 and 85 years with colorectal symptoms who had completed the PCQ. A sample of six was randomly selected. The approach was qualitative, using semi‐structured, in‐depth cognitive interviews, which were recorded and transcribed before content and thematic analysis. Results The study found some areas of concern in relation to the PCQ’s design and presentation, concerning such issues as the use of medical jargon or ambiguous wording, and the use of questions to which patients may not have an answer. It also found that patients responded to the form as something more than a screening tool, treating it variously as way of speeding up diagnosis and treatment, an opportunity to ‘play the system’, and a way of bypassing embarrassing encounters. Discussion and conclusions Although major problems were not identified, the minor issues observed in the PCQ’s design and presentation may reduce accuracy and patient satisfaction. A greater understanding of patients’ perception of the role and function of the PCQ may help clinicians to interpret responses to the form more accurately.