scholarly journals Youth-centered maternity care: a binational qualitative comparison of the experiences and perspectives of Latina adolescents and healthcare providers

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Martha J. Decker ◽  
Noelle Pineda ◽  
Abigail Gutmann-Gonzalez ◽  
Claire D. Brindis
Keyword(s):  
Decision Making ◽  
Maternity Care ◽  
Quality Care ◽  
Qualitative Interviews ◽  
Healthcare Providers ◽  
Qualitative Comparison ◽  
Latina Adolescents ◽  
Provider Perspectives ◽  
Centered Care ◽  
Delivery Options

Abstract Background Although there is growing recognition of the importance of person-centered maternity care, the needs and perspectives of pregnant adolescents are rarely considered. The purpose of this study was to compare the maternity care experiences of Mexican-origin adolescents in Guanajuato, Mexico and Fresno, California from both youth and healthcare provider perspectives. Methods Qualitative interviews and focus groups were conducted with a total of 89 respondents, including 74 pregnant and parenting adolescents as well as 15 providers between December 2016 and July 2017. Adolescents also completed a short demographic survey prior to participation. Transcripts in English and Spanish were coded and thematically analyzed using Dedoose software. Results were compared by location and between youth and providers. Results Four themes emerged regarding patient-provider interactions: the need for communication and clear explanations, respectful versus judgmental providers, engaging youth in decision-making, and a focus on the age of the youth and their partners. While youth had similar perspectives and priorities in both locations, youth in Mexico reported more negative healthcare experiences than youth in California. Perspectives varied between the youth and providers, with providers in both California and Mexico identifying several structural challenges in providing quality care to adolescents. In California, challenges to supporting immigrant Latina adolescents and their families included language and translation issues as well as barriers to care due to immigration status and documentation. In both locations, providers also mentioned high patient caseloads and their own concerns about the youth’s life choices. Conclusion Youth-centered care requires more effective and respectful patient-provider communication, where adolescents are engaged in their healthcare decision-making and delivery options. Changes in patient-provider interactions can help improve the maternity care experiences and outcomes of Latina adolescents. Healthcare systems and providers need to reconfigure their approaches to focus on the needs and priorities of adolescents.

scholarly journals Youth-Centered Maternity Care: A Binational Qualitative Comparison of the Experiences and Perspectives of Latina Adolescents and Healthcare Providers

2020 ◽  
Author(s):  
Martha J. Decker ◽  
Noelle Pineda ◽  
Abigail Gutmann-Gonzalez ◽  
Claire D. Brindis
Keyword(s):  
Decision Making ◽  
Maternity Care ◽  
Quality Care ◽  
Qualitative Interviews ◽  
Healthcare Providers ◽  
Qualitative Comparison ◽  
Latina Adolescents ◽  
Provider Perspectives ◽  
Centered Care ◽  
Delivery Options

Abstract Background Although there is growing recognition of the importance of person-centered maternity care, the needs and perspectives of pregnant adolescents are rarely considered. The purpose of this study was to compare the maternity care experiences of Mexican-origin adolescents in Guanajuato, Mexico and Fresno, California from both youth and healthcare provider perspectives. Methods Qualitative interviews and focus groups were conducted with a total of 89 respondents, including pregnant and parenting adolescents as well as providers between December 2016 and July 2017. Adolescents also completed a short demographic survey prior to participation. Transcripts in English and Spanish were coded and thematically analyzed using Dedoose software. Results were compared by location and between youth and providers. Results Four themes emerged regarding patient-provider interactions: the need for communication and clear explanations, respectful versus judgmental providers, engaging youth in decision-making, and a focus on the age of the youth and their partners. While youth had similar perspectives and priorities in both locations, youth in Mexico reported more negative healthcare experiences than youth in California. Perspectives varied between the youth and providers, with providers in both California and Mexico identifying several structural challenges in providing quality care to adolescents. In California, challenges to supporting immigrant Latina adolescents and their families included language and translation issues as well as barriers to care due to immigration status and documentation. In both locations, providers also mentioned high patient caseloads and their own concerns about the youth’s life choices. Conclusion Youth-centered care requires more effective and respectful patient-provider communication, where adolescents are engaged in their healthcare decision-making and delivery options. Changes in patient-provider interactions can help improve the maternity care experiences and outcomes of Latina adolescents. Healthcare systems and providers need to reconfigure their approaches to focus on the needs and priorities of adolescents.

scholarly journals Youth-Centered Maternity Care: A Binational Qualitative Comparison of the Experiences and Perspectives of Latina Adolescents and Healthcare Providers

2020 ◽  
Author(s):  
Martha J. Decker ◽  
Noelle Pineda ◽  
Abigail Gutmann-Gonzalez ◽  
Claire D. Brindis
Keyword(s):  
Decision Making ◽  
Maternity Care ◽  
Quality Care ◽  
Qualitative Interviews ◽  
Healthcare Providers ◽  
Qualitative Comparison ◽  
Latina Adolescents ◽  
Provider Perspectives ◽  
Centered Care ◽  
Delivery Options

Abstract Background: Although there is growing recognition of the importance of person-centered maternity care, the needs and perspectives of pregnant adolescents are rarely considered. The purpose of this study was to compare the maternity care experiences of Mexican-origin adolescents in Guanajuato, Mexico and Fresno, California from both youth and healthcare provider perspectives. Methods: Qualitative interviews and focus groups were conducted with a total of 89 respondents, including pregnant and parenting adolescents as well as providers between December 2016 and July 2017. Transcripts in English and Spanish were coded and analyzed using Dedoose software. Results were compared by location and between youth and providers. Results: Four themes emerged regarding patient-provider interactions: the need for communication and clear explanations, respectful versus judgmental providers, engaging youth in decision-making, and a focus on the age of the youth and their partners. While youth had similar perspectives and priorities in both locations, youth in Mexico reported more negative healthcare experiences than youth in California. Perspectives varied between the youth and providers, with providers in both California and Mexico identifying several structural challenges in providing quality care to adolescents. In California, challenges to supporting immigrant Latina adolescents and their families included language and translation issues as well as barriers to care due to immigration status and documentation. In both locations, providers also mentioned high patient caseloads and their own concerns about the youth’s life choices. Conclusion: Youth-centered care requires more effective and respectful patient-provider communication, where adolescents are engaged in their healthcare decision-making and delivery options. Changes in patient-provider interactions can help improve the maternity care experiences and outcomes of Latina adolescents. Healthcare systems and providers need to reconfigure their approaches to focus on the needs and priorities of adolescents.

scholarly journals Healthcare Provider Perspectives on Adherence to Adjuvant Endocrine Therapy after Breast Cancer

2021 ◽  
Vol 28 (2) ◽  
pp. 1472-1482
Author(s):  
Leah K. Lambert ◽  
Lynda G. Balneaves ◽  
A. Fuchsia Howard ◽  
Stephen L. K. Chia ◽  
Carolyn C. Gotay
Keyword(s):  
Breast Cancer ◽  
Endocrine Therapy ◽  
Breast Cancer Survivors ◽  
Current System ◽  
Quality Care ◽  
Healthcare Providers ◽  
Cancer Recurrence ◽  
Adjuvant Endocrine Therapy ◽  
Structural Factors ◽  
Provider Perspectives

Adherence to adjuvant endocrine therapy (AET) for breast cancer is suboptimal. The purpose of this study was to: (1) explore the experiences and perspectives of healthcare providers (HCPs) in providing care to breast cancer survivors prescribed AET, (2) identify how social and structural factors influence the provision of AET-related care, and (3) ascertain HCP recommendations for optimizing AET adherence and related care. Individual, in-depth interviews were conducted with 14 HCPs using an interpretive descriptive approach to inquiry and the theoretical lens of relational autonomy. Data was analyzed using thematic and constant comparative techniques. Healthcare providers focused on four main components of AET-related care: (1) the importance of having careful conversations about AET, (2) difficulties in navigating transitions in care, (3) symptom management as a big part of their role, and (4) dealing with AET discontinuation. Recommendations to improve AET adherence focused on developing sustainable and efficient models of delivering high-quality care to women on AET. Healthcare providers play a pivotal role educating women about AET and supporting their adherence to therapy. Sustainable healthcare system innovations and new models of care that address current system gaps are needed to enhance survivorship care, AET adherence, and ultimately, reduce cancer recurrence and mortality.

scholarly journals The Patient’s Perspective on Institutional Logics in Russian Maternity Care

2019 ◽  
Vol 17 (3) ◽  
pp. 439-452
Author(s):  
Екатерина Александровна Бороздина ◽  
Анастасия Андреевна Новкунская
Keyword(s):  
Maternity Care ◽  
Institutional Environment ◽  
Qualitative Interviews ◽  
Healthcare Providers ◽  
Institutional Logics ◽  
The Other ◽  
Institutional Dynamics ◽  
Healthcare Facilities ◽  
Expectant Mothers ◽  
Institutional Actors

The interplay between different institutional logics is a vital topic in contemporary institutional analyses of healthcare. In this paper, we consider relations between professional, bureaucratic, market, and informal logics in the volatile and ever-transforming context of post-Soviet maternity care. We approach this issue from an unconventional angle and study how various logics are interpreted, enacted and manipulated by women-patients. Neo-institutional scholars commonly enlist patients as institutional actors that are involved both in maintaining and changing the institutional order. However, current research neglects the patients’ perspective instead focusing on the practices of healthcare providers. In order to fill this gap, we investigate how expectant mothers make sense of and navigate the complex institutional environment of Russian maternity care. In our analysis we rely on empirical data from fifty-nine qualitative interviews with recent mothers conducted in St. Petersburg in 2015–2017. This data allows us to conclude that the institutional dynamics of maternity care are powered mostly by the rivalry of two logics – one bureaucratic, the other market-driven. The professional logic, meanwhile, remains underrepresented and dominated by the other two. Unlike healthcare practitioners, women perceive the bureaucratic logic as chaotic and unpredictable, while wealthy clients employ a repertoire of actions offered by the market logic to exercise more control of their hospital routine. Different institutional logics compete for dominance, leaving areas of uncertainty in regard to institutional rules. In some cases, patients use informality to manage such ambivalence and challenge the formal order of healthcare facilities. The common character of this strategy prompts us to suggest that informality forms a distinctive fourth logic that frames some actions and interactions within Russian maternity care.

scholarly journals ‘The System is Not Set up for the Benefit of Women’: Women’s Experiences of Decision-Making During Pregnancy and Birth in Ireland

2021 ◽  
pp. 104973232110554
Author(s):  
Susann Huschke
Keyword(s):  
Decision Making ◽  
Maternity Care ◽  
Qualitative Interviews ◽  
Informed Choice ◽  
Diverse Group ◽  
Subjective Experiences ◽  
Authoritative Knowledge ◽  
Depth Interview ◽  
Set Up ◽  
Pregnancy And Birth

In this article, I draw on in-depth qualitative interviews with 23 women, conducted in 2019/2020, focusing on their involvement in decision-making during pregnancy and birth. The study is located in Ireland, where comparably progressive national policies regarding informed choice in labour and birth clash with the day-to-day reality of a heavily medicalised, paternalistic maternity care system. I represent the subjective experiences of a diverse group of women through in-depth interview excerpts. In my analysis, I move beyond describing what is happening in the Irish maternity system to discussing why this is happening – relating the findings of the research to the international literature on authoritative knowledge, technocratic hospital cultures and risk-based discourses around birth. In the last section of the article, I offer concrete, empirically grounded and innovative recommendations how to enhance women’s involvement in decision-making.

scholarly journals “I can guess the month … but beyond that, I can’t tell” an exploratory qualitative study of health care provider perspectives on gestational age estimation in Rajasthan, India

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
K. Scott ◽  
S. Gupta ◽  
E. Williams ◽  
M. Arthur ◽  
U. V. Somayajulu ◽  
...  
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Gestational Age ◽  
Age Estimation ◽  
Clinical Decision Making ◽  
Healthcare Providers ◽  
Clinical Decision ◽  
Provider Perspectives ◽  
Gestational Age Estimation ◽  
Age Estimates

Abstract Background Accurately estimating gestational age is essential to the provision of time-sensitive maternal and neonatal interventions, including lifesaving measures for imminent preterm birth and trimester-specific health messaging. Methods We explored healthcare provider perspectives on gestational age estimation in the state of Rajasthan, India, including the methods they use (last menstrual period [LMP] dating, ultrasound, or fundal height measurement); barriers to making accurate estimates; how gestational age estimates are documented and used for clinical decision-making; and what could help improve the accuracy and use of these estimates. We interviewed 20 frontline healthcare providers and 10 key informants. Thematic network analysis guided our coding and synthesis of findings. Results Health care providers reported that they determined gestational age using some combination of LMP, fundal height, and ultrasound. Their description of their practices showed a lack of standard protocol, varying levels of confidence in their capacity to make accurate estimates, and differing strategies for managing inconsistencies between estimates derived from different methods. Many frontline healthcare providers valued gestational age estimation more to help women prepare for childbirth than as a tool for clinical decision making. Feedback on accuracy was rare. The providers sampled could not offer ultrasound directly, and instead could only refer women to ultrasound at higher level facilities, and usually only in the second or third trimesters because of late antenatal care-seeking. Low recall among pregnant women limited the accuracy of LMP. Fundal height was heavily relied upon, despite its lack of precision. Conclusion The accuracy of gestational age estimates is influenced by factors at four levels: 1. health system (protocols to guide frontline workers, interventions that make use of gestational age, work environment, and equipment); 2. healthcare provider (technical understanding of and capacity to apply the gestational age estimation methods, communication and rapport with clients, and value assessment of gestational age); 3. client (time of first antenatal care, migration status, language, education, cognitive approach to recalling dates, and experience with biomedical services); and, 4. the inherent limitations and ease of application of the methods themselves.

Adolescents, Parents, and Providers Respond to a Tablet-Based Clinical Support Tool for Type 1 Diabetes: A Qualitative Inquiry (Preprint)

2021 ◽  
Author(s):  
Lisa Yazel ◽  
Janet Panoch ◽  
Layana Al-Halbouni ◽  
Tamara Hannon
Keyword(s):  
Qualitative Interviews ◽  
Healthcare Providers ◽  
Clinical Decision ◽  
Qualitative Inquiry ◽  
Patient Centered ◽  
Diabetes Clinic ◽  
Support Tool ◽  
Centered Care ◽  
Evidence Based Care ◽  
Future Work

BACKGROUND Adolescents with diabetes face many challenges with self-management, including taking on increasing responsibility for their autonomy over personal healthcare. The American Diabetes Association (ADA) recommends that treatment is delivered with a patient-centered care model. Electronic clinical decision support (CDS) systems can facilitate use of evidence-based care algorithms and tailoring the adolescent diabetes appointment to patient needs. OBJECTIVE The objective of this study was to examine adolescent patient, parent, and provider experiences with implementing a tablet-based CDS with patient inputs in the pediatric diabetes clinic. METHODS Twenty post-implementation qualitative interviews were conducted with adolescents and parents, and six post-implementation interviews were conducted with healthcare providers. RESULTS Findings show that patients, parents, and providers liked the tablets versus using the paper forms. Patients, parents, and providers felt the tablet format promoted honestly with answering questions. Patients and parents were unsure if the provider looked at their responses, and providers reported barriers to using the system, affording an unclear effect on the visit. CONCLUSIONS Future work will develop CDS in T1D to improve patient and provider communication while positively affecting diabetes outcomes in adolescents. CLINICALTRIAL N/A

Enhancing patient-health care provider (HCP) communication in oncology care in the United States.

2016 ◽  
Vol 34 (3_suppl) ◽  
pp. 99-99
Author(s):  
Suzanne Lane ◽  
Shelagh Szabo ◽  
Ron Halbert ◽  
Hans-Peter Goertz ◽  
Catherine Lai ◽  
...  
Keyword(s):  
Quality Care ◽  
Qualitative Interviews ◽  
The United States ◽  
Patient Centered Care ◽  
Communication Tool ◽  
Patient Centered ◽  
Communication Tools ◽  
Patient Goals ◽  
Centered Care ◽  
The Impact

99 Background: Patient engagement is essential for high-quality care. This study aimed to develop novel communication tools to be used between patients and HCPs to address current gaps in cancer care. Methods: Qualitative interviews were conducted with 16 US patients with various cancers and stage, 6 oncology nurses, and 4 oncologists. Goals were to understand: patients’ changing concerns at diagnosis and during treatment; HCPs views on eliciting patient preferences; and perspectives from both on improving care. A thematic analysis was conducted to identify gaps in care. 8 patients rated their experience and importance of quality care items on a scale of 1 (not experienced/not important) to 5 (experienced/very important). Two draft tools were developed to address identified gaps. Results: None of the 16 patients reported using a communication tool before or during treatment. Gaps in quality care were identified, including communication, patient-centered care, education, and comprehensive care. Communication and patient-centered care items important to patients, but not always experienced, included clearly explained treatment options, time to discuss topics of concern, patient-led decision making, an open-minded care team, and the ability to change one’s mind (mean experience ≤ 4). The first tool assesses patient’s life and treatment goals and establishes early expectations through an open-ended questionnaire. This tool aims to enrich communication between patients and HCPs, enabling more patient-centered care. The second tool addresses the importance of ongoing education using a checklist. Treatment outcomes and the impact of treatment on QOL were identified as the two most important education items for patients when making treatment decisions (mean importance = 5). This tool aims to enhance educational discussions and enable patients to specify where more information is desired. Conclusions: Patients reported a need for communication tools at the beginning of treatment, specifically related to patient goals and educational needs. With patient and HCP input, two novel communication tools were developed to improve quality care. Future studies will validate and implement the tools in clinical practice.

The expectations of fathers concerning care provided by midwives to the mothers during labour

2012 ◽  
Vol 17 (1) ◽  
Author(s):  
Malmsey L.M. Sengane ◽  
Anna G.W. Nolte
Keyword(s):  
Decision Making ◽  
Communication Skills ◽  
Quality Care ◽  
Qualitative Interviews ◽  
Holistic Health ◽  
Role Expectations ◽  
Nursing Theory ◽  
Mothers And Fathers ◽  
Contextual Study ◽  
Descriptive Method

Midwives have been criticised for neglecting the expectations and needs of fathers. They either ignore the fathers or pressure them into becoming more involved than they would choose, if allowed to provide support to the mothers during labour. Whilst midwives are providing woman-centred care, it is important that they remember to involve the fathers in decision-making and to acknowledge their role, expectations and needs, because the birth of a child is one of the most important events in a person’s lifetime. This study focused on fathers’ expectations of the care provided to mothers by the midwives during labour. A qualitative, explorative, descriptive and contextual study design was utilised. In-depth qualitative interviews were conducted with fathers about the care provided to their partners or wives by midwives. Data were then analysed with an open descriptive method of coding that is appropriate for qualitative research. The results of the interviews were subsequently positioned within a holistic health-promotive nursing theory that encompassed body, mind and spirit. The results revealed that fathers saw the provision of comfort and support as the two main aspects for mothers in labour that they expected from midwives. The findings were that midwives should improve their communication skills with the mothers, as well as with the fathers if they are available. Fathers expected midwives to encourage them to accompany the mother during labour and to facilitate bonding between father, mother and baby. The results of this study should assist midwives to provide holistic quality care to mothers and fathers during labour.OpsommingVroedvroue word daarvan beskuldig dat hulle nie voldoen aan die verwagtinge en behoeftes van die vaders nie. Vaders word, óf deur hulle geïgnoreer, óf druk word op hulle uitgeoefen om meer betrokke te raak as waarmee hulle gemaklik is, indien hulle wel toegelaat word om moeders te ondersteun tydens die kraamproses. Vroedvroue verskaf moeder-gesentreerde sorg, maar dit is nogtans belangrik dat hulle onthou om die vaders te betrek in die besluitneming en hulle rol, verwagtinge en behoeftes te erken omdat die geboorte van ‘n kind een van die belangrikste gebeurtenisse in hulle lewens is. Die studie het gefokus op vaders se verwagtinge van die sorg wat verskaf word aan moeders tydens kraam. ‘n Kwalitatiewe, eksploratiewe, beskrywende en kontekstuele navorsingsontwerp is gebruik. Data is ingesamel deur in-diepte onderhoude met vaders te voer oor die sorg wat aan hul vroue of metgeselle tydens die kraamproses verskaf word deur vroedvroue. Data is daarna geanaliseer deur ‘n oop beskrywende metode te gebruik wat toepaslik is vir kwalitatiewe navorsing. Die resultate van die onderhoude is vervolgens geposisioneer binne ‘n holistiese, gesondheids-bevorderende teorie wat verwys na liggaam, psige en gees. Die resultate toon dat gemak en ondersteuning die twee hoofkategorieë is wat verskaf moet word deur vroedvroue aan moeders tydens die kraamproses. Die ander kategorieë wat aangedui word in die resultate, is dat vroedvroue hulle onderlinge kommunikasievaardighede moet verbeter, asook hul kommunikasie met die moeders en vaders indien laasgenoemde beskikbaar is. Die vaders het van vroedvroue verwag om hulle aan te moedig om moeders by te staan tydens die kraamproses en om binding tussen vader, moeder en baba aan te moedig.

Exploring Provider Reactions to Decision Aid Distribution and Shared Decision Making

2016 ◽  
Vol 37 (1) ◽  
pp. 113-126 ◽  
Author(s):  
Clarissa Hsu ◽  
David T. Liss ◽  
Dominick L. Frosch ◽  
Emily O. Westbrook ◽  
David Arterburn
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Health Care Providers ◽  
Decision Aid ◽  
Qualitative Interviews ◽  
Accurate Information ◽  
Shared Decision ◽  
Care Providers ◽  
Provider Attitudes ◽  
Provider Perspectives

Background. A critical component of shared decision making (SDM) is the role played by health care providers in distributing decision aids (DAs) and initiating SDM conversations. Existing literature indicates that decisions about designing and implementing DAs must take provider perspectives into account. However, little is known about how differences in provider attitudes across specialties may impact DA implementation and how provider attitudes may shift after DA implementation. Group Health’s Decision Aid Implementation project was carried out in six specialties using 12 video-based DAs for preference-sensitive conditions; this study focused on two of the six specialties. Design. In-depth, qualitative interviews with specialty care providers in two specialties—orthopedics and cardiology—at two time points during DA implementation. Data were analyzed using a thematic analysis approach. Results. We interviewed 19 care providers in orthopedics and cardiology. All respondents believed that providing patients with accurate information on their health conditions and treatment options was important and that most patients wanted an active role in decision making. However, respondents diverged in decision-making styles and views on the practicality and appropriateness of using the DAs and SDM. For example, cardiology specialists were ambivalent about DAs for coronary artery disease because many viewed DAs and SDM as unnecessary or inappropriate for this clinical condition. Provider attitudes towards DAs and SDM were generally stable over two years. Limitations. Limitations include a lack of patient perspectives, social desirability bias, and possible selection bias. Conclusions. Successfully implementing DAs in clinical practice to promote SDM requires addressing individual provider attitudes, beliefs, and knowledge of SDM by specialty. During DA development and implementation, providers should be asked for input about the specific conditions and care processes that are most appropriate for SDM.

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