Women’s Participation in Decision-Making in Maternity Care: A Qualitative Exploration of Clients’ Health Literacy Skills and Needs for Support
Abstract
:1. Introduction
- What health literacy skills do women in maternity care use for (shared) decision-making?
- What needs for support in shared decision-making do clients in maternity care perceive?
2. Materials and Methods
2.1. Study Design
2.2. Research Population
2.3. Data Collection
2.4. Procedure and Measures
2.4.1. Interview Guide
2.4.2. Background Characteristics
2.5. Data Analysis
Coding and Analysis
3. Results
3.1. Background Characteristics
3.2. Stage 1: Understanding Pregnancy and the Procedures of Labor
3.2.1. Skills Stage 1
Find Sources of Information about Pregnancy and Labor
Select and Appraise (Online) Information
Interpret Written or Spoken Pregnancy-Related Terminology
3.2.2. Perceived Needs for Support in Stage 1
3.3. Stage 2: Understanding the Consequences—Risks, Limitations, Benefits and Uncertainties
3.3.1. Skills Stage 2
Understanding Different Harms and Benefits of Options
Understanding the Likelihood of Harms Occurring to Mother and/or Child
Compare Options against Each Other
3.3.2. Perceived Needs for Support Stage 2
3.4. Stage 3: Identifying Salient Preferences and Combining Utilities with Probabilities
3.4.1. Skills Stage 3
Anticipating Health States during Labor or after Birth
Identifying Preferences for Different Outcomes
Combining Preferences with Probabilistic Information on Chance of Occurring
Sharing and Communicating Values to Significant Others, Peers, Partner
Using Previous Pregnancy and Birth Experiences and Own Knowledge
3.4.2. Perceived Support Needs Stage 3
3.5. Stage 4: Participating in the Decision with Maternity Care Professional
3.5.1. Skills Stage 4
Understanding that Involvement in Decision and Choice Is Possible
Articulate and Discuss Preference with Maternity Care Professional
Asking Questions to Maternity Care Professional
3.5.2. Perceived Needs Stage 4
3.6. Stage 5: Making a Decision
3.6.1. Skills
Cope with Practical Barriers of Options and Costs
Taking Responsibility for Mother’s and Child’s Health
3.6.2. Perceived Needs Stage 5
3.7. Other Decision-Making Skills
3.7.1. Coping with Changes
3.7.2. Coping with Uncertainty
3.7.3. Coping with Emotions
4. Discussion
Strength and Limitations
5. Practice Implication
6. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
Appendix A
References
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Background Characteristics | n (%) | Mean (SD *; Range) |
---|---|---|
Age | 33 years (6; 20–45 years) | |
Educational level | ||
Low | 4 (13%) | |
Middle | 2 (13%) | |
High | 17 (74%) | |
Ethnic background | ||
Dutch | 14 (61%) | |
Non-Dutch: Western | 2 (9%) | |
Non-Dutch: Non-Western | 7 (30%) | |
Marital status | ||
Married/living together with partner | 22 (96%) | |
Basic skills | ||
SAHL-D * | 8.8 (4; 0–13) ** | |
NVS-D * | 4.2 (2; 0–6) ** | |
Low basic skills | 10 (44%) | |
Parity | ||
primigravida/primipara | 10 (43.5%) | |
multigravida/multipara | 13 (56.5%) | |
Number of weeks after birth | 5 (2; 1,5–8) | |
Number of weeks pregnant | 34 (4; 25–39) |
Stage 1: Understanding Pregnancy Stages and the Procedures of Labor | Stage 2: Understanding the Consequences: Risks, Limitations, Benefits and Uncertainties | Stage 3: Identifying Preferences and Combining Utilities with Probabilities | Stage 4: Participate in Decision-Making with Maternity Care Professional | Stage 5: Make a Decision |
---|---|---|---|---|
(a) Find sources of information about pregnancy and labor | (a) Understand different harms and benefits of options | (a) Anticipate health states during labor or after birth | (a) Understand that involvement and choice is possible | (a) Self-efficacy |
(b) Select and appraise (online) information -Decide when to stop looking for information | (b) Understand the likelihood of these occurring to mother and/or baby—carry out basic calculations | (b) Identify preferences for different outcomes | (b) Articulate and discuss preference to maternity care professional | (b) Taking responsibility for mother’s and child’s health |
(c) Interpret written or spoken pregnancy-related terminology | (c) Interpret probabilities of harms occurring to mother and/or child | (c) Combine preferences with probabilistic information | (c) Ask questions to maternity care professional | (c) Cope with practical barriers of options and costs |
(d) Compare options against each other | (d) Share and communicate values to: -Significant others (e.g., friends, mother) -Peers -Partner | |||
(e) Use own knowledge and previous pregnancy and birth experiences |
Stage 1: Understanding pregnancy stages and the procedures of labor | Quote 1—making sense of a condition: “... the Pregnancy Plus app, and they also give you information from day to day, and week for week, about what you can approximately expect. And that gives you a lovely guideline for how your pregnancy is progressing.” (high health literacy, 33 weeks pregnant, primigravida) |
Quote 2—interpreting spoken or written medical terminology: “Yeah, it’s like you’re, I don’t know, trying to read the budget or something, really hard. Difficult language. I mean, I’m thinking, yeah but what am I really reading here?” (low HL, 6 weeks postpartum, primiparous) | |
Stage 2: Understanding the consequences: risks, limitations, benefits and uncertainties | Quote 3—understanding the likelihood of harms occurring: “Yeah, I think it’s too general. It really has to be simple, it has to be… you need to be able to put yourself in the place of someone that’s made that decision, why they did that. And not something like so-and-so percentage, no, that means nothing to me.” (low HL, 6 weeks postpartum, primiparous) |
Stage 3: Identifying preferences and combining utilities with probabilities | Quote 4—identifying preferences for different outcomes: “That means thoroughly weighing up all sorts of things in advance, whilst of course I still haven’t got a clue how things are going to work out. So to me that’s very, very difficult.” (high health literacy, 36 weeks pregnant, primigravida) |
Quote 5—combining preferences with probabilistic information: “Well, at first I actually thought that I would prefer [to give birth] without pain relief, but when I read those risks, I thought, like, these are small things, and it is not extreme, but these are things that I think, like, if I don’t have to, then I don’t need to.” (high HL, 39 weeks pregnant, primigravida) | |
Quote 6—using knowledge and experiences: “So besides finding it horrible the whole way things went during the childbirth, I found the aftermath horrible as well. And that made me decide... that I thought, like, that’s not something I want to deal with again.” (high health literacy, 6 weeks postpartum, multiparous) | |
Stage 4: Participate in decision-making with maternity care professional | Quote 7—understanding that involvement and choice is possible: “So do you want a caesarean or a breech birth? And that was completely new to us, new information. And that was a bit of a weird experience, because we didn’t even know we had any choice in the matter.” (low HL, 38 weeks pregnant, primiparous) |
Quote 8—asking questions: “…, but with breastfeeding, it did not go well immediately. I just sort of called in all backup, the midwife, the children’s healthcare left, the lactation consultant came over. Yeah, just take in all information that is available and that’s how I feel you decide.” (high HL, 33 weeks pregnant, multiparous) | |
Stage 5: Make a decision | Quote 9—take responsibilities for mother and child’s health: “In that case I’d indeed want to take more risks for myself than for the child, that’s for sure. Also, because it’s not just my child, it’s someone else’s child too. And I feel it deserves respect. Look, my own body, that’s my choice. But when it’s about somebody else’s child as well, then you’d never forgive yourself if something went wrong.” (low HL, 38 weeks pregnant, primiparous) |
Quote 10—coping with uncertainty: “Yeah, and that’s indeed awkward, because you’ve got no clue how things will work out and what it will be like. I mean, about position and mode of childbirth I can… I do have some ideas about that, but then I think, yeah, well, how will that really turn out… or will I still see it the same way then?” (low HL, 38 weeks pregnant, primiparous) |
Stage 1: Understanding pregnancy stages and the procedures of labor | Quote 11: “Well, I really liked that the obstetrician gave us a website, because it was instantly clear, like okay, this information is apparently trustworthy, because she said so.” (low HL, 38 weeks pregnant, primigravida) |
Stage 2: Understanding the consequences: risks, limitations, benefits and uncertainties | Quote 12: “Yes, I really like this, because I quite like to see facts, like 2 out of 1000 babies die around childbirth. That’s what I want to know: how many… not that there’s some chance, no, I want to know, okay, 2 out of 1000, as compared to (if we’re talking about caesarean) less than 0.5 of the 1000 babies die. So then you see it quite clearly, 0.2% or 0.05%, that’s what I want to know. How big is the difference, what are we talking about? So I think it’s great that this gives the real facts.” (low HL, 38 weeks pregnant, primigravida) |
Stage 3: Identifying preferences and combining utilities with probabilities | Quote 13: “And there wasn’t a conversation about these are the cons or these are the pros, this would be good for you, or this would not be good…And it was at a moment that I could not think clearly anymore, because I did not sleep for three days and I was devastated in pain.” (high HL, 2.5 weeks postpartum, primiparous) |
Stage 4: Participate in decision-making with maternity care professional | Quote 14: “Yes, I’m really pleased about that too, also because indeed it’s my own body and my baby, who of course might be absorbing medication too. So I’m really glad to have that freedom of choice and that I could make that decision.” (high HL, 1.5 weeks postpartum, primiparous) |
Quote 15: “The obstetrician who was there said after an hour, like, he hasn’t moved a single millimeter, and a first child is usually born after two hours of pushing. But I don’t really see that happening, that he’ll start moving in the second hour… So I’d advise you to just stop now, then I’ll just start the procedure for you now. And I was happy about that, I thought it was a good way of explaining. So then I thought, okay fine.” (high HL, 2.5 weeks postpartum, primiparous) | |
Stage 5: Make a decision | Quote 16: “So yeah, information can be difficult. Or like, as I was just saying, the information you get is, like, these are the pros and these are the cons and good luck. And then if you ask more questions later or you start discussing it further, then you do get some more information about it, and you do understand it better. So then I think that… yeah, that perhaps we could have been more assertive ourselves about that, and make an additional appointment to discuss it further. I’m not sure about that, but suddenly everything had to go so fast.” (low HL, 38 weeks pregnant, primiparous) |
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Murugesu, L.; Damman, O.C.; Derksen, M.E.; Timmermans, D.R.M.; de Jonge, A.; Smets, E.M.A.; Fransen, M.P. Women’s Participation in Decision-Making in Maternity Care: A Qualitative Exploration of Clients’ Health Literacy Skills and Needs for Support. Int. J. Environ. Res. Public Health 2021, 18, 1130. https://doi.org/10.3390/ijerph18031130
Murugesu L, Damman OC, Derksen ME, Timmermans DRM, de Jonge A, Smets EMA, Fransen MP. Women’s Participation in Decision-Making in Maternity Care: A Qualitative Exploration of Clients’ Health Literacy Skills and Needs for Support. International Journal of Environmental Research and Public Health. 2021; 18(3):1130. https://doi.org/10.3390/ijerph18031130
Chicago/Turabian StyleMurugesu, Laxsini, Olga C. Damman, Marloes E. Derksen, Danielle R. M. Timmermans, Ank de Jonge, Ellen M. A. Smets, and Mirjam P. Fransen. 2021. "Women’s Participation in Decision-Making in Maternity Care: A Qualitative Exploration of Clients’ Health Literacy Skills and Needs for Support" International Journal of Environmental Research and Public Health 18, no. 3: 1130. https://doi.org/10.3390/ijerph18031130