Department of Psychology, Stony Brook University, Stony Brook, NY, USA.
Department of Psychology, Pace University, New York, USA.
Soc Sci Med. 2017 Oct;190:133-140. doi: 10.1016/j.socscimed.2017.08.011. Epub 2017 Aug 18.
Favorable relationships with health care providers predict greater patient satisfaction and adherence to provider recommendations. However, the specific components of patient-provider relationships that account for these benefits have not been identified. The potential benefits of strong patient-provider relationships in pregnancy may be especially important, as care providers have frequent, intimate interactions with pregnant women that can affect their emotions and behaviors. In turn, prenatal emotions and health behaviors have potent effects on birth outcomes.
This study investigated whether pregnant women's relationships with their midwives predicted better self-care. Specific components of the patient-provider relationship (communication, integration, collaboration, and empowerment) were examined. We also investigated a mechanism through which these relationship components may be associated with salutary health behaviors: by alleviating women's anxiety.
In total, 139 low-risk patients of a university-affiliated midwifery practice in the northeastern United States completed well-validated measures assessing their relationship with midwives, state anxiety, and prenatal health behaviors in late pregnancy; state anxiety was also assessed in mid-pregnancy.
Women's perceptions of better communication, collaboration, and empowerment from their midwives were associated with more frequent salutary health behavior practices in late pregnancy. Controlling for mid-pregnancy anxiety, lower anxiety in late pregnancy mediated associations of communication and collaboration with health behavior practices, indicating that these associations were attributable to reductions in anxiety from mid- to late pregnancy.
Results substantiate that benefits of patient-provider relationships in pregnancy may extend beyond providing medical expertise. Some aspects of patient-provider relationships may offer direct benefits to pregnant women in promoting better health practices; other aspects of these relationships may indirectly contribute to better health practices by alleviating negative emotions. The benefits of strong midwife relationships may derive from the reassurance, comfort, and warmth these relationships offer, as well as the information and education that midwives provide to their patients.
与医疗保健提供者的良好关系可预测患者更高的满意度和对提供者建议的遵从度。然而，能够解释这些益处的医患关系的具体组成部分尚未确定。在妊娠期间，建立强有力的医患关系的潜在益处可能尤为重要，因为医疗保健提供者与孕妇有频繁、亲密的互动，这会影响她们的情绪和行为。反过来，产前的情绪和健康行为对分娩结果有很大影响。
本研究调查了孕妇与助产士的关系是否能预测更好的自我护理。研究考察了医患关系的特定组成部分（沟通、整合、协作和赋权）。我们还探讨了一种机制，即这些关系组成部分如何通过缓解女性焦虑与有益的健康行为相关联。
在美国东北部一所大学附属的助产士实践中，共有 139 名低风险患者完成了经过充分验证的评估其与助产士关系、状态焦虑和妊娠晚期产前健康行为的测量；妊娠中期也评估了状态焦虑。
女性对助产士更好的沟通、协作和赋权的感知与妊娠晚期更频繁地进行有益健康行为的实践有关。控制妊娠中期的焦虑后，妊娠晚期焦虑降低，调节了沟通和协作与健康行为实践之间的关联，这表明这些关联归因于从中期到晚期妊娠焦虑的降低。
结果证实，妊娠期间医患关系的益处可能不仅限于提供医学专业知识。医患关系的某些方面可能为促进更好的健康实践直接为孕妇提供益处；这些关系的其他方面可能通过缓解负面情绪间接促进更好的健康实践。与助产士建立良好关系的好处可能源于这些关系提供的安慰、舒适和温暖，以及助产士为患者提供的信息和教育。
