"People in regular society don't think you can be a good mother and have a substance use problem": Participatory action research with women with substance use in pregnancy.

OBJECTIVE

To work collaboratively with women accessing an integrated program for women with substance use in pregnancy to learn how services can be improved.

DESIGN

Qualitative design using focus groups within a participatory action framework.

SETTING

Sheway, a program located in the Downtown Eastside of Vancouver, BC.

PARTICIPANTS

A total of 21 co-researchers who were women who had accessed Sheway services.

METHODS

Semistructured focus groups were recorded and transcribed. Data analysis was iterative and reviewed weekly with focus group members. Themes were member checked and reviewed with co-researchers. The action phase of the project involved the co-researchers presenting their main findings to the Sheway staff members. The staff and women worked collaboratively to implement client-directed changes to the program.

MAIN FINDINGS

Co-researchers described Sheway as family. They expressed concern about transitioning from the program to other community services and identified stereotypes and negative treatment by health care providers as barriers to their transition out of the program. One action project developed by the co-researchers was a "transition group" where women could connect to current and former Sheway clients. The women could retain the social support they gained through Sheway while learning about other resources. The co-researchers also prioritized developing peer-to-peer mentorship to support new clients. The findings of the research were disseminated to Sheway staff, the Department of Family Practice at the University of British Columbia, and local family medicine maternity care providers with the hope of improving care for women with substance use in pregnancy.

CONCLUSION

A participatory action framework allowed women to engage as co-researchers. The co-researchers emphasized the importance of relationships and a sense of family with other women as well as providers as positive aspects of their care. Women involved in this project identified negative attitudes of health care providers toward substance use in pregnancy as barriers. Co-researchers proposed transition support and peer-to-peer networking as action projects to improve their care.