University of Guelph, Department of Population Medicine, 50 Stone Rd E, Guelph, ON, N1G 2W1, Canada.
Bwindi Community Hospital, P.O. Box 58, Kanungu, Uganda.
Midwifery. 2019 Nov;78:16-24. doi: 10.1016/j.midw.2019.07.005. Epub 2019 Jul 9.
With an increasing number of women attending antenatal care for the recommended number of contacts, focus now must be placed on the quality and utility of care; without understanding adherence, the true contribution of antenatal care to improved maternal health outcomes is difficult to determine.
This research explored the practicality of antenatal care recommendations for women and the factors which facilitate or hinder adherence and shape the overall utility of care.
Qualitative data were collected using a community-centred approach by means of focus group discussions with women and key informant interviews with healthcare providers throughout May and June of 2017. Data were analysed via thematic analysis guided by an essentialist/realist paradigm.
Kanungu District, Uganda; a district in southwestern Uganda.
A convenience sample of 38 Indigenous Batwa and non-Indigenous Bakiga women from four matched communities and three healthcare providers.
A number of barriers to antenatal care adherence were identified which included a lack of monetary and material resources, a lack of a shared understanding and perceived value of care, and gender and position-based power dynamics, all of which were compounded by previous experiences with antenatal care. The factors identified which influenced adherence were highly complex and non-linear, affected by individual, community, health centre, and health system-level factors. Promotion of spousal involvement in antenatal care had different effects based on pre-existing individual levels of spousal support, either improving or hindering adherence. A lack of resources created a double burden for women through which maternal health was jeopardized by the inability to adhere to antenatal care recommendations and the poor quality patient-provider relationships which resulted and deterred future antenatal care attendance.
The capacity to avail oneself of antenatal care varied significantly for women based on their socio-economic status, levels of autonomy, and spousal support. Strategies to improve antenatal care need to focus on health equity to ensure care has a high degree of utility for all women. The interconnectedness of care and those who deliver care necessitates healthcare providers to develop strong patient-provider relationships through their attitudes, behaviours, and the delivery of equitable care. In light of a historical emphasis on attendance, this research highlights the significance of improving the quality and utility of antenatal care, inclusive of Indigenous perspectives, to deliver high-value care.
随着越来越多的女性按照建议的次数接受产前护理，现在必须关注护理的质量和实用性；如果不了解依从性，就很难确定产前护理对改善产妇健康结果的真正贡献。
本研究探讨了妇女接受产前护理建议的实际情况，以及促进或阻碍依从性并影响护理整体实用性的因素。
2017 年 5 月至 6 月，采用以社区为中心的方法，通过焦点小组讨论和对整个乌干达卡农古区四个匹配社区和三名医疗服务提供者的关键知情人访谈收集定性数据。数据通过以本质主义/现实主义范式为指导的主题分析进行分析。
乌干达卡农古区；乌干达西南部的一个区。
从四个匹配的社区和三个医疗服务提供者中抽取了 38 名土着巴特瓦和非土着巴基加妇女的方便样本。
确定了一些影响产前护理依从性的障碍，包括缺乏金钱和物质资源、缺乏对护理的共同理解和感知价值，以及基于性别和地位的权力动态，所有这些都因以前的产前护理经历而变得更加复杂。影响依从性的因素非常复杂和非线性，受个人、社区、保健中心和卫生系统各级因素的影响。促进配偶参与产前护理会根据配偶支持的现有个人水平产生不同的效果，要么改善，要么阻碍依从性。资源匮乏使妇女面临双重负担，一方面是无法遵守产前护理建议，另一方面是不良的医患关系，这不仅危及产妇健康，还阻碍了她们未来接受产前护理的意愿。
根据妇女的社会经济地位、自主权水平和配偶支持程度，她们利用产前护理的能力有很大差异。改善产前护理的策略需要注重卫生公平，确保所有妇女都能获得高质量的护理。护理的相互关联性和提供护理的人需要医疗服务提供者通过他们的态度、行为和提供公平的护理来建立牢固的医患关系。鉴于历史上对出勤率的重视，本研究强调了提高产前护理质量和实用性的重要性，包括土着观点，以提供高价值的护理。
