Dawson Pauline, Hay-Smith Jean, Jaye Chrys, Gauld Robin, Auvray Benoit
Department of Women's and Children's Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.
Department of Women's and Children's Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand; Rehabilitation Teaching and Research Unit, University of Otago, Wellington, New Zealand.
Midwifery. 2021 Apr;95:102936. doi: 10.1016/j.midw.2021.102936. Epub 2021 Feb 4.
Birthing outcomes in New Zealand are demonstrably inequitable based on governmental reports and research. However, the last Ministry of Health maternal satisfaction survey in 2014 indicated that 77% of women were satisfied or very satisfied with care. This study used data from the maternal satisfaction survey to examine aspects of inequity in reported satisfaction with care.
Structural Equation Modelling (SEM) was used to infer latent variables of satisfaction with equity domains from responses to the satisfaction survey. Additional data (residential location and deprivation score), not used in the Ministry of Health primary analysis, were provided and included in this modelling.
SEM showed that satisfaction was not equitably distributed. Younger women, those from areas of high socio-economic deprivation, and remote rural women were most likely to be affected by dissatisfaction associated with physical access, cultural care, information provided, and/or barriers to equity associated with additional costs (all p<0.05). Financial burden of additional costs was also unevenly distributed.
While these findings are congruent with other research on the association between social determinants and maternal satisfaction, it is concerning that they remain sources of inequity in New Zealand twenty years after they were first identified as priorities to address. On the basis of this study, urgent attention needs to be paid to removing sources of inequity within the health system and maternity care in particular.
根据政府报告和研究，新西兰的分娩结果存在明显的不公平现象。然而，卫生部2014年的上一次产妇满意度调查显示，77%的女性对护理感到满意或非常满意。本研究利用产妇满意度调查的数据，来审视报告的护理满意度方面的不公平问题。
采用结构方程模型（SEM），根据满意度调查的回答推断公平领域满意度的潜在变量。提供了卫生部初步分析中未使用的其他数据（居住地点和贫困得分），并将其纳入该模型。
结构方程模型显示，满意度分布不均衡。年轻女性、来自社会经济高度贫困地区的女性以及偏远农村女性最有可能受到与就医便利性、文化护理、提供的信息和/或与额外费用相关的公平障碍有关的不满影响（所有p<0.05）。额外费用的经济负担分布也不均衡。
虽然这些发现与其他关于社会决定因素与产妇满意度之间关联的研究一致，但令人担忧的是，自它们首次被确定为需要解决的优先事项二十年后，这些问题在新西兰仍然是不公平的根源。基于本研究，需要紧急关注消除卫生系统内尤其是孕产妇护理方面的不公平根源。
