以青年为中心的孕产妇护理：拉丁裔青少年与医疗服务提供者经历及观点的双边质性比较
Youth-centered maternity care: a binational qualitative comparison of the experiences and perspectives of Latina adolescents and healthcare providers.
作者信息
Decker Martha J, Pineda Noelle, Gutmann-Gonzalez Abigail, Brindis Claire D
机构信息
Department of Epidemiology and Biostatistics, University of California, San Francisco, 550 16th Street, 2nd floor, San Francisco, CA, 94158, USA.
Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, 490 Illinois Street, 7th floor, San Francisco, CA, 94158, USA.
出版信息
BMC Pregnancy Childbirth. 2021 May 2;21(1):349. doi: 10.1186/s12884-021-03831-4.
BACKGROUND
Although there is growing recognition of the importance of person-centered maternity care, the needs and perspectives of pregnant adolescents are rarely considered. The purpose of this study was to compare the maternity care experiences of Mexican-origin adolescents in Guanajuato, Mexico and Fresno, California from both youth and healthcare provider perspectives.
METHODS
Qualitative interviews and focus groups were conducted with a total of 89 respondents, including 74 pregnant and parenting adolescents as well as 15 providers between December 2016 and July 2017. Adolescents also completed a short demographic survey prior to participation. Transcripts in English and Spanish were coded and thematically analyzed using Dedoose software. Results were compared by location and between youth and providers.
RESULTS
Four themes emerged regarding patient-provider interactions: the need for communication and clear explanations, respectful versus judgmental providers, engaging youth in decision-making, and a focus on the age of the youth and their partners. While youth had similar perspectives and priorities in both locations, youth in Mexico reported more negative healthcare experiences than youth in California. Perspectives varied between the youth and providers, with providers in both California and Mexico identifying several structural challenges in providing quality care to adolescents. In California, challenges to supporting immigrant Latina adolescents and their families included language and translation issues as well as barriers to care due to immigration status and documentation. In both locations, providers also mentioned high patient caseloads and their own concerns about the youth's life choices.
CONCLUSION
Youth-centered care requires more effective and respectful patient-provider communication, where adolescents are engaged in their healthcare decision-making and delivery options. Changes in patient-provider interactions can help improve the maternity care experiences and outcomes of Latina adolescents. Healthcare systems and providers need to reconfigure their approaches to focus on the needs and priorities of adolescents.
背景
尽管人们越来越认识到以患者为中心的孕产妇护理的重要性，但怀孕青少年的需求和观点却很少被考虑。本研究的目的是从青少年和医疗服务提供者的角度比较墨西哥瓜纳华托州和加利福尼亚州弗雷斯诺市墨西哥裔青少年的孕产妇护理经历。
方法
2016年12月至2017年7月期间，对总共89名受访者进行了定性访谈和焦点小组讨论，其中包括74名怀孕和育有子女的青少年以及15名医疗服务提供者。青少年在参与之前还完成了一份简短的人口统计学调查。使用Dedoose软件对英文和西班牙文的访谈记录进行编码并进行主题分析。结果按地点以及青少年和医疗服务提供者之间进行了比较。
结果
出现了四个关于医患互动的主题：沟通和清晰解释的必要性、尊重与评判的医疗服务提供者、让青少年参与决策以及关注青少年及其伴侣的年龄。虽然两个地点的青少年有相似的观点和优先事项，但墨西哥的青少年报告的负面医疗经历比加利福尼亚州的青少年更多。青少年和医疗服务提供者的观点各不相同，加利福尼亚州和墨西哥的医疗服务提供者都指出在为青少年提供优质护理方面存在一些结构性挑战。在加利福尼亚州，支持拉丁裔移民青少年及其家庭面临的挑战包括语言和翻译问题以及移民身份和文件导致的护理障碍。在两个地点，医疗服务提供者还提到了高患者负荷以及他们对青少年生活选择的担忧。
结论
以青少年为中心的护理需要更有效和尊重的医患沟通，让青少年参与他们的医疗决策和分娩选择。医患互动的改变有助于改善拉丁裔青少年的孕产妇护理经历和结果。医疗系统和医疗服务提供者需要重新调整他们的方法，以关注青少年的需求和优先事项。
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