School of Nursing, Ball State University, Muncie, Indiana.
Social Work Department, Ball State University, Muncie, Indiana.
J Midwifery Womens Health. 2022 Jan;67(1):75-94. doi: 10.1111/jmwh.13320. Epub 2022 Jan 21.
Women experiencing substance use disorders (SUD) have often reported challenges in their relationships with health care providers during the perinatal period that served as a barrier to care. Establishing trust is an important aspect in forming positive relationships. The purpose of this study was to identify provider characteristics associated with the development of trust when caring for women experiencing SUD during the perinatal period.
A systematic search was conducted using the databases of CINAHL, APA PsychINFO, and PubMed along with a manual search of Google Scholar between the years of 2000-2021. Studies were included if they were (1) original qualitative research; (2) published in English; (3) peer reviewed; (4) from the perspective of women experiencing SUD; (5) included descriptions of positive health care interactions between women experiencing SUD in the perinatal period and their health care providers; and (6) conducted in the United States or Canada. The studies were assessed for quality and validity using 10 criteria from the Joanne Briggs Institute critical appraisal checklist for qualitative research.
Findings from 21 qualitative studies were synthesized using a thematic synthesis approach and revealed 3 overarching themes that included 7 descriptive subthemes which identified provider characteristics associated with trust. The 7 descriptive subthemes included: developing rapport with women, demonstrating caring behaviors, including women in care, understanding women's SUD treatment efforts, reassuring women, delivering competent care, and educating women.
Participants' accounts of trusting interactions with health care providers occurred when providers viewed women approvingly, affirmed their treatment efforts and maternal abilities, and delivered competent care that was knowledgeable of issues associated with SUD. The findings suggest the importance of confronting implicit biases, integrated care, and fostering a stigma-free and trauma-informed working environment.
患有物质使用障碍（SUD）的女性在围产期经常报告与医疗保健提供者之间存在关系挑战，这成为了获得医疗服务的障碍。建立信任是形成积极关系的重要方面。本研究的目的是确定在围产期照顾患有 SUD 的女性时与建立信任相关的提供者特征。
使用 CINAHL、APA PsychINFO 和 PubMed 数据库进行系统搜索，并在 2000 年至 2021 年间对 Google Scholar 进行手动搜索。如果研究符合以下标准，则将其纳入：（1）原始定性研究；（2）以英文发表；（3）同行评审；（4）从患有 SUD 的女性的角度出发；（5）包括患有 SUD 的女性在围产期与医疗保健提供者之间的积极医疗互动的描述；（6）在美国或加拿大进行。使用 Joanne Briggs 研究所定性研究批判性评估清单中的 10 项标准评估研究的质量和有效性。
使用主题合成方法对 21 项定性研究的结果进行综合，得出 3 个总体主题，其中包括 7 个描述性子主题，确定了与信任相关的提供者特征。7 个描述性子主题包括：与女性建立融洽关系、表现出关爱行为、让女性参与护理、理解女性的 SUD 治疗努力、让女性安心、提供专业护理以及教育女性。
当提供者以赞许的态度看待女性、肯定她们的治疗努力和母性能力、并提供专业护理，了解与 SUD 相关的问题时，参与者就会报告对与医疗保健提供者的信任互动。这些发现表明，需要解决隐含偏见、整合护理以及营造无污名和创伤知情的工作环境的重要性。
