Judith Lumley Centre, La Trobe University, Bundoora, Victoria, Australia.
Realist Research Evaluation and Learning Initiative, Northern Institute Charles Darwin University, Casuarina, Darwin, Northern Territory, Australia.
Health Soc Care Community. 2022 Nov;30(6):e5423-e5433. doi: 10.1111/hsc.13965. Epub 2022 Aug 4.
How women are cared for while pregnant and having a new baby can have profound and lasting effects on their health and well-being. While mainstream maternity care systems aspire to provide care that is woman-centred, women with fewest social and economic resources often have reduced access. Community-based doula support programs offer complementary care for these women and are known to, on average, have positive outcomes. Less understood is how, when and why these programs work. A realist evaluation of an Australian volunteer doula program provided for women experiencing socioeconomic adversity explored these questions. The program provides free non-medical, social, emotional, and practical support by trained doulas during pregnancy, birth and new parenting. This paper reports the testing and refinement of one program theory from the larger study. The theory, previously developed from key informant interviews and rapid realist review of literature, hypothesised that the cultural matching of woman (client) and doula led to best outcomes. This was tested in realist interviews with women and focus groups with doulas, in January-February 2020. Seven English speaking, and six Arabic speaking clients were interviewed. Two focus groups were conducted with a total of eight doulas from diverse cultural and professional backgrounds. Data were analysed in NVivo. The study found cultural matching to be valued by some but not all women, and only when the doula was also genuinely interested, kind, timely and reliable. These approaches (with or without cultural matching) generate trust between the doula and woman. Trust theory, reflexivity theory and social relations theory supported explanatory understanding of the causal contribution of a doula knowing what it takes to build trust, to a woman deciding to trust her doula.
女性在怀孕期间和新生儿阶段的护理方式对她们的健康和幸福有着深远而持久的影响。虽然主流的孕产妇护理系统旨在提供以女性为中心的护理，但拥有最少社会和经济资源的女性往往获得的护理机会较少。以社区为基础的导乐支持计划为这些女性提供了补充性的护理，并且通常具有积极的效果。然而，这些计划是如何、何时以及为何发挥作用的，人们对此了解甚少。对澳大利亚为经历社会经济困境的女性提供的志愿导乐计划进行的现实主义评估探讨了这些问题。该计划由经过培训的导乐在怀孕期间、分娩期间和新育儿期间提供免费的非医疗、社会、情感和实际支持。本文报告了从更大规模研究中测试和完善的一个计划理论。该理论之前是从关键知情人访谈和对文献的快速现实主义评论中发展而来的，假设女性（客户）和导乐之间的文化匹配会带来最佳结果。这在 2020 年 1 月至 2 月期间通过对女性的现实主义访谈和对来自不同文化和专业背景的八位导乐的焦点小组进行了测试。对 7 名讲英语的和 6 名讲阿拉伯语的客户进行了访谈。总共进行了两次焦点小组讨论，有八位来自不同文化和专业背景的导乐参加。数据在 NVivo 中进行了分析。研究发现，文化匹配受到一些女性的重视，但不是所有女性都重视，只有当导乐真正感兴趣、善良、及时和可靠时，文化匹配才会受到重视。这些方法（无论是否有文化匹配）都能在导乐和女性之间建立信任。信任理论、反思理论和社会关系理论支持了对导乐了解建立信任所需条件以及女性决定信任她的导乐的因果贡献的解释性理解。
