Department of International Health, Johns Hopkins School of Public Health, Baltimore, Maryland, United States of America.
School of Community Health and Midwifery, University of Central Lancashire, Preston, United Kingdom.
PLoS One. 2022 Aug 12;17(8):e0270264. doi: 10.1371/journal.pone.0270264. eCollection 2022.
Effective postnatal care is important for optimal care of women and newborns-to promote health and wellbeing, identify and treat clinical and psychosocial concerns, and to provide support for families. Yet uptake of formal postnatal care services is low and inequitable in many countries. As part of a larger study examining the views of women, partners, and families requiring both routine and specialised care, we analysed a subset of data on the views and experiences of women related to routine postnatal care.
We undertook a qualitative evidence synthesis, using a framework analysis approach. We included studies published up to December 2019 with extractable qualitative data, with no language restriction. We focused on women in the general population and their accounts of routine postnatal care utilization. We searched MEDLINE, PUBMED, CINAHL, EMBASE, EBM-Reviews, and grey literature. Two reviewers screened each study independently; inclusion was agreed by consensus. Data abstraction and scientific quality assessment were carried out using a study-specific extraction form and established quality assessment tools. The analysis framework was developed a priori based on previous knowledge and research on the topic and adapted. Due to the number of included texts, the final synthesis was developed inductively from the initial framework by iterative sampling of the included studies, until data saturation was achieved. Findings are presented by high versus low/middle income country, and by confidence in the finding, applying the GRADE-CERQual approach.
Of 12,678 papers, 512 met the inclusion criteria; 59 articles were sampled for analysis. Five themes were identified: access and availability; physical and human resources; external influences; social norms; and experience of care. High confidence study findings included the perceived low value of postnatal care for healthy women and infants; concerns around access and quality of care; and women's desire for more emotional and psychosocial support during the postnatal period. These findings highlight multiple missed opportunities for postnatal care promotion and ensuring continuity of care.
Factors that influence women's utilization of postnatal care are interlinked, and include access, quality, and social norms. Many women recognised the specific challenges of the postnatal period and emphasised the need for emotional and psychosocial support in this time, in addition to clinical care. While this is likely a universal need, studies on mental health needs have predominantly been conducted in high-income settings. Postnatal care programmes and related research should consider these multiple drivers and multi-faceted needs, and the holistic postpartum needs of women and their families should be studied in a wider range of settings.
This protocol is registered in the PROSPERO database for systematic reviews: CRD42019139183.
有效的产后护理对于妇女和新生儿的最佳护理至关重要-促进健康和幸福，识别和治疗临床和社会心理问题，并为家庭提供支持。然而，在许多国家，正规的产后护理服务的利用率都很低且不平等。作为一项研究妇女、伴侣和家庭的需求的更大研究的一部分，我们分析了与常规产后护理相关的妇女观点和经验的部分数据。
我们使用框架分析方法进行了定性证据综合。我们纳入了截至 2019 年 12 月具有可提取定性数据的研究，无语言限制。我们专注于普通人群中的妇女及其对常规产后护理利用的描述。我们在 MEDLINE、PUBMED、CINAHL、EMBASE、EBM-Reviews 和灰色文献中进行了搜索。两名评审员独立筛选了每一项研究；通过共识达成纳入标准。使用特定于研究的提取表格和既定的质量评估工具进行数据提取和科学质量评估。分析框架是根据先前关于该主题的知识和研究预先制定的，并进行了调整。由于纳入的文本数量众多，最终的综合分析是通过对纳入研究的迭代抽样，从初始框架中归纳得出的，直到达到数据饱和为止。研究结果按高收入和中低收入国家以及应用 GRADE-CERQual 方法的研究结果置信度进行呈现。
在 12678 篇论文中，有 512 篇符合纳入标准；有 59 篇文章被抽样进行分析。确定了五个主题：获得和可用性；物理和人力资源；外部影响；社会规范；以及护理体验。高置信度的研究结果包括产后护理对健康妇女和婴儿的价值低；对护理的获取和质量的关注；以及妇女在产后期间对更多情感和心理社会支持的渴望。这些发现突显了促进产后护理和确保护理连续性的多个错失机会。
影响妇女利用产后护理的因素相互关联，包括获取途径、质量和社会规范。许多妇女认识到产后期间的具体挑战，并强调除了临床护理外，还需要在这段时间提供情感和心理社会支持。虽然这可能是一种普遍的需求，但关于心理健康需求的研究主要在高收入环境中进行。产后护理计划和相关研究应考虑这些多种驱动因素和多方面的需求，以及妇女及其家庭的整体产后需求应在更广泛的范围内进行研究。
本方案在 PROSPERO 数据库中注册，用于系统评价：CRD42019139183。
