从女性视角看助产士的同理心和共同决策 - 评估敏感性，以比较产前和产科护理的护理质量。
Midwives' empathy and shared decision making from women's perspective - sensitivity of an assessment to compare quality of care in prenatal and obstetric care.
机构信息
Department of Research Methods in the Health Sciences, University of Education Freiburg, Kunzenweg 21, 79117, Freiburg, Germany.
Department of Research Methods, University of Education Freiburg, Kunzenweg 21, 79117, Freiburg, Germany.
出版信息
BMC Pregnancy Childbirth. 2022 Sep 20;22(1):717. doi: 10.1186/s12884-022-05041-y.
BACKGROUND
For quality-oriented evaluation of prenatal and obstetric care, it is important to systematically consider the perspective of the women receiving care in order to comprehensively assess and optimize quality in a woman-centered manner. Empathy and Shared Decision Making (SDM) are essential components of woman-centered midwifery care. The aim of the study was to analyze measurement invariance of the items of the Consultation and Relational Empathy (CARE) and Shared Decision Making-Questionnaire (SDM-Q-9) scales depending on the prenatal versus obstetric care setting.
METHODS
One hundred fifty women retrospectively assessed aspects of woman-centered midwifery care in both prenatal and obstetric care setting. The birth of the child was a maximum of 12 months ago. A structural equation modelling approach was adopted to separate true effects from response shift (RS) effects depending on care setting. The latter were analyzed in terms of recalibration (changing women's internal measurement standards), Reprioritization (changing associations of items and construct) as well as Reconceptualization (redefining the target construct).
RESULTS
A response shift model was identified for both assessments (pregnancy/birth: CFI = .96/.96; SRMR = .046/.051). At birth, both scales indicated lower quality of care compared with prenatal care (SDM-Q-9-M/CARE-8-M:|d| = 0.190/0.392). Although no reconceptualization is required for the items of both scales, RS effects are evident for individual items. Due to recalibration and reprioritization effects, the true differences in the items are partly underestimated (SDM-Q-9-M/CARE-8-M: 3/2 items) or overestimated (4/2 items).
CONCLUSION
The structure of the constructs SDM and Empathy, indicating woman-centered midwifery care, are moderated by the care settings. To validly assess midwives' empathy and shared decision making from women's perspective, setting-dependent response shift effects have to be considered. The proven item-specific response effects contribute to a better understanding of construct characteristics in woman-centered care by midwives during pregnancy and childbirth.
背景
为了进行以质量为导向的产前和产科护理评估，系统地考虑接受护理的女性的观点非常重要，以便以女性为中心的方式全面评估和优化质量。同理心和共同决策（SDM）是以女性为中心的助产护理的重要组成部分。本研究的目的是分析咨询和关系同理心（CARE）和共同决策问卷（SDM-Q-9）量表项目的测量不变性，这些项目取决于产前和产科护理环境。
方法
150 名女性回顾性评估了产前和产科护理环境中以女性为中心的助产护理的各个方面。孩子出生的时间最长为 12 个月前。采用结构方程建模方法，根据护理环境分离真实效应和反应转移（RS）效应。后者根据重新校准（改变女性的内部测量标准）、重新优先化（改变项目和结构的关联）以及重新概念化（重新定义目标结构）进行分析。
结果
为两种评估（妊娠/分娩：CFI=0.96/0.96；SRMR=0.046/0.051）确定了反应转移模型。在分娩时，与产前护理相比，这两个量表都表明护理质量较低（SDM-Q-9-M/CRE-8-M：|d|=0.190/0.392）。尽管两个量表的项目都不需要重新概念化，但仍存在个体项目的 RS 效应。由于重新校准和重新优先化的影响，项目的真实差异部分被低估（SDM-Q-9-M/CRE-8-M：3/2 个项目）或高估（4/2 个项目）。
结论
SDM 和同理心的构建结构表明，以女性为中心的助产护理受到护理环境的调节。为了从女性的角度有效地评估助产士的同理心和共同决策，必须考虑基于环境的反应转移效应。已证明的特定项目的反应效应有助于助产士在妊娠和分娩期间更好地理解以女性为中心的护理中的结构特征。
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