Department of Obstetrics and Gynecology, Boston University Chobanian & Avedisian School of Medicine/Boston Medical Center, Boston, Massachusetts.
Department of Obstetrics and Gynecology, University of Miami, Miami, Florida.
Womens Health Issues. 2023 Jul-Aug;33(4):382-390. doi: 10.1016/j.whi.2022.11.005. Epub 2022 Dec 22.
We aimed to understand the degree to which pregnant individuals exposed to emerging infections, such as Zika, are engaged by providers in shared decision-making and explore potential barriers to inform strategies to improve care for those most at risk for inequities. Studies have demonstrated that Latinx and Black people are less likely to engage in shared decision-making and are less engaged by providers. Limited research explores factors impacting shared decision-making in prenatal care and in the setting of recent epidemics.
We conducted an exploratory qualitative study of individuals eligible for prenatal screening owing to Zika exposure during pregnancy. Given an established connection between autonomy and shared decision-making, we used the Reproductive Autonomy Scale and the Three Talk Model for shared decision-making to inform our semistructured interview guide. Interviews were conducted in Spanish or English. and participants were recruited from a federally qualified health center and a tertiary care obstetric clinic until thematic saturation was achieved. Interviews were recorded, translated, and transcribed and two coders used modified grounded theory to generate themes.
We interviewed 18 participants from May to December 2017. Participant narratives demonstrated reproductive autonomy in pregnancy decision-making, with decision support from families, fatalism in pregnancy planning, and limited engagement by providers around decisions and implications of Zika virus testing. Hierarchy in provider dynamics, perceived stigma around emigration and travel, and language barriers impacted participant engagement in shared decision-making.
Participants demonstrated personal autonomy in reproductive decision-making, but demonstrated limited engagement in shared decision-making with regard to prenatal Zika testing. Provider promotion of shared decision-making using culturally centered decision tools to elicit underlying beliefs and deepen context for option, choice, and decision talk is critical in prenatal counseling to support equitable outcomes during evolving pandemics.
我们旨在了解接触新兴感染（如寨卡病毒）的孕妇在多大程度上与提供者共同参与决策，并探讨潜在的障碍，为改善那些最容易受到不公平待遇的人的护理提供信息。研究表明，拉丁裔和非裔美国人参与共同决策的可能性较小，与提供者的互动也较少。有限的研究探讨了影响产前护理和最近流行病中共同决策的因素。
我们对因怀孕期间接触寨卡病毒而有资格接受产前筛查的个人进行了一项探索性定性研究。鉴于自主性和共同决策之间存在既定联系，我们使用生殖自主性量表和共同决策的三谈模型来为我们的半结构化访谈指南提供信息。访谈以西班牙语或英语进行，参与者从一家合格的联邦健康中心和一家三级保健产科诊所招募，直到主题达到饱和。访谈进行了录音、翻译和转录，两名编码员使用改进的扎根理论生成主题。
我们于 2017 年 5 月至 12 月期间对 18 名参与者进行了访谈。参与者的叙述表明，在妊娠决策中存在生殖自主性，家庭提供决策支持，对妊娠计划持宿命论态度，提供者对寨卡病毒检测的决策和影响的参与有限。提供者动态中的等级制度、围绕移民和旅行的污名化以及语言障碍影响了参与者参与共同决策。
参与者在生殖决策方面表现出个人自主性，但在产前寨卡检测方面表现出有限的共同决策参与。提供者使用以文化为中心的决策工具促进共同决策，以引出潜在的信念，并为选项、选择和决策对话提供更深入的背景，这对于产前咨询至关重要，可在不断演变的大流行病期间支持公平的结果。
