Johns Hopkins School of Nursing, Baltimore, Maryland, USA.
Columbia University, New York, New York, USA.
J Adv Nurs. 2023 Nov;79(11):4255-4267. doi: 10.1111/jan.15684. Epub 2023 Jun 14.
To describe how socioecological influences of housing instability affect pregnancy health among birthing and postpartum people.
We used the socioecological framework to guide this exploratory descriptive study using semi-structured, in-depth interviews.
We purposively recruited birthing people in the southern mid-Atlantic region. Seventeen one-time, semi-structured interviews were conducted between February 2020 and December 2021 with English-speaking unstably housed participants ≥18 years old, currently pregnant, or recently postpartum. Qualitative and quantitative content approaches were used to analyse transcribed interviews. Dedoose software was used to identify code patterns and refine the codebook until group consensus. The team examined code patterns, explored meaning in text and codified code-generated categories to describe experiences.
Majority (82.4%) of participants were African Americans between 22 and 41 years, and most were postpartum (76.5%). Participants described multiple forms of housing instability, reasons for losing housing, challenges with finding housing and strategies for finding housing. Participants did not describe housing instability as a barrier to receiving prenatal care. Building and sustaining individual relationships and social support were prominent factors affecting their housing challenges. Participants also reported a lack of obstetric provider inquiry about housing status during pregnancy. Many reported that challenges with housing triggered mental health issues, especially depression.
Nurses and other obstetric providers are key points of contact in the prenatal care setting for assessing housing stability. Additionally, refining social structures and funding support services within communities and prenatal health systems should be a strategy for future programme and policy planning improvement.
This study highlights critical areas for consideration when addressing social determinants for birthing people and reinforces the need for more comprehensive assessment in the prenatal setting.
Members of the public participated in this study as key informants for study interviews.
描述住房不稳定的社会生态影响如何影响分娩和产后人群的妊娠健康。
我们使用社会生态学框架来指导这项探索性描述性研究，采用半结构式深入访谈。
我们在南大西洋中部地区有目的地招募了分娩人群。2020 年 2 月至 2021 年 12 月，我们与英语为母语的、住房不稳定的 18 岁及以上的参与者进行了 17 次一次性半结构式访谈，这些参与者目前怀孕或最近刚分娩。采用定性和定量内容分析方法分析转录访谈。Dedoose 软件用于识别代码模式并完善代码手册，直到达成团队共识。该团队检查了代码模式，探索了文本中的含义，并对生成的代码类别进行了编码，以描述参与者的经历。
大多数参与者（82.4%）为 22 至 41 岁的非裔美国人，其中大多数为产后人群（76.5%）。参与者描述了多种形式的住房不稳定、失去住房的原因、寻找住房的挑战以及寻找住房的策略。参与者并未将住房不稳定描述为接受产前保健的障碍。建立和维持个人关系和社会支持是影响他们住房挑战的突出因素。参与者还报告说，缺乏产科医生在怀孕期间询问住房状况。许多人报告说，住房问题引发了心理健康问题，尤其是抑郁症。
护士和其他产科提供者是产前保健环境中评估住房稳定性的关键联系人。此外，应在社区和产前保健系统内完善社会结构和资金支持服务，这是未来项目和政策规划改进的策略。
这项研究强调了在解决分娩人群的社会决定因素时需要考虑的关键领域，并强调了在产前环境中进行更全面评估的必要性。
公众成员作为研究访谈的主要信息提供者参与了这项研究。
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