Ceasar Rachel Carmen, Gould Erin, Stal Julia, Laughter Jen, Tran Michelle, Wang Shirlene D, Granacki Jordan, Ziltzer Ryan S, Santos Jasmeen Joy
Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.
Department of Sociology, California State University, Fullerton, Fullerton, California, USA.
Womens Health Rep (New Rochelle). 2023 Jul 28;4(1):400-408. doi: 10.1089/whr.2023.0057. eCollection 2023.
To identify perceptions of cannabis use and risk among maternal health providers who provide care for people who use cannabis during pregnancy in safety-net health settings.
Using qualitative, constructivist ground theory methods, we conducted semistructured remote interviews with 10 providers (2 midwives, 6 OB/GYN physicians, and 2 OB/GYN residents) in Southern California, United States, between March 15, 2022, and April 6, 2022. We selected participants through selective sampling using a convenience sample and snowball approach. Providers were eligible for the study if they self-reported survey to being a maternal health provider (., physician, doula, midwife, and so on) providing care in a safety-net health setting and had cared for people who used cannabis during pregnancy in the last year. Analysis drew upon grounded theory methods to document the socio-structural contexts that contribute to provider perceptions about cannabis. This study was approved by the University of Southern California Institutional Review Board (UP-21-00282-AM009).
We identified three categories of provider perceptions of cannabis use and risk during pregnancy: (1) Relying on self-education, (2) Taking a case-by-case approach, and (3) Avoiding cannabis discussions to maintain an alliance with patients. Findings indicate that provider reluctance to counsel patients about cannabis in favor of preserving a therapeutic relationship can overlook the lack of resources and access to health care alternatives available to low-income patients that can shape self-medicating.
Nonpunitive policies and training on cannabis use are critical steps for supporting providers to counsel patients who use cannabis during pregnancy, alongside a harm reduction approach that acknowledges the broader socio-structural contexts and barriers facing patients who disclose use.
确定在安全网医疗环境中为孕期使用大麻的人群提供护理的孕产妇保健提供者对大麻使用及其风险的看法。
我们使用定性的、建构主义扎根理论方法，于2022年3月15日至2022年4月6日期间，对美国南加州的10名提供者（2名助产士、6名妇产科医生和2名妇产科住院医师）进行了半结构化远程访谈。我们采用便利抽样和滚雪球抽样的方法进行选择性抽样来选择参与者。如果提供者自我报告在安全网医疗环境中提供护理（如医生、分娩助理、助产士等），并且在过去一年中照顾过孕期使用大麻的人群，则符合该研究的条件。分析采用扎根理论方法，以记录影响提供者对大麻看法的社会结构背景。本研究经南加州大学机构审查委员会批准（UP-21-00282-AM009）。
我们确定了提供者对孕期大麻使用及其风险的三类看法：（1）依靠自我教育，（2）采取个案处理方法，（3）避免讨论大麻以维持与患者的联盟。研究结果表明，提供者不愿就大麻问题向患者提供咨询以维护治疗关系，可能会忽视低收入患者缺乏资源以及无法获得可替代医疗保健服务的情况，而这些情况可能会导致自我用药。
非惩罚性的大麻使用政策和培训是支持提供者为孕期使用大麻的患者提供咨询的关键步骤，同时还需要采取减少伤害的方法，承认披露使用情况的患者面临的更广泛社会结构背景和障碍。
