Louis LeAnn A, Appiah-Kubi Adu, Owusu-Antwi Ruth, Konney Thomas O, Moyer Cheryl A, Lawrence Emma R
Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI (Louis, Moyer, Lawrence).
Department of Obstetrics and Gynecology, School of Medicine, University of Health and Allied Sciences, Volta Region, Ghana (Appiah-Kubi).
AJOG Glob Rep. 2024 May 21;4(3):100358. doi: 10.1016/j.xagr.2024.100358. eCollection 2024 Aug.
Rates of maternal mortality are highest in low-resource settings. Family members are often involved in the critical periods surrounding a maternal death, including transportation to health centers and financial and emotional support during hospital admissions. Maternal death has devastating impacts on surviving family members, which are often overlooked and understudied.
Our study aimed to explore the hospital experiences of family members surrounding a maternal death, and to define their access to and need for institutional and psychosocial support.
This mixed methods cross-sectional study was conducted at an urban tertiary hospital in Ghana. Maternal mortalities from June 2019 to December 2020 were identified using death certificates. Participants, defined as husbands or other heads of households in families affected by maternal mortality, were purposively recruited. An interview guide was developed using grounded theory. In-person semi-structured interviews were conducted in English or Twi to explore impacts of maternal mortality on family members, with a focus on hospital experiences. Surveys were administered on types of and needs for institutional support. Interviews were audio recorded, translated, transcribed, coded with an iteratively-developed codebook, and thematically analyzed. Survey data was descriptively analyzed.
Fifty-one participants included 26 husbands of the deceased woman, 5 parents, 12 siblings, and 8 second-degree relatives. Interviews revealed an overall negative hospital experience for surviving family members, who expressed substantial dissatisfaction and distress. Four themes regarding the hospital experience emerged from the interviews: 1) poor communication from healthcare workers and hospital personnel, which contributed to 2) limited understanding of the patient's clinical status, hospital course, and cause of death; 3) maternal death perceived as avoidable; and 4) maternal death perceived as unexpected and shocking. Survey data revealed that only 10% of participants were provided psychosocial support following the maternal death event, yet 93.3% of those who did not receive support desired this resource.
The hospital experience was overall negative for family members and a lack of effective communication emerged as the root cause of this negative perception. Strategies to improve communication between healthcare providers and families are essential. In addition, there is an unmet need for formal mental health resources for families who experience a maternal death.
在资源匮乏地区，孕产妇死亡率最高。家庭成员常常在孕产妇死亡前后的关键时期参与其中，包括送往医疗中心的过程以及住院期间的经济和情感支持。孕产妇死亡对幸存的家庭成员有着毁灭性影响，而这些影响往往被忽视且研究不足。
我们的研究旨在探讨家庭成员在孕产妇死亡前后在医院的经历，并确定他们获得机构和心理社会支持的情况及需求。
这项混合方法横断面研究在加纳的一家城市三级医院进行。利用死亡证明确定2019年6月至2020年12月期间的孕产妇死亡病例。有目的地招募了参与者，这些参与者被定义为受孕产妇死亡影响家庭中的丈夫或其他户主。使用扎根理论制定了一份访谈指南。采用英语或特维语进行面对面的半结构化访谈，以探讨孕产妇死亡对家庭成员的影响，重点是在医院的经历。针对机构支持的类型和需求进行了调查。访谈进行了录音、翻译、转录，使用迭代开发的编码手册进行编码，并进行了主题分析。对调查数据进行了描述性分析。
51名参与者包括26名已故女性的丈夫、5名父母、12名兄弟姐妹和8名二级亲属。访谈显示，幸存的家庭成员在医院的总体经历是负面的，他们表达了极大的不满和痛苦。访谈中出现了四个关于医院经历的主题：1）医护人员和医院工作人员沟通不畅，这导致了2）对患者临床状况、住院过程和死因的了解有限；3）认为孕产妇死亡是可以避免的；4）认为孕产妇死亡是意外且令人震惊的。调查数据显示，只有10%的参与者在孕产妇死亡事件后获得了心理社会支持，但93.3%未获得支持的人希望得到这种资源。
家庭成员在医院的总体经历是负面的，缺乏有效沟通是这种负面认知的根本原因。改善医护人员与家庭之间沟通的策略至关重要。此外，对于经历孕产妇死亡的家庭来说，正式的心理健康资源需求尚未得到满足。
