Judith Lumley Centre, School of Nursing & Midwifery, La Trobe University, Bundoora, VIC, Australia.
Department of Clinical Sciences, Obstetrics and Gynaecology, Umeå University, Umeå SE-90187, Sweden.
Women Birth. 2024 Nov;37(6):101809. doi: 10.1016/j.wombi.2024.101809. Epub 2024 Sep 10.
Rural women and their babies experience poorer perinatal outcomes than their urban counterparts and this inequity has existed for decades. This study explored the barriers and enablers that exist for rural women in Australia in accessing perinatal care.
A qualitative descriptive design, using reflexive thematic analysis, was employed. Semi-structured interviews were conducted in 2023 with women who had recently given birth in rural Victoria, Australia (n=19). A purposive sampling strategy was used, recruiting women via social media platforms from rural communities across the state. The Socioecological Model (SEM) was used as a framework to organise the findings.
Study participants reported multilevel barriers and enablers to accessing perinatal care in their own communities. Intrapersonal factors included financial resources, transportation, self-advocacy, health literacy, rural stoicism, personal agency, and cost of care. Interpersonal factors included factors such as ineffective relationships, poor communication, and care provider accessibility. Organisational factors included inequitable distribution of services, under-resourcing of perinatal services in rural areas, technology-enabled care models and access to continuity of care. Community factors included effective or ineffective interprofessional or interorganisational collaboration. Policy factors included centralisation of perinatal care, lack of funded homebirth and midwifery care pathways and access to free perinatal care.
Participants in this study articulated several key barriers influencing access to perinatal care in rural areas. These factors impede help-seeking behaviour and engagement with care providers, compounding the impact of rurality and isolation on perinatal outcomes and experience of care. Key enablers to accessing perinatal care in rural communities were also identified and included personal agency, health literacy, social capital, effective collaboration and communication between clinicians and services, technology enabled care and free perinatal care.
农村妇女及其婴儿的围产期结局不如城市妇女及其婴儿，这种不平等现象已经存在了几十年。本研究探讨了澳大利亚农村妇女在获得围产期护理方面存在的障碍和促进因素。
采用描述性定性设计，使用反思性主题分析。2023 年，在澳大利亚维多利亚州农村地区最近分娩的妇女（n=19）中进行了半结构式访谈。采用目的性抽样策略，通过全州农村社区的社交媒体平台招募妇女。采用社会生态学模型（SEM）作为组织研究结果的框架。
研究参与者报告了在自己社区中获得围产期护理的多层次障碍和促进因素。个体因素包括经济资源、交通、自我倡导、健康素养、农村坚忍不拔、个人能动性和护理成本。人际因素包括关系无效、沟通不畅和护理提供者可及性等因素。组织因素包括服务分配不均、农村地区围产期服务资源不足、技术支持的护理模式和获得连续性护理的机会。社区因素包括有效的或无效的跨专业或跨组织合作。政策因素包括围产期护理的集中化、缺乏资助的家庭分娩和助产护理途径以及免费获得围产期护理。
本研究参与者阐述了影响农村地区获得围产期护理的几个关键障碍。这些因素阻碍了寻求帮助的行为和与护理提供者的接触，加剧了农村和孤立对围产期结局和护理体验的影响。还确定了农村社区获得围产期护理的一些关键促进因素，包括个人能动性、健康素养、社会资本、临床医生和服务之间有效的协作和沟通、技术支持的护理以及免费的围产期护理。
