Department of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver, Canada.
University of Manitoba, Indigenous Research Chair in Nursing, First Nations Health and Social Secretariat of Manitoba, Manitoba, Canada.
BMC Pregnancy Childbirth. 2024 Nov 8;24(1):737. doi: 10.1186/s12884-024-06928-8.
Qualitative studies document episodes of weight-related disrespectful care, particularly for people with high body mass index (BMI ≥ 30) and reveal implicit and explicit biases in health care providers. No large quantitative studies document the pervasiveness of weight stigma or if experiences change with increasing BMI.
The multi-stakeholder RESPCCT study team designed and distributed a cross-sectional survey on the experiences of perinatal services in all provinces and territories in Canada. From July 2020 to August 2021, participants who had a pregnancy within ten years responded to closed and open-ended questions. Chi square analysis assessed differences in mean scores derived from three patient-reported experience measures of autonomy (MADM), respect (MOR), and mistreatment (MIST). Controlling for socio-demographic factors, multivariate logistic regression analysis explored relationships between different BMI categories and respectful care.
Of 4,815 Canadians who participated, 3,280 with a BMI of ≥ 18.5 completed all the questions. Pre-pregnancy BMI was significantly associated with race/ethnicity, income sufficiency, and education but not with age. Individuals with higher BMIs were more likely to experience income insufficiency, have lower levels of education, and more frequently self-identified as Indigenous or White. Those with BMI ≥ 35 exhibited notably higher odds of reduced autonomy (MADM) scores, with an unadjusted odds ratio of 1.62 and an adjusted odds ratio of 1.45 compared to individuals with a normal weight. Individuals with BMIs of 25-25.9, 30-34.9, and ≥ 35 exhibited odds of falling into the lower tercile of respect (MOR) scores of 1.34, 1.51, and 2.04, respectively (p < .01). The odds of reporting higher rates of mistreatment (top 33% MIST scores) increased as BMI increased.
While socio-demographic factors like race and income play significant roles in influencing perinatal care experiences, BMI remains a critical determinant even after accounting for these variables. This study reveals pronounced disparities in the provision of respectful perinatal care to pregnant individuals with higher BMIs in Canada. Data suggest that those with higher BMIs face disrespect, discrimination, and mistreatment. Identification of implicit and explicit weight bias may give providers insight enabling them to provide more respectful care.
定性研究记录了与体重相关的不尊重护理的事件，特别是针对身体质量指数（BMI≥30）较高的人群，并揭示了医疗保健提供者中存在的隐含和明确偏见。没有大型定量研究记录体重耻辱感的普遍性，也没有研究表明这种经历是否会随着 BMI 的增加而改变。
多利益相关者 RESPCCT 研究团队设计并分发了一份关于加拿大所有省份和地区围产期服务体验的横断面调查。从 2020 年 7 月至 2021 年 8 月，在过去十年中有过怀孕经历的参与者对封闭式和开放式问题做出了回应。卡方分析评估了三个患者报告的自主性体验测量（MADM）、尊重（MOR）和虐待（MIST）的平均分数差异。在控制社会人口因素的情况下，多变量逻辑回归分析探讨了不同 BMI 类别与尊重护理之间的关系。
在 4815 名参与的加拿大人中，有 3280 名 BMI≥18.5 的人完成了所有问题。孕前 BMI 与种族/民族、收入充足程度和教育程度显著相关，但与年龄无关。BMI 较高的个体更有可能经历收入不足，教育程度较低，并且更频繁地自我认定为原住民或白人。BMI≥35 的个体自主性（MADM）评分明显降低，未调整的优势比为 1.62，调整后的优势比为 1.45，与体重正常的个体相比。BMI 为 25-25.9、30-34.9 和≥35 的个体，其尊重（MOR）评分处于较低三分位数的可能性分别为 1.34、1.51 和 2.04（p<0.01）。随着 BMI 的增加，报告更高虐待率（MIST 评分前 33%）的可能性也会增加。
虽然种族和收入等社会人口因素在影响围产期护理体验方面起着重要作用，但即使考虑到这些变量，BMI 仍然是一个关键决定因素。这项研究揭示了加拿大 BMI 较高的孕妇在获得尊重的围产期护理方面存在明显的差异。数据表明，BMI 较高的个体面临不尊重、歧视和虐待。识别隐含和明确的体重偏见可能会为提供者提供洞察力，使他们能够提供更尊重的护理。
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