Kors Joyce, Martin Linda, Verhoeven Corine J, Henrichs Jens, Peerdeman Saskia M, Kusurkar Rashmi A
Amsterdam UMC location Vrije Universiteit Amsterdam, Research in Education, Amsterdam, Netherlands.
LEARN! Research Institute for Learning and Education, Faculty of Psychology and Education, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.
Eur J Midwifery. 2025 Jan 13;9. doi: 10.18332/ejm/197053. eCollection 2025.
Maternity care professionals need to guide women through an increasing number of decision-making processes during pregnancy. Professionals tend to focus more on providing information than on decision support. According to the self-determination theory (SDT), professionals could help women make their own choices by fulfilling their three basic psychological needs: autonomy, competence, and relatedness through autonomy-supportive interactions. This study aimed to quantify autonomy-supportive and autonomy-thwarting interactions that professionals use during prenatal consultations and their association with women's perceptions of the healthcare climate during consultations.
A quantitative observation study with a cross-sectional design was conducted in the Netherlands from March to October 2020. Twenty-three maternity care professionals in 2 hospitals and 16 midwifery practices were purposefully sampled. During 104 prenatal consultations, professional interactions were audiotaped and coded using the Coding and Observing Need-Supportive Consultation in Maternity Care Consultations. The woman's perceived healthcare climate was assessed using the Healthcare Climate Questionnaire.
We observed that professionals derive their autonomy-supportive interactions from a small repertoire. They tend to use more autonomy-supportive interactions (mean=2.31, SD=0.58) that give room to the woman than interactions that stimulate active engagement (mean=1.41, SD=0.80). During structuring interactions, they tend to use more informative (mean=1.81, SD=0.59) than supportive interactions (mean=0.94, SD=0.55). Women generally perceived the healthcare climate as positive.
Women were rarely stimulated to be actively engaged in the consultations, while active woman engagement is vital in offering women-centered decision-making support. Professionals could improve their autonomy-supportive consultation climate by paying explicit attention to interactions involving women and offering structure.
产科护理专业人员需要在孕期引导女性经历越来越多的决策过程。专业人员往往更侧重于提供信息，而不是决策支持。根据自我决定理论（SDT），专业人员可以通过自主性支持性互动来满足女性的三种基本心理需求：自主性、能力感和关联性，从而帮助女性做出自己的选择。本研究旨在量化专业人员在产前咨询期间使用的自主性支持性和自主性阻碍性互动，以及它们与女性对咨询期间医疗氛围的感知之间的关联。
2020年3月至10月在荷兰进行了一项采用横断面设计的定量观察研究。从2家医院和16家助产机构中有意抽取了23名产科护理专业人员。在104次产前咨询期间，使用《产科护理咨询中编码和观察需求支持性咨询》对专业人员的互动进行录音和编码。使用《医疗氛围问卷》评估女性对医疗氛围的感知。
我们观察到，专业人员的自主性支持性互动方式有限。他们倾向于使用更多给予女性空间的自主性支持性互动（均值=2.31，标准差=0.58），而不是激发积极参与的互动（均值=1.41，标准差=0.80）。在构建互动时，他们倾向于使用更多提供信息的互动（均值=1.81，标准差=0.59），而不是支持性互动（均值=0.94，标准差=0.55）。女性总体上认为医疗氛围是积极的。
女性很少被激发积极参与咨询，而女性的积极参与对于提供以女性为中心的决策支持至关重要。专业人员可以通过明确关注与女性的互动并提供结构来改善他们的自主性支持性咨询氛围。
