Farewell Charlotte V, Gahrns Jennifer, Pangalangan Julia, Curl Emily, Pangalangan Anna
Res Sq. 2025 Apr 3:rs.3.rs-6234727. doi: 10.21203/rs.3.rs-6234727/v1.
Background Doula care across the perinatal period may significantly reduce the odds of perinatal mood and anxiety disorders particularly in communities experiencing deprivation. In 2023, SB23-288 was passed in Colorado titled "Improving Perinatal Health Outcomes" which requires doula services to be covered under Medicaid. The purpose of this phenomenological qualitative study was twofold: 1) To examine perceptions of SB23-288 among a purposive sample of community-based doulas who provide care for women experiencing low socioeconomic status (SES), and 2) To explore perceptions among both community-based doulas and low-SES postpartum women themselves, of multi-level resources that are most protective and may mitigate the risk of postpartum mood disorders. Methods A purposive sample of 16 low-SES postpartum women and 9 community-based doulas were recruited to participate in 30-60-minute interviews. Coding followed a constant comparison method and was an iterative process including a deductive, theory-driven approach based on the Conservation of Resources Theory and Socioecological Models and an inductive, data-driven approach. Results Four major themes emerged related to doulas perceptions of strengths and concerns of SB23-288: 1) Improved access to care for low-income individuals, 2) Cautious optimism for Medicaid coverage, 3) Reimbursement-related challenges, and 4) Concern with doula autonomy. Analyses also revealed concordance between doulas and postpartum women's perceptions of individual-level (e.g., lactation support) interpersonal-level (e.g., family support), and community-level (e.g., navigating healthcare and financial support) resources that promote postpartum mental health. Low-SES postpartum women also shared that knowledge related to postpartum physiology and physical recovery, connections to educational classes to provide peer support, and outdoor exposure were additional resources that promoted their mental health. Conclusions These findings underscore the vital role that community-based doulas play in supporting low-SES postpartum individuals and highlights both the opportunities and challenges presented by the expansion of doula care for under resourced individuals. The alignment between community-based doulas and low-SES postpartum women's perceptions of multi-level supports emphasizes the importance of holistic, community-centered care and additional training on multi-level and comprehensive resources to meet the needs of low-income clients.
背景 在围产期提供导乐护理可能会显著降低围产期情绪和焦虑障碍的几率，尤其是在贫困社区。2023年，科罗拉多州通过了SB23 - 288号法案，题为“改善围产期健康结果”，该法案要求医疗补助计划涵盖导乐服务。这项现象学定性研究的目的有两个：1）调查为社会经济地位低下（SES）的女性提供护理的社区导乐的目标样本对SB23 - 288号法案的看法；2）探索社区导乐和低SES产后女性自身对最具保护性且可能减轻产后情绪障碍风险的多层次资源的看法。方法 招募了16名低SES产后女性和9名社区导乐的目标样本参与30 - 60分钟的访谈。编码采用持续比较法，是一个迭代过程，包括基于资源守恒理论和社会生态模型的演绎、理论驱动方法以及归纳、数据驱动方法。结果 出现了四个与导乐对SB23 - 288号法案的优势和担忧的看法相关的主要主题：1）改善低收入人群获得护理的机会；2）对医疗补助覆盖持谨慎乐观态度；3）与报销相关的挑战；4）对导乐自主性的担忧。分析还揭示了导乐与产后女性对促进产后心理健康的个人层面（如哺乳支持）、人际层面（如家庭支持）和社区层面（如获取医疗保健和经济支持）资源的看法之间的一致性。低SES产后女性还分享说，与产后生理和身体恢复相关的知识、与提供同伴支持的教育课程的联系以及户外活动是促进她们心理健康的额外资源。结论 这些发现强调了社区导乐在支持低SES产后个体方面所起的重要作用，并突出了为资源不足的个体扩大导乐护理所带来的机遇和挑战。社区导乐与低SES产后女性对多层次支持看法的一致性强调了整体、以社区为中心的护理以及关于多层次和综合资源的额外培训以满足低收入客户需求的重要性。
