Wyss Carmen, Inauen Jennifer, Lienert Judit, Aubry Evelyne M
Applied Research and Development, Division of Midwifery, Department of Health Professions, Bern University of Applied Sciences, Bern, Switzerland
Graduate School for Health Sciences, University of Bern, Bern, Switzerland.
BMJ Open. 2025 Jul 22;15(7):e086409. doi: 10.1136/bmjopen-2024-086409.
The first objective of the study was to identify fundamental goals of childbirth care for women with higher body weight to inform decision-making processes by drawing on multi-stakeholder insights. The second objective included evaluating the method used to support these stakeholders in generating a more diverse set of fundamental goals.
Using an embedded mixed methods design, we engaged key stakeholders in two group workshops and 11 individual interviews to identify goals considered fundamentally important for achieving the best possible childbirth care. Participants individually brainstormed childbirth care goals, selected additional goals from a pre-established masterlist and discussed them. Thereafter, participants rated the goals' perceived importance for decision-making on a Likert scale. We thematically analyzed the goals and mapped them onto a means-ends network to identify and refine a set of fundamental goals. Methodological evaluations involved descriptive statistics and non-parametric testing.
Swiss maternity care.
21 stakeholders, including seven women with a preconceptional body mass index ≥ 30 kg/m, nine midwives, and five obstetricians experienced in maternity care for women with higher body weight.
We identified eight fundamental goals of childbirth care: low maternal and neonatal complication rates, physiological childbirth processes, positive initiation of bonding and breastfeeding, positive psychosocial care experience, low physical strain for care providers, low resource use in care setting, and low direct costs of childbirth care. Individual participants generated more diverse fundamental goals on average by combining individual brainstorming with goal selection from a masterlist than by brainstorming alone. A theoretical maximum of six participants captured all eight fundamental goals.
The fundamental goals provide a framework for benchmarking decisions to improve childbirth care for women with higher body weight. Additionally, individual brainstorming combined with goal selection from a masterlist appears to be a useful method for generating a diverse set of fundamental goals in a healthcare context, even with relatively few participants.
本研究的首要目标是，通过借鉴多方利益相关者的见解，确定体重较高女性的分娩护理基本目标，为决策过程提供信息。第二个目标包括评估用于支持这些利益相关者生成更多样化基本目标的方法。
采用嵌入式混合方法设计，我们让关键利益相关者参与了两次小组研讨会和11次个人访谈，以确定对实现最佳分娩护理至关重要的目标。参与者先各自集思广益列出分娩护理目标，然后从预先制定的总清单中选择其他目标并进行讨论。此后，参与者根据李克特量表对目标在决策中的重要性进行评分。我们对目标进行了主题分析，并将其映射到一个手段-目的网络上，以确定和完善一组基本目标。方法学评估包括描述性统计和非参数检验。
瑞士的产妇护理。
21名利益相关者，包括7名孕前体重指数≥30 kg/m²的女性、9名助产士和5名在为体重较高女性提供产妇护理方面经验丰富的产科医生。
我们确定了八项分娩护理基本目标：低孕产妇和新生儿并发症发生率、生理性分娩过程、积极的母婴联结和母乳喂养开端、积极的心理社会护理体验、护理人员的低体力负担、护理环境中的低资源使用以及低分娩护理直接成本。与单独进行头脑风暴相比，个体参与者通过将个人头脑风暴与从总清单中选择目标相结合，平均能生成更多样化的基本目标。理论上最多六名参与者能涵盖所有八项基本目标。
这些基本目标为衡量决策提供了一个框架，以改善体重较高女性的分娩护理。此外，个人头脑风暴与从总清单中选择目标相结合，似乎是在医疗背景下生成多样化基本目标的一种有用方法，即使参与者相对较少。
