Information and power: Women of color's experiences interacting with health care providers in pregnancy and birth
Information and power: Women of color's experiences interacting with health care providers in pregnancy and birth
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DOI：
10.1016/j.socscimed.2019.112491
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发表时间：
2019-10-01
影响因子：
5.4
通讯作者：
Lyndon, Audrey
中科院分区：
文献类型：
--
作者：
Altman, Molly R.;Oseguera, Talita;Lyndon, Audrey
理由：早产和其他不良出生结果不成比例地影响有色人种妇女。新出现的证据表明，社会驱动的问题，如不尊重，虐待，和歧视的医疗保健系统内的影响如何有色人种的经验，在怀孕，分娩和产后护理，这有助于为母亲和婴儿较差的结果。目的：根据社区合作伙伴的建议，我们探讨了在寻求怀孕和分娩护理的背景下，如何感知和理解与提供者的互动。方法：在这项建构主义扎根理论研究中，我们招募了22名18岁或以上的有色人种女性，她们产后6周到1年。妇女参加了探讨其经历的访谈，访谈内容被录音和转录。采用维度分析和情境分析方法对数据进行分析。结果：分析中出现了信息和权力的概念，其中提供者可以控制他们共享的信息，并“包装”信息，以对女性参与决策的能力施加权力。与提供者之间的既定关系以及公认的特权或边缘化程度影响了信息的共享方式。背景因素包括供应商的偏见和判断，对他们的病人，医疗保健系统的结构性问题，以及患者和provider.Conclusions之间的整体权力动态：妇女的颜色的经验，在怀孕和分娩期间，他们如何被治疗的供应商，特别是在如何分享和扣留信息的影响。提供者对信息的控制导致了一种权力动态，削弱了妇女保持自主权和为自己及其子女做出医疗保健决定的能力。这项研究提供了洞察力和动力，改变提供者如何分享信息，利用知情同意，并在怀孕和分娩护理期间为有色人种妇女提供尊重的护理。
Rationale: Preterm birth and other poor birth outcomes disproportionately affect women of color. Emerging evidence suggests that socially-driven issues such as disrespect, abuse, and discrimination within the health care system influence how people of color experience care during pregnancy, birth, and postpartum, which contributes to poorer outcomes for the mother and baby.Objective: As recommended by community partners, we explored how interactions with providers were perceived and understood in the context of seeking care for pregnancy and birth.Method: For this constructivist grounded theory study, we recruited 22 self-identified women of color 18 years of age or older and who were between six weeks and one year postpartum. Women participated in interviews exploring their experiences, which were audiorecorded and transcribed. Data were analyzed using dimensional analysis and situational analysis methods.Results: The concepts of information and power surfaced in analysis, in which providers have control over the information they share and "package" information to exert power over women's ability to participate in decision-making. An established relationship with providers and acknowledged levels of privilege or marginalization influenced how information was shared. Contextual factors included provider bias and judgment towards their patients, health care system structural issues, and the overall power dynamic between patient and provider.Conclusions: Women of color's experiences during pregnancy and birth were influenced by how they were treated by providers, particularly in how information was shared and withheld. The providers' control over information led to a power dynamic that diminished women's ability to maintain autonomy and make health care decisions for themselves and their children. This study provides insight and impetus for change in how providers share information, utilize informed consent, and provide respectful care to women of color during pregnancy and birth care.