A Qualitative Study of Hospitals and Payers Implementing Community Doula Support.
A Qualitative Study of Hospitals and Payers Implementing Community Doula Support.
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对实施社区导乐支持的医院和付款人的定性研究。
DOI：
10.1111/jmwh.13596
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发表时间：
2024
期刊：
影响因子：
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通讯作者：
Amutah-Onukagha,NdidiamakaN
中科院分区：
文献类型：
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作者：
Gebel,Christina;Larson,Elysia;Olden,HeatherA;Safon,CaraB;Rhone,ToniaJ;Amutah-Onukagha,NdidiamakaN
导乐护理对分娩结局的影响是公认的;然而，导乐支持仍然没有得到充分利用。随着对导乐护理需求的增加，确定实施的障碍和促进因素是不可或缺的。本研究的主要目的是检查导乐计划的实施，在不同阶段的implementation.MethodsRepresentatives从4家医院和2付款人参加了焦点小组讨论。导乐计划分为预期，初始和高级实施状态。编码和专题分析进行了演绎应用的综合框架实施Research.ResultsThere有20名参与者在5个焦点小组讨论。参与者大多数是女性，几乎所有人都在其组织工作了至少两年。与会者分享的突出主题包括重视内部结果数据或同行评议文献，以支持导乐护理以及轶事;导乐护理实施的资源密集型性质的现实超出了导乐的资金;以及对变革的个人倡导者（例如助产士）的需求，和一个支持性的组织文化，重视健康equity.DiscussionThe研究结果强调3上下文方面，应考虑实施导乐方案时。这些建议包括：（1）在获得利益相关者支持时，结合使用研究证据和轶事;（2）考虑资金以外的资源，如项目实施支持;（3）对组织文化进行批判性评估，作为影响导乐护理实施的主要驱动力。美国医院导乐工作人员的未来取决于医院管理部门和临床提供者的有意购买以及必要资源的可用性。
IntroductionThe impact of doula care on birth outcomes is well‐established; however, doula support remains underutilized. Identifying barriers and facilitators to implementation is integral as the demand for doula care increases. The primary objective of this study was to examine doula program implementation across hospitals and payers at varying stages of implementation.MethodsRepresentatives from 4 hospitals and 2 payers participated in focus group discussions. The doula programs were categorized as anticipated, initial, and advanced implementation statuses. Coding and thematic analysis were conducted using a deductive application of the Consolidated Framework for Implementation Research.ResultsThere were 20 participants across 5 focus group discussions. Participants were mostly female, and nearly all had worked at their organization for at least 2 years. Salient themes shared across participants included valuing internal outcome data or peer‐reviewed literature to support doula care as well as anecdotal stories; the reality of the resource‐intensive nature of doula care implementation that goes beyond funding for doulas; and both the need for individual champions for change, such as midwives, and a supportive organizational culture that values health equity.DiscussionThe findings of this study highlight 3 contextual aspects that should be considered when implementing doula programs. These recommendations include: (1) use of a combination of research evidence and anecdotes when eliciting stakeholder support; (2) consideration of resources beyond funding such as program implementation support; (3) critical evaluation of organizational culture as a primary driver influencing the implementation of doula care. The future of the doula workforce in United States hospitals rests on the crux of intentional buy‐in from hospital administration and clinical providers as well as the availability of requisite resources.