Project20: maternity care mechanisms that improve access and engagement for women with social risk factors in the UK - a mixed-methods, realist evaluation.
Project20: maternity care mechanisms that improve access and engagement for women with social risk factors in the UK - a mixed-methods, realist evaluation.
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DOI：
10.1136/bmjopen-2022-064291
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发表时间：
2023-02-07
期刊：
影响因子：
2.9
通讯作者：
中科院分区：
文献类型：
--
作者：
评估妇女如何获得和参与不同模式的孕产妇护理，专家模式是否改善了有社会风险因素的妇女的获得和参与，如果是，如何改善？现实主义的评价英国两个产科服务提供商。2019年获得孕产妇服务的妇女（n=1020）。采用多项回归分析的前瞻性观察队列，比较模型和产前护理地点之间的访问和参与措施。现实主义知情的，纵向采访妇女访问专家模式的护理进行了分析，以确定机制。获得和参与的措施，寻求保健的经验。妇女所经历的社会风险因素的数量随着剥夺分数的增加而增加，最贫困的人更有可能接受提供连续性护理的专家模式。接受医院产前护理的妇女更有可能在较晚的时候获得产科护理。（风险比（RR）2.51，95% CI 1.33至4.70），不太可能接受建议的产前检查次数（RR 0.61，95% CI 0.38至0.99），与社区护理相比，更有可能有超过15次预约（RR 4.90，95% CI 2.50至9.61）。与专家模式相比，获得标准护理的女性（RR 0.02，95% CI 0.00至0.11）和黑人女性（RR 0.02，95% CI 0.00至0.11）不太可能与已知的医疗保健专业人员预约。定性数据揭示了改善获得和参与的机制，包括自我转诊、与助产士小组的关系连续性、灵活性和在贫困社区环境中提供服务。提供连续护理的社区专家模式似乎减轻了在获得和参与孕产妇护理方面的不平等。调查结果使一个现实主义的方案理论的完善，告知那些发展符合现行政策的孕产妇服务。
To evaluate how women access and engage with different models of maternity care, whether specialist models improve access and engagement for women with social risk factors, and if so, how? Realist evaluation. Two UK maternity service providers. Women accessing maternity services in 2019 (n=1020). Prospective observational cohort with multinomial regression analysis to compare measures of access and engagement between models and place of antenatal care. Realist informed, longitudinal interviews with women accessing specialist models of care were analysed to identify mechanisms. Measures of access and engagement, healthcare-seeking experiences. The number of social risk factors women were experiencing increased with deprivation score, with the most deprived more likely to receive a specialist model that provided continuity of care. Women attending hospital-based antenatal care were more likely to access maternity care late (risk ratio (RR) 2.51, 95% CI 1.33 to 4.70), less likely to have the recommended number of antenatal appointments (RR 0.61, 95% CI 0.38 to 0.99) and more likely to have over 15 appointments (RR 4.90, 95% CI 2.50 to 9.61) compared with community-based care. Women accessing standard care (RR 0.02, 95% CI 0.00 to 0.11) and black women (RR 0.02, 95% CI 0.00 to 0.11) were less likely to have appointments with a known healthcare professional compared with the specialist model. Qualitative data revealed mechanisms for improved access and engagement including self-referral, relational continuity with a small team of midwives, flexibility and situating services within deprived community settings. Inequalities in access and engagement with maternity care appears to have been mitigated by the community-based specialist model that provided continuity of care. The findings enabled the refinement of a realist programme theory to inform those developing maternity services in line with current policy.
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影响因子：
1.6
作者：
Everitt, Louise;Homer, Caroline;Fenwick, Jennifer
通讯作者：
Fenwick, Jennifer
影响因子：
3.1
作者：
Cresswell JA;Yu G;Hatherall B;Morris J;Jamal F;Harden A;Renton A
通讯作者：
Renton A
影响因子：
4.5
作者：
Fernandez Turienzo C;Newburn M;Agyepong A;Buabeng R;Dignam A;Abe C;Bedward L;Rayment-Jones H;Silverio SA;Easter A;Carson LE;Howard LM;Sandall J;NIHR ARC South London Maternity and Perinatal Mental Health Research and Advisory Teams
通讯作者：
NIHR ARC South London Maternity and Perinatal Mental Health Research and Advisory Teams
影响因子：
4
作者：
Gale NK;Heath G;Cameron E;Rashid S;Redwood S
通讯作者：
Redwood S
影响因子：
168.9
作者：
HART, JT
通讯作者：
HART, JT