Reasons for late presentation for antenatal care, healthcare providers' perspective
Reasons for late presentation for antenatal care, healthcare providers' perspective
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DOI：
10.1186/s12913-019-4855-x
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发表时间：
2019-12-30
影响因子：
2.8
通讯作者：
Onoya, Dorina
中科院分区：
文献类型：
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作者：
Jinga, Nelly;Mongwenyana, Constance;Onoya, Dorina
背景：产前护理(ANC)为孕妇提供保健服务，以确保妇女及其婴儿获得尽可能好的妊娠结局。医疗保健提供者对患者行为和参与护理的原因的理解以及他们对这种洞察的反应可能会影响怀孕早期患者与提供者的互动和患者对ANC的需求。我们调查了医疗保健提供者对女性开始ANC的原因的洞察力，南非国家卫生部建议怀孕20周。我们还观察了晚期非国大报告对整体医疗服务提供者的工作体验和他们在与患者互动中的反应的影响。方法：对南非豪登省妇产科单元(MOU)和初级医疗中心(PHC)的10名医疗服务提供者进行了深入访谈。医疗保健提供者是在设施经理的协助下挑选出来的。使用定性分析软件NVivo 11进行数据分析，采用精确定位、检查和记录数据中的模式的主题方法。结果：由于担心流产和女性对传统护理的偏好，医护人员在怀孕早期就意识到患者需要保密。有过怀孕经历的妇女被认为知道怀孕的各个阶段，而忽视了及早启动ANC。阻碍非国大早期启动的障碍还包括：妇女需要平衡创收活动；去诊所的旅费以及在达到每日病人限额后拒绝护理。医疗保健提供者遇到了来自未预约患者的负面态度。这有一个互惠的效果，通过这种经历影响医疗服务提供者是否会以同理心或挫折感做出反应。结论：ANC的时机受到女性在怀孕期间做出的复杂决定的影响，从接受怀孕本身到承认需要ANC。为了对这一决策产生积极影响，造福于早期非国大，应在怀孕前通过提高认识方案消除知识缺乏等障碍。在培训医疗服务提供者时，应强调医疗服务提供者与妇女之间的关系，并将其视为影响ANC时机的一个重要因素。
Background: Antenatal care (ANC) provides healthcare services to pregnant women in an attempt to ensure, the best possible pregnancy outcome for women and their babies. Healthcare providers' understanding of their patient's behaviour and reasons for engagement in care and their response to this insight can influence patient-provider interactions and patient demand for ANC early in pregnancy. We examined the insight of healthcare providers into women's reasons for starting ANC later than the South African National Department of Health's recommended 20 weeks gestation. We also looked at the impact of late ANC presentation on overall healthcare providers' work experiences and their response in their interactions with patients.Methods: In-depth interviews were conducted with 10 healthcare providers at Maternal Obstetrics Units (MOU) and Primary Healthcare Centres (PHC) in Gauteng, South Africa. Healthcare providers were selected with the assistance of the facility managers. Data analysis was conducted using the qualitative analysis software NVivo 11, using a thematic approach of pinpointing, examining, and recording patterns within the data.Results: Healthcare providers were aware of patients need for secrecy in the early stages of pregnancy because of fears of miscarriage and women's preference for traditional care. Women with prior pregnancies presumed to know about stages of pregnancy and neglected to initiate ANC early. Barriers to early ANC initiation also include, women's need to balance income generating activities; travel cost to the clinic and refusal of care for coming after the daily patient limit has been reached. Healthcare providers encounter negative attitudes from un-booked patients. This has a reciprocal effect whereby this experience impacts on whether healthcare providers will react with empathy or frustration.Conclusions: Timing of ANC is influenced by the complex decisions women make during pregnancy, starting from accepting the pregnancy itself to acknowledging the need for ANC. To positively influence this decision making for the benefit of early ANC, barriers such as lack of knowledge should be addressed prior to pregnancy through awareness programmes. The relationship between healthcare providers and women should be emphasized when training healthcare providers and considered as an important factor that can affect the timing of ANC.