Patient-provider communication, maternal anxiety, and self-care in pregnancy
Patient-provider communication, maternal anxiety, and self-care in pregnancy
复制标题
DOI：
10.1016/j.socscimed.2017.08.011
复制
发表时间：
2017-10-01
影响因子：
5.4
通讯作者：
Lobel, Marci
中科院分区：
文献类型：
--
作者：
Nicoloro-SantaBarbara, Jennifer;Rosenthal, Lisa;Lobel, Marci
基本原理：与卫生保健提供者的良好关系预示着更高的患者满意度和对提供者建议的依从性。然而，导致这些好处的医患关系的具体组成部分尚未确定。在怀孕期间，牢固的医患关系的潜在好处可能尤其重要，因为护理提供者与孕妇有频繁的亲密互动，这可能会影响她们的情绪和行为。反过来，产前情绪和健康行为对分娩结果有强有力的影响。目的：本研究探讨孕妇与助产士的关系是否预示着更好的自我护理。研究了医患关系的具体组成部分（沟通、整合、协作和授权）。我们还研究了一种机制，通过这种机制，这些关系成分可能与有益的健康行为相关联：通过减轻女性的焦虑。方法：在美国东北部的一所大学附属助产实践中，总共有139名低风险患者完成了有效的测量，评估了他们与助产士的关系、妊娠后期的状态焦虑和产前健康行为；妊娠中期的状态焦虑也被评估。结果：妇女对助产士更好的沟通、合作和授权的看法与怀孕后期更频繁的有益健康行为实践有关。控制妊娠中期焦虑，妊娠后期较低的焦虑介导了沟通和协作与健康行为实践的关联，表明这些关联可归因于妊娠中期至晚期焦虑的减少。结论：结果证实，在怀孕期间，患者-提供者关系的好处可能超出提供医疗专业知识。医患关系的某些方面可在促进更好的保健做法方面为孕妇带来直接利益；这些关系的其他方面可能通过减轻负面情绪间接促进更好的健康做法。强大的助产士关系的好处可能来自于这些关系提供的保证、舒适和温暖，以及助产士向患者提供的信息和教育。(C) 2017 Elsevier Ltd.版权所有。
Rationale: Favorable relationships with health care providers predict greater patient satisfaction and adherence to provider recommendations. However, the specific components of patient-provider relationships that account for these benefits have not been identified. The potential benefits of strong patient-provider relationships in pregnancy may be especially important, as care providers have frequent, intimate interactions with pregnant women that can affect their emotions and behaviors. In turn, prenatal emotions and health behaviors have potent effects on birth outcomes.Objective: This study investigated whether pregnant women's relationships with their midwives predicted better self-care. Specific components of the patient-provider relationship (communication, integration, collaboration, and empowerment) were examined. We also investigated a mechanism through which these relationship components may be associated with salutary health behaviors: by alleviating women's anxiety.Methods: In total, 139 low-risk patients of a university-affiliated midwifery practice in the northeastern United States completed well-validated measures assessing their relationship with midwives, state anxiety, and prenatal health behaviors in late pregnancy; state anxiety was also assessed in mid pregnancy.Results: Women's perceptions of better communication, collaboration, and empowerment from their midwives were associated with more frequent salutary health behavior practices in late pregnancy. Controlling for mid-pregnancy anxiety, lower anxiety in late pregnancy mediated associations of communication and collaboration with health behavior practices, indicating that these associations were attributable to reductions in anxiety from mid- to late pregnancy.Conclusion: Results substantiate that benefits of patient-provider relationships in pregnancy may extend beyond providing medical expertise. Some aspects of patient-provider relationships may offer direct benefits to pregnant women in promoting better health practices; other aspects of these relationships may indirectly contribute to better health practices by alleviating negative emotions. The benefits of strong midwife relationships may derive from the reassurance, comfort, and warmth these relationships offer, as well as the information and education that midwives provide to their patients. (C) 2017 Elsevier Ltd. All rights reserved.