Factors affecting attendance at and timing of formal antenatal care: results from a qualitative study in Madang, Papua New Guinea.
Factors affecting attendance at and timing of formal antenatal care: results from a qualitative study in Madang, Papua New Guinea.
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DOI：
10.1371/journal.pone.0093025
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发表时间：
2014
期刊：
影响因子：
3.7
通讯作者：
Pool R
中科院分区：
文献类型：
--
作者：
Andrew EV;Pell C;Angwin A;Auwun A;Daniels J;Mueller I;Phuanukoonnon S;Pool R
适当的产前护理（ANC）对于母亲和孩子的健康至关重要。然而，在巴布亚新几内亚 (PNG)，只有三分之一的女性在怀孕期间接受任何 ANC 治疗。本文利用定性研究，探讨了对巴布亚新几内亚马当地区非国大出席率和首次访问时间的影响。使用多种定性方法在三个站点收集数据：术语和定义的免费列表和排序、焦点小组讨论、深入访谈、医疗机构观察以及孕妇案例研究。受访者包括孕妇及其亲属、生物医学和传统保健提供者、意见领袖和社区成员。尽管普遍认为 ANC 很重要，但受访者对 ANC 所涉及程序的理解有限。影响出席率的因素主要分为三类：可及性、对非国大的态度和人际问题。尽管女性将交通便利性（距离和成本）视为障碍，但那些居住在医疗机构附近且能够轻松负担 ANC 费用的女性也表现出出勤率较低。态度是由 ANC 之前的经历决定的，例如等待时间、护理质量以及对怀孕期间预防性护理和医疗干预的看法。人际关系因素包括与医疗保健提供者的关系、怀孕信息和家庭冲突。避免重复就诊的愿望、对胎儿强度和胎次的想法与第一次 ANC 就诊的时间特别相关。这项长期深入的研究（在巴布亚新几内亚马当开展的此类研究尚属首次）显示了社会文化和经济因素如何影响非国大的出席率。必须解决这些因素，以鼓励及时进行 ANC 就诊：干预措施可以侧重于卫生机构中 ANC 的提供，例如，通过解决医护人员对孕妇的态度。
Appropriate antenatal care (ANC) is key for the health of mother and child. However, in Papua New Guinea (PNG), only a third of women receive any ANC during pregnancy. Drawing on qualitative research, this paper explores the influences on ANC attendance and timing of first visit in the Madang region of Papua New Guinea. Data were collected in three sites utilizing several qualitative methods: free-listing and sorting of terms and definitions, focus group discussions, in-depth interviews, observation in health care facilities and case studies of pregnant women. Respondents included pregnant women, their relatives, biomedical and traditional health providers, opinion leaders and community members. Although generally reported to be important, respondents’ understanding of the procedures involved in ANC was limited. Factors influencing attendance fell into three main categories: accessibility, attitudes to ANC, and interpersonal issues. Although women saw accessibility (distance and cost) as a barrier, those who lived close to health facilities and could easily afford ANC also demonstrated poor attendance. Attitudes were shaped by previous experiences of ANC, such as waiting times, quality of care, and perceptions of preventative care and medical interventions during pregnancy. Interpersonal factors included relationships with healthcare providers, pregnancy disclosure, and family conflict. A desire to avoid repeat clinic visits, ideas about the strength of the fetus and parity were particularly relevant to the timing of first ANC visit. This long-term in-depth study (the first of its kind in Madang, PNG) shows how socio-cultural and economic factors influence ANC attendance. These factors must be addressed to encourage timely ANC visits: interventions could focus on ANC delivery in health facilities, for example, by addressing healthcare staff’s attitudes towards pregnant women.
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