Effect of health literacy interventions on pregnancy outcomes: A systematic review

BackgroundLow health literacy has been associated with worse health outcomes, but little is known about the effectiveness of health literacy interventions developed for pregnant women.AimTo assess the effectiveness of health literacy interventions on pregnancy outcomes through a systematic review of randomised controlled trials.MethodsRandomised controlled trials that assessed health literacy interventions designed to improve pregnancy outcomes were included. The study protocol was registered with PROSPERO (CRD42018094958).FindingsOf the 1512 records initially identified, 13 studies were included. Three reported on decision-aid interventions, six on face-to-face interventions and four on written interventions (including computer-based interventions or information leaflets). The primary outcomes of interest for this systematic review were knowledge (10/13 studies) and health literacy (2/13 studies) with one study not reporting either primary outcome. A significant improvement in knowledge was found across the 10 studies, however the two studies which measured health literacy only assessed health literacy at a single time-point. Secondary outcomes including health behaviours, fetal outcomes and health-service utilisation were reported in 11 studies, with inconsistent results.DiscussionFew health literacy interventions have been developed specifically for pregnant women. Although health literacy interventions have the potential to improve knowledge and pregnancy outcomes, current evidence is limited by inconsistent outcomes and measurement, and limited use of health literacy theory to inform intervention design and content. Few studies directly measured health literacy.ConclusionMore research is needed to properly assess the effect of health literacy interventions on pregnancy outcomes. This research should include consideration of health literacy theory in the development of the interventions.     

Midwives’ self-reported knowledge and skills to assess and promote maternal health literacy: A national cross-sectional survey

BackgroundLittle is known about midwives’ knowledge and skills to assess and promote maternal health literacy.AimsTo test the reliability and validity of a new tool to assess midwives’ health literacy knowledge, skills and attitudes.MethodsUsing a cross-sectional design, midwives were recruited through professional and social media networks. The online survey included demographic and professional questions and a new measure on midwives’ health literacy knowledge, skills and attitudes. Convergent validity was assessed using ten items from the Caring Assessment Scale. Perceived barriers to promoting maternal health literacy were sought.FindingsThree hundred and seven participants completed the survey. A two-factor solution accounted for 41% of variance and resulted in 14 items, including all attitude items, being removed. Cronbach’s alpha reliability was acceptable (Skills = .76; Knowledge = .66). Convergent validity was established. Most midwives (77.1%, n = 221) reported giving limited attention to formally assessing women’s health literacy. Between 30 to 60% of midwives never or only sometimes used specific techniques to promote maternal health literacy. Most (75%, n = 201) had not received education about health literacy.Discussion and ConclusionsThe new Transforming Maternity Care Collaborative Health Literacy tool was valid and reliable. Few midwives formally assessed or promoted women’s health literacy. Midwives require education about maternal health literacy assessment and promotion to ensure women understand information being conveyed. A large national survey of midwives using the new tool is recommended.     

The perceptions and practices of Thai health professionals providing maternity care for migrant Burmese women: An ethnographic study

BackgroundAcross the globe, many women including economic and humanitarian migrants receive inadequate antenatal care. Understanding the difficulties that migrant women encounter when accessing maternity care, including the approach of health professionals, is necessary because inadequate care is associated with increasing rates of morbidity and mortality. There are very few studies of migrant women’s access to and experience of maternity services when they have migrated from a low- to a middle-income country.AimTo examine the perceptions and practices of Thai health professionals providing maternity care for migrant Burmese women, and to describe women’s experiences of their encounters with health professionals providing maternity care in Ranong Province in southern Thailand.MethodsEthnography informed the study design. Individual interviews were conducted with 13 healthcare professionals and 10 Burmese women before and after birth. Observations of interactions (130 h) between health care providers and Burmese women were also conducted. Data were analysed using thematic analysis.FindingsThe healthcare professionals’ practices differed between the antenatal clinics and the postnatal ward. Numerous barriers to accessing culturally appropriate antenatal care were evident. In contrast, the care provided in the postnatal ward was woman and family centered and culturally sensitive. One overarching theme, “The system is in control’ was identified, and comprised three sub-themes (1) ‘Being processed’ (2) ‘Insensitivity to cultural practices’ and, (3) ‘The space to care’.Discussion and conclusionsThe health system and healthcare professionals controlled the way antenatal care was provided to Burmese migrant women. This bureaucratic and culturally insensitive approach to antenatal care impacted on some women’s decision to engage in antenatal care. Conversely, the more positive examples of woman-centered care evident after birth in the postnatal ward, can inform service delivery.     

Factors affecting rural women's utilisation of continuum of care services in remote or isolated villages or Pakistan – A mixed-methods study

IntroductionAn effective continuum of care for pregnancy and childbirth connects women and girls with essential reproductive and maternity care services. This study aimed to estimate the continuum of care utilisation rate of women who lived in remote and isolated regions of Pakistan and explored factors that influence women's utilisation of reproductive and maternity care services.MethodsA mixed-methods study was conducted in five rural villages of Sindh, Pakistan. A cross-sectional survey with 669 women who gave birth between July 2010 and September 2014 investigated women's maternity-care service utilisation during pregnancy, childbirth, and in the postpartum period. In-depth interviews with 15 women explored their maternity-care experiences with health providers.ResultsOnly 6.4% of 669 women participants reported to have completed the continuum of care for their last pregnancy. Skilled birth attendants, including health professionals, were used by 56.1% for antenatal care, 40.8% for both antenatal and childbirth, 22.3% for antenatal, childbirth and postnatal, and only 6.4% reported using all pregnancy-related and postpartum services. Limited knowledge about affordable health services, poor health literacy, and access to health services was associated with women's fragmented utilisation of maternity care. A lack of respectful maternity-care was also identified as a major barrier to women's utilisation of primary health care facilities, especially for childbirth.ConclusionThe existing primary health structure in Pakistan provides a good foundation to deliver continuity of care services; however, health services utilisation for reproductive and maternity care remains suboptimal in women who live in geographically remote regions of Pakistan.     

Alternative Therapies and Empowerment of Older Women

SUMMARY

There has been a striking increase in Americans' awareness and use of alternative therapies over the last decade. Women, in particular, have been drawn to explore these unconventional health practices, which include herbal medicine, acupuncture, homeopathy, manual therapies, energy healing, and mind-body therapies. From a feminist perspective, the rise in alternative therapies' use in the United States represents a shift in cultural concepts of health from an outmoded patriarchical model which disempowers older women, to a more feminine, holistic model which can reempower older women. Throughout history, older women have developed, applied, and taught the principles and practices of what are now considered alternative healing modalities, in their roles as mothers, expert herbalists, midwives, wise women, and shaman. By becoming familiar with these therapies, older women can increase their control over their health, enhance prevention and self-care, and enjoy a health-care pathway that leads to wholeness in body, mind, and spirit.     

Pregnancy after loss during the COVID19 pandemic

BackgroundRapid changes to how maternity health care is delivered has occurred in many countries across the globe in response to the COVID-19 pandemic. Maternity care provisions have been challenged attempting to balance the needs and safety of pregnant women and their care providers. Women experiencing a pregnancy after loss (PAL) during these times face particularly difficult circumstances.AimIn this paper we highlight the situation in three high income countries (Australia, Ireland and USA) and point to the need to remember the unique and challenging circumstances of these PAL families. We suggest new practices may be deviating from established evidence-based guidelines and outline the potential ramifications of these changes.FindingsRecommendations for health care providers are suggested to bridge the gap between the necessary safety requirements due to the pandemic, the role of the health care provider, and the needs of families experiencing a pregnancy after loss.DiscussionChanges to practices i.e. limiting the number of antenatal appointments and access to a support person may have detrimental effects on both mother, baby, and their family. However, new guidelines in maternity care practices developed to account for the pandemic have not necessarily considered women experiencing pregnancy after loss.ConclusionBereaved mothers and their families experiencing a pregnancy after loss should continue to be supported during the COVID-19 pandemic to limit unintended consequences.     

Health belief dualism in the postnatal practices of rural Swazi women: an ethnographic account

ObjectiveThis study explores and describes the values, beliefs, and practices of rural Swazi women regarding childbearing in the postpartum period.MethodA retrospective ethnographic research design was used. A snowballing sampling method was used to recruit fifteen participants. Face-to-face unstructured audio-taped interviews and field notes were utilised to gather data.FindingsResults showed that rural Swazi women held a dual health belief system of modern and traditional medicinal use; practiced lengthy periods of postpartum confinement; customarily gave regular enemas and traditional medicines to their babies; undertook the specific cultural practice of taking the baby to enyonini [a tree struck by lightening] to perform specific rituals; used self-prescribed pharmacy medicines; used both traditional and modern contraception; as well as practiced breastfeeding.ConclusionRural Swazi women observe modern health practices alongside traditional customary practices that are inherent to their health belief and value systems in the postnatal period. These customary beliefs and values underpin their birth practices postpartum. Recommendations include the need to consider including formal knowledge on cultural aspects of childbirth and postpartum care into midwifery education; a review of maternal care practices and policies to incorporate widely practised traditional elements including redressing the use of self-prescribed pharmacy medicines to ensure a higher level of safety.     

Breastfeeding practices in women with type 1 diabetes: A discussion of the psychosocial factors and policies in Sweden and Australia

BackgroundWomen with type 1 diabetes (T1DM) face many challenges during their pregnancy, birth and in the postnatal period, including breastfeeding initiation and continuation while maintaining stable glycaemic control. In both Sweden and Australia the rates of breastfeeding initiation are high. However, overall there is limited information about the breastfeeding practices of women with T1DM and the factors affecting them. Similarities in demographics, birth rates and health systems create bases for discussion.AimThe aim of this paper is to discuss psychosocial factors, policies and practices that impact on the breastfeeding practices of women with T1DM.FindingsSwedish research indicates that the overall breastfeeding rate in women with T1DM remains significantly lower than in women without diabetes in the first 2 and 6 months after childbirth with no differences in exclusive breastfeeding. Breastfeeding initiation and continuation among women with T1DM in Sweden has been shown to be influenced by health services delivery, supportive breastfeeding polices and socio-economic factors, particular perceived support from social networks and health professionals.ConclusionThere is limited research on the impact of attitudes towards breastfeeding, emotional and social well-being and diabetes-related stress on the decision of women with T1DM to initiate and continue to breastfeed for at least 6 months. A more comprehensive understanding of the breastfeeding practices and psychosocial factors operating during the first 6 months after birth for women with T1DM will be instrumental in the future design of interventions promoting initiation and continuation of breastfeeding in Sweden, Australia and elsewhere.     

Taking Charge of Self: Breast Health Practices of Older Rural Women

ABSTRACT

The purpose of this grounded theory study was to explore breast health practices of older Vermont women residing in rural communities. Although the three components of breast health-mammography, clinical breast exam, and self-breast exam-are recommended for women 40 years and over, minimal research has empirically analyzed the breast health practices of healthy women to ascertain if, in fact, these procedures are followed, and if so, what the motivation is for doing so. Twelve women, 50–64 years, participated in face-to-face, audiotaped interviews. Data analysis, including line-by-line and constant comparative approaches, occurred concurrently with data collection. Taking Charge of Self, the generated theory, describes participants' engagement in a process of learning how to take charge of their lives. The analysis indicates that health care providers have a powerful role in the lives of women in this age group. With an increasing emphasis on health promotion and disease prevention, health care providers are positioned to cultivate and support women's development of the personal or internal motivation for health and well-being.     

Is it possible to incorporate evidence-based professional midwifery practices into public health services in Mexico?

Problem and backgroundDuring the past two decades, Mexico has launched innovative maternal health initiatives to improve maternal and neonatal outcomes, placing emphasis on the incorporation of professional midwifery practices into the healthcare system. This study explored the perceptions of healthcare providers and women using public birth care services regarding professional midwifery practices and how can the inclusion of evidence-based midwifery techniques improve the quality of service.MethodologyWe conducted a qualitative, cross-sectional study of three healthcare networks in Mexico. A content analysis was performed of data collected through 109 semi-structured interviews: 72 with healthcare providers and 37 with women.ResultsHealthcare providers and women had minimal knowledge of the competencies and skills of professional midwives. Medical personnel accepted the incorporation of some evidence-based midwifery practices. Women had experienced fear and anguish during childbirth so they considered that incorporating professional midwifery practices into maternal health services would be favourable in that it would render birth care more respectful.Discussion and conclusionsHealthcare providers are willing to consider the inclusion of some evidence-based midwifery practices in health services and regard assistance from professional midwives. They believe that structural conditions will complicate their incorporation. Although the women interviewed had experienced fear, anxiety and loneliness during childbirth, most of them admitted to feeling “safer” in a hospital (secondary-care health centre) setting where possible complications could be resolved. This perception of safety served to justify the delivery of healthcare in a manner that is inattentive to women’s needs, which go beyond biomedical issues and include emotions and the positive experience of childbirth.     

Paperbark and pinard: A historical account of maternity care in one remote Australian Aboriginal town

Background and aimMaternity care in remote areas of the Australian Northern Territory is restricted to antenatal and postnatal care only, with women routinely evacuated to give birth in hospital. Using one remote Aboriginal community as a case study, our aim with this research was to document and explore the major changes to the provision of remote maternity care over the period spanning pre-European colonisation to 1996.MethodsOur research methods included historical ethnographic fieldwork (2007–2013); interviews with Aboriginal women, Aboriginal health workers, religious and non-religious non-Aboriginal health workers and past residents; and archival review of historical documents.FindingsWe identified four distinct eras of maternity care. Maternity care staffed by nuns who were trained in nursing and midwifery serviced childbirth in the local community. Support for community childbirth was incrementally withdrawn over a period, until the government eventually assumed responsibility for all health care.ConclusionsThe introduction of Western maternity care colonised Aboriginal birth practices and midwifery practice. Historical population statistics suggest that access to local Western maternity care may have contributed to a significant population increase. Despite population growth and higher demand for maternity services, local maternity services declined significantly. The rationale for removing childbirth services from the community was never explicitly addressed in any known written policy directive. Declining maternity services led to the de-skilling of many Aboriginal health workers and the significant community loss of future career pathways for Aboriginal midwives. This has contributed to the current status quo, with very few female Aboriginal health workers actively providing remote maternity care.     

Afghan families and health professionals’ access to health information during and after pregnancy

BackgroundHaving a baby in a new country can be challenging, especially if unable to communicate in a preferred language. The aim of this paper is to explore the provision of health information for Afghan women and men during pregnancy, childbirth and the first year after birth in Melbourne, Australia.MethodsCommunity engagement underpinned the study design. Qualitative study with bicultural researchers conducting semi-structured interviews. Interviews and focus groups were also conducted with health professionals.ResultsSixteen Afghan women and 14 Afghan men with a baby aged 4–12 months participated. Thirty four health professionals also participated. Verbal information provided by a health professional with an interpreter was the most common way in which information was exchanged, and was generally viewed favourably by Afghan women and men. Families had limited access to an interpreter during labour and some families reported difficulty accessing an interpreter fluent in their dialect. Availability of translated information was inconsistent and health professionals occasionally used pictures to support explanations. Women and men were unsure of the role of health professionals in providing information about issues other than pregnancy and infant wellbeing.ConclusionBoth individual and health system issues hinder and enable the availability and use of information. Consistent, understandable and ‘actionable’ information is required to meet the needs of diverse families. Health professionals need to be supported with adequate alternatives to written information and access to appropriate interpreters. Inconsistent provision of information is likely to contribute to low health literacy and poor maternal and child health outcomes.     

Midwife readiness to provide woman-centred weight gain support: Exploring perspectives across models of care

ProblemMore than half of women start pregnancy above a healthy weight and two-thirds gain excess weight during pregnancy, increasing the risk of complications.BackgroundLittle research has examined the influence model of care has on weight-related outcomes in pregnancy.AimTo explore how continuity vs non-continuity models of midwifery care influence perceived readiness to provide woman-centred interventions with women supporting pregnancy weight gain, healthy eating and physical activity.MethodsFocus groups were conducted with midwives working in either continuity or non-continuity models of care at a tertiary hospital in Queensland, Australia. Focus group questions elicited elements around practices, the healthcare environment and woman-centred care skills. Findings were analysed using the Framework Approach to qualitative research.FindingsFour focus groups, involving 15 participants from the continuity of care model and 53 from the non-continuity model, were conducted. Continuity of care participants reported greater readiness to provide woman-centred interventions than those from non-continuity models. Barriers faced by both groups included gaps in communication training, education resources and multidisciplinary support.DiscussionMidwives across models of care require greater support in this area, in particular training in communication and better multidisciplinary service integration to support women.ConclusionThe care model appears to influence capacity to deliver person/woman-centred interventions, highlighting the need for tailored training for the healthcare setting. The roles of other health professionals in delivering weight management interventions during pregnancy also need to be examined.     

Older Women and the Health Care System: A Time for Change

SUMMARY

In spite of women's active involvement in a woman's health care movement, the mainline health care system continues to hold tight to its androcentric focus. If women are to be subjected to a health care system that employs sexist and ageist practices, the quality of life in their later years will continue to be jeopardized. The purpose of this paper is to first, recognize the existing health care practices which limit the health care opportunities and choices of older women; and secondly, to discuss how such basic feminist principles as education, egalitarianism, empowerment, and inclusion can be used to improve an older woman's experience.     

Stigma,guilt and motherhood: Experiences of pregnant women with COVID-19 in Brazil

BackgroundThe COVID-19 pandemic raises health issues worldwide. Infected pregnant women may have negative mental health outcomes, but little is known about their emotional experiences.AimWe aimed to understand the experience of women infected with COVID-19 during pregnancy, regarding their feelings, their relationships, and the influence of social media.MethodsWe conducted a qualitative study among 22 women infected with COVID-19 during pregnancy, from a tertiary hospital during the first wave of the pandemic in Brazil (May–August 2020). We applied semi-directed interviews, sociodemographic and health data sheets, and field diaries. We built the sample purposefully. Interviews were audio-recorded and transcribed verbatim. We used thematic analysis and discussed data considering the health psychology framework.ResultsWe created five categories following a timeline perspective, from before infection to the experience after recovering. Pregnant women were resistant to believing the diagnosis. They described a fear of serious symptoms or death, concerns about the fetus, sorrow from being isolated, and worries about stigma. Family relationships were ambiguous, generating either support or tension. The attachment to the health team through telemedicine or support during hospitalization produced a feeling of security.ConclusionsParticipants psychologically denied the COVID-19 diagnosis and did not accomplish isolation properly, even upon medical recommendations. The illness may produce a traumatic experience, regardless of mild or severe symptoms, but family/friend support and contact with the health team helped them to cope. We offer important insights for the clinical approach and future research, emphasizing that infected pregnant women require emotional support.     

Determinants of prenatal health care utilisation by low-risk women: A prospective cohort study

BackgroundPrenatal health care is pivotal in providing adequate prevention and care to pregnant women.AimWe examined the determinants of inadequate prenatal health care utilisation by low-risk women in primary midwifery-led care in the Netherlands.MethodsWe used longitudinal data from the population-based DELIVER study with 20 midwifery practices across the Netherlands in 2009 and 2010 as the experimental setting. The participants were 3070 pregnant women starting pregnancy care in primary midwifery care.FindingsWe collected patient-reported data on potential determinants of prenatal care utilisation derived from the Andersen model. Prenatal health care utilisation was measured by a revised version of the Kotelchuck Index, which measures a combination of care entry and number of visits. Low-risk pregnant women (not referred during pregnancy) were more likely to use prenatal care inadequately if they intended to deliver at a hospital, if they did not use folic acid adequately periconceptionally, or if they were exposed to cigarette smoke during pregnancy. Among those who were referred to secondary care, women reporting a chronic illnesses or disabilities, and women who did not use folic acid periconceptionally were more likely to make inadequate use of prenatal care.ConclusionInadequate prenatal health care use in primary midwifery care is more likely in specific groups, and the risk groups differ when women are referred to secondary care. The findings suggest routes that can target interventions to women who are at risk of not adequately using prenatal prevention and care services.     

Childbearing traditions of Indian women at home and abroad: An integrative literature review

BackgroundThe percentage of overseas-born mothers giving birth in Australia has increased to 31.5% in 2012 and Indian women represent 10% (the highest proportion). It is important for midwives in Australia to be aware of the childbearing traditions of Indian women and how these influence Indian women birthing in Australia.AimTo explore childbearing practices in India and Indian women's experience of giving birth abroad; and to discuss the relevant findings for midwives working with Indian women in Australia.MethodAn integrative literature review was employed. 32 items, including 18 original research articles were thematically reviewed to identify commonly occurring themes relating to Indian women's childbearing traditions.FindingsFive themes relating to traditional childbearing practices of women birthing in India were identified. These themes included diversity and disparity; social context of childbirth and marriage; diet based on Ayurveda; pollution theory and confinement; and finally, rituals and customs.ConclusionIndian women giving birth abroad and by implication in Australia experience a transition to motherhood in a new culture. While adjusting to motherhood, they are also negotiating between their old and new cultural identities. To provide culturally safe care, it is essential that midwives reflect on their own culture while exploring what traditions are important for Indian women.