Do maternity services in New Zealand's public healthcare system deliver on equity? Findings from structural equation modelling of national maternal satisfaction survey data

Dawson, Pauline; Hay‐Smith, Jean; Jaye, Chrys; Gauld, Robin; Auvray, Benoit

doi:10.1016/j.midw.2021.102936

Cited by 3 publications

(5 citation statements)

References 25 publications

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“…However, there were 5.4% (n = 69) of respondents in the dataset who experienced a lack of cultural/ religious sensitivity from a hospital midwife. This finding supports findings from the qualitative branch of the Maternity Consumer Survey ( 2023) and the conclusion reached by Dawson et al (2021) that there remain issues around cultural midwifery care in Aotearoa that are yet to be addressed. The findings from the qualitative analysis reflect other international studies defining the characteristics of hospital midwifery care that contribute to a positive maternity care experience (Berg at al., 1996;Hildingsson & Thomas, 2007;Hodnett, 2002;Karlstrӧm et al, 2015;Lewis et al, 2016;McKinnon et al, 2014;Nilsson et al, 2013;Todd et al, 2017); namely, that satisfaction with maternity care is built on the quality of the relationship between the provider and the woman.…”

Section: Discussionsupporting

confidence: 88%

“…A study by Dawson et al (2021) used data from the 2014 Maternity Satisfaction Survey to explore aspects of inequity within women's satisfaction and experiences of their maternity care. Using structural equation modelling, these authors found that highly deprived and remote rural women "were most likely to be affected by dissatisfaction associated with equity aspects of their maternity care and/or barriers to equity associated with additional costs" (p. 4).…”

Section: Introductionmentioning

confidence: 99%

“…Using structural equation modelling, these authors found that highly deprived and remote rural women "were most likely to be affected by dissatisfaction associated with equity aspects of their maternity care and/or barriers to equity associated with additional costs" (p. 4). Despite the presence of a continuity of care and partnership model addressing some aspects of maternal inequity (Homer et al, 2019;Neely et al, 2020), Dawson et al (2021) argue that issues around affordability, access and cultural care are yet to be fully addressed. While this study looked at maternity care in all settings, a qualitative branch of the 2023 Maternity Consumer Survey found that negative hospital maternity care experiences for participants included cultural, physical and identity needs not being met (Research New Zealand, 2023b).…”

Section: Introductionmentioning

confidence: 99%

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Partnership in a hospital setting: Consumer perspectives of hospital midwifery care in Aotearoa New Zealand

Daellenbach,

Dixon,

Anderson

et al. 2024

nzcomjnl

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Background: Midwives in Aotearoa New Zealand, regardless of the setting, practise within a model of midwifery partnership. Soliciting feedback on practice provides an essential mechanism for midwives to work towards improving their practice. The New Zealand College of Midwives provides such a process for consumers of midwifery services to give feedback on their experiences directly to the midwife, via online consumer feedback forms. Aim: To identify the characteristics of midwifery care that contribute to positive and negative midwifery care relationships within the hospital setting. Methods: A retrospective mixed methods approach was used to analyse the consumer feedback on hospital midwives received between 1 January and 31 December, 2019. Quantitative data from feedback forms were analysed descriptively in combination with an iterative and reflexive thematic approach for the qualitative data. The analysis sought to identify characteristics of care that contributed to a positive or negative midwifery care experience in a hospital setting. Findings: There were 1,284 online feedback forms received for hospital midwives. The majority of respondents who completed feedback questionnaires were satisfied with their care (92%), reporting that hospital midwives provided information/explanations to support informed decision-making (94.0%), that they felt involved in planning/decisions about their care (93.7%) and that they experienced respect for decisions made (93.7%); these characteristics having the highest levels of agreement. Via qualitative analysis, we identified four key themes as contributing to the midwifery care experience in a hospital setting. Positive experience themes included: Building trust quickly, Respecting decision-making and Fostering maternal confidence, resulting in Meaningful partnerships. The negative experience themes were found to be the inverse of a positive midwifery care experience in a hospital setting. Specifically, these were: Not giving time and Judgement and disrespect, resulting in an Unsafe space and an Absence of partnership. Conclusion: The data from consumer feedback forms for 2019 affirm that the quality of the relationship with a hospital midwife is important in shaping the maternity care experience of women and birthing whānau in Aotearoa New Zealand. The characteristics of care that contribute to a positive midwifery care relationship in hospital reflect the principles outlined in the model of midwifery partnership.

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Section: Discussionsupporting

confidence: 88%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Partnership in a hospital setting: Consumer perspectives of hospital midwifery care in Aotearoa New Zealand

Daellenbach,

Dixon,

Anderson

et al. 2024

nzcomjnl

View full text Add to dashboard Cite

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“…12,13 The impact of rurality on maternal satisfaction has been studied previously; however, the correlations vary and there is a lack of research on rural care in America. Studies in Australia, 14 New Zealand, 15 and Northwest Ethiopia 16 showed a negative correlation between rurality and maternity care satisfaction; whereas a study from Nepal 17 showed a positive correlation, and a Scottish study 18 showed no correlation. Additionally, two Canadian qualitative studies reported that birth experience was influenced by geographic realities, the availability of local health services resources, and relational care characterized by time spent with the patient, continuity, and personalization.…”

Section: Introductionmentioning

confidence: 90%

Patient Perspectives of Rural Kansas Maternity Care

Blythe

Istas²,

Johnston³

et al. 2021

kjm

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Introduction. Pregnant women in rural areas face a unique set of challenges due to geographic maldistribution of obstetric services. The perspectives of rural Kansas women were sought regarding experience of birth and satisfaction with maternity care. Methods. Medical student research assistants facilitated discussion groups in rural Kansas communities with women who had given birth in the last 24 months. Guiding questions were used to facilitate discussion. Survey instruments were used to gather information about satisfaction with maternity care. Data for qualitative and quantitative analysis was aggregated using Rural Urban Commuting Area (RUCA) codes. Results. 14 groups with 47 total participants completed the survey and discussion. Participants were representative of a variety of Large Rural, Small Rural, and Isolated areas in Kansas as described by RUCA Code Four Category Classification. Survey results indicate that satisfaction with maternity care in participants’ home county was significantly higher in Small Rural and Isolated compared to Large Rural RUCA. Qualitative analysis results show positive experiences related to: doctor characteristics, relationship with doctor, doctor’s involvement with care, alternative labor options, and distance convenience. Negative experiences were related to: doctor bedside manner, doctor not there until delivery, and staff related complaints. Conclusions. Women in Small Rural and Isolated RUCA codes appear to be more satisfied with care contrary to previous study findings.

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“…However, the reasons that pregnant women remain unimmunised are often complex and multifactorial [ 14 , 15 ]. Some women may not receive adequate information about recommended vaccinations during pregnancy [ 14 ], particularly if they live in areas of high deprivation [ 16 ], resulting in lack of awareness in these groups that vaccinations are recommended during pregnancy [ 14 ]. They may also be uncertain about the risks and benefits of vaccinating [ 17 ], possibly fuelled by misinformation [ 14 ].…”

Section: Introductionmentioning

confidence: 99%

Knowledge and decisions about maternal immunisation by pregnant women in Aotearoa New Zealand

Young

Charania

Gauld

et al. 2022

BMC Health Serv Res

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Background Maternal vaccinations for influenza and pertussis are recommended in New Zealand to protect mothers and their infant from infection. However, maternal immunisation coverage in New Zealand is suboptimal. Furthermore, there is unacceptable inequitable maternal immunisation rates across the country with Māori and Pacific women having significantly lower maternal immunisation rates than those of other New Zealanders. Methods This research set out to explore what pregnant/recently pregnant Māori and Pacific women knew about immunisation during pregnancy and what factors influenced their decision to be vaccinated. A semi-structured interview guide was developed with questions focusing on knowledge of pertussis and influenza vaccination during pregnancy and decision-making. Māori and Pacific women aged over 16 years were purposively sampled and interviewed in Dunedin and Gisborne, New Zealand between May and August 2021. Interviews were analysed following a directed qualitative content approach. Data were arranged into coding nodes based on the study aims (deductive analysis) informed by previous literature and within these participant experiences were inductively coded into themes and subthemes. Results Not all women were aware of maternal vaccine recommendations or they diseases they protected against. Many underestimated how dangerous influenza and pertussis could be and some were more concerned about potential harms of the vaccine. Furthermore, understanding potential harms of infection and protection provided by vaccination did not necessarily mean women would choose to be vaccinated. Those who decided to vaccinate felt well-informed, had vaccination recommended by their healthcare provider, and did so to protect their and their infant’s health. Those who decided against vaccination were concerned about safety of the vaccines, lacked the information they needed, were not offered the vaccine, or did not consider vaccination a priority. Conclusions There is a lack of understanding about vaccine benefits and risks of vaccine-preventable diseases which can result in the reinforcement of negative influences such as the fear of side effects. Furthermore, if vaccine benefits are not understood, inaccessibility of vaccines and the precedence of other life priorities may prevent uptake. Being well-informed and supported to make positive decisions to vaccinate in pregnancy is likely to improve vaccine coverage in Māori and Pacific Island New Zealanders.

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Do maternity services in New Zealand's public healthcare system deliver on equity? Findings from structural equation modelling of national maternal satisfaction survey data

Cited by 3 publications

References 25 publications

Partnership in a hospital setting: Consumer perspectives of hospital midwifery care in Aotearoa New Zealand

Partnership in a hospital setting: Consumer perspectives of hospital midwifery care in Aotearoa New Zealand

Patient Perspectives of Rural Kansas Maternity Care

Knowledge and decisions about maternal immunisation by pregnant women in Aotearoa New Zealand

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