Qualitative study of evidence based leaflets in maternity care

Abstract

Objective To examine the use of evidence based leaflets on informed choice in maternity services. Design Non-participant observation of 886 antenatal consultations. 383 in depth interviews with women using maternity services and health professionals providing antenatal care. Setting Women's homes; antenatal and ultrasound clinics in 13 maternity units in Wales. Participants Childbearing women and health professionals who provide antenatal care. Intervention Provision of 10 pairs of Informed Choice leaflets for service users and staff and a training session in their use. Main outcome measures Participants' views and commonly observed responses during consultations and interviews. Results Health professionals were positive about the leaflets and their potential to assist women in making informed choices, but competing demands within the clinical environment undermined their effective use. Time pressures limited discussion, and choice was often not available in practice. A widespread belief that technological intervention would be viewed positively in the event of litigation reinforced notions of "right" and "wrong" choices rather than "informed" choices. Hierarchical power structures resulted in obstetricians defining the norms of clinical practice and hence which choices were possible. Women's trust in health professionals ensured their compliance with professionally defined choices, and only rarely were they observed asking questions or making alternative requests. Midwives rarely discussed the contents of the leaflets or distinguished them from other literature related to pregnancy. The visibility and potential of the leaflets as evidence based decision aids was thus greatly reduced. Conclusions The way in which the leaflets were disseminated affected promotion of informed choice in maternity care. The culture into which the leaflets were introduced supported existing normative patterns of care and this ensured informed compliance rather than informed choice.

Undergoing prenatal screening for Down's syndrome: presentation of choice and information in Europe and Asia

“…A study of the effectiveness of 10 'informed choice' leaflets for pregnant women in Wales found that they did not promote informed choice. 8 For example, many were withheld from women, or lost amidst other written information, and there was little opportunity for discussion. The amount of positive information about Down's syndrome in the written information from the UK may reflect social attitudes towards this condition in the UK and/or the influence of The Down's Syndrome Association, a large national charity which champions the rights of people with Down's syndrome and strives to improve knowledge of the condition.…”

Association between quality of family planning services and client's satisfaction level in maternal and child health centers in Port Said city

“…"Socially complex interventions", such as the Informed Choice leaflets, should be valuated within the context in which they are used and through a prudent combination of qualitative and quantitative methods. [21] Therefore, assessment of quality of family planning service at any level in our country is very important. Increasing quality of family planning service could help to sustain contraceptive use.…”

Involvement of first-time mothers with different levels of education in the decision-making for their delivery by a planned Caesarean section. Women’s satisfaction with information given by gynaecologists and midwives

“…This is surprising since less educated woman are more likely to have a Caesarean section (Tollånes et al 2007). In a qualitative study, Stapleton et al (2002) showed that pregnant women normally follow the advice of their gynaecologist, who usually fails to adequately inform them about the risks of a technical intervention. In a retrospective study (Mould et al 1996), 51.7% (15 of 29) of women who had undergone an elective Caesarean section felt that they had made a significant or full contribution towards the decision, and 31.0% were of the opinion that they had made only a small contribution or none at all.…”