Risk Perception of Health Professionals in Intrapartum Care Decisions: Protocol for a Mixed Methods Study

Abstract

Background Risk perception plays an important role in decision-making processes. Differences in obstetric intervention rates suggest that, in addition to medical indications, the risk perception of obstetric health professionals might have a major influence on their decision-making process during childbirth. Although studies have investigated whether risk perception affects the role of midwifery or influences decision making during childbirth, little is known about what obstetric health professionals actually perceive as risk or risky situations and whether different risk perceptions lead to more interventions during intrapartum care. Objective The objective of this study is to understand the association of risk perception and the decision-making processes of obstetric health professionals (midwives and obstetricians) in Germany during intrapartum care. The study has 3 specific aims: (1) gain insight into what obstetric health professionals perceive as risk in the German clinical setting, (2) assess the extent to which personal and systemic factors have an impact on obstetric health professionals’ risk perception, and (3) investigate whether different perceptions of risk are associated with different decisions being made by obstetric health professionals. Methods This is an exploratory sequential mixed methods study with 2 phases, a qualitative followed by a quantitative phase. In the first phase, qualitative data are collected and analyzed by conducting focus group discussions and applying qualitative content analysis to address aim 1. In the second phase, for aims 2 and 3 and to help explain the qualitative results, quantitative data are collected and analyzed by conducting an observational study using case vignettes within a survey constructed on the basis of the qualitative results. Results Enrollment in the first (qualitative) phase began in July 2019, and data collection and analysis have been completed. The second (quantitative) phase is currently planned, and data collection is expected to start in December 2020. First results of the qualitative phase are expected to be submitted for publication in 2020, with completion of the second phase scheduled for 2021. Conclusions This mixed methods study will examine the perception of risk and its association with the decision-making processes of obstetric health professionals during their care of women in childbirth. The rationale for this approach is that the qualitative data and their analysis explore participants' views in more depth, while the quantitative data will help to provide and explore a general understanding of the research problem. The results are expected to be relevant to health care professionals, policymakers, and educational institutions in order to minimize underuse, overuse, and misuse of interventions during intrapartum care. Trial Registration German Clinical Trials Register DRKS00017172; https://tinyurl.com/y2zoowkx International Registered Report Identifier (IRRID) DERR1-10.2196/21443

Association of personal and systemic factors on intrapartum risk perception and obstetric intervention rates: a cross-sectional study

“…This cross-sectional survey using case vignettes is the quantitative second part of a mixed-methods-study [ 38 , 39 ], and uses an exploratory sequential mixed-methods design [ 40 , 41 ]. Participants were clinically active midwives and obstetricians who, at the time of the survey, were currently working or had worked in delivery in the past 24 months as an employed/caseload midwife or obstetrician and who had qualified more than 1 year ago.…”

“…Participants were also invited via general calls for participation on social media platforms. Details of the recruitment strategy can be found in the study protocol [ 38 ]. Due to the exploratory design of the survey and as the aim was to invite as many midwives and obstetricians working in birth suites/labour wards as possible to participate, no formal sample calculation was carried out.…”

“…Completion of the survey took about 20 minutes. The case vignettes were constructed using the results of the first part of the mixed methods design (described in detail in [ 38 , 39 ]), whereby the fourth case has been analysed separately due to its special nature and is not part of this publication. Details on the case vignettes and their respective characteristics are shown in Box 1 in the Supplementary Material 2 ).…”