Models of intrapartum care and women's trade-offs in remote and rural Scotland: A mixed-methods study
Authors: Pitchforth, E., Watson, V., Tucker, J., Ryan, M., Van Teijlingen, E., Farmer, J., Ireland, J., Thomson, E., Kiger, A. and Bryers, H.
Journal: BJOG: An International Journal of Obstetrics and Gynaecology
Volume: 115
Issue: 5
Pages: 560-569
eISSN: 1471-0528
ISSN: 1470-0328
DOI: 10.1111/j.1471-0528.2007.01516.x
Abstract:Objective: To explore women's preferences for, and trade-offs between, key attributes of intrapartum care models. Design: Mixed-methods study using discrete choice experiments (DCEs) and focus groups. Setting: The North of Scotland. Population: Women from the catchment areas of eight rural maternity units in the North of Scotland. Methods: Based on current policy, 'model of care' and 'time travelled' were selected as key attributes of intrapartum care in remote and rural settings. A DCE questionnaire explored women's preferences for and trade-offs between these attributes. Focus groups validated the DCE attributes and provided valuable information about the drivers of women's preferences for place of delivery. Main outcome measures: Preferences for attributes of intrapartum care. Results: Eight focus groups were conducted, and 877 eligible women completed the questionnaire. Overall, the DCE results found women preferred delivery in a unit to home birth and consultant-led care (CLC) to midwife-managed care (MMC). Women preferring CLC associated it with covering every eventuality and increased safety. Although women preferred shorter travel times, trade-offs indicated a willingness to travel for approximately 2 hours to get one's preferred choice. Focus group findings and subgroup DCE analysis showed heterogeneity of preferences related to experience, risk status, geographic location, perception of care and family circumstances. Conclusions: In contrast to service redesign offering local midwife-managed intrapartum care, most rural women in our study expressed a preference to give birth in hospital and have CLC because they felt safer. Women were willing to travel for this but within limits. Qualitative results showed that women's preferences were influenced by their home and family context, beliefs and previous pregnancy experiences. Challenges for service redesign are to provide comprehensive obstetric services within acceptable travel time, while responding to the heterogeneity of women's preferences. © 2007 The Authors.
Source: Scopus
Models of intrapartum care and women's trade-offs in remote and rural Scotland: a mixed-methods study.
Authors: Pitchforth, E., Watson, V., Tucker, J., Ryan, M., van Teijlingen, E., Farmer, J., Ireland, J., Thomson, E., Kiger, A. and Bryers, H.
Journal: BJOG
Volume: 115
Issue: 5
Pages: 560-569
eISSN: 1471-0528
DOI: 10.1111/j.1471-0528.2007.01516.x
Abstract:OBJECTIVE: To explore women's preferences for, and trade-offs between, key attributes of intrapartum care models. DESIGN: Mixed-methods study using discrete choice experiments (DCEs) and focus groups. SETTING: The North of Scotland. POPULATION: Women from the catchment areas of eight rural maternity units in the North of Scotland. METHODS: Based on current policy, 'model of care' and 'time travelled' were selected as key attributes of intrapartum care in remote and rural settings. A DCE questionnaire explored women's preferences for and trade-offs between these attributes. Focus groups validated the DCE attributes and provided valuable information about the drivers of women's preferences for place of delivery. MAIN OUTCOME MEASURES: Preferences for attributes of intrapartum care. RESULTS: Eight focus groups were conducted, and 877 eligible women completed the questionnaire. Overall, the DCE results found women preferred delivery in a unit to home birth and consultant-led care (CLC) to midwife-managed care (MMC). Women preferring CLC associated it with covering every eventuality and increased safety. Although women preferred shorter travel times, trade-offs indicated a willingness to travel for approximately 2 hours to get one's preferred choice. Focus group findings and subgroup DCE analysis showed heterogeneity of preferences related to experience, risk status, geographic location, perception of care and family circumstances. CONCLUSIONS: In contrast to service redesign offering local midwife-managed intrapartum care, most rural women in our study expressed a preference to give birth in hospital and have CLC because they felt safer. Women were willing to travel for this but within limits. Qualitative results showed that women's preferences were influenced by their home and family context, beliefs and previous pregnancy experiences. Challenges for service redesign are to provide comprehensive obstetric services within acceptable travel time, while responding to the heterogeneity of women's preferences.
Source: PubMed
Models of intrapartum care and women's trade-offs in remote and rural Scotland: a mixed-methods study
Authors: Pitchforth, E., Watson, V., Tucker, J., Ryan, M., van Teijlingen, E., Farmer, J., Ireland, J., Thomson, E., Kiger, A. and Bryersi, H.
Journal: BJOG-AN INTERNATIONAL JOURNAL OF OBSTETRICS AND GYNAECOLOGY
Volume: 115
Issue: 5
Pages: 560-569
eISSN: 1471-0528
ISSN: 1470-0328
DOI: 10.1111/j.1471-0528.2007.01516.x
Source: Web of Science (Lite)
Models of intrapartum care and women’s trade-offs in remote and rural Scotland: A mixed-methods study
Authors: Pitchforth, E., Watson, V., Tucker, J.S., Ryan, M., van Teijlingen, E., Farmer, J., Ireland, J., Thomson, E., Kiger, A. and Bryers, H.
Journal: BJOG: An International Journal of Obstetrics & Gynaecology
Volume: 115
Pages: 560-569
ISSN: 1470-0328
DOI: 10.1111/j.1471-0528.2007.01516.x
Abstract:Objective To explore women's preferences for, and trade-offs between, key attributes of intrapartum care models.
Design Mixed-methods study using discrete choice experiments (DCEs) and focus groups.
Setting The North of Scotland.
Population Women from the catchment areas of eight rural maternity units in the North of Scotland.
Methods Based on current policy, 'model of care' and 'time travelled' were selected as key attributes of intrapartum care in remote and rural settings. A DCE questionnaire explored women's preferences for and trade-offs between these attributes. Focus groups validated the DCE attributes and provided valuable information about the drivers of women's preferences for place of delivery.
Main outcome measures Preferences for attributes of intrapartum care.
Results Eight focus groups were conducted, and 877 eligible women completed the questionnaire. Overall, the DCE results found women preferred delivery in a unit to home birth and consultant-led care (CLC) to midwife-managed care (MMC). Women preferring CLC associated it with covering every eventuality and increased safety. Although women preferred shorter travel times, trade-offs indicated a willingness to travel for approximately 2 hours to get one's preferred choice. Focus group findings and subgroup DCE analysis showed heterogeneity of preferences related to experience, risk status, geographic location, perception of care and family circumstances.
Conclusions In contrast to service redesign offering local midwife-managed intrapartum care, most rural women in our study expressed a preference to give birth in hospital and have CLC because they felt safer. Women were willing to travel for this but within limits. Qualitative results showed that women's preferences were influenced by their home and family context, beliefs and previous pregnancy experiences. Challenges for service redesign are to provide comprehensive obstetric services within acceptable travel time, while responding to the heterogeneity of women's preferences.
Source: Manual
Preferred by: Edwin van Teijlingen
Models of intrapartum care and women's trade-offs in remote and rural Scotland: a mixed-methods study.
Authors: Pitchforth, E., Watson, V., Tucker, J., Ryan, M., van Teijlingen, E., Farmer, J., Ireland, J., Thomson, E., Kiger, A. and Bryers, H.
Journal: BJOG : an international journal of obstetrics and gynaecology
Volume: 115
Issue: 5
Pages: 560-569
eISSN: 1471-0528
ISSN: 1470-0328
DOI: 10.1111/j.1471-0528.2007.01516.x
Abstract:Objective
To explore women's preferences for, and trade-offs between, key attributes of intrapartum care models.Design
Mixed-methods study using discrete choice experiments (DCEs) and focus groups.Setting
The North of Scotland.Population
Women from the catchment areas of eight rural maternity units in the North of Scotland.Methods
Based on current policy, 'model of care' and 'time travelled' were selected as key attributes of intrapartum care in remote and rural settings. A DCE questionnaire explored women's preferences for and trade-offs between these attributes. Focus groups validated the DCE attributes and provided valuable information about the drivers of women's preferences for place of delivery.Main outcome measures
Preferences for attributes of intrapartum care.Results
Eight focus groups were conducted, and 877 eligible women completed the questionnaire. Overall, the DCE results found women preferred delivery in a unit to home birth and consultant-led care (CLC) to midwife-managed care (MMC). Women preferring CLC associated it with covering every eventuality and increased safety. Although women preferred shorter travel times, trade-offs indicated a willingness to travel for approximately 2 hours to get one's preferred choice. Focus group findings and subgroup DCE analysis showed heterogeneity of preferences related to experience, risk status, geographic location, perception of care and family circumstances.Conclusions
In contrast to service redesign offering local midwife-managed intrapartum care, most rural women in our study expressed a preference to give birth in hospital and have CLC because they felt safer. Women were willing to travel for this but within limits. Qualitative results showed that women's preferences were influenced by their home and family context, beliefs and previous pregnancy experiences. Challenges for service redesign are to provide comprehensive obstetric services within acceptable travel time, while responding to the heterogeneity of women's preferences.Source: Europe PubMed Central