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van Wijngaarden M, Blonk H, Simmelink R, van der Lee N, van der Vliet-Torij HH, Nieuwenhuijze M, de Jonge A, Verhoeven C. Working in smaller teams in community midwifery practices to foster continuity of carer: Midwives' experiences - A qualitative study in the Netherlands. Women Birth 2024; 37:101663. [PMID: 39154393 DOI: 10.1016/j.wombi.2024.101663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Revised: 07/09/2024] [Accepted: 07/31/2024] [Indexed: 08/20/2024]
Abstract
BACKGROUND Midwife-led continuity of carer (MLCC) improves health outcomes and increases pregnant women's satisfaction. Working in smaller teams in community midwifery practices is one of the ways to promote continuity of carer. AIM To gain insight into the experiences of Dutch community midwives regarding working in smaller teams, by identifying motivators and barriers. METHODS A qualitative study was conducted using individual, semi-structured interviews (n=9). The sample was purposively selected. The interviews were analysed using the Abbreviated Grounded Theory. FINDINGS Four themes were identified: 1) Ideal implementation of working in smaller teams, 2) Best care for pregnant women, 3) Conflicts with the current maternity care system, 4) Personal interests of the midwife. The core concept connecting all themes was midwives' experiences of an 'inner conflict' regarding working in smaller teams. CONCLUSION A strong motivation for working in smaller teams is the wish to provide the best care for pregnant women through offering more continuity of carer. The structure of maternity care, financially and organisationally, acts as a barrier in the transition to working in smaller teams. How community midwives manage these motivators and barriers depends on their personal interests, vision, and personal life. The balance between the motivators and barriers can create an inner conflict among the midwives. This inner conflict encompasses an ethical issue: what is the best care and what is it worth? A discussion within the professional group concerning the practical and ethical aspects of working in smaller teams is needed to find ways to reduce the inner conflict of community midwives who wish to work in smaller teams, thereby promoting the implementation of MLCC.
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Affiliation(s)
| | - Hinke Blonk
- Midwifery Academy Amsterdam, the Netherlands
| | - Renate Simmelink
- Midwifery Academy Amsterdam, the Netherlands; Amsterdam University Medical Center, Location VUmc, Department of Midwifery Science, Amsterdam, the Netherlands; Amsterdam Public Health, Quality of Care, Amsterdam, the Netherlands; University of Groningen, University Medical Center Groningen, Department of Primary and Long-term Care, the Netherlands
| | | | | | - Marianne Nieuwenhuijze
- Research Centre for Midwifery Science, Zuyd University, Maastricht, the Netherlands; Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
| | - Ank de Jonge
- Midwifery Academy Amsterdam, the Netherlands; Amsterdam University Medical Center, Location VUmc, Department of Midwifery Science, Amsterdam, the Netherlands; Amsterdam Public Health, Quality of Care, Amsterdam, the Netherlands; University of Groningen, University Medical Center Groningen, Department of Primary and Long-term Care, the Netherlands
| | - Corine Verhoeven
- Midwifery Academy Amsterdam, the Netherlands; Amsterdam University Medical Center, Location VUmc, Department of Midwifery Science, Amsterdam, the Netherlands; University of Groningen, University Medical Center Groningen, Department of Primary and Long-term Care, the Netherlands; Amsterdam Reproduction and Development, Amsterdam, the Netherlands; Division of Midwifery, School of Health Sciences, University of Nottingham, Nottingham, United Kingdom; Department of Obstetrics and Gynaecology, Maxima Medical Centre, Veldhoven, the Netherlands
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Stanhope KK, Goebel A, Simmonds M, Timi P, Das S, Immanuelle A, Jamieson DJ, Boulet SL. The impact of screening for social risks on OBGYN patients and providers: A systematic review of current evidence and key gaps. J Natl Med Assoc 2023; 115:405-420. [PMID: 37330393 PMCID: PMC10526693 DOI: 10.1016/j.jnma.2023.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 05/11/2023] [Accepted: 06/01/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND Increasingly, policymakers and professional organizations support screening for social assets and risks during clinical care. Scant evidence exists on how screening impacts patients, providers, or health systems. OBJECTIVE To systematically review published literature for evidence of the clinical utility of screening for social determinants of health in clinical obstetric and gynecologic (OBGYN) care. SEARCH STRATEGY We systematically searched Pubmed (March 2022, 5,302 identified) and identified additional articles using hand sorting (searching articles citing key articles (273 identified) and through bibliography review (20 identified)). SELECTION CRITERIA We included all articles that measured a quantitative outcome of systematic social determinants of health (SDOH) screening in an OBGYN clinical setting. Each identified citation was reviewed by two independent reviewers at both the title/abstract and full text stages. DATA COLLECTION AND ANALYSIS We identified 19 articles for inclusion and present the results using narrative synthesis. MAIN RESULTS The majority of articles reported on SDOH screening during prenatal care (16/19) and the most common SDOH was intimate partner violence (13/19 studies). Overall, patients had favorable attitudes towards SDOH screening (in 8/9 articles measuring attitudes), and referrals were common following positive screening (range 5.3%-63.6%). Only two articles presented data on the effects of SDOH screening on clinicians and none on health systems. Three articles present data on resolution of social needs, with inconsistent results. CONCLUSIONS Limited evidence exists on the benefits of SDOH screening in OBGYN clinical settings. Innovative studies leveraging existing data collection are needed to expand and improve SDOH screening.
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Affiliation(s)
- Kaitlyn K Stanhope
- Department of Gynecology and Obstetrics, Emory University School of Medicine, 49 Jesse Hill Jr. Drive SE Atlanta, GA 30303, United States.
| | - Anna Goebel
- Department of Gynecology and Obstetrics, Emory University School of Medicine, 49 Jesse Hill Jr. Drive SE Atlanta, GA 30303, United States
| | - Monica Simmonds
- Center for Black Women's Wellness, 477 Windsor St SW, Atlanta, GA 30312, United States
| | - Patience Timi
- Department of Gynecology and Obstetrics, Emory University School of Medicine, 49 Jesse Hill Jr. Drive SE Atlanta, GA 30303, United States
| | - Sristi Das
- Department of Gynecology and Obstetrics, Emory University School of Medicine, 49 Jesse Hill Jr. Drive SE Atlanta, GA 30303, United States
| | - Asha Immanuelle
- Center for Black Women's Wellness, 477 Windsor St SW, Atlanta, GA 30312, United States
| | - Denise J Jamieson
- Department of Gynecology and Obstetrics, Emory University School of Medicine, 49 Jesse Hill Jr. Drive SE Atlanta, GA 30303, United States
| | - Sheree L Boulet
- Department of Gynecology and Obstetrics, Emory University School of Medicine, 49 Jesse Hill Jr. Drive SE Atlanta, GA 30303, United States
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Niessink-Beckers S, Verhoeven CJ, Nahuis MJ, Horvat-Gitsels LA, Gitsels-van der Wal JT. Maternal characteristics associated with referral to obstetrician-led care in low-risk pregnant women in the Netherlands: A retrospective cohort study. PLoS One 2023; 18:e0282883. [PMID: 36921011 PMCID: PMC10016726 DOI: 10.1371/journal.pone.0282883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 02/27/2023] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND In the Netherlands, maternity care is divided into midwife-led care (for low-risk women) and obstetrician-led care (for high-risk women). Referrals from midwife-led to obstetrician-led care have increased over the past decade. The majority of women are referred during their pregnancy or labour. Referrals are based on a continuous risk assessment of the health and characteristics of mother and child, yet referral for non-medical factors and characteristics remain unclear. This study investigated which maternal characteristics are associated with women's referral from midwife-led to obstetrician-led care. MATERIALS AND METHODS A retrospective cohort study in one midwife-led care practice in the Netherlands included 1096 low-risk women during January 2015-17. The primary outcomes were referral from midwife-led to obstetrician-led care in (1) the antepartum period and (2) the intrapartum period. In total, 11 maternal characteristics were identified. Logistic regression models of referral in each period were fitted and stratified by parity. RESULTS In the antepartum period, referral among nulliparous women was associated with an older maternal age (aOR, 1.07; 95%CI, 1.05-1.09), being underweight (0.45; 0.31-0.64), overweight (2.29; 1.91-2.74), or obese (2.65; 2.06-3.42), a preconception period >1 year (1.34; 1.07-1.66), medium education level (0.76; 0.58-1.00), deprivation (1.87; 1.54-2.26), and sexual abuse (1.44; 1.14-1.82). Among multiparous women, a referral was associated with being underweight (0.40; 0.26-0.60), obese (1.61; 1.30-1.98), a preconception period >1 year (1.71; 1.27-2.28), employment (1.38; 1.19-1.61), deprivation (1.23; 1.03-1.46), highest education level (0.63; 0.51-0.80), psychological problems (1.24; 1.06-1.44), and one or multiple consultations with an obstetrician (0.68; 0.58-0.80 and 0.64; 0.54-0.76, respectively). In the intrapartum period, referral among nulliparous women was associated with an older maternal age (1.02; 1.00-1.05), being underweight (1.67; 1.15-2.42), a preconception period >1 year (0.42; 0.31-0.57), medium or high level of education (2.09; 1.49-2.91 or 1.56; 1.10-2.22, respectively), sexual abuse (0.46; 0.33-0.63), and multiple consultations with an obstetrician (1.49; 1.15-1.94). Among multiparous women, referral was associated with an older maternal age (1.02; 1.00-1.04), being overweight (0.65; 0.51-0.83), a preconception period >1 year (0.33; 0.17-0.65), non-Dutch ethnicity (1.98; 1.61-2.45), smoking (0.75; 0.57-0.97), sexual abuse (1.49; 1.09-2.02), and one or multiple consultations with an obstetrician (1.34; 1.06-1.70 and 2.09; 1.63-2.69, respectively). CONCLUSIONS This exploratory study showed that several non-medical maternal characteristics of low-risk pregnant women are associated with referral from midwife-led to obstetrician-led care, and how these differ by parity and partum period.
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Affiliation(s)
- Susan Niessink-Beckers
- Amsterdam UMC, Vrije Universiteit Amsterdam, Midwifery Science, AVAG, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
- * E-mail:
| | - Corine J. Verhoeven
- Amsterdam UMC, Vrije Universiteit Amsterdam, Midwifery Science, AVAG, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
- Department of Obstetrics and Gynecology, Maxima Medical Center, Veldhoven, Netherlands
- Division of Midwifery, School of Health Sciences, University of Nottingham, Nottingham, United Kingdom
| | - Marleen J. Nahuis
- Department of Obstetrics and Gynecology, Noordwest Hospital Group location Alkmaar, Alkmaar, Netherlands
| | - Lisanne A. Horvat-Gitsels
- UCL Great Ormond Street Institute of Child Health, Faculty of Population Health Sciences, University College London, London, United Kingdom
| | - Janneke T. Gitsels-van der Wal
- Amsterdam UMC, Vrije Universiteit Amsterdam, Midwifery Science, AVAG, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
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The Experiences of Midwives in Caring for Vulnerable Pregnant Women in The Netherlands: A Qualitative Cross-Sectional Study. Healthcare (Basel) 2022; 11:healthcare11010130. [PMID: 36611593 PMCID: PMC9819850 DOI: 10.3390/healthcare11010130] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 12/20/2022] [Accepted: 12/23/2022] [Indexed: 01/03/2023] Open
Abstract
Vulnerable pregnant women have an increased risk for preterm birth and perinatal mortality. This study identifies the perspectives, perceived barriers, and perceived facilitators of midwives toward current care for vulnerable pregnant women in the Netherlands. Knowing those perspectives, barriers, and facilitators could help increase quality of care, thereby reducing the risks of preterm birth and perinatal mortality. Midwives working in primary care practices throughout the Netherlands were interviewed. Semi-structured interviews were conducted remotely through a video conference program, audio recorded, transcribed verbatim, and coded based on the theoretical domains framework and concepts derived from the interviews, using NVivo-12. All midwives provided psychosocial care for vulnerable pregnant women, expected positive consequences for those women resulting from that care, considered it their task to identify and refer vulnerable women, and intended to improve the situation for mother and child. The main barriers perceived by midwives were too many organizations being involved, inadequate communication between care providers, lack of time to care for vulnerable women, insufficient financing to provide adequate care, and uncooperative clients. The main facilitators were having care coordinators, treatment guidelines, vulnerability detection tools, their own knowledge about local psychosocial organizations, good communication skills, cooperative clients, consultation with colleagues, and good communication between care providers. The findings suggest that midwives are highly motivated to care for vulnerable women and perceive a multitude of facilitators. However, they also perceive various barriers for providing optimal care. A national guideline on how to care for vulnerable women, local overviews of involved organizations, and proactive midwives who ensure connections between the psychosocial and medical domain could help to overcome these barriers, and therefore, maximize effectiveness of the care for vulnerable pregnant women.
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de Groot N, Bijma HH, Bonsel GJ, Lambregtse-van den Berg MP. The role of structured Antenatal Risk Management (sARM) on experiences with antenatal care by vulnerable clients. Midwifery 2018; 67:39-45. [PMID: 30223106 DOI: 10.1016/j.midw.2018.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Revised: 08/19/2018] [Accepted: 09/04/2018] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Vulnerable clients (i.e. clients reporting psychopathology, psychosocial problems, or substance use, and/or features of deprivation) represent a challenge in perinatal care, both in term of care process and outcome. Adhering to a structured care process (i.e. structured Antenatal Risk Management [sARM]) has shown to benefit professionals in supporting vulnerable clients, but its effect on client experiences is yet to be determined. As better processes are assumed to benefit outcome, we investigated the relationship between vulnerable clients' experiences with antenatal care in perinatal units adhering to differing degrees of sARM. METHODS We combined data from two sources: on the client level antenatal collected survey data from which vulnerability status (Mind2Care instrument) and client experiences (ReproQ questionnaire) were derived, and on the unit level interview data from healthcare providers from which the unit degree of sARM was ascertained. RESULTS A total of N = 1.176 clients from N = 38 units were included in the study. Vulnerable clients with psychosocial problems reported more negative experiences than non-vulnerable clients. In high sARM units, vulnerable clients, regardless of type of problems, reported more negative experiences than non-vulnerable clients. In multiple regression analysis this effect disappeared and only vulnerability defined as psychosocial problems remained predictive for negative experiences. CONCLUSIONS Vulnerable clients, specifically those with psychosocial problems, present a challenge in perinatal healthcare. Negative appraisal of care might be an unavoidable drawback of adhering to sARM. It also stresses the need for improving caregiver-client expectations and system side improvements.
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Affiliation(s)
- Nynke de Groot
- Department of Obstetrics and Gynaecology, Division of Obstetrics & Prenatal Medicine, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands; Department of Gynaecology, Division Woman and Baby, Wilhelmina Child Hospital, University Medical Centre Utrecht, Utrecht, The Netherlands.
| | - Hilmar H Bijma
- Department of Obstetrics and Gynaecology, Division of Obstetrics & Prenatal Medicine, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands.
| | - Gouke J Bonsel
- Department of Obstetrics and Gynaecology, Division of Obstetrics & Prenatal Medicine, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands; Department of Gynaecology, Division Woman and Baby, Wilhelmina Child Hospital, University Medical Centre Utrecht, Utrecht, The Netherlands.
| | - Mijke P Lambregtse-van den Berg
- Department of Obstetrics and Gynaecology, Division of Obstetrics & Prenatal Medicine, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands; Department of Psychiatry, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands; Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands.
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Larsson Å, Wärnå-Furu C, Näsman Y. The meaning of caring in prenatal care from Swedish women's perspectives. Scand J Caring Sci 2016; 31:702-709. [PMID: 27859526 DOI: 10.1111/scs.12383] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Accepted: 07/19/2016] [Indexed: 11/30/2022]
Abstract
AIM To deepen understanding of the meaning of caring in prenatal care from Swedish women's perspectives. METHOD Ten women, who had given birth between 1 and 2 months previously, were interviewed. The women have taken part in the routine programme that constitutes maternity care Sweden. A hermeneutic approach inspired by Gadamer was used to analyse the data and gain a deeper understanding of the women's experiences. FINDINGS Three themes were identified in the hermeneutical analysis. The themes highlight an existential and ontological aspect for caring as experienced of the women in the study: invitation and caring promise, witnessing and confirmation, and caring emerges in vulnerability. CONCLUSION The life-changing gravidity and vulnerability motivates caritative care during pregnancy. Reception of caring is not just a superficial feeling, but gives a new understanding of life on an ontological level. In a genuine caring relationship, the pregnant woman not only receives something but also a power and an opportunity to go further and find her own inner strength.
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Affiliation(s)
- Åsa Larsson
- Faculty of Education and Welfare Studies, Åbo Akademi University, Vasa, Finland
| | - Carola Wärnå-Furu
- Faculty of Education and Welfare Studies, Åbo Akademi University, Vasa, Finland
| | - Yvonne Näsman
- Faculty of Education and Welfare Studies, Åbo Akademi University, Vasa, Finland
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de Groot N, Venekamp AA, Torij HW, Lambregtse-Van den Berg MP, Bonsel GJ. Vulnerable pregnant women in antenatal practice: Caregiver's perception of workload, associated burden and agreement with objective caseload, and the influence of a structured organisation of antenatal risk management. Midwifery 2016; 40:153-61. [PMID: 27449324 DOI: 10.1016/j.midw.2016.07.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 06/16/2016] [Accepted: 07/03/2016] [Indexed: 11/27/2022]
Abstract
INTRODUCTION pregnancy care for vulnerable women is often perceived as a burden by caregivers as vulnerable clients require complex case management, additional time, and more often show adverse perinatal outcomes. Vulnerable clients bring about additional work strain for the caregiver, especially when the workload is high. We define client vulnerability as coexistence of psychopathology, psychosocial problems or substance use, together with features of deprivation. We investigated, as part of a national programme, whether the subjective caregiver's perception of workload and the objective registry-based caseload of vulnerable clients are in agreement, and whether a structured organisation of antenatal risk management reduces the burden associated with the perceived workload, in particular if the objective caseload is high. METHODS we combined three data sources: (1) at the unit level (i.e. midwifery practice, obstetric unit) interview data from caregivers, from which we derived a) the (subjective) caregiver's perception of workload, b) the associated burden and c) organisational structure of antenatal risk management, (2) at the unit level perinatal registry data, from which we derived a) unit characteristics and b) (objective) unit specific caseload, and (3) at the individual client level survey data collected during the first antenatal visit, from which the prevalence of vulnerable clients was derived. The study area was the South-West Netherlands (2.5 million inhabitants), containing areas with varying degrees of urbanisation and deprivation. FINDINGS sixteen units had complete data on all measures. Generally, subjective workload and objective caseload were only weakly related, the relation being modified by the organisation of antenatal risk management. If the organisational structure of antenatal risk management was low, the experienced burden was high, even if the objective caseload was low. Highly structured antenatal risk management was associated with a medium to low burden. DISCUSSION our observational study suggests that even a high caseload can be dealt with by structured antenatal risk management. A change from the current individual case-finding policies towards a more universal screen-like approach may thus benefit both the client and the caregiver.
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Affiliation(s)
- Nynke de Groot
- Department of Obstetrics and Gynecology, Division of Obstetrics & Prenatal Medicine, University Medical Centre Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands.
| | - Angélica A Venekamp
- Rotterdam University of Applied Science, Center of Expertise Innovations in Care, P.O. Box 25035, 3001 HA Rotterdam, The Netherlands.
| | - Hanneke W Torij
- Rotterdam University of Applied Science, Center of Expertise Innovations in Care, P.O. Box 25035, 3001 HA Rotterdam, The Netherlands.
| | | | - Gouke J Bonsel
- Department of Obstetrics and Gynecology, Division of Obstetrics & Prenatal Medicine, University Medical Centre Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands.
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Kennedy AB, Cambron JA, Sharpe PA, Travillian RS, Saunders RP. Process for massage therapy practice and essential assessment. J Bodyw Mov Ther 2016; 20:484-96. [PMID: 27634069 DOI: 10.1016/j.jbmt.2016.01.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Revised: 12/14/2015] [Accepted: 01/23/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND Little evidence exists about processes in massage therapy practice. Investigating current frameworks is warranted. This qualitative study is a secondary data analysis using grounded theory to understand how massage therapy experts describe massage therapy practice. METHODS 31 massage therapy experts were invited to a 2-day symposium to discuss best practices for the profession. Through qualitative analysis, memoing, and discussion, the data were summarized into themes. RESULTS Three themes were identified around massage therapy practice: 1) client centered, 2) structure for practice, and 3) influencing factors. Each theme is clarified and expanded. DISCUSSION Conceptual models were developed for research and clinical practice and a definition for massage therapy practice was identified. Challenges and limitations are discussed. CONCLUSION The goal of providing these models is to give massage therapists tools to deliver the best possible care. The models need testing to see if they help advance the profession.
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Affiliation(s)
| | | | | | | | - Ruth P Saunders
- University of South Carolina, Department of Health Promotion, Education, and Behavior, USA
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