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Gebeyehu NA, Adella GA, Tegegne KD. Disrespect and abuse of women during childbirth at health facilities in Eastern Africa: systematic review and meta-analysis. Front Med (Lausanne) 2023; 10:1117116. [PMID: 37153101 PMCID: PMC10157168 DOI: 10.3389/fmed.2023.1117116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 04/03/2023] [Indexed: 05/09/2023] Open
Abstract
Background Disrespectful and abusive maternity care is a sign of poor treatment that influences women's choice to deliver their babies in institutions. Such malpractices continue to go unreported and are rarely exposed in developing countries, despite their serious burden. Therefore, this meta-analysis study aimed to estimate disrespect and abuse of women during childbirth in East Africa. Methods PubMed, Google Scholar, Scopus, and Science Direct databases were searched. Data were extracted using Microsoft Excel and analyzed using STATA statistical software (v. 14). Publication bias was checked by forest plot, Begg's rank test, and Egger's regression test. To look for heterogeneity, I2 was computed, and an overall estimated analysis was carried out. Subgroup analysis was done by study region, sample size, and publication. The pooled odds ratio for associated factors was also computed. Results Out of 654 articles assessed, 18 met the criteria and were included in this study. There were a total of 12,434 study participants. The pooled prevalence of disrespect and abuse of women during childbirth in East Africa was 46.85% (95% CI: 45.26.72-66.98), I2 = 81.9%. It was lower in studies with sample size greater than 5000 (33%). The disrespect and abuse rates between community-based studies (44.96%) and institutional-based studies (47.35%) did not differ significantly, though. Instrumental delivery (AOR = 2.70; 95%CI: 1.79-4.08), presence of complications (AOR = 6.41; 95% CI: 1.36-30.14), receiving care at government hospitals (AOR = 3.66; 95% CI: 1.09-12.23), and poor wealth index (AOR = 2.16; 95% CI: 1.26-3.70) were associated factors. Conclusion In East Africa, disrespect and abuse of women during childbirth was high. Instrumental delivery, presence of complications during childbirth, receiving care at government hospitals and poor wealth index were predictors of maternal disrespect and abuse. Safe delivery practice should be promoted. Training in compassionate and respectful maternity care, particularly in public hospitals, has also been recommended.
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Affiliation(s)
- Natnael Atnafu Gebeyehu
- School of Midwifery, College of Health Science and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Gtachew Asmare Adella
- School of Public Health, College of Health Sciences and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Kirubel Dagnaw Tegegne
- Department of Nursing, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
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Inclusive, supportive and dignified maternity care (SDMC)-Development and feasibility assessment of an intervention package for public health systems: A study protocol. PLoS One 2022; 17:e0263635. [PMID: 35139119 PMCID: PMC8827422 DOI: 10.1371/journal.pone.0263635] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 01/21/2022] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Mistreatment, discrimination, and poor psycho-social support during childbirth at health facilities are common in lower- and middle-income countries. Despite a policy directive from the World Health Organisation (WHO), no operational model exists that effectively demonstrates incorporation of these guidelines in routine facility-based maternity services. This early-phase implementation research aims to develop, implement, and test the feasibility of a service-delivery strategy to promote the culture of supportive and dignified maternity care (SDMC) at public health facilities. METHODS Guided by human-centred design approach, the implementation of this study will be divided into two phases: development of intervention, and implementing and testing feasibility. The service-delivery intervention will be co-created along with relevant stakeholders and informed by contextual evidence that is generated through formative research. It will include capacity-building of maternity teams, and the improvement of governance and accountability mechanisms within public health facilities. The technical content will be primarily based on WHO's intrapartum care guidelines and mental health Gap Action Programme (mhGAP) materials. A mixed-method, pre-post design will be used for feasibility assessment. The intervention will be implemented at six secondary-level healthcare facilities in two districts of southern Sindh, Pakistan. Data from multiple sources will be collected before, during and after the implementation of the intervention. We will assess the coverage of the intervention, challenges faced, and changes in maternity teams' understanding and attitude towards SDMC. Additionally, women's maternity experiences and psycho-social well-being-will inform the success of the intervention. EXPECTED OUTCOMES Evidence from this implementation research will enhance understanding of health systems challenges and opportunities around SDMC. A key output from this research will be the SDMC service-delivery package, comprising a comprehensive training package (on inclusive, supportive and dignified maternity care) and a field tested strategy to ensure implementation of recommended practices in routine, facility-based maternity care. Adaptation, Implementation and evaluation of SDMC package in diverse setting will be way forward. The study has been registered with clinicaltrials.gov (Registration number: NCT05146518).
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Zheng MY, Lui H, Patino G, Mmonu N, Cohen AJ, Breyer BN. Morbidity and Mortality Caused by Noncompliance With California Hospital Licensure: Immediate Jeopardies in California Hospitals, 2007-2017. J Patient Saf 2022; 18:e401-e406. [PMID: 35188929 DOI: 10.1097/pts.0000000000000822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The California Department of Public Health investigates compliance with hospital licensure and issues an administrative penalty when there is an immediate jeopardy. Immediate jeopardies are situations in which a hospital's noncompliance of licensure requirements causes serious injury or death to patient. In this study, we critically examine immediate jeopardies between 2007 and 2017 in California. METHODS All immediate jeopardies reported between 2007 and 2017 were abstracted for hospital, location, date, details of noncompliance, and patient's health outcome. RESULTS Of 385 unique immediate jeopardies, 141 (36.6%) caused mortality, 120 (31.2%) caused morbidity, 96 (24.9%) led to a second surgery, 9 (2.3%) caused emotional trauma without physical trauma, and 19 (4.9%) were caught before patients were harmed. Immediate jeopardy categories included the following: surgical (34.2%), medication (18.9%), monitoring (14.2%), falls (7.8%), equipment (5.4%), procedural (5.4%), resuscitation (4.4%), suicide (3.9%), MD/RN miscommunication (3.4%), and abuse (2.3%). CONCLUSIONS Noncompliance to hospital licensure causes significant morbidity and mortality. Statewide hospital licensure policies should focus on enacting standardized reporting requirements of immediate jeopardies into an Internet-based form that public health officials can regularly analyze to improve hospital safety.
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Affiliation(s)
- Micha Y Zheng
- From the Department of Urology, University of California, San Francisco, San Francisco
| | - Hansen Lui
- Department of Urology, University of California, Davis, Sacramento, California
| | - German Patino
- Department of Urology, Hospital Universitario San Ignacio, Bogota, Colombia
| | | | - Andrew J Cohen
- The Brady Urological Institute at JHBMC, Baltimore, Maryland
| | - Benjamin N Breyer
- Department of Urology, Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California
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Rassenhofer M, Korger S, Fegert JM, Hoffmann U. Häufigkeiten von Übergriffen auf Kinder und Jugendliche durch Angehörige der Heil- und Pflegeberufe. KINDHEIT UND ENTWICKLUNG 2021. [DOI: 10.1026/0942-5403/a000355] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Zusammenfassung. Theoretischer Hintergrund: Kindesmisshandlung, -missbrauch und Vernachlässigung stellen ein gesamtgesellschaftliches Entwicklungsrisiko für Kinder in Deutschland dar. Zweithäufigster Kontext des Geschehens nach dem familiären Umfeld sind Institutionen. Fragestellung: Der vorliegende Artikel gibt eine Übersicht zu Häufigkeiten von Übergriffen durch Angehörige der Heil- und Pflegeberufe mit Schwerpunkt auf dem kinder- und jugendpsychiatrischen/-psychotherapeutischen Bereich. Methode: Mittels Literaturrecherche wird der Forschungsstand zum Thema dargestellt. Ergebnisse: Neben Auswertungen zu Zwangsmaßnahmen, welche von Betroffenen häufig als viktimisierend erlebt werden, existieren für Deutschland zwei repräsentative retrospektive Befragungen zum medizinischen Bereich. Hier ergaben sich Prävalenzen zwischen einem Fünftel und einem Drittel der Befragten, die mindestens eine Form von Gewalt oder Vernachlässigung bejahten. Diskussion und Schlussfolgerung: Neben alarmierenden Zahlen zeigt sich der große Bedarf an weiterer Forschung zum Thema.
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Affiliation(s)
- Miriam Rassenhofer
- Klinik für Kinder- und Jugendpsychiatrie/Psychotherapie, Universitätsklinikum Ulm
| | - Simone Korger
- Klinik für Kinder- und Jugendpsychiatrie/Psychotherapie, Universitätsklinikum Ulm
| | - Jörg M. Fegert
- Klinik für Kinder- und Jugendpsychiatrie/Psychotherapie, Universitätsklinikum Ulm
| | - Ulrike Hoffmann
- Klinik für Kinder- und Jugendpsychiatrie/Psychotherapie, Universitätsklinikum Ulm
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Hameed W, Uddin M, Avan BI. Are underprivileged and less empowered women deprived of respectful maternity care: Inequities in childbirth experiences in public health facilities in Pakistan. PLoS One 2021; 16:e0249874. [PMID: 33858009 PMCID: PMC8049770 DOI: 10.1371/journal.pone.0249874] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 03/27/2021] [Indexed: 11/19/2022] Open
Abstract
Background Attainment of healthcare in respectful and dignified manner is a fundamental right for every woman regardless of the individual status. However, social exclusion, poor psychosocial support, and demeaning care during childbirth at health facilities are common worldwide, particularly in low- and middle-income countries. We concurrently examined how women with varying socio-demographic characteristics are treated during childbirth, the effect of women’s empowerment on mistreatment, and health services factors that contribute to mistreatment in secondary-level public health facilities in Pakistan. Methods A cross-sectional survey was conducted during August–November 2016 among 783 women who gave birth in six secondary-care public health facilities across four contiguous districts of southern Sindh. Women were recruited in health facilities and later interviewed at home within 42 days of postpartum using a WHO’s framework-guided 43-item structured questionnaire. Means, standard deviation, and average were used to describe characteristics of the participants. Multivariable linear regression was applied using Stata 15.1. Results Women experiencing at least one violation of their right to care by hospital staff during intrapartum care included: ineffective communication (100%); lack of supportive care (99.7%); loss of autonomy (97.5%); failure of meeting professional clinical standards (84.4%); lack of resources (76.3%); verbal abuse (15.2%); physical abuse (14.8%); and discrimination (3.2%). Risk factors of all three dimensions showed significant association with mistreatment: socio-demographic: primigravida and poorer were more mistreated; health services: lesser-education on birth preparedness and postnatal care leads to higher mistreatment; and in terms of women’s empowerment: women who were emotionally and physically abused by family, and those with lack of social support and lesser involvement in joint household decision making with husbands are more likely to be mistreated as compared to their counterparts. The magnitude of relationship between all significant risk factors and mistreatment, in the form of β coefficients, ranged from 0.2 to 5.5 with p-values less than 0.05. Conclusion There are glaring inequalities in terms of the way women are treated during childbirth in public health facilities. Measures of socio-demographic, health services, and women’s empowerment showed a significant independent association with mistreatment during childbirth. At the health system level, there is a need for urgent solutions for more inclusive care to ensure that all women are treated with compassion and dignity, complemented by psychosocial support for those who are emotionally disturbed and lack social support.
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Affiliation(s)
- Waqas Hameed
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Mudassir Uddin
- Department of Statistics, University of Karachi, Karachi, Pakistan
| | - Bilal Iqbal Avan
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
- * E-mail:
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Relationship of post-traumatic stress disorder with disrespect and abuse during childbirth in a group of Iranian postpartum women: a prospective study. Ann Gen Psychiatry 2021; 20:8. [PMID: 33485389 PMCID: PMC7827985 DOI: 10.1186/s12991-021-00331-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 01/12/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Disrespect and abuse (D&A) violate the fundamental principles of ethics, human rights, and basic obligations to protect and relieve patients. This study aimed to identify the status of D&A and its relationship with the post-traumatic stress disorder (PTSD) among Iranian women. METHODS This prospective study was conducted on 288 mothers admitted to the maternity wards of three public and three private hospitals in Tabriz. The data collection tools were socio-demographic and obstetric questionnaires as well as D&A (6-18 h postpartum) and PTSD (one month postpartum) scales, which were completed by participants in interviews. Multivariate logistic regression was employed to determine the relationship between PTSD and D&A in adjusting the socio-demographic and obstetric variables. RESULTS In this study, 74.7% of mothers reported one or multiple types of D&A. According to the diagnostic criteria for PTSD, 16.3% of the participants experienced postpartum PTSD. The mean (± standard deviation) of the PTSD score was reported 7.32 (± 2.0) in the women experiencing D&A, whereas it was 1.0 (± 0.0) in the women having no experiences of D&A. According to the Mann-Whitney U test results, there was a significant relationship between the total and all subscales of PTSD score and D&A (p < 0.001). The multivariate logistic regression results indicated that the likelihood of PTSD was significantly lower in the participants without any D&A experiences than in those with D&A experiences (aOR: 0.06; 95% CI 0.01 to 0.58; p = 0.015). CONCLUSION Given the PTSD-D&A relationship, it is recommended to improve maternal care in maternity facilities to prevent any unintended PTSD complications.
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Infanti JJ, Zbikowski A, Wijewardene K, Swahnberg K. Feasibility of Participatory Theater Workshops to Increase Staff Awareness of and Readiness to Respond to Abuse in Health Care: A Qualitative Study of a Pilot Intervention Using Forum Play among Sri Lankan Health Care Providers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17207698. [PMID: 33096886 PMCID: PMC7589055 DOI: 10.3390/ijerph17207698] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 10/16/2020] [Accepted: 10/20/2020] [Indexed: 11/16/2022]
Abstract
Women globally experience mistreatment by health providers during childbirth. Researchers have identified strategies to counteract this type of abuse in health care, but few have been evaluated. We used a theater technique, Forum Play, in a brief training intervention to increase awareness of abuse in health care and promote taking action to reduce or prevent it. The intervention was implemented in four workshops with 50 participating physicians and nurses from three hospitals in Colombo, Sri Lanka. This article reports the views of 23 workshop participants who also took part in four focus group discussions on the acceptability and feasibility of the method. The participants reported that the intervention method stimulated dialogue and critical reflection and increased their awareness of the everyday nature of abuses experienced by patients. Participants appreciated the participatory format of Forum Play, which allowed them to re-enact scenarios they had experienced and rehearse realistic actions to improve patient care in these situations. Structural factors were reported as limitations to the effectiveness of the intervention, including under-developed systems for protecting patient rights and reporting health provider abuses. Nonetheless, the study indicates the acceptability and feasibility of a theater-based training intervention for reducing the mistreatment of patients by health care providers in Sri Lanka.
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Affiliation(s)
- Jennifer J. Infanti
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, N-7491 Trondheim, Norway
- Correspondence: ; Tel.: +47-94721964
| | - Anke Zbikowski
- Women’s Clinic, Ryhov County Hospital, SE-55185 Jönköping, Sweden;
| | - Kumudu Wijewardene
- Department of Community Medicine, Faculty of Medical Sciences, University of Sri Jayewardenepura, Gangodawila, Nugegoda 10250, Sri Lanka;
| | - Katarina Swahnberg
- Department of Health and Caring Sciences, Faculty of Health and Life Sciences, Linnaeus University, SE-391 82 Kalmar, Sweden;
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Counteracting Abuse in Health Care: Evaluating a One-Year Drama Intervention with Staff in Sweden. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17165931. [PMID: 32824182 PMCID: PMC7459683 DOI: 10.3390/ijerph17165931] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 08/10/2020] [Accepted: 08/12/2020] [Indexed: 11/18/2022]
Abstract
In Northern European countries 13–28% of female patients seeking gynecological health care have reported abuse by health care staff (AHC). We conducted workshops with health care staff using the improvised role-play method Forum Play (FP), based on techniques developed by Boal. The study explores to what extent the intervention increased the staff’s awareness of AHC and their ability to take action against it. A total of 16 half-day FP workshops were conducted with staff from a Swedish women’s clinic over one year. Self-reported questionnaires were distributed to all staff before, during, and after the intervention. Primary outcome measures were the number of reported occasions of AHC and FP participants’ ability to act in AHC-situations. We found an increase in the participants’ self-reported ability to act in AHC-related situations. However, no change could be observed in the number of reported occasions of AHC between baseline and one year after the intervention. Health care staff’s participation in workshops using improvised role-play can increase staff’s perceived ability to take action in AHC situations. The voluntary nature of the intervention may have attracted those who were already aware of the topic, and likely explains the unchanged awareness of AHC.
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Malet S, Choux C, Akrich M, Simon E, Sagot P. [Mistreatment during childbirth: A prospective multicentric survey among women in maternities in Burgundy]. ACTA ACUST UNITED AC 2020; 48:790-799. [PMID: 32376481 DOI: 10.1016/j.gofs.2020.04.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Indexed: 01/30/2023]
Abstract
OBJECTIVES The purpose of this study was to estimate the prevalence of mistreatment during childbirth (MDCB), to assess the subjective experience of women and to identify the factors associated with MDCB. METHODS This prospective multicentered study included every single public maternity of the Burgundy Perinatal Network from the 15th of February to the 15th of March 2019. An anonymous questionnaire was distributed on postpartum's second day. It encompassed the following categories of MDCB: verbal, physical abuse, information, consent, failure to meet professional standards of care (PSC), poor rapport between women and providers (PRBWP), and discrimination, as well as the subjective experience, physical and psychological. RESULTS Out of 1793 eligible women, 1149 answered (64.1%). Women reported a positive experience of childbirth, physical (89.8%) and psychological (93.4%). On the other hand, 506 women (44%) reported MDCB. The incidence of verbal (2.3%) or physical (0.4%) abuse or discrimination (3.5%) was marginal. MDCB reported was mainly a lack of research and/or respect of consent (21.5%), lack of satisfying information for at least one procedure (14.4%), declaration of lack of respect of PSC (24.2%), PRBWP (11.1%). When the subjective experience of childbirth was negative on the physical aspect, one MDCB was declared in 80% of cases (P<0.01). CONCLUSIONS This study highlights the importance of involving women in care's decisions. We should systematize the information and seeking of consent in a dynamic way and promote free choice for women.
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Affiliation(s)
- S Malet
- Service de gynécologie-obstétrique, CHU de Dijon Bourgogne, 14, rue Gaffarel, 21000 Dijon, France
| | - C Choux
- Service de gynécologie-obstétrique, CHU de Dijon Bourgogne, 14, rue Gaffarel, 21000 Dijon, France.
| | - M Akrich
- Collectif interassociatif autour de la naissance - CIANE, 40, rue Chanzy, 75011 Paris, France
| | - E Simon
- Service de gynécologie-obstétrique, CHU de Dijon Bourgogne, 14, rue Gaffarel, 21000 Dijon, France
| | - P Sagot
- Service de gynécologie-obstétrique, CHU de Dijon Bourgogne, 14, rue Gaffarel, 21000 Dijon, France
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Respectful maternity care and its related factors in maternal units of public and private hospitals in Tabriz: a sequential explanatory mixed method study protocol. Reprod Health 2020; 17:9. [PMID: 31959206 PMCID: PMC6971930 DOI: 10.1186/s12978-020-0863-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 01/14/2020] [Indexed: 11/29/2022] Open
Abstract
Background Disrespect and abuse (D&A) can violate human rights, affect women’s decisions on the type of delivery method, and exacerbate their mental health conditions; therefore, this study aims to: a) assess the status of D&A and respectful maternity care (RMC) during childbirth and their relationships with childbirth experience, socio-demographic and obstetrics characteristics; b) explain women’s perceptions of various RMC aspects and determinants during childbirth; and c) present a guideline for promoting of RMC. Methods/design A mixed methods sequential explanatory design will be used to conduct this study in 3 phases. The first phase is a quantitative study with a longitudinal descriptive-analytical design to identify any D&A and RMC and their relationships with childbirth experience among 334 women who have given birth in public and private hospitals in Tabriz, Iran. The sample will be selected proportional to each population. The second phase is a qualitative study to explore women’s perceptions of various RMC aspects and their determinants during childbirth. The conventional content analysis approach will be used to analyze the data. The third phase is focused on developing a guideline to improve the quality of maternity care. The literature review, findings of phase one and two, and focus group discussion (FGDs) with staff in the labour ward and using a Delphi technique will be used to complete the final phase. Discussion Considering the vulnerability of women during labor and delivery and the effect of D&A on cesarean section rates, a supportive guideline can improve the quality of maternity care and reduce D&A during childbirth, and improve women’s childbirth experiences. Ethical code IR.TBZMED.REC.1398.202.
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Swahnberg K, Zbikowski A, Wijewardene K, Josephson A, Khadka P, Jeyakumaran D, Mambulage U, Infanti JJ. Can Forum Play Contribute to Counteracting Abuse in Health Care? A Pilot Intervention Study in Sri Lanka. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16091616. [PMID: 31072034 PMCID: PMC6539783 DOI: 10.3390/ijerph16091616] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 04/30/2019] [Accepted: 05/06/2019] [Indexed: 11/16/2022]
Abstract
Obstetric violence refers to the mistreatment of women in pregnancy and childbirth care by their health providers. It is linked to poor quality of care, lack of trust in health systems, and adverse maternal and neonatal outcomes. Evidence of interventions to reduce and prevent obstetric violence is limited. We developed a training intervention using a participatory theatre technique called Forum Play inspired by the Theatre of the Oppressed for health providers in Sri Lanka. This paper assesses the potential of the training method to increase staff awareness of obstetric violence and promote taking action to reduce or prevent it. We conducted four workshops with 20 physicians and 30 nurses working in three hospitals in Colombo, Sri Lanka. Participants completed a questionnaire before and three-to-four months after the intervention. At follow-up, participants more often reported that they had been involved in situations of obstetric violence, indicating new knowledge of the phenomenon and/or an increase in their ability to conceptualise it. The intervention appears promising for improving the abilities of health care providers to recognise obstetric violence, the first step in counteracting it. The study demonstrates the value of developing further studies to assess the longitudinal impacts of theatre-based training interventions to reduce obstetric violence and, ultimately, improve patient care.
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Affiliation(s)
- Katarina Swahnberg
- Department of Health and Caring Sciences, Faculty of Health and Life Sciences, Linnaeus University, Hus Vita, S-391 82 Kalmar, Sweden.
| | - Anke Zbikowski
- Jönköping's County Hospital Ryhov, Women's Clinic, S-55185 Jönköping, Sweden.
| | - Kumudu Wijewardene
- Department of Community Medicine, Faculty of Medical Sciences, University of Sri Jayewardenepura, Gangodawila, Nugegoda 10250, Sri Lanka.
| | | | - Prembarsha Khadka
- Department of Health and Caring Sciences, Faculty of Health and Life Sciences, Linnaeus University, Hus Vita, S-391 82 Kalmar, Sweden.
| | - Dinesh Jeyakumaran
- Department of Community Medicine, Faculty of Medical Sciences, University of Sri Jayewardenepura, Gangodawila, Nugegoda 10250, Sri Lanka.
| | - Udari Mambulage
- Department of Community Medicine, Faculty of Medical Sciences, University of Sri Jayewardenepura, Gangodawila, Nugegoda 10250, Sri Lanka.
| | - Jennifer J Infanti
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Postboks 8905, N-7491 Trondheim, Norway.
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Wangel AM, Ouis P. Reflections on the Translation Into Arabic and Validation Process of the NorAQ Abuse Questionnaire. JOURNAL OF INTERPERSONAL VIOLENCE 2019; 34:585-598. [PMID: 27094009 DOI: 10.1177/0886260516644595] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The use of validated instruments and questionnaires on abuse is of great importance to evaluate and compare the prevalence in different populations worldwide. However, most of the questionnaires available and published are in English. For example, the NorVold Abuse Questionnaire (NorAQ) instrument which was used for the Bidens study in six European countries. A substantial proportion of the pregnant population in the catchment area of the clinical site in Sweden is Arabic-speaking women. As abuse and violence against women is a global concern, it is important to translate these questionnaires to other languages. This process is not just merely a matter of finding a correlating word but also needs to be validated for content and consider the wording in a linguistic and cultural context. This article gives an account of the translation and content validity process and its challenges and pitfalls from Swedish and English into the Arabic language version.
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Brüggemann AJ, Forsberg C, Thornberg R. Re-negotiating agency - patients using comics to reflect upon acting in situations of abuse in health care. BMC Health Serv Res 2019; 19:58. [PMID: 30674310 PMCID: PMC6343282 DOI: 10.1186/s12913-019-3902-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Accepted: 01/14/2019] [Indexed: 11/30/2022] Open
Abstract
Background There is a growing body of international research that displays the prevalence and character of abuse in health care. Even though most of these studies are conducted from a patient perspective little is known about how patients conceptualize their agency in relation to such situations. This study aimed to explore how patients reason about their potential to act in abusive situations. Methods Qualitative interviews were conducted with thirteen patients in Sweden. Central in the interviews were three comics, inspired by Boal’s Forum Theatre and part of an earlier online intervention study in which the informants had participated. Each comic showed a situation in which a patient feels abused, and on the opposite side were suggestions for how the patient could act in response. Informants were asked to reflect about situations of abuse and in specific upon the comics. We used the methodology of constructivist grounded theory throughout the study, including the analysis. Results It appeared that the informants constantly re-negotiated their and other patients’ agency in relation to the specifics of the event, patients’ and staff’s responsibilities, and the patients’ needs and values. This process questions views of agency as fixed and self-evident, and can be understood as part of changing discourses about patients’ social role and possibilities to organize their care. Using a feminist theory of power we expected the informants to elicit instances of resistance to domination, which is central to the comics. While doing that, the informants also hinted at parallel stories of empowerment and less visible forms of agency in spite of domination. Conclusion The current analysis showed different ways in which the informants constantly re-negotiated their agency in potentially abusive situations. Not only did the informants engage in reflections about immediate responses to these untoward situations, they also engaged in thoughts about strategies that could protect them and counteract abuse in health care over the long-term. This opens up for future research into ways patients organize their care and identify threats and barriers to the care they need, which could be valuable knowledge for care quality improvement.
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Affiliation(s)
- A Jelmer Brüggemann
- Gender and Medicine, Department of Clinical and Experimental Medicine, Linköping University, 581 83, Linköping, Sweden. .,Department of Thematic Studies - Technology and Social Change, Linköping University, 581 83, Linköping, Sweden.
| | - Camilla Forsberg
- Gender and Medicine, Department of Clinical and Experimental Medicine, Linköping University, 581 83, Linköping, Sweden.,Department of Behavioural Sciences and Learning, Linköping University, 581 83, Linköping, Sweden
| | - Robert Thornberg
- Department of Behavioural Sciences and Learning, Linköping University, 581 83, Linköping, Sweden
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15
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Hållstam A, Stålnacke BM, Svensén C, Löfgren M. Living with painful endometriosis - A struggle for coherence. A qualitative study. SEXUAL & REPRODUCTIVE HEALTHCARE 2018; 17:97-102. [PMID: 30193728 DOI: 10.1016/j.srhc.2018.06.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Revised: 05/14/2018] [Accepted: 06/14/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The study sought to examine women's experience of painful endometriosis including long-term aspects, social consequences, impact of treatment and development of own coping strategies. STUDY DESIGN This qualitative study was based on 16 individual interviews analyzed according to grounded theory. The thirteen women (age 24-48) were recruited at a pain clinic in Stockholm, Sweden. RESULTS A theory illustrating women's experience of living with painful endometriosis was developed with three categories and one core category. Bidirectional interactions between the categories and with the core category were found. Endometriosis influenced the women's sensations, feelings and reactions, creating a sense of difference from other women (category: Woman with painful endometriosis). The condition led to either helpful or harmful encounters with health care and significant others (category: Dependence). It also had overall physical, social and existential consequences (category: A ruined life). To cope, the women had to struggle for coherence by searching for understanding, coping and meaning (core category: Living with painful endometriosis). CONCLUSIONS Living with severe painful endometriosis signified a struggle for coherence. The women needed to deal with feelings of difference, dependence and a ruined life and thus struggled for understanding, coping and meaning. Health-care providers should promote the struggle for coherence by explaining the feeling of difference, minimizing dependence and supporting the process of disease-related grief.
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Affiliation(s)
- A Hållstam
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, and Anesthesiology and Intensive Care Unit, Södersjukhuset, SE-118 83 Stockholm, Sweden.
| | - B M Stålnacke
- Department of Community Medicine and Rehabilitation, Rehabilitation Medicine, Umeå University, SE- 901 85 Umeå, Sweden; Department of Clinical Sciences, Karolinska Institutet, and Department of Rehabilitation Medicine, Danderyd Hospital, SE-182 88 Stockholm, Sweden.
| | - C Svensén
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, and Anesthesiology and Intensive Care Unit, Södersjukhuset, SE-118 83 Stockholm, Sweden; University of Texas Medical Branch at Galveston, UTMB Health, Department of Anesthesiology, Galveston, TX, USA.
| | - M Löfgren
- Department of Clinical Sciences, Karolinska Institutet, and Department of Rehabilitation Medicine, Danderyd Hospital, SE-182 88 Stockholm, Sweden.
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Orpin J, Puthussery S, Davidson R, Burden B. Women's experiences of disrespect and abuse in maternity care facilities in Benue State, Nigeria. BMC Pregnancy Childbirth 2018; 18:213. [PMID: 29879944 PMCID: PMC5992700 DOI: 10.1186/s12884-018-1847-5] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 05/23/2018] [Indexed: 11/10/2022] Open
Abstract
Background Disrespect and abuse (D&A) of women in health facilities continues to be a prevailing public health issue in many countries. Studies have reported significantly high prevalence of D&A among women during pregnancy and childbirth in Nigeria, but little is known about women’s perceptions and experiences of D&A during maternity care in the country. The aim of this study was to explore: 1) how women perceived their experiences of D&A during pregnancy, childbirth, and in the postnatal period in Benue State, Nigeria; and 2) how women viewed the impact of D&A on the future use of health facilities for maternity care. Method Five focus group discussions with a sample of 32 women were conducted as part of a qualitative phenomenological study. All the women received maternity care in health facilities in Benue State, Nigeria and had experienced at least one incident of disrespect and abuse. Audio-recorded discussions were transcribed and analysed using a six-stage thematic analysis using NVivo11. Results The participants perceived incidents such as being shouted at and the use of abusive language as a common practice. Women described these incidents as devaluing and dehumanising to their sense of dignity. Some women perceived that professionals did not intend to cause harm by such behaviours. Emerged themes included: (1) ‘normative’ practice; (2) dehumanisation of women; (3) 'no harm intended' and (4) intentions about the use of maternity services in future. The women highlighted the importance of accessing health facilities for safe childbirth and expressed that the experiences of D&A may not impact their intended use of health facilities. However, the accounts reflected their perceptions about the inherent lack of choice and an underlying sense of helplessness. Conclusion Incidents of D&A that were perceived as commonplace carry substantial implications for the provision of respectful maternity care in Nigeria and other similar settings. As a country with one of the highest rates of maternal deaths, the findings point to the need for policy and practice to address the issue urgently through implementing preventive measures, including empowering women to reinforce their right to be treated with dignity and respect, and sensitising health care professionals.
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Affiliation(s)
- Joy Orpin
- Institute for Health Research, University of Bedfordshire, Putteridge Bury, Hitchin Road, Luton, Bedfordshire, LU2 8LE, UK
| | - Shuby Puthussery
- School of Health Care Practice & Institute for Health Research, University of Bedfordshire, Putteridge Bury, Hitchin Road, Luton, Bedfordshire, LU2 8LE, UK.
| | - Rosemary Davidson
- Institute for Health Research, University of Bedfordshire, Putteridge Bury, Hitchin Road, Luton, Bedfordshire, LU2 8LE, UK
| | - Barbara Burden
- School of Health Care Practice & Institute for Health Research, University of Bedfordshire, Putteridge Bury, Hitchin Road, Luton, Bedfordshire, LU2 8LE, UK
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17
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Hameed W, Avan BI. Women's experiences of mistreatment during childbirth: A comparative view of home- and facility-based births in Pakistan. PLoS One 2018; 13:e0194601. [PMID: 29547632 PMCID: PMC5856402 DOI: 10.1371/journal.pone.0194601] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 02/16/2018] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Respectful and dignified healthcare is a fundamental right for every woman. However, many women seeking childbirth services, especially those in low-income countries such as Pakistan, are mistreated by their birth attendants. The aim of this epidemiological study was to estimate the prevalence of mistreatment and types of mistreatment among women giving birth in facility- and home-based settings in Pakistan in order to address the lack of empirical evidence on this topic. The study also examined the association between demographics (socio-demographic, reproductive history and empowerment status) and mistreatment, both in general and according to birth setting (whether home- or facility-based). MATERIAL AND METHODS In phase one, we identified 24 mistreatment indicators through an extensive literature review. We then pre-tested these indicators and classified them into seven behavioural types. During phase two, the survey was conducted (April-May 2013) in 14 districts across Pakistan. A total of 1,334 women who had given birth at home or in a healthcare facility over the past 12 months were interviewed. Linear regression analysis was employed for the full data set, and for facility- and home-based births separately, using Stata version 14.1. RESULTS There were no significant differences in manifestations of mistreatment between facility- and home-based childbirths. Approximately 97% of women reported experiencing at least one disrespectful and abusive behaviour. Experiences of mistreatment by type were as follows: non-consented care (81%); right to information (72%); non-confidential care (69%); verbal abuse (35%); abandonment of care (32%); discriminatory care (15%); and physical abuse (15%). In overall analysis, experience of mistreatment was lower among women who were unemployed (β = -1.17, 95% CI -1.81, -0.53); and higher among less empowered women (β = 0.11, 95% CI 0.06, 0.16); and those assisted by a traditional birth attendant as opposed to a general physician (β = 0.94, 95% CI 0.13, 1.75). Sub-group analyses for home-based births identified the same significant associations with mistreatment, with ethnicity included. In facility-based births, there was a significant relationship between women's employment and empowerment status and mistreatment. Women with prior education on birth preparedness were less likely to experience mistreatment compared to those who had received no previous birth preparedness education. CONCLUSION In order to promote care that is woman-centred and provided in a respectful and culturally appropriate manner, service providers should be cognisant of the current situation and ensure provision of quality antenatal care. At the community level, women should seek antenatal care for improved birth preparedness, while at the interpersonal level strategies should be devised to leverage women's ability to participate in key household decisions.
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Affiliation(s)
- Waqas Hameed
- Research Scholar, Department of Statistics, University of Karachi, Sindh, Pakistan
| | - Bilal Iqbal Avan
- Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
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18
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Dynes MM, Twentyman E, Kelly L, Maro G, Msuya AA, Dominico S, Chaote P, Rusibamayila R, Serbanescu F. Patient and provider determinants for receipt of three dimensions of respectful maternity care in Kigoma Region, Tanzania-April-July, 2016. Reprod Health 2018; 15:41. [PMID: 29506559 PMCID: PMC5838967 DOI: 10.1186/s12978-018-0486-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 02/25/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Lack of respectful maternity care (RMC) is increasingly recognized as a human rights issue and a key deterrent to women seeking facility-based deliveries. Ensuring facility-based RMC is essential for improving maternal and neonatal health, especially in sub-Saharan African countries where mortality and non-skilled delivery care remain high. Few studies have attempted to quantitatively identify patient and delivery factors associated with RMC, and none has modeled the influence of provider characteristics on RMC. This study aims to help fill these gaps through collection and analysis of interviews linked between clients and providers, allowing for description of both patient and provider characteristics and their association with receipt of RMC. METHODS We conducted cross-sectional surveys across 61 facilities in Kigoma Region, Tanzania, from April to July 2016. Measures of RMC were developed using 21-items in a Principal Components Analysis (PCA). We conducted multilevel, mixed effects generalized linear regression analyses on matched data from 249 providers and 935 post-delivery clients. The outcomes of interest included three dimensions of RMC-Friendliness/Comfort/Attention; Information/Consent; and Non-abuse/Kindness-developed from the first three components of PCA. Significance level was set at p < 0.05. RESULTS Significant client-level determinants for perceived Friendliness/Comfort/Attention RMC included age (30-39 versus 15-19 years: Coefficient [Coef] 0.63; 40-49 versus 15-19 years: Coef 0.79) and self-reported complications (reported complications versus did not: Coef - 0.41). Significant provider-level determinants included perception of fair pay (Perceives fair pay versus unfair pay: Coef 0.46), cadre (Nurses/midwives versus Clinicians: Coef - 0.46), and number of deliveries in the last month (11-20 versus < 11 deliveries: Coef - 0.35). Significant client-level determinants for Information/Consent RMC included labor companionship (Companion versus none: Coef 0.37) and religiosity (Attends services at least weekly versus less often: Coef - 0.31). Significant provider-level determinants included perception of fair pay (Perceives fair pay versus unfair: Coef 0.37), weekly work hours (Coef 0.01), and age (30-39 versus 20-29 years: Coef - 0.34; 40-49 versus 20-29 years: Coef - 0.58). Significant provider-level determinants for Non-abuse/Kindness RMC included the predictors of age (age 50+ versus 20-29 years: Coef 0.34) and access to electronic mentoring (Access to two mentoring types versus none: Coef 0.37). CONCLUSIONS These findings illustrate the value of including both client and provider information in the analysis of RMC. Strategies that address provider-level determinants of RMC (such as equitable pay, work environment, access to mentoring platforms) may improve RMC and subsequently address uptake of facility delivery.
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Affiliation(s)
- M. M. Dynes
- Centers for Disease Control and Prevention, Division of Reproductive Health, Atlanta, Georgia
| | - E. Twentyman
- Centers for Disease Control and Prevention, Division of Reproductive Health, Atlanta, Georgia
| | - L. Kelly
- Centers for Disease Control and Prevention, Division of Reproductive Health, Atlanta, Georgia
| | - G. Maro
- Bloomberg Philanthropies Tanzania, Kigoma, Tanzania
| | | | | | - P. Chaote
- Kigoma Region Ministry of Health, Kigoma, Tanzania
| | - R. Rusibamayila
- Ministry of Health Community Development Gender Elderly and Children, Dar es Salaam, Tanzania
| | - F. Serbanescu
- Centers for Disease Control and Prevention, Division of Reproductive Health, Atlanta, Georgia
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Vedam S, Stoll K, Rubashkin N, Martin K, Miller-Vedam Z, Hayes-Klein H, Jolicoeur G. The Mothers on Respect (MOR) index: measuring quality, safety, and human rights in childbirth. SSM Popul Health 2017; 3:201-210. [PMID: 29349217 PMCID: PMC5768993 DOI: 10.1016/j.ssmph.2017.01.005] [Citation(s) in RCA: 111] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Revised: 01/17/2017] [Accepted: 01/18/2017] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Abuse of human rights in childbirth are documented in low, middle and high resource countries. A systematic review across 34 countries by the WHO Research Group on the Treatment of Women During Childbirth concluded that there is no consensus at a global level on how disrespectful maternity care is measured. In British Columbia, a community-led participatory action research team developed a survey tool that assesses women's experiences with maternity care, including disrespect and discrimination. METHODS A cross-sectional survey was completed by women of childbearing age from diverse communities across British Columbia. Several items (31/130) assessed characteristics of their communication with care providers. We assessed the psychometric properties of two versions of a scale (7 and 14 items), among women who described experiences with a single maternity provider (n=2514 experiences among 1672 women). We also calculated the proportion and selected characteristics of women who scored in the bottom 10th percentile (those who experienced the least respectful care). RESULTS To demonstrate replicability, we report psychometric results separately for three samples of women (S1 and S2) (n=2271), (S3, n=1613). Analysis of item-to-total correlations and factor loadings indicated a single construct 14-item scale, which we named the Mothers on Respect index (MORi). Items in MORi assess the nature of respectful patient-provider interactions and their impact on a person's sense of comfort, behavior, and perceptions of racism or discrimination. The scale exhibited good internal consistency reliability. MORi- scores among these samples differed by socio-demographic profile, health status, experience with interventions and mode of birth, planned and actual place of birth, and type of provider. CONCLUSION The MOR index is a reliable, patient-informed quality and safety indicator that can be applied across jurisdictions to assess the nature of provider-patient relationships, and access to person-centered maternity care.
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Affiliation(s)
- Saraswathi Vedam
- Birth Place Research Lab, Division of Midwifery, University of British Columbia, 5950 University Boulevard, Vancouver, BC, Canada V6T 1Z3
| | - Kathrin Stoll
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, Canada V6T 1Z3
| | - Nicholas Rubashkin
- Department of Global Health Sciences, University of California San Francisco, Mission Hall Building, 550 - 16th Street, 3rd Floor, San Francisco, CA 94158, USA
- Department of Obstetrics and Gynecology, University of California San Francisco, Mission Hall Building, 550 - 16th Street, 3rd Floor, San Francisco, CA 94158, USA
| | - Kelsey Martin
- Birth Place Research Lab, Division of Midwifery, University of British Columbia, 5950 University Boulevard, Vancouver, BC, Canada V6T 1Z3
| | - Zoe Miller-Vedam
- Human Rights in Childbirth, 6312 SW Capitol Highway St, 234 Portland, OR 97239, USA
| | - Hermine Hayes-Klein
- Human Rights in Childbirth, 6312 SW Capitol Highway St, 234 Portland, OR 97239, USA
| | - Ganga Jolicoeur
- Midwives Association of British Columbia, 2-175 E. 15th Avenue, Vancouver, BC, Canada V5T 2P6
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Shafran-Tikva S, Chinitz D, Stern Z, Feder-Bubis P. Violence against physicians and nurses in a hospital: How does it happen? A mixed-methods study. Isr J Health Policy Res 2017; 6:59. [PMID: 29089061 PMCID: PMC5664846 DOI: 10.1186/s13584-017-0183-y] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 10/24/2017] [Indexed: 12/05/2022] Open
Abstract
Background Violence against medical personnel is unexpected in hospitals which are devoted to healing, and yet, it is frequent and of concern in the health system. Little is known about the factors that lead to hospital violence, and even less is known about the interactions among these factors. The aim of the study was to identify and describe the perceptions of staff and patients regarding the factors that lead to violence on the part of patients and those accompanying them. Methods A mixed-methods study in a large, general, university tertiary hospital. A self-administered survey yielding 678 completed questionnaires, comprising 34% nurses and 66% physicians (93% response rate). Eighteen in-depth interviews were conducted separately with both victims and perpetrators of violent episodes, and four focus-groups (N = 20) were undertaken separately with physicians, staff nurses, head-nurses, and security personnel. Results Violence erupts as a result of interacting factors encompassing staff behavior, patient behavior, hospital setting, professional roles, and waiting times. Patients and staff reported similar perceptions and emotions regarding the episodes of violence in which they were involved. Of 4,047 statements elicited in the staff survey regarding the eruption of violence, 39% referred to staff behavior; 26 % to patient/visitor behavior; 17% to organizational conditions, and 10% to waiting times. In addition, 35% of the staff respondents reported that their own behavior contributed to the creation of the most severe violent episode in which they were involved, and 48% stated that staff behavior contributed to violent episodes. Half of the reasons stated by physicians and nurses for violence eruption were related to patient dissatisfaction with the quality of service, the degree of staff professionalism, or an unacceptable comment of a staff member. In addition, data from the focus groups pointed to lack of understanding of the hospital system on the part of patients, together with poor communication between patients and providers and expectations gaps. Conclusions Our various and triangulated data sources show that staff and patients share conditions of overload, pressure, fatigue, and frustration. Staff also expressed lack of coping tools to prevent violence. Self-conscious awareness regarding potential interacting factors can be used to develop interventions aimed at prevention of and better coping with hospital violence for both health systems' users and providers.
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Affiliation(s)
- Sigal Shafran-Tikva
- Hadassah University Medical Center, P.O.B 12109, Kiryat Hadassah, 12000, Jerusalem, Israel.
| | - David Chinitz
- Health Policy and Management in the School of Public Health, Hebrew University-Hadassah Israel, Jerusalem, Israel
| | - Zvi Stern
- Hadassah Mt Scopus Hospital in Jerusalem, Jerusalem, Israel
| | - Paula Feder-Bubis
- Department of Health Systems Management, School of Public Health, Faculty of Health Sciences and Guilford Glazer Faculty of Business and Management, Ben-Gurion University of the Negev, P.O.B. 653, Beer-Sheva, 8410501, Israel
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21
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Madeira S, Pileggi V, Souza JP. Abuse and disrespect in childbirth process and abortion situation in Latin America and the Caribbean-systematic review protocol. Syst Rev 2017; 6:152. [PMID: 28768550 PMCID: PMC5541749 DOI: 10.1186/s13643-017-0516-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Accepted: 06/09/2017] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Studies show that a large number of women around the world have experienced situations of abuse, disrespect, abuse, and neglect during childbirth and/or abortion. This violence is a serious violation of the rights of women, especially because it is a period in which the woman is more physiologically, socially, and psychologically vulnerable. Although this type of violence is known, there is still no international consensus on the definition of such violence and its prevalence is not known. In this sense, this systematic review aims (1) to find quantitative data about abuse and disrespect in obstetric care (delivery and/or abortion) in Latin America and the Caribbean to estimate the average prevalence of this type of abuse and (2) to identify interventions-including programs, laws, and regulations-which have been implemented to prevent or respond to abuse and disrespect in childbirth process and abortion situation, evaluating its effectiveness on a global scale. METHODS For this, we will use a refined and pre-established strategy to search databases such as PubMed, Embase, LILACS, and Scielo, and the studies found will pass through a selection process to complete the screening stage. DISCUSSION Data will be extracted using standardized forms with the following information: scope of study, sample characteristics, objectives, design, data collection, methods of analysis, data source, and results. Considering the heterogeneity of the definitions of abuse, disrespect, and mistreatment of women in labor or abortion, it may not be possible to carry out the meta-analysis of the frequency of events reported in the included articles. Events reported by the original articles will be classified according to a typology of abuse, disrespect, and maltreatment in the labor or abortion process described by Bohren et al. (PLoS Med, 2015). SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42016038651.
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Affiliation(s)
- Sofia Madeira
- GLIDE Technical Cooperation and Research, Department of Social Medicine - Ribeirão Preto Medical School, University of São Paulo (FMRP/USP), Avenida dos Bandeirantes, 3900, Ribeirão Preto, SP, 14049-900, Brazil.
| | - Vicky Pileggi
- Department of Pediatrics of Ribeirão Preto Medical School, University of São Paulo (FMRP/USP), Ribeirão Preto, SP, Brazil
| | - João Paulo Souza
- GLIDE Technical Cooperation and Research, Department of Social Medicine - Ribeirão Preto Medical School, University of São Paulo (FMRP/USP), Avenida dos Bandeirantes, 3900, Ribeirão Preto, SP, 14049-900, Brazil
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22
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Güneş G, Karaçam Z. The feeling of discomfort during vaginal examination, history of abuse and sexual abuse and post-traumatic stress disorder in women. J Clin Nurs 2017; 26:2362-2371. [DOI: 10.1111/jocn.13574] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/28/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Gizem Güneş
- Division of Midwifery; Aydın School of Health; Adnan Menderes University, Aydın; Aydın Turkey
| | - Zekiye Karaçam
- Division of Midwifery; Aydın School of Health; Adnan Menderes University, Aydın; Aydın Turkey
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Rask M, Swahnberg K, Lindell G, Oscarsson M. Women's experiences of abnormal Pap smear results - A qualitative study. SEXUAL & REPRODUCTIVE HEALTHCARE 2017; 12:3-8. [PMID: 28477928 DOI: 10.1016/j.srhc.2017.01.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 01/02/2017] [Indexed: 10/20/2022]
Abstract
OBJECTIVES To describe women's experiences of abnormal Pap smear result. METHODS Ten women were recruited from a women's health clinic. Qualitative interviews based on six open-ended questions were conducted, transcribed verbatim, and analyzed by content analysis. RESULTS The women believed that their abnormal Pap smear result was indicative of having cancer. This created anxiety in the women, which resulted in the need for emotional support and information. Testing positive with human papillomavirus (HPV) also meant consequences for the relatives as well as concerns about the sexually transmitted nature of the virus. Finally, the women had a need to be treated with respect by the healthcare professionals in order to reduce feelings of being abused. CONCLUSIONS In general, women have a low level of awareness of HPV and its relation to abnormal Pap smear results. Women who receive abnormal Pap smear results need oral information, based on the individual women's situation, and delivered at the time the women receive the test result. It is also essential that a good emotional contact be established between the women and the healthcare professionals.
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Affiliation(s)
- Marie Rask
- Department of Health and Caring Sciences, Linnaeus University, Sweden.
| | | | - Gunnel Lindell
- Department of Women's and Children's Health, Karolinska Institute, Sweden; Kalmar County Hospital, Kalmar, Sweden.
| | - Marie Oscarsson
- Department of Health and Caring Sciences, Linnaeus University, Sweden.
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Rishal P, Joshi SK, Lukasse M, Schei B, Swahnberg K. 'They just walk away' - women's perception of being silenced by antenatal health workers: a qualitative study on women survivors of domestic violence in Nepal. Glob Health Action 2016; 9:31838. [PMID: 27978940 PMCID: PMC5159679 DOI: 10.3402/gha.v9.31838] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 10/21/2016] [Accepted: 10/24/2016] [Indexed: 11/18/2022] Open
Abstract
Background Domestic violence during pregnancy has detrimental effects on the health of the mother and the newborn. Antenatal care provides a ‘window of opportunity’ to identify and assist victims of domestic violence during pregnancy. Little is known about the experience, needs, and expectations from the women's perspective in relation to domestic violence in Nepal. Objective Our study aims to explore how women who have experienced domestic violence evaluate their antenatal care and their expectations and needs from health centers. Design Twelve in-depth interviews were conducted among women who had experienced domestic violence during pregnancy and utilized antenatal care. The women were recruited from two different organizations in Nepal. Results Women in our study concealed their experience of domestic violence due to fear of being insulted, discriminated, and negative attitudes of the health care providers. The women wished that the health care providers were compassionate and asked them about their experience, ensured confidentiality and privacy, and referred them to services that is free of cost. Conclusions Findings from our study may help the health care providers to change their attitudes toward women survivors of domestic violence. Identifying and assisting these women through antenatal care could result in improved services for them and their newborns.
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Affiliation(s)
- Poonam Rishal
- Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; ;
| | - Sunil Kumar Joshi
- Department of Community Medicine, Kathmandu Medical College, Kathmandu, Nepal
| | - Mirjam Lukasse
- Faculty of Health Sciences, Department of Nursing and Health Promotion, Oslo and Akershus University College of Applied Sciences, Oslo, Norway
| | - Berit Schei
- Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,Department of Obstetrics and Gynecology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Katarina Swahnberg
- Department of Health and Caring Sciences, Faculty of Health and Life Science, Linnaeus University, Kalmar, Sweden
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- Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway Department of Community Medicine, Kathmandu Medical College, Kathmandu, Nepal Faculty of Health Sciences, Department of Nursing and Health Promotion, Oslo and Akershus University College of Applied Sciences, Oslo, Norway Department of Obstetrics and Gynecology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway Department of Health and Caring Sciences, Faculty of Health and Life Science, Linnaeus University, Kalmar, Sweden
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Wangel AM, Ryding EL, Schei B, Östman M, Lukasse M. Emotional, physical, and sexual abuse and the association with symptoms of depression and posttraumatic stress in a multi-ethnic pregnant population in southern Sweden. SEXUAL & REPRODUCTIVE HEALTHCARE 2016; 9:7-13. [DOI: 10.1016/j.srhc.2016.04.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Revised: 04/18/2016] [Accepted: 04/29/2016] [Indexed: 12/29/2022]
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Wijma B, Zbikowski A, Brüggemann AJ. Silence, shame and abuse in health care: theoretical development on basis of an intervention project among staff. BMC MEDICAL EDUCATION 2016; 16:75. [PMID: 26922381 PMCID: PMC4769844 DOI: 10.1186/s12909-016-0595-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Accepted: 02/13/2016] [Indexed: 05/26/2023]
Abstract
As health care exists to alleviate patients' suffering it is unacceptable that it inflicts unnecessary suffering on patients. We therefore have developed and evaluated a drama pedagogical model for staff interventions using Forum Play, focusing on staff's experiences of failed encounters where they have perceived that the patient felt abused. In the current paper we present how our preliminary theoretical framework of intervening against abuse in health care developed and was revised during this intervention. During and after the intervention, five important lessons were learned and incorporated in our present theoretical framework. First, a Forum Play intervention may break the silence culture that surrounds abuse in health care. Second, organizing staff training in groups was essential and transformed abuse from being an individual problem inflicting shame into a collective responsibility. Third, initial theoretical concepts "moral resources" and "the vicious violence triangle" proved valuable and became useful pedagogical tools during the intervention. Four, the intervention can be understood as having strengthened staff's moral resources. Five, regret appeared to be an underexplored resource in medical training and clinical work.The occurrence of abuse in health care is a complex phenomenon and the research area is in need of theoretical understanding. We hope this paper can inspire others to further develop theories and interventions in order to counteract abuse in health care.
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Affiliation(s)
- Barbro Wijma
- />Gender and Medicine, Department of Clinical and Experimental Medicine, Faculty of Medicine and Health Sciences, Linköping University, 581 83 Linköping, Sweden
| | - Anke Zbikowski
- />Gender and Medicine, Department of Clinical and Experimental Medicine, Faculty of Medicine and Health Sciences, Linköping University, 581 83 Linköping, Sweden
- />Department of Obstetrics and Gynaecology, Ryhov County Hospital, Jönköping, Sweden
| | - A. Jelmer Brüggemann
- />Gender and Medicine, Department of Clinical and Experimental Medicine, Faculty of Medicine and Health Sciences, Linköping University, 581 83 Linköping, Sweden
- />Current address: Department of Thematic Studies - Technology and Social Change, Faculty of Arts and Sciences, Linköping University, 581 83 Linköping, Sweden
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Schaad B, Bourquin C, Bornet F, Currat T, Saraga M, Panese F, Stiefel F. Dissatisfaction of hospital patients, their relatives, and friends: Analysis of accounts collected in a complaints center. PATIENT EDUCATION AND COUNSELING 2015; 98:771-776. [PMID: 25800651 DOI: 10.1016/j.pec.2015.02.019] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Revised: 02/08/2015] [Accepted: 02/20/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE This study aimed to analyze complaints of patients, their relatives, and friends who consulted a complaints center based (Espace Patients & Proches (EPP)) in a hospital so as to better understand the reasons that motivated them and their underlying expectations. METHODS This study was based on the analysis of written accounts of the 253 situations that occurred during the first year of operation of the EPP. The accounts were analyzed qualitatively using an inductive, thematic analytic approach. RESULTS We identified 372 different types of complaints and 28 main analytic themes. Five clustered themes emerged from the analysis of the interconnections among the core themes: (1) interpersonal relationship (N=160-the number of accounts including a complaint related to this general theme); (2) technical aspects of care (N=106); (3) health-care institution (N=69); (4) billing and insurance; (5) access to information (N=13). CONCLUSION The main reason for patients, their relatives, and friends going to EPP was related to the quality of the interpersonal relationship with health-care professionals. Such complaints were markedly more frequent than those concerning technical aspects of care. PRACTICE IMPLICATIONS These results raise important questions concerning changing patient expectations as well as how hospitals integrate complaints into the process of quality health care.
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Affiliation(s)
- Béatrice Schaad
- Communication Office, Lausanne University Hospital, Switzerland.
| | - Céline Bourquin
- Psychiatric Liaison Service, Lausanne University Hospital, Switzerland
| | - Floriane Bornet
- Espace Patients & Proches, Lausanne University Hospital, Switzerland
| | - Thierry Currat
- Espace Patients & Proches, Lausanne University Hospital, Switzerland
| | - Michael Saraga
- Psychiatric Liaison Service, Department of Ambulatory Care and Community Medicine, Lausanne University Hospital, Switzerland
| | - Francesco Panese
- Institute of History of Medicine and Public Health, Lausanne University, Switzerland
| | - Friedrich Stiefel
- Psychiatric Liaison Service, Lausanne University Hospital, Switzerland
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A first online intervention to increase patients' perceived ability to act in situations of abuse in health care: reports of a Swedish pre-post study. BMC Med Ethics 2015; 16:35. [PMID: 26003674 PMCID: PMC4448297 DOI: 10.1186/s12910-015-0027-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Accepted: 05/07/2015] [Indexed: 11/17/2022] Open
Abstract
Background Efforts to counteract abuse in health care, defined as patient-experienced abuse, have mainly focused on interventions among caregivers. This study is the first to test an online intervention focusing on how patients can counteract such abuse. The intervention aimed at increasing patients’ intention and perceived ability to act in future situations where they risk experiencing abuse. Methods Participants were recruited through a nephrology clinic in Sweden. The intervention consisted of an online program that aimed to stimulate patients to think of possible actions in situations in which they risk experiencing abuse. The program comprised stories and exercises in text and comic form. The participants filled out a questionnaire immediately before and after going through the program, as well as during follow-up four to eight weeks later. Results Forty-eight patients (39 %) participated in the study and spent, on average, 41 min responding to questions and going through the program. Both men and women, of various ages and educational backgrounds, participated. An increase in participants' self-reported ability to identify opportunities to act in a given situation was seen immediately afterwards, as well as during follow up. Conclusion The current study suggests that it is feasible and most likely useful to a variety of patients to work with the provided material that has the aim of counteracting abuse in health care. It would be of interest to further develop ways of using comics and to test similar interventions in other health care settings.
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Lukasse M, Schroll AM, Karro H, Schei B, Steingrimsdottir T, Van Parys AS, Ryding EL, Tabor A. Prevalence of experienced abuse in healthcare and associated obstetric characteristics in six European countries. Acta Obstet Gynecol Scand 2015; 94:508-17. [DOI: 10.1111/aogs.12593] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Accepted: 01/18/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Mirjam Lukasse
- Department of Health, Nutrition and Management; Faculty of Health Sciences; Oslo and Akershus University College of Applied Sciences; Oslo Norway
| | - Anne-Mette Schroll
- Center of Fetal Medicine; Department of Obstetrics; Copenhagen University Hospital; Rigshospitalet; Copenhagen Denmark
| | - Helle Karro
- Department of Obstetrics and Gynecology; University of Tartu; Tartu Estonia
| | - Berit Schei
- Department of Public Health and General Practice at the Faculty of Medicine; Norwegian University of Science and Technology (NTNU); Trondheim Norway
- Department of Obstetrics and Gynecology; St. Olav's University Hospital; Trondheim Norway
| | - Thora Steingrimsdottir
- Department of Obstetrics and Gynecology; Landspitali University Hospital; Reykjavik Iceland
| | | | - Elsa Lena Ryding
- Department of Women's and Children's Health; Division of Obstetrics and Gynecology; Karolinska Institute; Solna Sweden
| | - Ann Tabor
- Center of Fetal Medicine; Department of Obstetrics; Copenhagen University Hospital; Rigshospitalet; Copenhagen Denmark
- Faculty of Health Sciences; Copenhagen University; Copenhagen Denmark
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Prevalence and associated factors of fear of childbirth in six European countries. SEXUAL & REPRODUCTIVE HEALTHCARE 2014; 5:99-106. [DOI: 10.1016/j.srhc.2014.06.007] [Citation(s) in RCA: 125] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Revised: 05/07/2014] [Accepted: 06/23/2014] [Indexed: 01/06/2023]
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Kruk ME, Kujawski S, Mbaruku G, Ramsey K, Moyo W, Freedman LP. Disrespectful and abusive treatment during facility delivery in Tanzania: a facility and community survey. Health Policy Plan 2014; 33:e26-e33. [DOI: 10.1093/heapol/czu079] [Citation(s) in RCA: 178] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2014] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - Stephanie Kujawski
- Averting Maternal Death and Disability Program, Columbia University Mailman School of Public Health, 60 Haven Avenue, New York, NY 10032, USA
| | - Godfrey Mbaruku
- Ifakara Health Institute, Plot 463, Kiko Avenue Mikocheni, Dar-es-Salaam, Tanzania PO Box 78373
| | - Kate Ramsey
- Averting Maternal Death and Disability Program, Columbia University Mailman School of Public Health, 60 Haven Avenue, New York, NY 10032, USA
| | - Wema Moyo
- Ifakara Health Institute, Plot 463, Kiko Avenue Mikocheni, Dar-es-Salaam, Tanzania PO Box 78373
| | - Lynn P Freedman
- Averting Maternal Death and Disability Program, Columbia University Mailman School of Public Health, 60 Haven Avenue, New York, NY 10032, USA
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Schei B, Lukasse M, Ryding EL, Campbell J, Karro H, Kristjansdottir H, Laanpere M, Schroll AM, Tabor A, Temmerman M, Van Parys AS, Wangel AM, Steingrimsdottir T. A history of abuse and operative delivery--results from a European multi-country cohort study. PLoS One 2014; 9:e87579. [PMID: 24498142 PMCID: PMC3909197 DOI: 10.1371/journal.pone.0087579] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Accepted: 12/23/2013] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE The main aim of this study was to assess whether a history of abuse, reported during pregnancy, was associated with an operative delivery. Secondly, we assessed if the association varied according to the type of abuse and if the reported abuse had been experienced as a child or an adult. DESIGN The Bidens study, a cohort study in six European countries (Belgium, Iceland, Denmark, Estonia, Norway, and Sweden) recruited 6724 pregnant women attending routine antenatal care. History of abuse was assessed through questionnaire and linked to obstetric information from hospital records. The main outcome measure was operative delivery as a dichotomous variable, and categorized as an elective caesarean section (CS), or an operative vaginal birth, or an emergency CS. Non-obstetrically indicated were CSs performed on request or for psychological reasons without another medical reason. Binary and multinomial regression analysis were used to assess the associations. RESULTS Among 3308 primiparous women, sexual abuse as an adult (≥ 18 years) increased the risk of an elective CS, Adjusted Odds Ratio 2.12 (1.28-3.49), and the likelihood for a non-obstetrically indicated CS, OR 3.74 (1.24-11.24). Women expressing current suffering from the reported adult sexual abuse had the highest risk for an elective CS, AOR 4.07 (1.46-11.3). Neither physical abuse (in adulthood or childhood <18 years), nor sexual abuse in childhood increased the risk of any operative delivery among primiparous women. Among 3416 multiparous women, neither sexual, nor emotional abuse was significantly associated with any kind of operative delivery, while physical abuse had an increased AOR for emergency CS of 1.51 (1.05-2.19). CONCLUSION Sexual abuse as an adult increases the risk of an elective CS among women with no prior birth experience, in particular for non-obstetrical reasons. Among multiparous women, a history of physical abuse increases the risk of an emergency CS.
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Affiliation(s)
- Berit Schei
- Department of Public Health and General Practice, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Obstetrics and Gynaecology, St.Olav's University Hospital, Trondheim, Norway
| | - Mirjam Lukasse
- Department of Public Health and General Practice, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Health, Nutrition and Management, Oslo and Akershus University College of Applied Sciences, Oslo, Norway
| | - Elsa Lena Ryding
- Department of Women's and Children's Health, Division of Obstetrics and Gynaecology, Karolinska Institutet/University Hospital, Stockholm, Sweden
| | - Jacquelyn Campbell
- John Hopkins University, School of Nursing, Baltimore, Maryland, United States of America
| | - Helle Karro
- Department of Obstetrics and Gynaecology, University of Tartu, Tartu, Estonia
| | - Hildur Kristjansdottir
- Department of Obstetrics and Gynaecology, Landspitali University Hospital, Reykjavik, Iceland
- Directorate of Health, Reykjavik, Iceland
| | - Made Laanpere
- Department of Obstetrics and Gynaecology, University of Tartu, Tartu, Estonia
| | - Anne-Mette Schroll
- Centre of Fetal Medicine, Department of Obstetrics, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Ann Tabor
- Centre of Fetal Medicine, Department of Obstetrics, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Marleen Temmerman
- Department of Obstetrics and Gynaecology, Ghent University Hospital, Ghent, Belgium
| | - An-Sofie Van Parys
- Department of Obstetrics and Gynaecology, Ghent University Hospital, Ghent, Belgium
| | | | - Thora Steingrimsdottir
- Department of Obstetrics and Gynaecology, Landspitali University Hospital, Reykjavik, Iceland
- Primary Health Care of the Capital Area, Centre of Development, Reykjavik, Iceland
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Geirsson RT. Anorexia to obesity: problems for now and the future. Acta Obstet Gynecol Scand 2013; 92:875-6. [DOI: 10.1111/aogs.12206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Schroll AM, Kjærgaard H, Midtgaard J. Encountering abuse in health care; lifetime experiences in postnatal women - a qualitative study. BMC Pregnancy Childbirth 2013; 13:74. [PMID: 23521853 PMCID: PMC3614521 DOI: 10.1186/1471-2393-13-74] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2012] [Accepted: 03/04/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Abuse in health care (AHC) has been associated with potential severe health consequences, and has further been related to maternal morbidity and mortality in childbirth. To improve our understanding of what qualifies as AHC and to support and optimise the health of women with these experiences, the objective of this study was to describe how women, who had previously endured AHC, gave meaning to and managed their experience during pregnancy, childbirth, and in the early postnatal period. METHOD Women, who had reported substantial suffering as a result of a previous experience of abuse within the healthcare system, were purposefully selected from a Danish sample of a multinational cohort study on negative life events among pregnant women (the BIDENS Study). Eleven women were interviewed individually by means of a semi-structured interview guide. Transcripts of the interviews were analysed by means of qualitative systematic text condensation analysis. RESULTS Four categories were identified to describe the women's experience of AHC and its consequences on pregnancy and childbirth: abusive acts of unintentional harm, dehumanization, bodily remembrance, and finding the strength to move on. Abuse in health care may have profound consequences on the reproductive lives of the women, among others affecting sexuality, the desire to have children and the expectations of mode of delivery. However, the women described constructive ways to manage the experience, to which healthcare professionals could also contribute significantly. CONCLUSIONS Regardless of whether AHC is experienced in childhood or adulthood, it can influence the lives of women during pregnancy and childbirth. By recognising the potential existence of AHC, healthcare professionals have a unique opportunity to support women who have experienced AHC.
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Affiliation(s)
- Anne-Mette Schroll
- Rigshospitalet, Copenhagen University Hospital, Center for Foetal Medicine and Pregnancy (4002), Blegdamsvej 9, Copenhagen Ø, DK-2100, Denmark.
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What contributes to abuse in health care? A grounded theory of female patients? stories. Int J Nurs Stud 2013; 50:404-12. [DOI: 10.1016/j.ijnurstu.2012.10.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2012] [Revised: 09/20/2012] [Accepted: 10/07/2012] [Indexed: 11/22/2022]
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Warren C, Njuki R, Abuya T, Ndwiga C, Maingi G, Serwanga J, Mbehero F, Muteti L, Njeru A, Karanja J, Olenja J, Gitonga L, Rakuom C, Bellows B. Study protocol for promoting respectful maternity care initiative to assess, measure and design interventions to reduce disrespect and abuse during childbirth in Kenya. BMC Pregnancy Childbirth 2013; 13:21. [PMID: 23347548 PMCID: PMC3559298 DOI: 10.1186/1471-2393-13-21] [Citation(s) in RCA: 71] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Accepted: 01/21/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Increases in the proportion of facility-based deliveries have been marginal in many low-income countries in the African region. Preliminary clinical and anthropological evidence suggests that one major factor inhibiting pregnant women from delivering at facility is disrespectful and abusive treatment by health care providers in maternity units. Despite acknowledgement of this behavior by policy makers, program staff, civil society groups and community members, the problem appears to be widespread but prevalence is not well documented. Formative research will be undertaken to test the reliability and validity of a disrespect and abuse (D&A) construct and to then measure the prevalence of disrespect and abuse suffered by clinic clients and the general population. METHODS/DESIGN A quasi-experimental design will be followed with surveys at twelve health facilities in four districts and one large maternity hospital in Nairobi and areas before and after the introduction of disrespect and abuse (D&A) interventions. The design is aimed to control for potential time dependent confounding on observed factors. DISCUSSION This study seeks to conduct implementation research aimed at designing, testing, and evaluating an approach to significantly reduce disrespectful and abusive (D&A) care of women during labor and delivery in facilities. Specifically the proposed study aims to: (i) determine the manifestations, types and prevalence of D&A in childbirth (ii) develop and validate tools for assessing D&A (iii) identify and explore the potential drivers of D&A (iv) design, implement, monitor and evaluate the impact of one or more interventions to reduce D&A and (v) document and assess the dynamics of implementing interventions to reduce D&A and generate lessons for replication at scale.
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Affiliation(s)
| | - Rebecca Njuki
- Population Council, P.O Box 17643–00500, Nairobi, Kenya
| | - Timothy Abuya
- Population Council, P.O Box 17643–00500, Nairobi, Kenya
| | | | - Grace Maingi
- Federation of Women Lawyers, P.O. BOX 46324–00100, Nairobi, Kenya
| | - Jane Serwanga
- Federation of Women Lawyers, P.O. BOX 46324–00100, Nairobi, Kenya
| | - Faith Mbehero
- National Nurses Association of Kenya, P.O BOX 49422–00100, Nairobi, Kenya
| | - Louisa Muteti
- National Nurses Association of Kenya, P.O BOX 49422–00100, Nairobi, Kenya
| | - Anne Njeru
- Ministry of Public Health and Sanitation, Division of Reproductive Health, P. O. Box 43319–00100, Nairobi, Kenya
| | - Joseph Karanja
- University of Nairobi, P. O. Box 19676, Nairobi, KNH, Kenya
- Kenya Obstetrical and Gynecological Society, P.O Box 19459–00202, Nairobi, Kenya
| | - Joyce Olenja
- University of Nairobi, P. O. Box 19676, Nairobi, KNH, Kenya
| | - Lucy Gitonga
- Ministry of Medical Services, Department of Nursing, P.O. Box: 30016–00100, Nairobi, Cathedral Road, Nairobi, Kenya
| | - Chris Rakuom
- Ministry of Medical Services, Department of Nursing, P.O. Box: 30016–00100, Nairobi, Cathedral Road, Nairobi, Kenya
| | - Ben Bellows
- Population Council, P.O Box 17643–00500, Nairobi, Kenya
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Ethical guidelines and the prevention of abuse in healthcare. Eur J Obstet Gynecol Reprod Biol 2012; 165:18-28. [DOI: 10.1016/j.ejogrb.2012.07.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2011] [Revised: 05/28/2012] [Accepted: 07/24/2012] [Indexed: 11/20/2022]
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Wangel AM, Schei B, Ryding EL, Ostman M. Mental health status in pregnancy among native and non-native Swedish-speaking women: a Bidens study. Acta Obstet Gynecol Scand 2012; 91:1395-401. [PMID: 22881599 DOI: 10.1111/j.1600-0412.2012.01512.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To describe mental health status in native and non-native Swedish-speaking pregnant women and explore risk factors of depression and posttraumatic stress (PTS) symptoms. DESIGN AND SETTING A cross-sectional questionnaire study was conducted at midwife-based antenatal clinics in Southern Sweden. SAMPLE A non-selected group of women in mid-pregnancy. METHODS Participants completed a questionnaire covering background characteristics, social support, life events, mental health variables and the short Edinburgh Depression Scale. MAIN OUTCOME MEASURES Depressive symptoms during the past week and PTS symptoms during the past year. RESULTS Out of 1003 women, 21.4% reported another language than Swedish as their mother tongue and were defined as non-native. These women were more likely to be younger, have fewer years of education, potential financial problems, and lack of social support. More non-native speakers self-reported depressive, PTS, anxiety and, psychosomatic symptoms, and fewer had had consultations with a psychiatrist or psychologist. Of all women, 13.8% had depressive symptoms defined by Edinburgh Depression Scale 7 or above. Non-native status was associated with statistically increased risks of depressive symptoms and having ≥1 PTS symptom compared with native-speaking women. Multivariate modeling including all selected factors resulted in adjusted odds ratios for depressive symptoms of 1.75 (95% confidence interval: 1.11-2.76) and of 1.56 (95% confidence interval: 1.10-2.34) for PTS symptoms in non-native Swedish speakers. CONCLUSION Non-native Swedish-speaking women had a more unfavorable mental health status than native speakers. In spite of this, non-native speaking women had sought less mental health care.
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Swahnberg K, Wijma B. Staff's perception of abuse in healthcare: a Swedish qualitative study. BMJ Open 2012; 2:e001111. [PMID: 23015598 PMCID: PMC3467650 DOI: 10.1136/bmjopen-2012-001111] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2012] [Accepted: 08/20/2012] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE The study aim was to apprehend staff's perception of abuse in healthcare (AHC) after an intervention based on 'Forum Play', and make comparisons to preintervention interviews and interviews with male and female patients. AHC can be described as a failing encounter from the patient's perspective. DESIGN Qualitative interview follow-up study. SETTING A Swedish Women's Clinic. PARTICIPANTS In a preintervention study 21 staff members were interviewed. Eligible for the follow-up study were 14 informants who had participated in the intervention. Four declined participation leaving ten informants for this study. INTERVENTION During January 2008-January 2009, all staff members (N=136) were invited to participate in Forum Play workshops. Seventy-four participants took part in at least 1 of the 17 half-day workshops. PRIMARY OUTCOME MEASURES Staffs perception of AHC. RESULTS The core category, 'a summoning stone in the shoe', was constructed of five categories: 'Dehumanising the patient', 'Unacceptable: you are bound to act!', 'Ubiquitous', 'Unintentional' and 'Relative'. Forum Play had demonstrated possibilities to act even in seemingly 'impossible' situations, and that the taboo status of AHC was altered at the clinic. When our results were compared to those in the preintervention study, we found an increased awareness about AHC, more concrete examples of AHC, a stronger empathy for patients, and fewer explanations, justifications and trivialisations of AHC. CONCLUSION In this follow-up study staff's perception of AHC was closer to the patient's perspective. Compared to the preintervention interviews staff showed a greater willingness not only to acknowledge AHC, but also to take on a responsibility to act in order to stop or prevent AHC. Explanations for this stance could be that Forum Play had showed staff that there were possibilities to act, and that the taboo status of AHC had been broken at the clinic.
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Affiliation(s)
- Katarina Swahnberg
- Division of Gender and Medicine, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
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Swahnberg K, Edholm S, Fredman K, Wijma B. Men's Perceived Experiences of Abuse in Health Care: Their Relationship to Childhood Abuse. ACTA ACUST UNITED AC 2012. [DOI: 10.3149/jmh.1102.137] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Brüggemann AJ, Wijma B, Swahnberg K. Patients' silence following healthcare staff's ethical transgressions. Nurs Ethics 2012; 19:750-63. [PMID: 22547488 DOI: 10.1177/0969733011423294] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The aim of this study was to examine to what extent patients remained silent to the health care system after they experienced abusive or wrongful incidents in health care. Female patients visiting a women's clinic in Sweden (n = 530) answered the transgressions of ethical principles in Health care questionnaire (TEP), which was constructed to measure patients' abusive experiences in the form of staff's transgressions of ethical principles in health care. Of all the patients, 63.6% had, at some point, experienced staff's transgressions of ethical principles, and many perceived these events as abusive and wrongful. Of these patients, 70.3% had remained silent to the health care system about at least one transgression. This silence is a loss of essential feedback for the health care system and should not automatically be interpreted as though patients are satisfied.
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Affiliation(s)
- A Jelmer Brüggemann
- Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Sweden.
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Brüggemann AJ, Swahnberg K. Patients' silence towards the healthcare system after ethical transgressions by staff: associations with patient characteristics in a cross-sectional study among Swedish female patients. BMJ Open 2012; 2:e001562. [PMID: 23204076 PMCID: PMC3532985 DOI: 10.1136/bmjopen-2012-001562] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES To identify which patient characteristics are associated with silence towards the healthcare system after experiences of abusive or ethically wrongful transgressive behaviour by healthcare staff. DESIGN Cross-sectional questionnaire study using the Transgressions of Ethical Principles in Health Care Questionnaire. SETTING A women's clinic in the south of Sweden. PARTICIPANTS Selection criteria were: consecutive female patients coming for an outpatient appointment, ≥18-year-old, with the ability to speak and understand the Swedish language, and a known address. Questionnaires were answered by 534 women (60%) who had visited the clinic, of which 293 were included in the present study sample. PRIMARY OUTCOME MEASURE How many times the respondent remained silent towards the healthcare system relative to the number of times the respondent spoke up. RESULTS Associations were found between patients' silence towards the healthcare system and young age as well as lower self-rated knowledge of patient rights. Both variables showed independent effects on patients' silence in a multivariate model. No associations were found with social status, country of birth, health or other abuse. CONCLUSIONS The results offer opportunities for designing interventions to stimulate patients to speak up and open up the clinical climate, for which the responsibility lies in the hands of staff; but more research is needed.
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Affiliation(s)
- A Jelmer Brüggemann
- Gender and Medicine, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
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NorVold Abuse Questionnaire for men (m-NorAQ): validation of new measures of emotional, physical, and sexual abuse and abuse in health care in male patients. ACTA ACUST UNITED AC 2011; 8:69-79. [PMID: 21536226 DOI: 10.1016/j.genm.2011.03.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2011] [Indexed: 11/20/2022]
Abstract
BACKGROUND There are far more prevalence studies on abuse of females than on males as subjects of abuse. The NorVold Abuse Questionnaire (NorAQ) measures emotional, physical, and sexual abuse, as well as abuse in health care, in women and men. OBJECTIVE The aim of this study was to test the concurrent validity and test-retest reliability of the questions in the version of NorAQ administered to men (m-NorAQ) against the interview model. METHODS The validation was tested in a subsample (n = 86) of a male patient sample who had filled out the m-NorAQ (N = 1667). Respondents completed m-NorAQ twice and were then interviewed. Before the interview, respondents were instructed to answer questions based on personal experience. The interview consisted of 4 open-ended questions about lifetime experiences of emotional, physical, and sexual abuse and abuse in health care. RESULTS Results indicated that respondents in the subsample had discussed the experiences of abuse more often in both formal and informal settings than had subjects in the total patient sample. Measures of sensitivity for m-NorAQ were good to excellent (emotional abuse, 83%; physical abuse, 76%; sexual abuse, 68%; abuse in health care, 93%), as were those for specificity (emotional abuse, 72%; physical abuse, 92%; sexual abuse, 99%, abuse in health care, 90%); likelihood ratios were satisfactory (emotional abuse, 3; physical abuse, 9; sexual abuse, 46; abuse in health care, 9); and test-retest reliability measures were excellent (emotional abuse, 80%-95%; physical abuse, 77%-88%; sexual abuse, 91%-100%; abuse in health care, 84%-92%). CONCLUSION m-NorAQ showed good to excellent concurrent validity for the different types of abuse and excellent reliability for all questions about abuse. In spite of methodological challenges, validation studies must be conducted as a minimum precaution to ensure that an instrument accurately measures abuse as intended.
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Abstract
AIMS AND OBJECTIVES To analyse the concept of abuse in health care. This analysis also covers how abuse in health care is different from the related concepts of medical error, patient satisfaction and personal identity threat. BACKGROUND Abuse in health care is an emerging concept in need of a clear analysis and definition. At the same time, boundaries to the related concepts are not demarcated. DESIGN Concept analysis as developed by Walker and Avant. METHOD The databases Cumulative Index to Nursing and Allied Health Literature, Medline, and Google Scholar were used to obtain articles published between 1997 and 2009. A total of eleven articles are referred to on abuse in health care, four on medical error, six on patient satisfaction and three on personal identity threat. RESULTS Abuse in health care is defined by patients' subjective experiences of encounters with the health care system, characterized by devoid of care, where patients suffer and feel they lose their value as human beings. The events are most often unintended. We also found differences with the aforementioned related concepts: medical error does not share the patients' perspective, and patient satisfaction does not offer room for patients' abusive experiences. The concept of personal identity threat shares all attributes with abuse in health care, but it lacks an antecedent that signifies the social structures underlying the phenomenon. CONCLUSIONS Abuse in health care covers a phenomenon that has severe consequences but is invisible if seen from a medical error or patient satisfaction perspective.
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Affiliation(s)
- Adrianus Jelmer Brüggemann
- Division of Gender and Medicine, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden.
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Swahnberg K, Wijma B. Staff's awareness of abuse in health care varies according to context and possibilities to act. J Psychosom Obstet Gynaecol 2011; 32:65-71. [PMID: 21391861 DOI: 10.3109/0167482x.2011.555021] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES The aim of this study was to explore awareness of abuse in health care (AHC) from a staff perspective. Patient evaluation studies often focus on patient satisfaction, and serious negative experiences might therefore be obscured. In our research, we have found that abuse in health care (AHC) is commonly reported by male and female patients, when asked for in a strait way, but so far no intervention studies against AHC have been published. Investigating staff's awareness of AHC is our first step toward developing interventions against AHC. STUDY DESIGN Data were collected at a Swedish clinic of obstetrics and gynecology. Qualitative interviews with 21 informants were analysed with constant comparative analyses. RESULTS The core category - 'Staff's awareness of AHC varies according to context and possibilities to act' - was derived from the interaction between five categories; Moral imagination, Relativism, Explanations, Dissociation from AHC and Acting against AHC. Awareness of AHC was not a permanent state that did/did not exist as all participants displayed both high and low awareness; depending on the context. CONCLUSION Staff's awareness depends on more than personal characteristics; therefore, AHC interventions have to target individual behavior as well as cultures and structures in health care.
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Affiliation(s)
- Katarina Swahnberg
- Department of Clinical and Experimental Medicine, Division of Gender and Medicine, Linköping University, Linköping, Sweden.
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Strong discomfort during vaginal examination: why consider a history of abuse? Eur J Obstet Gynecol Reprod Biol 2011; 157:200-5. [PMID: 21470763 DOI: 10.1016/j.ejogrb.2011.02.025] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2010] [Revised: 02/05/2011] [Accepted: 02/26/2011] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To study factors associated with strong discomfort during vaginal examinations (SD/VE) by means of four hypotheses. STUDY DESIGN A cross sectional postal questionnaire study, conducted at three Swedish departments of obstetrics and gynaecology and with a random population sample (n=4453). MAIN OUTCOME MEASURES The associations between a self-reported history of emotional, physical and sexual abuse and abuse in health care, flashbacks during the previous year, emotional contact with the examiner, and SD/VE during the index visit (discomfort estimated on a ten-point scale; six-ten=SD). Statistical analyses used were Chi-square, Binary logistic regression, and Pearson Correlation. RESULTS Eighteen percent of the women reported SD/VE. There was an association between SD/VE and a lifetime history of abuse. Having experienced combinations of abuse, especially combinations including emotional abuse and abuse in health care, was strongly associated with SD/VE. SD/VE was furthermore associated with flashbacks during the previous year, and negative emotional contact with the examiner during the index visit. CONCLUSIONS We conclude that women who unexpectedly react with SD/VE are more likely to have a background of abuse, and may even run a risk of feeling re-traumatised during the VE. A clinical implication is to consider a history of abuse in patients who react with SD/VE or experience negative emotional contact during the consultation.
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Swahnberg K, Zbikowski A, Wijma B. Ethical lapses: staff's perception of abuse in health care. J Psychosom Obstet Gynaecol 2010; 31:123-9. [PMID: 20569188 DOI: 10.3109/0167482x.2010.491169] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Objective. Studies have shown high lifetime prevalence of abuse in health care (AHC) in Nordic gynaecological patients. For patients AHC implies feeling disempowered, dehumanised and devalued. The aim of our study was to apprehend health care staff's perceptions of AHC. Study design. Qualitative interviews with staff at a Swedish gynaecological clinic analysed by Constant comparative analysis (N = 21). Results. The two categories - ethical failures against a patient and staff members avoid responsibility - gives two disparate pictures of what AHC is. The interviews showed that these pictures can exist alongside even if they contradict each other. The core category 'ethical lapses' brings staff's contradictory reflections on AHC together in one picture. Notable is that the dualistic notion of AHC did not result in a moral conflict within staff members. Conclusion. Health care staff perceives AHC primarily as ethical lapses. Avoiding responsibility for AHC might lead to a failing recognition of AHC, implying that the problem is not properly dealt with. Our study highlights the need for a more open attitude in health care staff toward AHC. To counteract AHC, staff members need to accept that AHC occurs also in their own units, bringing in moral conflicts in the everyday work.
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Affiliation(s)
- Katarina Swahnberg
- Division of Gender and Medicine, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping 581 83, Sweden.
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Svavarsdottir EK. Detecting intimate partner abuse within clinical settings: self-report or an interview. Scand J Caring Sci 2010; 24:224-32. [DOI: 10.1111/j.1471-6712.2009.00709.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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