Women's and care providers' perspectives of quality prenatal care: a qualitative descriptive study
1 School of Nursing and Department of Clinical Epidemiology and Biostatistics, Faculty of Health Sciences, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada
2 Faculty of Nursing, University of Manitoba, 89 Curry Place, Winnipeg, Manitoba R3T 2N2, Canada
3 School of Nursing, Faculty of Health Sciences, McMaster University, 1200 Main Street West, Hamilton, Ontario L8N 3Z5, Canada
4 Department of Paediatrics and Community Health Sciences, Faculty of Medicine, University of Calgary and Alberta Centre for Child, Family and Community Research, 2888 Shaganappi Trail NW, Calgary, Alberta T3B 6A8, Canada
5 School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, British Columbia V6T 3Z1, Canada
6 IWK Health Centre and Department of Obstetrics and Gynecology, Faculty of Medicine, Dalhousie University, 5980 University Avenue, P.O. Box 9700, Halifax, Nova Scotia B3K 6R8, Canada
7 Faculty of Nursing, University of Alberta, 5-258 Edmonton Clinic Health Academy, 11405-87th Avenue, Edmonton, Alberta T6G 1C9, Canada
8 St. Boniface General Hospital and Department of Obstetrics, Gynecology and Reproductive Sciences, Faculty of Medicine, University of Manitoba, 409 Tache Avenue, Winnipeg, Manitoba R2H 2A6, Canada
9 School of Nursing and Department of Clinical Epidemiology and Biostatistics, Faculty of Health Sciences, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada
10 Department of Obstetrics and Gynecology and Department of Clinical Epidemiology and Biostatistics, Faculty of Health Sciences, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada
BMC Pregnancy and Childbirth 2012, 12:29 doi:10.1186/1471-2393-12-29Published: 13 April 2012
Much attention has been given to the adequacy of prenatal care use in promoting healthy outcomes for women and their infants. Adequacy of use takes into account the timing of initiation of prenatal care and the number of visits. However, there is emerging evidence that the quality of prenatal care may be more important than adequacy of use. The purpose of our study was to explore women's and care providers' perspectives of quality prenatal care to inform the development of items for a new instrument, the Quality of Prenatal Care Questionnaire. We report on the derivation of themes resulting from this first step of questionnaire development.
A qualitative descriptive approach was used. Semi-structured interviews were conducted with 40 pregnant women and 40 prenatal care providers recruited from five urban centres across Canada. Data were analyzed using inductive open and then pattern coding. The final step of analysis used a deductive approach to assign the emergent themes to broader categories reflective of the study's conceptual framework.
The three main categories informed by Donabedian's model of quality health care were structure of care, clinical care processes, and interpersonal care processes. Structure of care themes included access, physical setting, and staff and care provider characteristics. Themes under clinical care processes were health promotion and illness prevention, screening and assessment, information sharing, continuity of care, non-medicalization of pregnancy, and women-centredness. Interpersonal care processes themes were respectful attitude, emotional support, approachable interaction style, and taking time. A recurrent theme woven throughout the data reflected the importance of a meaningful relationship between a woman and her prenatal care provider that was characterized by trust.
While certain aspects of structure of care were identified as being key dimensions of quality prenatal care, clinical and interpersonal care processes emerged as being most essential to quality care. These processes are important as they have a role in mitigating adverse outcomes, promoting involvement of women in their own care, and keeping women engaged in care. The findings suggest key considerations for the planning, delivery, and evaluation of prenatal care. Most notably, care should be woman-centred and embrace shared decision making as an essential element.