Maternity Services

A substantial number of small surgical services in rural Canada have been discontinued in the past 15 years because of difficulties recruiting and retaining practitioners, health care restructuring and a lack of a coherent evidence base regarding the safety of small services. The objective of this study was to examine the safety of small perinatal surgical services. We accessed perinatal data for singleton births that occurred in British Columbia between Apr. 1, 2000, and Mar. 31, 2007. We defined hospital service levels, population catchment areas surrounding each hospital and the postal codes linked to those catchment areas. Births were linked with specific catchment areas and amalgamated by service level. We made comparisons among service strata populations and adjusted for potentially confounding characteristics. A total of 87 294 births occurred during the study period. The births were distributed across 6 strata of services, which ranged from no local maternity services to ser...

A substantial number of small surgical services in rural Canada have been discontinued in the past 15 years because of difficulties recruiting and retaining practitioners, health care restructuring and a lack of a coherent evidence base regarding the safety of small services. The objective of this study was to examine the safety of small perinatal surgical services. We accessed perinatal data for singleton births that occurred in British Columbia between Apr. 1, 2000, and Mar. 31, 2007. We defined hospital service levels, population catchment areas surrounding each hospital and the postal codes linked to those catchment areas. Births were linked with specific catchment areas and amalgamated by service level. We made comparisons among service strata populations and adjusted for potentially confounding characteristics. A total of 87 294 births occurred during the study period. The births were distributed across 6 strata of services, which ranged from no local maternity services to ser...

Disrespect and abuse (D&A) experienced by women during facility-based childbirth has gained global recognition as a threat to eliminating preventable maternal mortality and morbidity. This study explored the frequency and associated factors of D&A in four rural health centres in Ethiopia. Experiences of women who delivered in these facilities were captured by direct observation of client-provider interaction (N = 193) and exit interview at time of discharge (N = 204). Incidence of D&A was observed in each facility, with failure to ask woman for preferred birth position most commonly observed [n = 162, 83.9%, 95% confidence interval (95% CI) 78.0-88.5%]. During exit interviews, 21.1% (n = 43, 95% CI 15.4-26.7%) of respondents reported at least one occurrence of D&A. Bivariate models using client characteristics and index birth experience showed that women's reporting of D&A was significantly associated with childbirth complications [odds ratio (OR) = 7.98, 95% CI 3.70, 17.22], we...

We explore variations in service performance and quality improvement across healthcare organisations using the concept of improvement capability. We draw upon a theoretically informed framework comprising eight dimensions of improvement capability, firstly to describe and compare quality improvement within healthcare organisations and, secondly to investigate the interactions between organisational performance and improvement capability. A multiple qualitative case study using semi-structured interviews guided by the improvement capability framework. Five National Health Service maternity services sites across the UK. We focused on maternity services due to high levels of variation in quality and the availability of performance metrics which enabled us to select organisations from across the performance spectrum. About 52 hospital staff members across the five case studies in positions relevant to the research questions, including midwives, obstetricians and clinical managers/leader...

The provision of high quality healthcare information about pregnancy is important to women and to healthcare professionals and it is 1 driven, in part, by a desire to improve clinical outcomes,. The objective of this study was to examine the use of digital media by women' to access pregnancy information. A questionnaire was distributed to women attending a large maternity hospital. Of the 522 respondents, the mean age was 31.8 years, 45% (235/522) were nulliparous, 62% (324/522) lived in the capital city and 29% (150/522) attended the hospital as private patients. Overall 95% (498/522) used the internet for pregnancy information, 76% (399/522) had a smartphone and 59% (235/399) of smartphone owners had used a pregnancy smartapp. The nature of internet usage for pregnancy information included discussion forums (70%), social networks (67%), video media (48%), e-books (15%), blogs (13%), microblogs (9%) and podcasts (4%). Even women who were socially disadvantaged reported high lev...

This thesis contains no material which has been accepted for the award of any other degree or diploma at any university or equivalent institution and that, to the best of my knowledge and belief, this thesis contains no material previously published or written by another person, except where due reference is made in the text of the thesis.

National surveys on care experiences are increasingly adopted as regulatory mechanisms for improving care quality and increasing public trust in healthcare services. Based on data collected as part of Ireland's 2020 National Maternity Experience Survey, this study investigates care-related factors that contribute most to confidence and trust in the professional workforce (or carers) within Irish maternity services. The survey covered the full spectrum of maternity care and received 3,206 responses which were analysed using structural equation modelling. Results show that trust in carers may be enhanced through greater attention to the quality of interpersonal aspects of maternity care in a few core areas. We found that factors related to dignity and respect (β=0.270), involvement in decision-making (β=0.186), pain management (β=0.172), and communication (β=0.151) are core determinants of confidence and trust in the professional workforce of maternity services. Perceived quality of care in these four aspects increased on average, with the women's age. Women under 29 rated their experiences in these areas as significantly lower than the average. Women with a disability also rated their experiences significantly lower than average in three core areas. Our results suggest that trustworthy, equitable, and high-quality maternity care requires ongoing development of interpersonal skills within the maternity services professional workforce particularly in caring for younger women (under 29 years) and those with a disability.

This work examines the ethical aspects of restricting homebirth. It focuses on how restricting homebirth can breach the principle of autonomy because pregnant citizens 1 not only risk losing control over the medical decisions facing them, but also autonomy over their actions and control over their bodies. Using Berlin's discussion on freedom, this work discusses the rather hidden oppressive nature of birth restrictions that appears when it is framed as helping pregnant individuals choose a moral option as per the advice of medical authorities at the expense of seeing an institutional failure to provide informed choice or options for birthing places for their so-called "best interest". Three main arguments are offered why restricting homebirth can potentially violate autonomy: (1) imposing the authority to decide on the maternal body issues; (2) imposing standards on motherhood and pregnancy; and (3) imposing how to ascribe value to risk. These arguments highlight how the state and medical institutions have established authorities in the birthing process to justify restricting homebirth. When the state and medical institutions are framed as the moral authority for birth places, contrasting preferences of pregnant individuals are bound to be judged with guilt-ridden sentiments, shame and other value-laden labels related to one's choice rather than be seen as a reflection of the quality of institutional support. Homebirth restriction reflects that a pregnant person's decision of birthplace is not isolated from the availability of one's choice. Indeed, there is an ethical interest in restricting homebirth, as this could be benevolent at best and discriminatory at worst.

Background: Caesarean section (C-section) rates are often low among the poor and very high among the betteroff in low-and middle-income countries. We examined to what extent these differences are explained by medical need in an African context. Methods: We analyzed electronic records of 12,209 women who gave birth in a teaching hospital in Kenya in 2014. C-section rates were calculated by socioeconomic position (SEP), using maternal occupation (professional, small business, housewife, student) as indicator. We assessed if women had documented clinical indications according to hospital guidelines and if socioeconomic differences in C-section rates were explained by indication. Results: Indication for C-section according to hospital guidelines was more prevalent among professionals than housewives (16% vs. 9% of all births). The C-section rate was also higher among professionals than housewives (21.1% vs. 15.8% [OR 1.43; 95%CI 1.23-1.65]). This C-section rate difference was largely explained by indication (4.7 of the 5.3 percentage point difference between professionals and housewives concerned indicated C-sections, often with previous C-section as indication). Repeat C-sections were near-universal (99%). 43% of primary C-sections had no documented indication. Over-use was somewhat higher among professionals than housewives (C-section rate among women without indication: 6.6 and 5.5% respectively), which partly explained socioeconomic differences in primary C-section rate.

Background The postnatal period remains unstandardized in terms of care and postnatal visits with a dearth of information on the experience from Canadian women. Purpose To explore (1) with whom and how often women receive postnatal follow-up visits and (2) the postnatal care experiences of Canadian mothers. Methods Using a cross-sectional design, women who had given birth within the past 6 months were recruited to complete an online survey. Frequencies were computed for quantitative outcomes and thematic analysis was used for qualitative responses. Results A total of 561 mothers completed the survey. Women saw on average 1.9 different postnatal healthcare providers, primarily family doctors (72.4%). 3.2% had no postnatal visits and 37.6% had 4  or more within 6 weeks. 76.1% women were satisfied with their postnatal care. Women's satisfactory care in the postnatal period was associated with in-person and at home follow-ups, receiving support, and receiving timely, appropriate car...

Gypsy/Travellers have poor health and experience discrimination alongside structural and cultural barriers when accessing health services and consequently may mistrust those services. Our study aims to investigate which approaches to community engagement are most likely to be effective at enhancing trust between Gypsy/Travellers and mainstream health services. This multi-method 30-month study, commenced in June 2015, and comprises four stages. 1. Three related reviews: a) systematic review of Gypsy/Travellers' access to health services; b) systematic review of reviews of how trust has been conceptualised within healthcare; c) realist synthesis of community engagement approaches to enhance trust and increase Gypsy/Travellers' participation in health services. The reviews will consider any economic literature; 2. Online consultation with health and social care practitioners, and civil society organisations on existing engagement activities, including perceptions of barriers an...

The present series of three independent studies examines how workaholism and work engagement combine relying on a variety of distinct methodologies: interaction effects (Study 1, n = 160), a personcentered approach (Study 2, including two samples of n = 321 and 332), and a hybrid mixture regression approach (Study 3, n = 283). This research also documents the relations between workaholism, work engagement, and work outcomes (i.e., work-family conflicts, work performance, sleeping difficulties, and burnout). Furthermore, this research investigates the role of workload (Studies 2 and 3) and perceived social support (Study 2) in the prediction of profile membership. Studies 1 and 2 showed that that the combination of high levels of work engagement with high levels of workaholism was associated with a variety of negative outcomes. In Study 3, the highest levels of sleeping difficulties and workfamily conflicts were associated with the workaholic profile, followed by the engaged-workaholic profile, and finally the engaged profile. Finally, in Studies 2 and 3, workload showed strong associations with an increased likelihood of membership into the profiles characterized by higher levels of workaholism.

Background: Immigration to Canada has significantly increased in recent years, particularly in the Prairie Provinces. There is evidence that pregnant newcomer women often encounter challenges when attempting to navigate the health system. Our aim was to explore newcomer women's experiences in Canada regarding pregnancy, delivery and postpartum care and to assess the degree to which Canada provides equitable access to pregnancy and delivery services. Methods: Data were obtained from the Canadian Maternity Experiences Survey. Women (N = 6,241) participated in structured computer-assisted telephone interviews. Women from Alberta, Saskatchewan and Manitoba were included in this analysis. A total of 140 newcomers (arriving in Canada after 1996) and 1137 Canadian-born women met inclusion criteria. Results: Newcomers were more likely to be university graduates, but had lower incomes than Canadian-born women. No differences were found in newcomer ability to access acceptable prenatal care, although fewer received information regarding emotional and physical changes during pregnancy. Rates of C-sections were higher for newcomers than Canadian-born women (36.1% vs. 24.7%, p = 0.02). Newcomers were also more likely to be placed in stirrups for birth and have an assisted birth. Conclusion: Although newcomers residing in Prairie Provinces receive adequate maternity care, improvements are needed with respect to provision of information related to postpartum depression and informed choice around the need for C-sections.

Background: Evidence suggests that immigrant women having different ethnocultural backgrounds than those dominant in the host country have difficulty during their access to and reception of maternity care services, but little knowledge exists on how factors such as ethnic group and cultural beliefs intersect and influence health care access and outcomes. Amongst immigrant populations in Canada, refugee women are one of the most vulnerable groups and pregnant women with immediate needs for health care services may be at higher risk of health problems. This paper describes findings from the qualitative dimension of a mixed-methodological study. Methods: A focused ethnographic approach was conducted in 2010 with Sudanese women living in an urban Canadian city. Focus group interviews were conducted to map out the experiences of these women in maternity care, particularly with respect to the challenges faced when attempting to use health care services. Results: Twelve women (mean age 36.6 yrs) having experience using maternity services in Canada within the past two years participated. The findings revealed that there are many beliefs that impact upon behaviours and perceptions during the perinatal period. Traditionally, the women mostly avoid anything that they believe could harm themselves or their babies. Pregnancy and delivery were strongly believed to be natural events without need for special attention or intervention. Furthermore, the sub-Saharan culture supports the dominance of the family by males and the ideology of patriarchy. Pregnancy and birth are events reflecting a certain empowerment for women, and the women tend to exert control in ways that may or may not be respected by their husbands. Individual choices are often made to foster self and outward-perceptions of managing one's affairs with strength. Conclusion: In today's multicultural society there is a strong need to avert misunderstandings, and perhaps harm, through facilitating cultural awareness and competency of care rather than misinterpretations of resistance to care.

Background: Facilitating the provision of appropriate health care for immigrant and Aboriginal populations in Canada is critical for maximizing health potential and well-being. Numerous reports describe heightened risks of poor maternal and birth outcomes for immigrant and Aboriginal women. Many of these outcomes may relate to food consumption/practices and thus may be obviated through provision of resources which suit the women's ethnocultural preferences. This project aims to understand ethnocultural food and health practices of Aboriginal and immigrant women, and how these intersect with respect to the legacy of Aboriginal colonialism and to the social contexts of cultural adaptation and adjustment of immigrants. The findings will inform the development of visual tools for health promotion by practitioners. Methods/Design: This four-phase study employs a case study design allowing for multiple means of data collection and different units of analysis. Phase 1 consists of a scoping review of the literature. Phases 2 and 3 incorporate pictorial representations of food choices (photovoice in Phase 2) with semi-structured photo-elicited interviews (in Phase 3). The findings from Phases 1-3 and consultations with key stakeholders will generate key understandings for Phase 4, the production of culturally appropriate visual tools. For the scoping review, an emerging methodological framework will be utilized in addition to systematic review guidelines. A research librarian will assist with the search strategy and retrieval of literature. For Phases 2 and 3, recruitment of 20-24 women will be facilitated by team member affiliations at perinatal clinics in one of the city's most diverse neighbourhoods. The interviews will reveal culturally normative practices surrounding maternal food choices and consumption, including how women negotiate these practices within their own worldview and experiences. A structured and comprehensive integrated knowledge translation plan has been formulated. Discussion: The findings of this study will provide practitioners with an understanding of the cultural differences that affect women's dietary choices during maternity. We expect that the developed resources will be of immediate use within the women's units and will enhance counseling efforts. Wide dissemination of outputs may have a greater long term impact in the primary and secondary prevention of these high risk conditions.

Background: Immigration to Canada has significantly increased in recent years, particularly in the Prairie Provinces. There is evidence that pregnant newcomer women often encounter challenges when attempting to navigate the health system. Our aim was to explore newcomer women's experiences in Canada regarding pregnancy, delivery and postpartum care and to assess the degree to which Canada provides equitable access to pregnancy and delivery services. Methods: Data were obtained from the Canadian Maternity Experiences Survey. Women (N = 6,241) participated in structured computer-assisted telephone interviews. Women from Alberta, Saskatchewan and Manitoba were included in this analysis. A total of 140 newcomers (arriving in Canada after 1996) and 1137 Canadian-born women met inclusion criteria. Results: Newcomers were more likely to be university graduates, but had lower incomes than Canadian-born women. No differences were found in newcomer ability to access acceptable prenatal care, although fewer received information regarding emotional and physical changes during pregnancy. Rates of C-sections were higher for newcomers than Canadian-born women (36.1% vs. 24.7%, p = 0.02). Newcomers were also more likely to be placed in stirrups for birth and have an assisted birth. Conclusion: Although newcomers residing in Prairie Provinces receive adequate maternity care, improvements are needed with respect to provision of information related to postpartum depression and informed choice around the need for C-sections.

Ce travail de thèse vise à produire des connaissances sur l'activité réelle, individuelle-sociale d'infirmières-puéricultrices en interaction avec le nouveau-né grand prématuré. Ces connaissances constituent des pistes d'améliorations pour la formation des professionnelles, dans un contexte où la prématurité est un problème de santé publique mondial et où les soins à ces nouveau-nés représentent un enjeu crucial pour leur développement neurosensoriel. Toutefois la formation concernant ces soins à hauts risques possède peu d'ancrage avec les données scientifiques permettant de prendre en compte l'activité humaine déployée dans ces situations complexes. Cette recherche a donc pour objectif de décrire, analyser et caractériser cette activité peu explorée, afin de comprendre comment en situation réelle, deux puéricultrices expérimentées utilisent en-action différentes ressources corporelles, langagières et artefactuelles pour inter-agir avec l'enfant, cet autrui qui ne parle pas et dont les réactions sont spécifiques. Cette étude à visée épistémique et transformative s'inscrit dans le cadre du programme de recherche « Cours d'Action » qui privilégie une approche anthropologique enactive. L'activité est considérée comme située et s'accompagne en permanence de construction de sens qui s'actualise dans des actions pratiques, des communications, des interprétations, des focalisations et des émotions. Cette approche permet d'accéder à la compréhension de l'activité des acteurs, en partie silencieuse, à partir de leur point de vue. Le dispositif méthodologique articule : des données concernant les contraintes de l'activité dans les corps, situations et cultures construites selon les méthodes usuelles de l'ethnographie ; des données psycho-phénoménologiques construites lors d'entretiens d'autoconfrontation de situations filmées et des données proxémiques. Les résultats montrent que l'activité des puéricultrices est contrainte par l'environnement spatial, humain et technologique nécessaire à la survie de l'enfant. Elle donne à voir un engagement exploratoire et exécutoire qui s'actualise par une veille continue orientée vers le nouveau-né et son environnement. Trois préoccupations prépondérantes émergent et structurent cette activité : 1) Maintenir une continuité de présence avec le nouveau-né pendant le soin, en s'appuyant sur l'organisation de l'environnement de travail et une communication par corps qui vise aussi à conserver une proximité physique ; 2) Exercer une vigilance, dont les activités de prévention, surveillance et enquête constituent les orientations prioritaires, dans lesquelles les appareils technologiques sont des médiateurs de l'action et contraignent l'activité des puéricultrices à partir de boucles perception-action ; 3) Maintenir le confort par le soutien du nouveau-né dans la gestion du stress en s'appuyant sur des perceptions pluri-sensorielles qui favorisent l'articulation d'actions multimodales et contribuent au maintien de l'interaction. Ces résultats montrent l'importance des dimensions sensorielles et sensorimotrices de l'expérience des puéricultrices qui étayent le prendre soin et donnent à voir leur engagement dans la recherche d'une essentielle coordination avec le nouveau-né. Ils conduisent à envisager des pistes d'enrichissement pour la formation prenant en compte sérieusement les dimensions sensibles et incorporées de l'activité en situation de soin. Les situations étudiées ouvrent un questionnement plus large concernant toutes les situations de soins auprès de populations fragiles dont les modalités de communication sont altérées et où vont se mêler des aspects techniques et relationnels.

Disrespect and abuse (D&A) experienced by women during facility-based childbirth has gained global recognition as a threat to eliminating preventable maternal mortality and morbidity. This study explored the frequency and associated factors of D&A in four rural health centres in Ethiopia. Experiences of women who delivered in these facilities were captured by direct observation of client-provider interaction (N = 193) and exit interview at time of discharge (N = 204). Incidence of D&A was observed in each facility, with failure to ask woman for preferred birth position most commonly observed [n = 162, 83.9%, 95% confidence interval (95% CI) 78.0-88.5%]. During exit interviews, 21.1% (n = 43, 95% CI 15.4-26.7%) of respondents reported at least one occurrence of D&A. Bivariate models using client characteristics and index birth experience showed that women's reporting of D&A was significantly associated with childbirth complications [odds ratio (OR) = 7.98, 95% CI 3.70, 17.22], we...

Background The postnatal period remains unstandardized in terms of care and postnatal visits with a dearth of information on the experience from Canadian women. Purpose To explore (1) with whom and how often women receive postnatal follow-up visits and (2) the postnatal care experiences of Canadian mothers. Methods Using a cross-sectional design, women who had given birth within the past 6 months were recruited to complete an online survey. Frequencies were computed for quantitative outcomes and thematic analysis was used for qualitative responses. Results A total of 561 mothers completed the survey. Women saw on average 1.9 different postnatal healthcare providers, primarily family doctors (72.4%). 3.2% had no postnatal visits and 37.6% had 4  or more within 6 weeks. 76.1% women were satisfied with their postnatal care. Women's satisfactory care in the postnatal period was associated with in-person and at home follow-ups, receiving support, and receiving timely, appropriate car...

Background: In Australia, women who give birth are transitioned from maternity services to child and health services once their baby is born. This horizontal integration of services is known as Transition of Care (ToC). Little is known of the scope and processes of ToC for new mothers and the most effective way to provide continuity of services. The aim of this paper is to explore and describe the ToC between maternity services to CFH services from the perspective of Australian midwives and child and family health (CFH) nurses. Method: This paper reports findings from phase two of a three phase mixed methods study investigating the feasibility of implementing a national approach to CFH services in Australia (the CHoRUS study). Data were collected through a national survey of midwives (n = 655) and CFH nurses (n = 1098). Issues specifically related to ToC between maternity services and CFH services were examined using descriptive statistics and content analysis of qualitative responses. Results: Respondents described the ToC between maternity services and CFH services as problematic. Key problems identified included communication between professionals and services and transfer of client information. Issues related to staff shortages, early maternity discharge, limited interface between private and public health systems and tension around role boundaries were also reported. Midwives and CFH nurses emphasised that these issues were more difficult for families with identified social and emotional health concerns. Strategies identified by respondents to improve ToC included improving electronic transfer of information, regular meetings between maternity and CFH services, and establishment of liaison roles. Conclusion: Significant problems exist around the ToC for all families but particularly for families with identified risks. Improved ToC will require substantial changes in information transfer processes and in the professional relationships which currently exist between maternity and CFH services.

Background: Canada's diverse society and its statutory commitment to multiculturalism means that a synthesis of knowledge related to the healthcare experiences of immigrants is essential to realise the health potential for future Canadians. Although concerns about the maternity experiences of immigrants in Canada are relatively new, recent national guidelines explicitly call for the tailoring of services to user needs. We therefore assessed the experiences of immigrant women accessing maternity-care services in Canada. In particular, we investigated the experiences of immigrant women in Canada in accessing and navigating maternity and related healthcare services from conception to 6 months postpartum in Canada. Our focus was on (a) the accessibility and acceptability of maternity-care services for immigrant women and (b) the effects of the perceptions and experiences of these women on their birth and postnatal outcomes. Methods: We conducted a systematic review using a systematic search and narrative synthesis of peer-reviewed and non-peer-reviewed reports of empirical research, with the aim of providing stakeholders with perspectives on maternity-care services as experienced by immigrant women. We partnered with key stakeholders ('integrated knowledge users') to ensure the relevancy of topics and to tailor recommendations for effective translation into future policy, practice and programming. Two search phases and a three-stage selection process for published and grey literature were conducted prior to appraisal of literature quality and narrative synthesis of the findings. Results: Our knowledge synthesis of maternity care among immigrants to Canada provided a coherent evidence base for (a) eliciting a better understanding of the factors that generate disparities in accessibility, acceptability and outcomes during maternity care; and (b) improving culturally based competency in maternity care. Our synthesis also identified pertinent issues in multiple sectors that should be addressed to configure maternity services and programs appropriately. Conclusions: Although immigrant women in Canada are generally given the opportunity to obtain necessary services, they face many barriers in accessing and utilising these services. These barriers include lack of information about or awareness of the services, insufficient supports to access these services and discordant expectations between the women and their service providers.

The framework provided by the Millennium Development Goals includes maternal health as an area of priority. Postnatal depression (PND) is a serious public health issue because it occurs at a crucial time in a mothers’ life, can persist for long periods, and can have adverse effects on partners and the emotional, behavioural, and cognitive development of infants and children. Internationally, public health nurses (PHNs) are key professionals in the delivery of health care to mothers in the postpartum period, and international research collaborations are encouraged. Two researchers from the European Academy of Nursing Science (EANS) identified a need to collaborate and strengthen research capacity and discussion on postnatal depression, a public health nursing issue in both countries. Within the context of public health and public health nursing in Ireland and Norway, the aim of this paper is to present a discussion on the concept of PND, prevalence, and outcomes; screening issues for...

Disrespect and abuse (D&A) experienced by women during facility-based childbirth has gained global recognition as a threat to eliminating preventable maternal mortality and morbidity. This study explored the frequency and associated factors of D&A in four rural health centres in Ethiopia. Experiences of women who delivered in these facilities were captured by direct observation of client-provider interaction (N = 193) and exit interview at time of discharge (N = 204). Incidence of D&A was observed in each facility, with failure to ask woman for preferred birth position most commonly observed [n = 162, 83.9%, 95% confidence interval (95% CI) 78.0-88.5%]. During exit interviews, 21.1% (n = 43, 95% CI 15.4-26.7%) of respondents reported at least one occurrence of D&A. Bivariate models using client characteristics and index birth experience showed that women's reporting of D&A was significantly associated with childbirth complications [odds ratio (OR) = 7.98, 95% CI 3.70, 17.22], we...

Background: Infections acquired during childbirth are a common cause of maternal and perinatal mortality and morbidity. Changing provider behaviour and organisational settings within the health system is key to reducing the spread of infection. Objective: To explore the opinions of health personnel on health system factors related to infection control and their perceptions of change in a sample of hospital maternity units. Design: An organisational change process called 'appreciative inquiry' (AI) was introduced in three maternity units of hospitals in Gujarat, India. AI is a change process that builds on recognition of positive actions, behaviours, and attitudes. In-depth interviews were conducted with health personnel to elicit information on the environment within which they work, including physical and organisational factors, motivation, awareness, practices, perceptions of their role, and other health system factors related to infection control activities. Data were obtained from three hospitals which implemented AI and another three not involved in the intervention. Results: Challenges which emerged included management processes (e.g. decision-making and problemsolving modalities), human resource shortages, and physical infrastructure (e.g. space, water, and electricity supplies). AI was perceived as having a positive influence on infection control practices. Respondents also said that management processes improved although some hospitals had already undergone an accreditation process which could have influenced the changes described. Participants reported that team relationships had been strengthened due to AI. Conclusion: Technical knowledge is often emphasised in health care settings and less attention is paid to factors such as team relationships, leadership, and problem solving. AI can contribute to improving infection control by catalysing and creating forums for team building, shared decision making and problem solving in an enabling environment.

Background Evaluating women’s satisfaction should reflect the entire maternity care experience (antenatal, intrapartum and postnatal). The Women’s Experience Maternity Care Scale (WEMCS) questionnaire enables this assessment. The purpose of this study was to translate in French, adapt and explore the psychometric properties of the WEMCS and to determine the best cut-off on the optimal satisfaction for the three scales. Methods Backward, forward translation and cross-cultural adaptation were processed to validate the French version of WEMCS: Échelle de Satisfaction de l’Experience des soins en Maternité (ESEM). Psychometric tests assessed the questionnaire, which includes three scales, such as construct validity, internal consistency, Cronbach’s alpha coefficients and ceiling and floor effects. A receiver operating characteristic (ROC) curve was used to determine the best cut-off values for optimal satisfaction. Reproducibility was verified by test–retest reliability. Results Primipa...

Purpose – The aim of this study was two-fold: first, to examine the noxious effects of presenteeism on employees' work well-being in a cross-cultural context involving Chinese and British employees; second, to explore the role of supervisory support as a pan-cultural stress buffer in the presenteeism process. Design/methodology/approach – Using structured questionnaires, the authors compared data collected from samples of 245 Chinese and 128 British employees working in various organizations and industries. Findings – Cross-cultural comparison revealed that the act of presenteeism was more prevalent among Chinese and they reported higher levels of strains than their British counterparts. Hierarchical regression analyses showed that presenteeism had noxious effects on exhaustion for both Chinese and British employees. Moreover, supervisory support buffered the negative impact of presenteeism on exhaustion for both Chinese and British employees. Specifically, the negative relation...

Purpose – The aim of this study was two-fold: first, to examine the noxious effects of presenteeism on employees' work well-being in a cross-cultural context involving Chinese and British employees; second, to explore the role of supervisory support as a pan-cultural stress buffer in the presenteeism process. Design/methodology/approach – Using structured questionnaires, the authors compared data collected from samples of 245 Chinese and 128 British employees working in various organizations and industries. Findings – Cross-cultural comparison revealed that the act of presenteeism was more prevalent among Chinese and they reported higher levels of strains than their British counterparts. Hierarchical regression analyses showed that presenteeism had noxious effects on exhaustion for both Chinese and British employees. Moreover, supervisory support buffered the negative impact of presenteeism on exhaustion for both Chinese and British employees. Specifically, the negative relation...

Background: Infections acquired during childbirth are a common cause of maternal and perinatal mortality and morbidity. Changing provider behaviour and organisational settings within the health system is key to reducing the spread of infection. Objective: To explore the opinions of health personnel on health system factors related to infection control and their perceptions of change in a sample of hospital maternity units. Design: An organisational change process called ‘appreciative inquiry ’ (AI) was introduced in three maternity units of hospitals in Gujarat, India. AI is a change process that builds on recognition of positive actions, behaviours, and attitudes. In-depth interviews were conducted with health personnel to elicit information on the environment within which they work, including physical and organisational factors, motivation, awareness, practices, perceptions of their role, and other health system factors related to infection control activities. Data were obtained f...

Background: Infections acquired during childbirth are a common cause of maternal and perinatal mortality and morbidity. Changing provider behaviour and organisational settings within the health system is key to reducing the spread of infection. Objective: To explore the opinions of health personnel on health system factors related to infection control and their perceptions of change in a sample of hospital maternity units. Design: An organisational change process called 'appreciative inquiry' (AI) was introduced in three maternity units of hospitals in Gujarat, India. AI is a change process that builds on recognition of positive actions, behaviours, and attitudes. In-depth interviews were conducted with health personnel to elicit information on the environment within which they work, including physical and organisational factors, motivation, awareness, practices, perceptions of their role, and other health system factors related to infection control activities. Data were obtained from three hospitals which implemented AI and another three not involved in the intervention. Results: Challenges which emerged included management processes (e.g. decision-making and problemsolving modalities), human resource shortages, and physical infrastructure (e.g. space, water, and electricity supplies). AI was perceived as having a positive influence on infection control practices. Respondents also said that management processes improved although some hospitals had already undergone an accreditation process which could have influenced the changes described. Participants reported that team relationships had been strengthened due to AI. Conclusion: Technical knowledge is often emphasised in health care settings and less attention is paid to factors such as team relationships, leadership, and problem solving. AI can contribute to improving infection control by catalysing and creating forums for team building, shared decision making and problem solving in an enabling environment.

The prevalence of work addiction is constantly increasing worldwide, ranging from 8.3% to 30%, especially among physicians. The aim of this study was to assess the prevalence and characteristics of Work Addiction among academic physicians and its influence on their mental and physical health. This is a cross-sectional survey conducted among the 293 academic physicians practicing in the teaching hospitals of the faculty of Medicine of Monastir in Tunisia. We used a self-administered questionnaire, with the «Work Addiction Risk Test » and the «SF-8 health survey». The participation rate was 24.3%, 24% were addicted to work and 56% were at high risk of addiction. WART score was significantly higher in single, females with medical history of depression or associated depression, poor physical and mental health and psychosomatic symptoms. It was significantly decreased with age, and seniority. Certain psychosocial factors increased WART score. Mental health score was significantly lower i...

Background: Utilization indices exist to measure quantity of prenatal care, but currently there is no published instrument to assess quality of prenatal care. The purpose of this study was to develop and test a new instrument, the Quality of Prenatal Care Questionnaire (QPCQ). Methods: Data for this instrument development study were collected in five Canadian cities. Items for the QPCQ were generated through interviews with 40 pregnant women and 40 health care providers and a review of prenatal care guidelines, followed by assessment of content validity and rating of importance of items. The preliminary 100-item QPCQ was administered to 422 postpartum women to conduct item reduction using exploratory factor analysis. The final 46-item version of the QPCQ was then administered to another 422 postpartum women to establish its construct validity, and internal consistency and test-retest reliability. Results: Exploratory factor analysis reduced the QPCQ to 46 items, factored into 6 subscales, which subsequently were validated by confirmatory factor analysis. Construct validity was also demonstrated using a hypothesis testing approach; there was a significant positive association between women's ratings of the quality of prenatal care and their satisfaction with care (r = 0.81). Convergent validity was demonstrated by a significant positive correlation (r = 0.63) between the "Support and Respect" subscale of the QPCQ and the "Respectfulness/Emotional Support" subscale of the Prenatal Interpersonal Processes of Care instrument. The overall QPCQ had acceptable internal consistency reliability (Cronbach's alpha = 0.96), as did each of the subscales. The test-retest reliability result (Intra-class correlation coefficient = 0.88) indicated stability of the instrument on repeat administration approximately one week later. Temporal stability testing confirmed that women's ratings of their quality of prenatal care did not change as a result of giving birth or between the early postpartum period and 4 to 6 weeks postpartum. Conclusion: The QPCQ is a valid and reliable instrument that will be useful in future research as an outcome measure to compare quality of care across geographic regions, populations, and service delivery models, and to assess the relationship between quality of care and maternal and infant health outcomes.

Empirical research on workaholism has been hampered by a lack of consensus regarding the definition and appropriate measurement of the construct. In the present study, we first review prior conceptualizations of workaholism in an effort to identify a definition of workaholism. Then, we conduct a meta-analysis of the correlates and outcomes of workaholism to clarify its nomological network. Results indicate that workaholism is related to achievement-oriented personality traits (i.e., perfectionism, Type A personality), but is generally unrelated to many other dispositional (e.g., conscientiousness, self-esteem, positive affect) and demographic (e.g., gender, parental status, marital status) variables. Findings are mixed regarding the relationship between workaholism and affectively laden variables, which speaks to the complex nature of workaholism. Results also show that workaholism is related to many negative outcomes, such as burnout, job stress, work–life conflict, and decreased p...

For over a decade, enquiries into adverse perinatal outcomes have led to reports that poor collaboration has been detrimental to the safety and experience of maternity care. Despite efforts to improve collaboration, investigations into maternity care at Morecambe Bay (UK) and Djerriwarrh Health Services (Australia) have revealed that poor collaboration and decision-making remain a threat to perinatal safety. The Labouring Together study will investigate how elements hypothesised to influence the effectiveness of collaboration are reflected in perceptions and experiences of clinicians and childbearing women in Victoria, Australia. The study will explore conditions that assist clinicians and women to work collaboratively to support positive maternity outcomes. Results of the study will provide a platform for consumers, clinician groups, organisations and policymakers to work together to improve the quality, safety and experience of maternity care. 4 case study sites have been selected...

teaches entrepreneurship, new venture strategy, new venture resourcing, and business planning in the Brisbane Graduate School of Business at Queensland University of Technology, where he has been Head of School since July 1997. His research interests include entrepreneurial attitudes and abilities, the self-employment decision, work motivation, and issues relating to new venture funding and new venture strategy.

Today, there is a swift increase on the number of people trying to prove themselves due the changing work environment and fear of unemployment. Although work is a positive value for people in our current society, when it is over-important for people, it could have negative consequences such as workaholism. The concept of workaholism introduced by Oates in 1968 is described as the compulsion or the uncontrollable need to work incessantly. A workaholic is a person who is addicted to work and always think about work. Workaholics are work oriented people that spend most of their time working in and out of the office. There are many reasons of workaholism in its roots such as technological, social, and financial. The frequent use of mobile devices such as cell phones and laptop computers makes it possible to work at alternative workplaces, such as at home or in airport lounges. Accordingly, more importance is given on the researches related to workaholic concept. The main question of the...

Patient safety is an important objective in health care. Preventable adverse events (pAEs) as the counterpart to patient safety are harmful incidents that fell behind health care standards and have led to temporary or permanent harm or death. As safe communication and mutual understanding are of crucial importance for providing a high quality of care under everyday conditions, we aimed to identify barriers and facilitators that impact safe communication in obstetrics from the subjective perspective of health care workers. A qualitative study with 20 semi-structured interviews at two university hospitals in Germany was conducted to explore everyday perceptions from a subjective perspective (subjective theories). Physicians, midwives, and nurses in a wide span of professional experience and positions were enrolled. We identified a structural area of conflict at the professional interface between midwives and physicians. Mandatory interprofessional meetings, acceptance of subjective mi...

Background: Utilization indices exist to measure quantity of prenatal care, but currently there is no published instrument to assess quality of prenatal care. The purpose of this study was to develop and test a new instrument, the Quality of Prenatal Care Questionnaire (QPCQ). Methods: Data for this instrument development study were collected in five Canadian cities. Items for the QPCQ were generated through interviews with 40 pregnant women and 40 health care providers and a review of prenatal care guidelines, followed by assessment of content validity and rating of importance of items. The preliminary 100-item QPCQ was administered to 422 postpartum women to conduct item reduction using exploratory factor analysis. The final 46-item version of the QPCQ was then administered to another 422 postpartum women to establish its construct validity, and internal consistency and test-retest reliability. Results: Exploratory factor analysis reduced the QPCQ to 46 items, factored into 6 subscales, which subsequently were validated by confirmatory factor analysis. Construct validity was also demonstrated using a hypothesis testing approach; there was a significant positive association between women's ratings of the quality of prenatal care and their satisfaction with care (r = 0.81). Convergent validity was demonstrated by a significant positive correlation (r = 0.63) between the "Support and Respect" subscale of the QPCQ and the "Respectfulness/Emotional Support" subscale of the Prenatal Interpersonal Processes of Care instrument. The overall QPCQ had acceptable internal consistency reliability (Cronbach's alpha = 0.96), as did each of the subscales. The test-retest reliability result (Intra-class correlation coefficient = 0.88) indicated stability of the instrument on repeat administration approximately one week later. Temporal stability testing confirmed that women's ratings of their quality of prenatal care did not change as a result of giving birth or between the early postpartum period and 4 to 6 weeks postpartum. Conclusion: The QPCQ is a valid and reliable instrument that will be useful in future research as an outcome measure to compare quality of care across geographic regions, populations, and service delivery models, and to assess the relationship between quality of care and maternal and infant health outcomes.

Background: Through the World Health Assembly Resolution, 'Health of Migrants', the international community has identified migrant health as a priority. Recommendations for general hospital care for international migrants in receiving-countries have been put forward by the Migrant Friendly Hospital Initiative; adaptations of these recommendations specific to maternity care have yet to be elucidated and validated. We aimed to develop a questionnaire measuring migrant-friendly maternity care (MFMC) which could be used in a range of maternity care settings and countries. Methods: This study was conducted in four stages. First, questions related to migrant friendly maternity care were identified from existing questionnaires including the Migrant Friendliness Quality Questionnaire, developed in Europe to capture recommended general hospital care for migrants, and the Mothers In a New Country (MINC) Questionnaire, developed in Australia and revised for use in Canada to capture the maternity care experiences of migrant women, and combined to create an initial MFMC questionnaire. Second, a Delphi consensus process in three rounds with a panel of 89 experts in perinatal health and migration from 17 countries was undertaken to identify priority themes and questions as well as to clarify wording and format. Third, the draft questionnaire was translated from English to French and Spanish and back-translated and subsequently culturally validated (assessed for cultural appropriateness) by migrant women. Fourth, the questionnaire was piloted with migrant women who had recently given birth in Montreal, Canada. Results: A 112-item questionnaire on maternity care from pregnancy, through labour and birth, to postpartum care, and including items on maternal socio-demographic, migration and obstetrical characteristics, and perceptions of care, has been created-the Migrant Friendly Maternity Care Questionnaire (MFMCQ)in three languages (English, French and Spanish). It is completed in 45 minutes via interview administration several months post-birth.

Refugee and asylum-seeking women in Canada may have significant harmful childbearing health outcomes and unmet health and social care needs. The most vulnerable of these women are: those who have left their countries by force (e.g., war, rape or abuse histories), are separated from their families, have limited knowledge of the host country languages, and are visible minorities. Asylum-seekers face additional stresses related to their unknown future status and are marginalized with regards to access to provincial health care systems. The prevalence and severity of health issues in this population is not known nor is the extent of response from social service and health care systems (including variation in provincial service delivery). Understanding the magnitude of health and social concerns of newcomers requires data from a representative sample of childbearing refugee and asylum-seeking women resettling in Canada to permit comparisons to be made with non-refugee immigrant and Canad...

Refugee and asylum-seeking women in Canada may have significant harmful childbearing health outcomes and unmet health and social care needs. The most vulnerable of these women are: those who have left their countries by force (eg, war, rape or abuse histories), are ...

Although work factors have been associated with both presenteeism and exhaustion among hospital physicians, we lack knowledge on the dynamic relationship between demands in the work context and presenteeism and how this can be mediated by symptoms of exhaustion when controlling for job resources. The objective of this study is to examine a health impairment process of presenteeism among university hospital physicians. A cross-sectional survey of 545 university hospital physicians in Norway was conducted. Variables included in the model were presenteeism, exhaustion, work-family conflict, role conflict, social support and control over work pace. Findings from structural equation modeling indicated that exhaustion mediates the relationship between job demands and presenteeism. Job resources had no direct effect on presenteeism in the hypothesized model. The variables in the study explained 17% of the variance in presenteeism. The study is one of the first to demonstrate that the relationship between job demands and presenteeism is mediated by exhaustion when controlling for job resources. The results highlight the importance of considering the link between health symptoms and job demands to reduce the negative effects of presenteeism.

Although the benefits of breastfeeding to six months are well-established, only about half of Australian women succeed. The factors associated with successful breastfeeding are rarely translated into effective interventions. A new educational and support program, called the Milky Way program has been demonstrated to be effective in supporting women to achieve prolonged breastfeeding. In the Milky Way program, breastfeeding is considered an embodied performance which requires an engaged combination of body, mind and spirit. This paper aims to explain how the two theories that informed the program were used to better enable women's long term breastfeeding success. The theory of self-efficacy is first described as a way to develop women's cognitive processes to organise and execute the course of actions to breastfeed for a longer period of time. Birth territory theory is then presented. This theory discusses women as embodied selves; an essential concept for breastfeeding succe...

Patient safety is an important objective in health care. Preventable adverse events (pAEs) as the counterpart to patient safety are harmful incidents that fell behind health care standards and have led to temporary or permanent harm or death. As safe communication and mutual understanding are of crucial importance for providing a high quality of care under everyday conditions, we aimed to identify barriers and facilitators that impact safe communication in obstetrics from the subjective perspective of health care workers. A qualitative study with 20 semi-structured interviews at two university hospitals in Germany was conducted to explore everyday perceptions from a subjective perspective (subjective theories). Physicians, midwives, and nurses in a wide span of professional experience and positions were enrolled. We identified a structural area of conflict at the professional interface between midwives and physicians. Mandatory interprofessional meetings, acceptance of subjective mi...

Refugee and asylum-seeking women in Canada may have significant harmful childbearing health outcomes and unmet health and social care needs. The most vulnerable of these women are: those who have left their countries by force (e.g., war, rape or abuse histories), are separated from their families, have limited knowledge of the host country languages, and are visible minorities. Asylum-seekers face additional stresses related to their unknown future status and are marginalized with regards to access to provincial health care systems. The prevalence and severity of health issues in this population is not known nor is the extent of response from social service and health care systems (including variation in provincial service delivery). Understanding the magnitude of health and social concerns of newcomers requires data from a representative sample of childbearing refugee and asylum-seeking women resettling in Canada to permit comparisons to be made with non-refugee immigrant and Canad...