Patient-centered respectful maternity care: a factor analysis contextualizing marginalized identities, trust, and informed choice
Abstract Background Increasing rates of maternal mortality and morbidity, coupled with ever-widening racial health disparities in maternal health outcomes, indicate that radical improvements need to be made in the delivery of maternity care. This study explored the provision of patient-centered mate...
| Main Authors: | , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2024-04-01
|
| Series: | BMC Pregnancy and Childbirth |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12884-024-06491-2 |
| _version_ | 1797209001532850176 |
|---|---|
| author | Annie Glover Carly Holman Patrick Boise |
| author_facet | Annie Glover Carly Holman Patrick Boise |
| author_sort | Annie Glover |
| collection | DOAJ |
| description | Abstract Background Increasing rates of maternal mortality and morbidity, coupled with ever-widening racial health disparities in maternal health outcomes, indicate that radical improvements need to be made in the delivery of maternity care. This study explored the provision of patient-centered maternity care from the perspective of pregnant and postpartum people; experiences of respect and autonomy were examined through the multi-dimensional contexts of identity, relational trust, and protection of informed choices. Methods We conducted primary data collection among individuals who experienced a pregnancy in the five years preceding the survey (N = 484) using the validated Mothers on Respect Index (MORi) and Mothers Autonomy in Decision Making (MADM) scale. We conducted an exploratory factor analysis (EFA) which produced three factor variables: trust, informed choice, and identity. Using these factor variables as dependent variables, we conducted bivariate and multivariate analysis to examine the relationship between these factor variables and social marginalization, as measured by race, disability, justice-involvement, and other social risk factors, such as food and housing insecurity. Results Results of our bivariate and multivariate models generally confirmed our hypothesis that increased social marginalization would be associated with decreased experiences of maternity care that was perceived as respectful and protective of individual autonomy. Most notably, AI/AN individuals, individuals who are disabled, and individuals who had at least one social risk factor were more likely to report experiencing identity-related disrespect and violations of their autonomy. Conclusions In light of the findings that emphasize the importance of patient identity in their experience in the healthcare system, patient-centered and respectful maternity care must be provided within a broader social context that recognizes unequal power dynamics between patient and provider, historical trauma, and marginalization. Provider- and facility-level interventions that improve patient experiences and health outcomes will be more effective if they are contextualized and informed by an understanding of how patients’ identities and traumas shape their healthcare experience, health-seeking behaviors, and potential to benefit from clinical interventions and therapies. |
| first_indexed | 2024-04-24T09:47:45Z |
| format | Article |
| id | doaj.art-7978736975be4bec8f796313e5f9fac8 |
| institution | Directory Open Access Journal |
| issn | 1471-2393 |
| language | English |
| last_indexed | 2024-04-24T09:47:45Z |
| publishDate | 2024-04-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Pregnancy and Childbirth |
| spelling | doaj.art-7978736975be4bec8f796313e5f9fac82024-04-14T11:32:13ZengBMCBMC Pregnancy and Childbirth1471-23932024-04-0124111310.1186/s12884-024-06491-2Patient-centered respectful maternity care: a factor analysis contextualizing marginalized identities, trust, and informed choiceAnnie Glover0Carly Holman1Patrick Boise2University of Montana Rural Institute for Inclusive CommunitiesUniversity of Montana Rural Institute for Inclusive CommunitiesUniversity of Montana Rural Institute for Inclusive CommunitiesAbstract Background Increasing rates of maternal mortality and morbidity, coupled with ever-widening racial health disparities in maternal health outcomes, indicate that radical improvements need to be made in the delivery of maternity care. This study explored the provision of patient-centered maternity care from the perspective of pregnant and postpartum people; experiences of respect and autonomy were examined through the multi-dimensional contexts of identity, relational trust, and protection of informed choices. Methods We conducted primary data collection among individuals who experienced a pregnancy in the five years preceding the survey (N = 484) using the validated Mothers on Respect Index (MORi) and Mothers Autonomy in Decision Making (MADM) scale. We conducted an exploratory factor analysis (EFA) which produced three factor variables: trust, informed choice, and identity. Using these factor variables as dependent variables, we conducted bivariate and multivariate analysis to examine the relationship between these factor variables and social marginalization, as measured by race, disability, justice-involvement, and other social risk factors, such as food and housing insecurity. Results Results of our bivariate and multivariate models generally confirmed our hypothesis that increased social marginalization would be associated with decreased experiences of maternity care that was perceived as respectful and protective of individual autonomy. Most notably, AI/AN individuals, individuals who are disabled, and individuals who had at least one social risk factor were more likely to report experiencing identity-related disrespect and violations of their autonomy. Conclusions In light of the findings that emphasize the importance of patient identity in their experience in the healthcare system, patient-centered and respectful maternity care must be provided within a broader social context that recognizes unequal power dynamics between patient and provider, historical trauma, and marginalization. Provider- and facility-level interventions that improve patient experiences and health outcomes will be more effective if they are contextualized and informed by an understanding of how patients’ identities and traumas shape their healthcare experience, health-seeking behaviors, and potential to benefit from clinical interventions and therapies.https://doi.org/10.1186/s12884-024-06491-2Maternity carePatient-centered careRespectful carePatient autonomyHealth disparities |
| spellingShingle | Annie Glover Carly Holman Patrick Boise Patient-centered respectful maternity care: a factor analysis contextualizing marginalized identities, trust, and informed choice BMC Pregnancy and Childbirth Maternity care Patient-centered care Respectful care Patient autonomy Health disparities |
| title | Patient-centered respectful maternity care: a factor analysis contextualizing marginalized identities, trust, and informed choice |
| title_full | Patient-centered respectful maternity care: a factor analysis contextualizing marginalized identities, trust, and informed choice |
| title_fullStr | Patient-centered respectful maternity care: a factor analysis contextualizing marginalized identities, trust, and informed choice |
| title_full_unstemmed | Patient-centered respectful maternity care: a factor analysis contextualizing marginalized identities, trust, and informed choice |
| title_short | Patient-centered respectful maternity care: a factor analysis contextualizing marginalized identities, trust, and informed choice |
| title_sort | patient centered respectful maternity care a factor analysis contextualizing marginalized identities trust and informed choice |
| topic | Maternity care Patient-centered care Respectful care Patient autonomy Health disparities |
| url | https://doi.org/10.1186/s12884-024-06491-2 |
| work_keys_str_mv | AT annieglover patientcenteredrespectfulmaternitycareafactoranalysiscontextualizingmarginalizedidentitiestrustandinformedchoice AT carlyholman patientcenteredrespectfulmaternitycareafactoranalysiscontextualizingmarginalizedidentitiestrustandinformedchoice AT patrickboise patientcenteredrespectfulmaternitycareafactoranalysiscontextualizingmarginalizedidentitiestrustandinformedchoice |