Examining the Perceived Quality of Person-Centered Maternity Care (PCMC) in Prenatal Telehealth Services during the COVID-19 Pandemic in Georgia: A Qualitative Study Pubblico
Rosales, Cindy (Spring 2021)
Abstract
BACKGROUND: Maternal Mortality is a core health indicator used to track the overall health status of a population. While globally, the maternal mortality ratio has declined over the past eighteen years, the United States (U.S.) maternal mortality ratio has more than doubled since 1987. Georgia has the second-highest maternal mortality ratio in the U.S. To address the maternal mortality crisis and expand access to care, the healthcare model has integrated telehealth. Recently, the COVID-19 pandemic has catalyzed the sweeping adoption of telehealth in maternity care. Yet, there is limited understanding of how providers and healthcare facilities have adapted to prenatal care recommendations and how women have perceived the quality of these changes during prenatal telehealth appointments.
OBJECTIVE: This qualitative study examined the perceived quality of person-centered maternity care (PCMC) in prenatal telehealth services during the COVID-19 pandemic among women in Georgia. Specifically, this study sought to understand how patients experienced the patient-provider relationship within the context of the following PCMC domains: dignity/respectful care, autonomy, privacy/confidentiality, communication, social support, supportive care, and trust.
METHODS: Seventeen women living in Georgia between the ages of 18-45 years participated in semi-structured, in-depth interviews via Zoom. Eligible patients had to receive prenatal care in-person and through telehealth during the COVID-19 pandemic (March - November 2020) in Georgia. Patients were excluded if they did not speak English, we're unable to consent and had no prenatal telehealth experience. Patients reflected upon their experiences and interactions with their prenatal care provider(s) during both in-person and telehealth appointments. Data were analyzed using thematic analysis.
RESULTS: Patients represented both urban and rural counties in Georgia. Most women identified as white (65%, N=11), over a third were college graduates (76%, N=13), and for 47% of women, this was their first pregnancy (N=8). The following three themes emerged: 1) Telehealth is a medium to relieve COVID-19 anxiety during pregnancy care, but it presents challenges to patients perceived privacy and trust of their providers; 2) COVID-19 has changed how prenatal care is accessed and delivered, but the patient-provider relationship remains central to the quality of care; 3) Telehealth increased patient’s comfortability accessing prenatal care and communicating with their provider.
CONCLUSION: This study’s findings show the emotional, structural, and social impact the pandemic has had on the access and delivery to prenatal care and the perceived quality of PCMC. The findings from this study present an opportunity to create clinical practice guidelines that can guide infrastructure and workforce changes needed to standardize and integrate telehealth into perinatal care models. Also, the findings from this study may provide a model for future researchers to conduct longitudinal studies aimed at measuring the quality of PCMC in telehealthcare during pregnancy and postpartum.
Keywords: Telehealth, prenatal care, person-centered care, person-centered maternity care, COVID-19
Table of Contents
Chapter I – Introduction
Purpose Statement & Research Questions
Framework
Significance Statement
Chapter II – Literature Review
Introduction
Quality of Care
Telehealth
Novel Coronavirus (COVID-19) Pandemic
Purpose Statement
Chapter III: Student Contribution
Overview of the EGHI Telehealth Project
Role of Student with EGHI Project
Project Design
Data Collection Instruments
Recruitment & Data Collection
Data Analysis
Student Contribution to Thesis
Chapter IV - Manuscript
Introduction
Purpose Statement & Research Questions
Framework
Significance Statement
Methods
Study Design
Sample and recruitment
Data Collection
Analytic Method
Ethical Statement
Results
Discussion
Strengths & Limitations
Future implications ideas
Conclusion
Chapter V – Public Health Implications
A Call for Evidence-Based Telehealth Guidelines
A Call for Future Research
Conclusion
References
Appendix A – WHO framework for the quality of maternal and newborn health care
Appendix B - Person-Centered Care Framework for Reproductive Health Equity
Appendix C – Interview Guide
About this Master's Thesis
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