Midwives' provision of health promotion in antenatal care: A qualitative explorative study.

PROBLEM: Studies indicate that health promotion in antenatal care can be improved. Moreover, a schism seems to exist between health promotion and prevention in antenatal care. BACKGROUND: Antenatal care to support and improve maternal health is a core midwifery activity in which prevention as well as HP and woman-centeredness are important. AIM: To explore how Danish midwives experienced antenatal care and practiced health promotion. METHODS: Midwives undertaking antenatal care were interviewed individually (n=8) and two focus groups (n=10) were created. Thematic analysis was performed inductively, and the theoretical models from Piper's health promotion practice Framework for midwives were used to analyse the midwives' health promotion approach. FINDINGS: Two major themes were highlighted. Theme 1: 'The antenatal care context for health promotion' described factors contributing to quality in health promotion in antenatal care, such as communication and building relationships with the pregnant women. Theme 2: 'The health promotion approach in antenatal care' described both midwife-focused and woman-focused approaches to pregnant women's health. Barriers to high-quality antenatal care and a holistic health promotion approach were identified, such as shared-care issues, documentation demands and lack of time. DISCUSSION: The midwives' experiences were discussed in the context of a health promotion approach. Why midwives practice using a midwife-centred approach has many explanations, but midwives need to learn and help each other understand how they can practice woman-focused care while simultaneously providing prophylactic, evidence-based care. CONCLUSION: Midwives mainly had a midwife-focused approach. To further promote women's health, midwives need to focus on a woman-focused approach.

A qualitative study about the experiences of ethnic minority pregnant women with gestational diabetes.

BACKGROUND: Gestational diabetes mellitus demands rapid health behaviour changes for the pregnant woman to obtain stable blood glucose levels. In Denmark, the general incidence of gestational diabetes mellitus is about 3%, but more than 4.5% among non-Western immigrants and descendants. Women belonging to ethnic minorities may be particularly challenged by health behaviour changes due to educational, language and cultural barriers. AIM: To explore how non-Western ethnic minority pregnant women in Denmark experience the hospital-based information about gestational diabetes mellitus and how they integrate this information into their everyday life. A secondary aim was to investigate how health literacy and distributed health literacy affect this process. METHODS: Semistructured, qualitative interviews with 11 women. Thematic analysis was conducted with a special focus on health literacy as analytical approach. RESULTS: Three themes were identified: Reaction to the diagnosis, Everyday life and Information needs. All women felt sad and worried by the diagnosis. Some struggled to implement the recommended behaviour changes, and many lacked supports from their spouse. The hospital-based information was positively evaluated, but in some cases, the information was misunderstood. Social networks, language skills, and the ability to seek and assess information were important factors influencing the degree to which the women experienced gestational diabetes mellitus to be a challenge. CONCLUSION: Women were generally satisfied with the hospital-based information. Women with low health literacy/poor Danish language skills seem to be most challenged by the diagnosis. Future research should examine ways to organise patient-centred health care while simultaneously supporting women's opportunity to increase health literacy through, for example social network and the Internet.