Efficacy of a videoconferencing intervention compared with standard postnatal care at primary care health centres in Catalonia.

OBJECTIVE: to evaluate the efficacy of an intervention combining videoconferencing and telephone contact compared to standard post partum care of recent mothers attending health centres in Catalonia were recorded. DESIGN: multicentre, randomised parallel controlled clinical trial. PARTICIPANTS AND SETTING: 1598 post partum women with Internet access attending eight 'Attention to Sexual and Reproductive Health' (Catalan acronym ASSIR) units at Primary Health Care centres, in Catalonia (Spain). INTERVENTION: at each of the eight ASSIR units, 100 women were randomly assigned to the intervention group (IG) and 100 to the control group (CG). Women in the IG could consult midwives by videoconference or telephone and could also receive standard care. Women in the control group received standard care from midwives at their health centres or at home. MEASURES: number and type of visits, reasons for consultation, type of feeding at six weeks and women's satisfaction with the intervention on a scale of 1 to 5. FINDINGS: 1401 women were studied (80.9% of the initial sample), 683 in the IG and 718 in the CG. Two hundred and seventy-six women (40.4%) used videoconferencing or telephone in the IG. The mean total visits, virtual and face-to-face, was higher in IG women than in controls (2.74 versus 1.22). IG women made fewer visits to the health centre (mean=1) than CG women (mean=1.17). Both differences were statistically significant, with p<0.001 and p=0.002 respectively. The prevalence of breast feeding was similar in the two groups (IG 64.5%, and CG 65.4%). The mean overall satisfaction of women with midwife care was very high in both groups (IG 4.77, CG 4.76). CONCLUSIONS AND IMPLICATIONS FOR THE PRACTICE: virtual care via videoconferencing is effective for post partum women. It reduces the number of health centre visits and allows mothers to consult health staff immediately and from their own home.

Satisfaction with pregnancy and birth services: the quality of maternity care services as experienced by women.

OBJECTIVES: To investigate the opinions of women regarding satisfaction with the quality of maternity care received, and to establish whether health-care technology increases satisfaction or interferes with the construction of personal satisfaction in the process of care. DESIGN AND SETTING: Information was gathered using focus groups. The area of study comprised the postnatal groups run as part of the Sexual and Reproductive Health Programme of the Catalan Health Authority, Spain. PARTICIPANTS: Five focus groups were held between May 2006 and July 2007. FINDINGS: Quality of care is a complex concept in which a number of independent core features can be identified. These core features were grouped into three basic categories: safety (the hospital and its technological facilities, and the technical expertise of health professionals), the relationship between the carers and the service user, and the structural aspects that determine the context in which health care is provided. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: The mothers in this study were satisfied with health-care technology and viewed it as a source of security. Technology was indispensable to reduce the anxiety provoked by their perceived lack of confidence in their ability as mothers. During pregnancy and, especially, when giving birth, women believe that their feelings and values should be understood by professionals, from whom they seek empathy and personal commitment, not just information.

Tecnología y humanización en la asistencia al nacimiento. La percepción de las mujeres / Technology and humanization in childbirth care. Women’s perception

Objetivos: Conocer la opinión de las mujeres en relación con la tecnología sanitaria aplicada al seguimiento del embarazo y asistencia al parto, así como sus vivencias y sentimientos respecto a la calidad humana de la relación asistencial, y si ésta se adecuó a sus expectativas. Personas y método: Estudio con metodología cualitativa. Los datos se han obtenido mediante la realización de cuatro grupos focales. Resultados: El análisis de los datos ha permitido la construcción de dos categorías básicas: la opinión sobre las diferentes tecnologías aplicadas a lo largo del proceso asistencial, y la adecuación a las expectativas previas de la vivencia de la calidad humana en la relación asistencial. Conclusiones: La mayoría de las mujeres acepta las tecnologías sanitarias a su alcance. El significado del aumento de la dependencia tecnológica, sobre todo para la ecografía obstétrica, permite diferentes lecturas; un sector minoritario de mujeres prefiere una atención menos medicalizada durante el proceso de atención al parto. Todas las mujeres quieren sentirse protagonistas de su embarazo y parto. Confían plenamente en la competencia profesional de los expertos, cuya presencia les confiere seguridad, pero demandan mayor presencia de cualidades personales como el cariño y el trato deferente (AU)

Objective: To know women’s opinion regarding health care technologies applied to pregnancy follow-up and labour care, besides their personal experiences and feelings towards the human quality of the care provided and if this care relationship was meeting patient’s expectations. Participants and method: The study was performed with quality evaluation methods. Data were obtained into four focal groups. Results: Data analysis allowed us to make a classification on two basic categories: the patient perception about the different technologies applied on the care process, and the fit of the care relationship to the human quality standards that the patient expected. Conclusions: Most women accept the available health care technologies. This means there is an increase on the technological dependence, in particular regarding obstetric echography, can have different interpretations; there is a small women’s sector who prefers a less medicalized care in the process of childbirth. But all women want to play a major part in pregnancy and delivery; they are quite confident in the professional competence of experts; their presence alone reassures the patient, but the latter demands more personal qualities in care providers, such as warmth and deferential attitude in their relationship (AU)

Atención al embarazo en mujeres africanas inmigrantes. Percepción de las matronas de asistencia primaria / Prenatal care in African immigrants. The perception of primary care midwives

Objetivo. Identificar las dificultades de las matronas de la provincia de Barcelona implicadas en el control del embarazo, en relación con la comunicación y atención a mujeres inmigradas procedentes de los países del Magreb o de Senegal y Gambia. Método. Estudio observacional descriptivo, con recogida de datos mediante cuestionario autocumplimentado, por parte de las matronas de la provincia de Barcelona, durante el año 2002. Resultados. El número medio de mujeres magrebíes visitadas por cada matrona fue de 14, y 11 el promedio para mujeres procedentes de Senegal y Gambia. El 68% de matronas consideraba que el desconocimiento del idioma suponía una dificultad importante para la realización de la educación sanitaria. El abordaje de temas como la sexualidad, el ejercicio físico o la alimentación resultó problemático. El 53% de matronas utilizaba material de soporte. El 66% había realizado algún tipo de actividad formativa en interculturalidad. Conclusiones. Los problemas de comunicación dificultan la realización de una actividad asistencial de calidad, y consideramos necesario potenciar las medidas para mejorar esta comunicación. El conocimiento de la diversidad y la interculturalidad se convierte en un tema de especial importancia en los albores del siglo xxi. Las matronas han demostrado especial interés en mejorar su formación en la materia

Objective. To identify the difficulties of midwives in Barcelona (Spain) involved in prenatal care in relation to communication with immigrant women from the Maghreb countries, Senegal and Gambia and their healthcare. Method. We performed an observational, descriptive study with data collection through a questionnaire self completed by midwives from the province of Barcelona throughout 2002. Results. The mean number of Maghrebi women visited by each midwife was 14 and the mean number from Senegal and Gambia was 11. Sixty-eight percent of the midwives believed that language barriers were a significant difficulty in providing health education. The approach to subjects such as sexuality, physical exercise and diet was problematical. Fifty-three percent of the midwives used additional material. Sixty-six percent had undergone cross-cultural training. Conclusions. Communication difficulties hampered the delivery of healthcare. Measures to improve communication should be implemented. Cross-cultural awareness is becoming increasingly important at the beginning of the twenty-first century. The midwives expressed special interest in increasing their knowledge of this subject