Moving from Interprofessional Disarticulation to Transformative Dialogue and Action: Examining a Transdisciplinary Process to Address Equitable Access to High Quality Maternity Care in North America
Notice bibliographique
Résumé
Maternity providers in North America are in conflict about birth place, debating issues related to safety, autonomy, and quality of care. Very little is known about how birth place interacts with experience and outcomes of maternity care, or about how to resolve these differences among provider disciplines within established health care systems. A multi-stakeholder group of leaders convened at a series of Home Birth Summits in the United States to delineate a Common Ground Agenda, including nine priority areas for action and research. The aim of this doctoral study was to examine how and why this transdisciplinary process generated new evidence and tools that can improve maternity services. Methods I synthesized the results of four original research studies using a range of methodologies as appropriate to the study topic. In the Canadian Birth Place Study, I examine mixed methods data on provider attitudes to place of birth. In the Changing Childbirth in British Colombia (BC) and Giving Voice to Mothers studies, psychometric analysis cross-sectional survey data led to development of four new person-centered measures of experience of maternity care. In the Access and Integration Maternity Care Mapping Study, a Delphi study created a scoring system (MISS) to assess midwifery integration. Correlation and regression analyses elicit linkages between integration and key maternal-newborn outcomes. Finally, I triangulated results of these studies within the Taming Wicked Problems Framework, to elicit an underlying and contributory factor for effective transdisciplinary action. Results Among maternity care providers (n=825), 84% of variance in attitudes to home birth was attributable to provider type alone. Women from diverse backgrounds (n=2051, 3586 pregnancies) reported reduced autonomy and respect when cared for by physicians and when 9 giving birth in institutional settings. Among women in the United States (US) (n=2700), disparities in experiences of care, including mistreatment, links to race, socioeconomic status, place of birth and type of provider. U.S. states with higher midwifery integration and greater access to home birth reported significantly fewer adverse maternal-newborn outcomes and significantly higher rates of physiologic birth. Discussion The participatory approach and synthesis of outcomes of these studies was essential to understand and address inequities in experience and access to quality maternity health services in the US. Person-centered care emerged as a hidden common value that informed a transdisciplinary research process, and community-responsive knowledge translation outputs. Conclusion Increasing knowledge among all types of providers about quality and safety of birth place, and person-centered care, could improve outcomes across birth settings. The Summit process of transdisciplinary engagement reduced interprofessional conflict and facilitated cocreation of evidence and tools that improve quality, safety, and accountability in North American maternity care.
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Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,001 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
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