Introduction
Materials and methods
Study design
Participant recruitment
Data collection and analysis
Results
Basic characteristics of participants
Characteristics of participants | Overall (N = 22) (%) |
---|---|
Age (mean, minimum-maximum and SD) | 32.05, 24–41, 4.70 |
Age ≥ 35 | 8 |
Age < 35 | 14 |
Education (n) (%) | |
1. Basic education or less | 0 |
2. Secondary education or vocational qualifications | 3 (13.64) |
3. Bachelor level | 5 (22.73) |
4. Master level | 13 (59.09) |
5. Licentiate or doctor’s degree | 1 (4.55) |
Employment status (n) (%) | |
1. Student | 2 (9.09) |
2. Employed | 19 (86.36) |
3. Unemployed | 1 (4.55) |
Pregnancy/Postpartum stage (on the date of interview) | |
1. First trimester and second trimester | 6 (27.27) |
2. Third trimester | 6 (27.27) |
3. One to three months postpartum | 6 (27.27) |
4. After three months postpartum | 4 (18.18) |
Gravidity, including current pregnancy (n) (%) | |
1. One | 11 (50.00) |
2. More than one | 11 (50.00) |
Parity (n) (%) | |
1. None | 9 (40.91) |
2. One | 8 (36.36) |
3. More than one | 5 (22.73) |
Health status from women’s own perspectives (n) (%) | |
1. Generally healthy | 15 (68.18) |
2. Chronic diseases, gestation-related or birth-related health problems or other health problems | 7 (31.82) |
Assessment on ICHOM-PCB-PRMs
Importance and relevance
Patient reported measures | Key points with number of participants and percentage | Sample quotations Age, parity, gestation weeks/postpartum months |
---|---|---|
Patient reported case-mix variables | These measures are important (n = 22, 100%). Education was not found important (n = 15, 68.18%). The question about social network and supports was found to be especially important by half (n = 11, 50.00%). | I would say that these are useful for Neuvola to know. To know the background of the mother and the family. Makes it easier to target the service. (31, G2P1, H32 + 2) Education is also a question that “why do you ask” in my point of view. (29, G2P0, H29 + 2) The question about social network and supports should be asked repeatedly during pregnancy. (30, G1P0, H28 + 1) |
PROMs Health related quality of life | These measures are important (n = 22, 100%). Mental health questions were considered especially important (n = 12, 54.55%). | I think these are really good and relevant questions. When I had a burnout and depression, these were the kind of issues I handled. (29, G2P0, H29 + 2) Giving birth is a huge change of life. And by asking these you get the feeling of being cared for, and that mental wellbeing is important. (40, G1P1, 5 weeks postpartum) |
PROMs Incontinence | These measures are important (n = 20, 90.91%). Relevant to ask so that one could get help if needed (n = 6, 27.73%). Measures were felt important but not familiar because of little experience or knowledge about the concept (n = 9, 40.91%). | I have never seen these kinds of questions asked. I would say yes. Because these are embarrassing issues that one maybe doesn’t want to talk about if not asked. These are good. (25, G2P1, H32 + 2) But these went to a really detailed level. It would be important that somebody who really goes through these should get help. And women should be given support and help even if the problem is not so bad, at a lower threshold. (32, G3P3, 1 month postpartum) I have never been asked about these at Neuvola. (25, G1P0, H30 + 5) |
PROMs Pain with intercourse | These measures are important (n = 17, 77.27%), especially for the relationship. These were not relevant if one didn’t have sex at the time (n = 5, 22.73%). | I suppose this influences the partnership a lot. (31, G2P1, H32 + 2) A couple’s sexual behaviour is important and may cause conflicts, and is also a sensitive issue. (25, G2P1, H32 + 2) Is there really a need to ask these questions during pregnancy? Unless there are some problems with it. Maybe this should be asked after birth, in Neuvola, after first follow-up (2–4 months postpartum), because many don’t have sex so soon after birth. (29, G1P1, 2 months postpartum) |
PROMs Confidence with role as a mother | All thought these measurements were important (n = 22, 100%). | Yes, this is important. And if one doesn’t have experience yet, then it should be asked if she is nervous about it. (30, G2P2, 4 months postpartum) Absolutely yes. I didn’t have personal experience with kids before I had my own. So, I have had to think and process quite a lot by myself and learn more. So, it is really good to ask. (36, G2P1, 2 months postpartum) |
PROMs Mother-infant attachment | Questions are important (n = 18, 81.82%). | All kinds of emotions are normal. And someone might get scared if she has some negative feelings. Then everything is not nice. And there might be postpartum depression problems. (28, G1P0, H24 + 4) For me, with this third child I have more positive feelings compared to the first one. These questions might raise thoughts during pregnancy. (32, G3P3, 1 month postpartum) |
PROMs Maternal confidence with breastfeeding | These questions are important (n = 17, 77.27%). | Maybe it is difficult to think of those during pregnancy. There maybe should be a choice that “I don’t know yet,” and that might start a conversation in Neuvola. It felt difficult in Neuvola when I was asked this, I said that I really don’t know yet. (31, G2P1, H32 + 2) This is interesting. Because the breastfeeding theme is important. (32, G2P2, 6 months postpartum) |
PROMs Success with breastfeeding | These questions were important (n = 19, 86.36%). Relevance depended on the situation (n = 6, 27.73%). | Yes, it would be important to ask how this is going. I think this should be talked about to find out if there are any problems, and what are the mothers’ feelings. I have heard that someone has exhausted herself with this issue and felt like a bad mum when she didn’t succeed. (25, G1P0, H30 + 5) What is the purpose? I would want to add a question in the future that if breastfeeding didn’t succeed at first, would you want to have another try later? (32, G3P3, 1 month postpartum) |
PROMs Postpartum depression | These are important and relevant questions (n = 22, 100%). | Yes, absolutely. These cases need to be found. And this might help those people who wouldn’t want to talk about problems otherwise. (30, G2P1, H24 + 4) |
PREMs Satisfaction with the result of care | These are important and relevant questions (n = 22, 100%). | I was hoping for this kind of question. (39, G1P0, H27 + 2) |
PREMs Confidence as an active participant in healthcare decisions | These questions are important and relevant. Also, these raise some concerns (n = 21, 90.91%). Choices and decisions are not relevant in some contexts (n = 5, 22.75%). | Yes. So that one can find out how to do better in the future if the confidence is not so good. This is also an important issue so that service can be improved. (31, G2P1, H32 + 2) This question about being an active participant in healthcare decisions really aroused feelings in me. The decisions and actions of professionals are questioned. But I feel that nowadays people think that they have a right to make the decisions about everything in healthcare. (36, G2P1, 2 months postpartum) I don’t really know what the healthcare decisions are during pregnancy. I have just gone with the flow myself. (30, G1P0, H28 + 1) |
PREMs Confidence in healthcare providers | These questions are important and relevant (n = 18, 81.82%). | Kind of yes, important question, but this too could be difficult to answer if the one who is asking is the one you are disappointed with. (35, G1P0, H20 + 6) Yes, I think so. Especially if the delivery was difficult and something went wrong. So, there might be FOB the next time. This subject should be talked through already at this stage, and not just in the next possible pregnancy. (25, G1P0, H30 + 5) |
PREMs Birth experience | These questions are important and relevant (n = 22, 100%). Question about the delivery rooms being clean and hygienic was found not so important (n = 5, 22.73%). Questions are not relevant for Cesarean section (n = 5, 22.7%). | Yes. These concern satisfaction. I think that almost everything can be improved. That’s why they are important questions. (24, G1P0, H30 + 3) Maybe the last one about the cleaning of the delivery room. Does that need to be asked? I think that should be obvious. (41, G4P0, H19 + 6) What about caesarean section? (41, G4P0, H19 + 6) |
Quality
Patient reported measures | Key points with number of participants and percentage | Sample quotations Age, parity, gestation weeks/postpartum months |
---|---|---|
Patient reported case-mix variables | These measures are understandable (n = 22, 100%). These options are appropriate (n = 19, 86.36%). These questions are not difficult to answer (n = 17, 77.27%). The question about social network might be difficult; it should be asked differently (n = 8, 36.36%). | Questions are understandable and easy to answer. (29, G2P0, H29 + 2) Question about social network is a bit difficult, like how to quantify those people who can help you? But maybe it is better to really think about those persons from whom I would really ask for help? We have that neighbour there, but would I really count her in or not, then not. So, this is a good question. This is an old question, but it’s asked differently. Not just ask “Do you feel you have a sufficient social network?” (25, G2P1, H32 + 2) |
PROMs Health related quality of life | These measures are understandable (n = 18, 81.82%). These options are appropriate (n = 19, 86.36%). Some questions are difficult for the women to answer (n = 12, 54.55%). Open answers should be allowed (n = 5, 22.73%). | Yes, they are understandable. I think the term “in general” is a bit difficult. (29, G2P0, H29 + 2) Yes, it is better than just yes/no answers. (35, G1P0, H20 + 6) Might be difficult if you have mood changes .It would help if these were asked repeatedly (32, G3P3, 1month postpartum) Maybe there should be a free speech part (39, G1P0, H27 + 2) |
PROMs Incontinence | These measures are understandable (n = 22, 100%). These options are appropriate (n = 22, 100%). These questions are not difficult to answer (n = 18, 81.82%). These might be a bit embarrassing (n = 7, 31.82%). | I have heard that these are embarrassing issues to talk about that one might not want to or dare to speak of. (30, G1P0, H28 + 1) |
PROMs Pain with intercourse | These measures are understandable (n = 22,100%). These options are appropriate (n = 18, 81.82%). These questions are not difficult to answer (n = 17, 77.27%). It is difficult to answer if women haven’t had sex yet. (n = 5, 22.73%). | Question is understandable but I would like it to be more specific. I was thinking that should it be more specific, a question like what kind of pain, or is the pain in the stomach (pressure) or in the vagina. (29, G2P0, H29 + 2) Limit of 30 days might be too short. Not all are so active during pregnancy or after birth? (32, G3P2, 2 months postpartum) |
PROMs Confidence with role as a mother | These measurements are understandable (n = 22, 100%). These options are appropriate (n = 18, 81.82%). These questions are not difficult to answer (n = 15, 68.18%). Women may feel pressed if they are asked or the answers are negative (n = 5, 22.73%). | This might feel like a bit of a sensitive question. One might think that she is thought to be a bad mother because this is asked. Or if she is unconfident (40, G1P1, 5 weeks postpartum) |
PROMs Mother-infant attachment | These measurements are understandable (n = 21, 95.45%). These options are appropriate (n = 15, 68.18%). Words used to describe feelings are too strong and negative. (n = 5, 22.73%). These questions are not difficult to answer (n = 13, 59.09%). It is difficult to answer because one doesn’t know what would happen if one answered negatively (n = 7, 31.82%). | These are very strong words. Maybe it would be better to ask what kind of adjectives one would use to describe the baby? These are too strong words. I don’t think anyone would feel aggressive or disappointed towards the baby but maybe with some situations. (40, G1P1, 5 weeks postpartum) But does one dare to answer honestly if one had some negative thoughts? And one could think that what could happen if you have negative thoughts. Like in Facebook conversations some are afraid of social workers if they told negative thoughts. (32, G3P3, 1 month postpartum) |
PROMs Maternal confidence with breastfeeding | These measures are understandable (n = 16, 72.73%). Some questions are difficult to understand and need to be modified (n = 7, 31.82%). These options are appropriate (n = 15, 68.18%). More options are needed (n = 8, 36.36%). These questions are difficult to answer (n = 11, 50%). Difficulties could be found if the participant didn’t have experience yet (n = 11, 50. %). | Some questions are a little bit strange, like what does it mean “I can always continue to breastfeed my baby for every feeding”? Maybe that one keeps on breastfeeding and not give formula? Is the question about “maternal confidence with breastfeeding” a bit prejudiced? So, is it a failure if one doesn’t breastfeed? I wouldn’t say anything about succeeding. (25, G2P1, H32 + 2) There maybe should be a choice that “I don’t know yet” and that might start a conversation in Neuvola. (31, G2P1, H32 + 2) It is hard to answer these questions without experience. (24, G1P0, H30 + 3) |
PROMs Success with breastfeeding | These measures are understandable (n = 21, 95.45%). These options are appropriate (n = 19, 86.36%). These questions are not difficult to answer (n = 22, 100%) | Yes, it is understandable. (40, G1P1, 1 month postpartum) |
PROMs Postpartum depression | These measures are understandable (n = 20, 90.91%). These options are appropriate (n = 17, 77.27%). These questions are not difficult to answer (n = 14, 63.64%). It might be difficult to give accurate and honest answers (n = 9, 40.91%). | Maybe here is a problem with the scaling. (37, G2P2, 7 months postpartum) How brave you would be to answer this honestly? (30, G2P1, H25 + 4) |
PREMs Satisfaction with the result of care | These measurements are understandable (n = 19, 86.36%). These options are appropriate (n = 16, 72.73%). These questions are not difficult to answer (n = 12, 54.55%). Difficulties were found if the one is not satisfied with the one who is asking (n = 14, 63.64%). Questions should be asked separately for different providers involved in the care process (n = 11, 50.00%). | There might be a problem with this measure. Who will ask this and how will these issues be handled? Do you want to tell if you are really disappointed in your car? Will the answers go to your own nurse in Neuvola? (29, G2P0, H29 + 2) I think the evaluation of care given at Neuvola, the screening unit, the hospital and my home after birth should be separated. (39, G1P0, H27 + 2) |
PREMs Confidence as an active participant in healthcare decisions | These measures are understandable (n = 19, 86.36%). These options are appropriate (n = 21, 95.45%). Open answers should be allowed (n = 5, 22.73%). These questions are not difficult to answer (n = 17, 77.27%). It is difficult to answer the questions because different providers are involved. Questions should be asked separately for different providers (n = 9, 40.91%). Giving direst negative feedback might be difficult (n = 5, 22.73%). | These might be hard to answer. I would prefer to answer open-ended questions than these. (35, G1P0, H20 + 6) Who is asking and how these would influence the care in future? (29, G2P0, H29 + 2) It could be difficult to give negative feedback straight to those persons working there. (25, G2P1, H32 + 2) I think the evaluation be separated for different providers. (39, G1P0, H27 + 2) |
PREMs Confidence in healthcare providers | These measurements are understandable (n = 22, 100%). These options are appropriate (n = 17, 77.27%). Open answers should be allowed (n = 5, 22.73%). These questions are not difficult to answer (n = 14, 63.64%). It is difficult to answer question because different providers are involved (n = 5, 22.73%). | Here too should be an “open text” part. Opportunity is required to tell what went wrong. (30, G2P1, H25 + 4) There are so many different people in healthcare. So, you might feel confident for some and not so confident for others. This could be difficult to answer. Could be asked in the hospital after birth. But this should be a more open-ended question. (35, G2P2, 7 months postpartum) |
PREMs Birth experience | These questions are understandable (n = 22, 100%). These options are appropriate (n = 19, 86.36%). These questions are not difficult to answer (n = 18, 81.82%). | Well, hard for me to say now because I don’t have the experience. But these are quite concrete so I suppose these would not be difficult to answer. If someone has had a very traumatic delivery, then it could be difficult to handle these questions. (26, G1P0, H21 + 4) |
Willingness to answer
Patient reported measures | Key points with number of participants and percentage | Sample quotations Age, parity, gestation weeks/postpartum months |
---|---|---|
Patient reported case-mix variables | These measurements are answered willingly (n = 22, 100%). | I know that many women don’t like to tell their height and weight. Those are quite delicate issues. I wouldn’t mind talking about those, but I know some might. Some women don’t even want to get their weight measured in Neuvola. (29, G2P0, H29 + 2) |
PROMs Health related quality of life | These measurements are answered willingly (n = 20, 90.91%). | I would be happy to answer these questions. (29, G2P0, H29 + 2) |
PROMs Incontinence | These measurements are answered willingly (n = 17, 77.27%). Willingness depends on some factors, including the availability of help, the connection with the person who is asking, and privacy (n = 6, 27.73%). | If it’s about my wellbeing, then yes. And I would get some help after answering. (29, G2P0, H29 + 2) If I would get some help after answering, I am willing to answer the questions. (32, G3P3, 1 month postpartum) |
PROMs Pain with intercourse | These measurements are answered willingly (n = 19, 86.36%). | Not maybe happily if I had problems, but yes, I would answer. (35, G1P0, H20 + 6) This might be easier to answer in “Maisa” (an online patient portal). This kind of personal question would be easier to answer like that and then discussed in Neuvola if needed. (30, G2P1, H25 + 4) |
PROMs Confidence with role as a mother | These measurements are answered willingly (n = 18, 81.82%). | I am willing to answer these questions. But formulation of the question should be inclusive. For me the question should be “Confident with role as a parent,” not “a mother”.” (41, G4P1, H19 + 6) |
PROMs Mother-infant attachment | These measurements are answered willingly (n = 16, 72.73%). Willingness depends on the availability of help, the purpose of questions, and possible consequences of negative answers (n = 7, 31.82%). | I would like to answer these questions and I feel I need help (24, G1P0, H30 + 3) I wonder if I would dare to answer honestly if I had negative thoughts. (30, G2P1, H25 + 4) Maybe here too should be a brief introduction that it’s natural to feel many things. Because some might feel like a bad mother if they choose some negative things. (35, G1P0, H20 + 6) |
PROMs Maternal confidence with breastfeeding | These measurements are answered willingly (n = 19, 86.36%). | Yes, then one could find out how this is going. (31, G2P1, H32 + 2) |
PROMs Success with breastfeeding | These measurements are answered willingly (n = 20, 90.91%). | I would like to answer these questions. But why is this asked? Is it that breastmilk is good, but formula is not good for your baby? So, what then? Would there be advise? What will happen if I say that I have been giving formula? What is the amount of milk? (39, G1P0, H27 + 2) |
PROMs Postpartum depression | These measurements are answered willingly (n = 20, 90.91%). | Yes, I will answer these questions if everything was well. But maybe not if I had some problems. (30, G2P2, 4 months postpartum) |
PREMs Satisfaction with the result of care | These measurements are answered willingly (n = 19, 86.36%). There are concerns about who is asking these (n = 7, 31.82%). | Kind of yes, but then I would wonder about its effect. Like if I weren’t very pleased with some place and they get to see the answers, so how will the answers be handled? There is a fear of how it would affect future treatment (41, G4P0, H19 + 6) It will depend on who is asking. If you want to give feedback, you have to have the courage to say it. It’s like a “double-edged sword” if it’s asked by your nurse in Neuvola and you are not too happy during pregnancy. If the chemistry doesn’t work. (37, G2P2, 7 months postpartum) |
PREMs Confidence as an active participant in healthcare decisions | These measurements are answered willingly (n = 16, 72.73%). | Kind of yes, but then I would wonder about its effect. (41, G4P0, H19 + 6) Like before, if the one who was asking these would be the one that I was not happy with, I don’t know if I would dare to answer. (36, G1P0, H21 + 4) |
PREMs Confidence in healthcare providers | These measurements are answered willingly (n = 18, 81.82%). | Yes, I am willing to. But if you are afraid that these might influence your treatment in the future, then these would be difficult to answer. Anonymous would make it easier. It would be good that one could answer anonymously. (30, G1P0, H28 + 1) |
PREMs Birth experience | These measurements are answered willingly (n = 22, 100%). | Yes, I am willing to. But I feel this is not so much for mothers who underwent a Sect. (32, G4P1, 2 months postpartum) |
Timing of answering
Patient reported measures | First trimester | Second trimester | Third trimester | Soon or early after birth | One month postpartum | Three months postpartum | Six months postpartum | Key comments from women (more than five women mentioning) |
---|---|---|---|---|---|---|---|---|
Patient reported case-mix variables | n = 21, 95.45% | None | None | None | None | Some questions, e.g., social support, could be asked repeatedly during pregnancy (n = 11, 50.00%). | ||
PROMs Health related quality of life | n = 9, 40.91% | n = 6, 27.73% | n = 8, 36.36% | None | After birth, but not immediately, n = 19, 86.36.% | This should be asked repeatedly during pregnancy and after birth (n = 14,63.64%). | ||
PROMs Incontinence | n = 2, 9.09% | None | n = 7, 31.82% | None | After birth, but not immediately, n = 18, 81.82% | None | ||
PROMs Pain with intercourse | During pregnancy, n = 15, 68.18% I trimester, n = 5, 22.73% II trimester, n = 3, 13.64% III trimester, n = 2, 9.09% | None | After birth, n = 15, 68.18% Two to four months after birth during follow-up visit, n = 6, 27.73% | This should not be asked too early after birth (n = 6, 27.73%) This should be asked repeatedly during pregnancy and after birth (n = 7, 31.82%). | ||||
PROMs Confidence with role as a mother | n = 2, 9.09% | n = 4, 18.18% | n = 12, 54.55% | n = 8, 36.36% | After birth but not too early, n = 12, 54.55% | This should be asked repeatedly during pregnancy and after birth (n = 5, 22.73%). | ||
PROMs Mother-infant attachment | During pregnancy, n = 5, 22.73% I trimester, n = 1, 4.55% II trimester, n = 1, 4.55% III trimester, n = 3, 13.64% | n = 8, 36.36% | After birth, n = 15, 68.18% One to two months postpartum, n = 7, 31.82% | This should be asked repeatedly after birth (n = 6, 27.73%). | ||||
PROMs Maternal confidence with breastfeeding | During pregnancy, n = 5, 22.73% II trimester, n = 2, 9.09% III trimester, n = 6, 27.73% | n = 9, 40.91% | After birth, n = 16, 72.73% | This should not be asked during pregnancy (n = 5, 22.73%). | ||||
PROMs Success with breastfeeding | None | n = 7, 31.82% | After birth, n = 11, 50.00% One month postpartum, n = 6, 27.73% Three to six months postpartum, n = 3, 13.64% | This should be asked repeatedly after birth (n = 7, 31.82%). | ||||
PROMs Postpartum depression | During pregnancy, n = 21, 95.45% I trimester, n = 3, 13.64% II trimester, n = 11, 50.00% | None | After birth, n = 21, 95.45% One month postpartum, n = 5, 22.73% Three to six months postpartum, n = 5, 22.73% | This should be asked repeatedly and regularly (n = 12, 54.55%). This should not be asked too early after birth (n = 6, 27.73%). | ||||
PREMs Satisfaction with care | During pregnancy, n = 15, 68.18% I trimester, n = 1, 4.55% II trimester, n = 2, 9.09% III trimester, n = 6, 27.73% | n = 9, 40.91% | After birth, n = 15, 68.18% One month postpartum, n = 6, 27.73% Three to six months, n = 4, 18.18% | This should be asked at every stage (n = 7, 31.82%). | ||||
PREMs Confidence as an active participant in healthcare decisions | During pregnancy, n = 15, 68.18% I trimester, n = 1, 4.55% III trimester, n = 7, 31.82% | n = 12, 54.55% | After birth, n = 16, 72.73% One to two months postpartum, n = 5, 22.73% Six months postpartum, 1, 4.55% | This should be asked repeatedly (n = 6, 27.73%). | ||||
PREMs Confidence in healthcare providers | During pregnancy, n = 13, 59.09% II trimester, n = 2, 9.09% | n = 11, 50.00% | After birth, n = 14, 63.64% One month postpartum, n = 6, 27.73% Two months postpartum, n = 1, 4.55% Few months postpartum, n = 1, 4.55% | This should be asked repeatedly after different stages or events (n = 5, 22.73%). | ||||
PREMs Birth experience | None | n = 19, 86.36% | One to two months postpartum, n = 8, 36.36% | This could be asked repeatedly after birth (n = 6, 27.27%). |
Women’s views on the future implementation of PRMs
Themes | Key points (over 5) | Sample quotations |
---|---|---|
Benefits or motivations | Answering PRMs questions is a chance to tell one’s own feelings and be heard (n = 7, 31.82%). | By answering questions, you are heard and it is easier for the professional too to see what is going on. (39, G1P0, H27 + 2) |
Possible difficulties or risks | Giving negative feedback directly to care provider might be difficult (n = 11, 50.00%). | I might not want to answer if I had some negative feedback for the care provider who is asking. This could be difficult. But if it was asked, then one could just say “everything is ok” even though they are not thinking so. Then this doesn’t work. (31, G2P1, H32 + 2) |
It will be difficult to respond to questions if the possible consequences of answering questions and availability of follow-up care are not clear (n = 7, 31.82%). | I will wonder who will see the answers and how the answer will be addressed. That should be clear beforehand. (32, G2P2, 6 months postpartum) | |
Women’s mental problems, physical problems and difficult circumstances may hinder their responses to the questions (n = 6, 27.27%). | I would not want to answer the questions if I had some mental issues. (24, G1P0, H30 + 3) | |
Preferred practices or conditions | Women should have chances to discuss with professionals and get help based on answers (n = 15, 68.18%). | I would like to process these questions and answers with some healthcare professionals. Especially if there would be some private questions. (24, G1P0, H30 + 3) |
Questions should be short, not too many and not asked too often (n = 8, 36.36%). | Maybe during pregnancy there should be a few short questions only, and more questions if needed. (35, G1P0, H20 + 6) | |
Questions could be answered before appointments (n = 6, 27.27%). | Maybe one could fill these at home before an appointment at Neuvola. I think these would be nicer to answer at home, so you have time to think about these yourself before talking with healthcare professionals. And then you would go through these with someone. And there would be a way to handle things if needed. Then it would be good to answer in private and with time. (28, G1P0, H24 + 4) | |
It would be convenient to answer digitally (n = 6, 27.27%). | I would expect questions are in a digital form and answers are filed for different nurses and up to date. (32, G2P2, 6 months postpartum) | |
There should be clear information and instruction on the purpose of questions and possible consequences of answering questions (n = 5, 22.73%). | A woman should be told that it is important to tell how she is doing physically and mentally. One should not be afraid to answer questions. (31, G1P0, H28 + 1) |
Benefits or motivations
Possible difficulties or risks
Preferred practices or conditions
Discussion
Patient reported measures | Adaptation, rationales, and considerations |
---|---|
Patient reported case-mix variables | Our study suggests that education should be removed from the measurement, as our women believed that one should get equal and high-quality care from public health care system regardless of education level. In contrast, our local professionals reported that education might be important to know for recognizing who may need extra support (Chen et al. 2021). |
PROMs Health related quality of life | In addition to predefined options, there should be some space for women to provide open-ended answers or describe their situations in detail. Offering the possibility for women to write free form answers might empower the women more, and help professionals to develop better insights into women’s situations. |
PROMs Incontinence | This measure could be removed from regular measurement but asked for details from those who bring up the issue and ask for help. |
PROMs Pain with intercourse | This measure could be removed from regular measurement but asked for details from those who bring up the issue and ask for help. |
PROMs Mother-infant attachment | Some words like “aggressive” were thought to be too strong and negative and made participants uncomfortable to respond, which should be avoided in questions. |
PROMs Maternal confidence with breastfeeding | More explanation may be needed for a first-time mother to answer the questions. Or instead of asking about confidence of breastfeeding that would be difficult for the primiparous to answer, it may be better to ask what kind of information women would need to breastfeed. |
PROMs Success with breastfeeding | Non-breastfeeding mothers may feel judged, embarrassed, or offended by the breastfeeding questions. This measure could be removed from regular measurement but asked for details from those who bring up the issue and ask for help. |
PREMs Confidence as an active participant in healthcare decisions | This measure could also be removed from regular measurement, as in a normal situation, women may prefer to go with the flow to get health care and do what is recommended by professionals, and information need should be asked. In addition to predefined options, there should be some space for women to provide open-ended answers or describe their situations in detail. Offering the possibility for women to write free form answers might empower the women more, and help professionals to develop better insights into women’s situations. |
PREMs Confidence in healthcare providers | This measure could also be removed from regular measurement, as in a normal situation, women may prefer to go with the flow to get health care and do what is recommended by professionals, and information need should be asked. In addition to predefined options, there should be some space for women to provide open-ended answers or describe their situations in detail. Offering the possibility for women to write free form answers might empower the women more and help professionals to develop better insights into women’s situations. |
PREMs Birth experience | This is no problems regarding the hygiene of delivery rooms in Finland, so the question about hygiene could be removed from birth experience. This is in line with the Finnish maternity care professionals’ view (Chen et al. 2021). However, the BSS-R scale (Birth Satisfaction Scale-Revised) in the ICHOM-PCB set, used to measure birth experience, is an international standard measure, so the removal of components from the scale for local use may cause problems in international comparison and benchmarking. |