Women's Participation in Decision-Making in Maternity Care: A Qualitative Exploration of Clients' Health Literacy Skills and Needs for Support.

Olga C. Damman,Ank de Jonge,Laxsini Murugesu,Mirjam P. Fransen,Ellen M. A. Smets,Danielle R. M. Timmermans,Marloes E. Derksen

doi:10.3390/ijerph18031130

Abstract

Shared decision-making requires adequate functional health literacy (HL) skills from clients to understand information, as well as interactive and critical HL skills to obtain, appraise and apply information about available options. This study aimed to explore women’s HL skills and needs for support regarding shared decision-making in maternity care. In-depth interviews were held among women in Dutch maternity care who scored low (n = 10) and high (n = 13) on basic health literacy screening test(s). HL skills and perceived needs for support were identified through thematic analysis. Women appeared to be highly engaged in the decision-making process. They mentioned searching and selecting general information about pregnancy and labor, constructing their preferences based on their own pre-existing knowledge and experiences and by discussions with partners and significant others. However, women with low basic skills and primigravida perceived difficulties in finding reliable information, understanding probabilistic information, constructing preferences based on benefit/harm information and preparing for consultations. Women also emphasized dealing with uncertainties, changing circumstances of pregnancy and labor, and emotions. Maternity care professionals could further support clients by guiding them towards reliable information. To facilitate participation in decision-making, preparing women for consultations (e.g., agenda setting) and supporting them in a timely manner to understand benefit/harm information seem important.

Highlights

Clients in maternity care are expected to participate in decisions about available options during pregnancy and labor [1]
A qualitative design was chosen to explore the perspectives of clients regarding skills they use in the decision-making process and their needs for support in shared decision-making (SDM)
Our findings showed that the health literacy (HL) skills discussed by women largely corresponded with the skills described in the framework of decision-making stages and HL skills developed by McCaffery et al [8]

Summary

Introduction

Clients (i.e., women and partners) in maternity care are expected to participate in decisions about available options during pregnancy and labor [1]. For many decisions in maternity care, e.g., on pain relief during labor, place and mode of labor, infant-feeding, or end of puerperium, women’s own values are important [2]. These decisions are often referred to as ‘preference-sensitive’ decisions, for which decision-making is not reliant on clinical expertise alone, and on a woman’s own preferences related to perceived benefits and harms. The SAHL-D assesses both word recognition and comprehension in the health domain.

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Methods

Results

Discussion

Conclusion