Negative Care Experiences Research Articles

Differential associations between experiences of contraceptive care and subsequent contraceptive access and preferences among family planning patients by racial and ethnic identity: Evidence from Arizona, Iowa, and Wisconsin.

While many frameworks exist for building person-centered and equitable systems of contraceptive care, evidence indicates that the reality of patients' experiences of care is often not in alignment with these ideals. Historical and current contexts of racism in the healthcare system contribute to negative perceptions and experiences of care, as well as reduced care-seeking behavior, for those who identify as Black, Indigenous, and people of color (BIPOC). Our objective in this analysis is to examine whether people's past experiences of contraceptive care are a driver of subsequent barriers to contraceptive access, and whether this relationship differs across racial and ethnic identity. We draw on panel data from five waves of surveys collected between 2018-2023 among patients ages fifteen and older seeking family planning care at sites that receive public funding for these services in Arizona, Iowa, and Wisconsin. Overall and stratified by race/ethnicity, we examine cross-sectional and longitudinal associations between patients' experiences of high-quality, person-centered contraceptive care and three contraceptive access outcomes: use of preferred contraception, satisfaction with contraceptive method, and experience of no barriers to accessing preferred contraception. We find longitudinal associations between patients experiencing higher-quality, more person-centered contraceptive care and subsequent satisfaction with contraceptive methods. Among non-Hispanic white-identifying patients, we find similar associations between shifting to higher-quality contraceptive care and use of preferred contraception, but we find no statistical relationship between experiencing higher-quality care and subsequent contraceptive outcomes for patients who identify as Black, Indigenous, or Person of Color (BIPOC). Highlighting the dissonance between clinical guidance for quality contraceptive care and patient experiences of care, and especially whether similar experiences across racial and ethnic identity lead to differential outcomes, is a crucial step toward bringing contraceptive care systems into alignment with principles of sexual and reproductive health equity.

Experiences and attitudes of psychiatric nurses in caring for patients with repeated non-suicidal self-injury in China: a qualitative study

BackgroundThe incidence of non-suicidal self-injury (NSSI) is high and often occurs repeatedly. Psychiatric nurses play a vital role in the care and treatment of NSSI patients, as they have the most frequent contact with patients. The experiences and attitudes of nurses has a direct affect on the quality of care they provide to patients. Negative care experiences and attitudes of patient aversion on behalf of nurses may delay the observation and treatment of changes in the patient’s condition, leading to irreversible risks. Although cross-sectional studies have investigated the attitudes of medical staff toward NSSI patients, quantitative research results cannot comprehensively reflect the emotional experiences and complex psychological changes of the study subjects. A few studies have focused on the psychiatric nurses’ care experiences and attitudes toward patients with repeated NSSI.ObjectiveThis study aimed to explore psychiatric nurses’ care experiences and attitudes toward patients during repeated NSSI.MethodsA thematic analysis qualitative study was used. Using purposive sampling, 18 psychiatric nurses were recruited from a mental health center in Chengdu, China. Semi-structured interviews were conducted and audio-recorded. Audio-recordings were transcribed verbatim and analyzed using six-phase thematic analysis.ResultsFour themes emerged from the analysis: psychiatric nurses’ care experiences, perceptions, care attitudes and coping style toward repeated NSSI patients. Psychiatric nurses have experienced negative care experiences and severe career burnout during the patient’s repeated NSSI. Nurses’ attitudes toward NSSI patients changed during repeated NSSI, from understanding to indifference to anger and resentment. At the same time, it was found that nurses’ coping style with NSSI patients could be divided into three stages, namely, active coping, neglect and perfunctory, and criticism and punishment.ConclusionsThe findings have implications for health care systems regarding interventions to improve nurses’ care experiences and attitudes toward repeated NSSI patients. These findings suggest that enhancing nurses’ understanding of NSSI, establishing standardized emergency response and intervention programs, guiding positive professional values and responsibility, and improving nurses’ caring attitudes can promote the early detection and timely intervention of NSSI.

Perceptions of Health Care Provider Interactions Among Medicare Beneficiaries With Hearing Trouble and the Role of an Accompanying Companion.

Hearing trouble (HT) impairs communication with health care providers (HCPs) and may lead to negative care experiences that impact health outcomes. The current study aimed to examine how HT influences patient perceptions of provider interactions and whether having an accompanying companion during health care visits modifies perceptions of provider interactions. This cross-sectional study analyzed 9,104 responses from the 2016 Medicare Current Beneficiary Survey. Compared to beneficiaries without HT, those with HT had greater odds of negative perceptions of HCP interactions. Beneficiaries with HT had greater odds of disagreeing with positive statements about care, including provider competence, provider cares to check everything, provider response, and provider rarely in a hurry. Having an accompanying companion during health care visits was not found to significantly modify perceptions of interactions. Findings suggest HT is a modifiable factor impacting health care communication. Implementing simple accommodation strategies in clinical practice can improve nursing care for older adults with HT. [Journal of Gerontological Nursing, xx(xx), xx-xx.].

Examining the Care Experiences of People Experiencing Homelessness in Kingston

Background Across Canada, approximately 235,000 individuals face housing instability, and homelessness has been associated with an increased use of emergency department (ED) care. EDs are a safety net for people experiencing homelessness (PEH), when faced with limitations to primary care access, such as limited service hours and locations. PEH have reported negative ED care experiences, including feeling judged, not having health concerns taken seriously, and experiencing stigmatizing behaviour. Prior negative experiences contribute to the avoidance of care services, exacerbating issues for PEH. Objective This study examines the experiences of unhoused populations accessing ED services, to better understand the adversity they face. Methods The study is participatory and cross-sectional, using the sensemaking Spryng.io platform to survey patients at the Kingston Health Sciences Centre EDs. Sensemaking methodology (SM) uses a mixed-methods research approach that collects data through storytelling. This enables individuals to naturally convey complex information and make sense of their experiences. Within the sensemaking survey, individuals who self-identified as a PEH answered an additional subset of questions about their experiences accessing care. Follow-up focus group discussions (FGDs) will take place at St. Vincent de Paul, an organization that supports people in Kingston with resources such as food, clothes, and housing. FGDs will be used to validate the sensemaking results and co-create care improvement strategies. Conclusion By engaging PEH, our results can lead to actionable care improvement strategies. The study is also a foundation for future research collaborating with PEH and community partners, to mitigate negative care experiences.

Development and implementation determinants of competency frameworks for mental health clinicians and service providers working with youth: a scoping review protocol

IntroductionDespite high prevalence, access to mental healthcare for Canadian youth is limited, with less than 20% receiving adequate treatment. Marginalised and at-risk youth face particular challenges, including cultural misunderstandings, long...

Examining the experiences of vulnerably housed patients visiting Kingston, Ontario’s emergency departments: a qualitative analysis

IntroductionVulnerably housed individuals access emergency departments (EDs) more frequently than the general population. Despite Canada’s universal public health care system, vulnerably housed persons face structural barriers to care and experience discrimination from healthcare providers. This study examines how vulnerably housed persons perceive their experience of care in the ED and Urgent Care Center (UCC) in Kingston, Ontario and aims to develop strategies for improving care for this group.MethodsAs part of a larger mixed-methods study, narratives were collected from participants attending the ED/UCC as well as community-based partner organizations, asking them to describe an experience of a recent ED visit (< 24 months). Participants could identify as members of up to three equity-deserving groups (EDGs) (for example homeless, part of an ethnic minority, having a disability, experiencing mental health issues). Coding and thematic analysis were completed for the experiences of participants who identified as being vulnerably housed (n = 171). Results were presented back to individuals with lived experience and service providers working with clients with unstable housing.ResultsParticipants reported judgement related to a past or presumed history of mental health or substance use and based on physical appearance. They also often felt unheard and that they were treated as less than human by healthcare providers. Lack of effective communication about the ED process, wait times, diagnosis, and treatment led to negative care experiences. Participants reported positive experiences when their autonomy in care-decision making was respected. Furthermore, having a patient-centered approach to care and addressing specific patient needs, identities and priorities led to positive care experiences.ConclusionsThe ED care experiences of vulnerably housed persons may be improved through healthcare provider training related to trauma-informed and patient-centered care and communication strategies in the ED. Another potential strategy to improve care is to have advocates accompany vulnerably housed persons to the ED. Finally, improving access to primary care may lead to reduced ED visits and better longitudinal care for vulnerably housed persons.

Improving assessment and management of suicide risk among people who inject drugs: A mixed methods study conducted at the Medically Supervised Injecting Centre, Sydney.

People who inject drugs are 13 times more likely to die by suicide than the general population. Guidelines for responding to risk in this population are limited. Harm reduction services attended by people who inject drugs require targeted strategies to address the complexities of suicide risk among this population. Co-design, engaging health professionals and people with lived experience informed the study. Mixed methods were used to understand the experience of managing suicide risk among clients attending the Medically Supervised Injecting Centre (MSIC) in Sydney. A survey was administered to assess staff confidence in managing risk. Focus groups were conducted with health professionals and MSIC clients to explore experiences of suicide management, response and opportunities for improvement. Half (N = 17) the MSIC staff surveyed reported over 10 years' experience working with this population. Confidence in managing suicide risk was low. Three key themes emerged from focus groups (N = 17): (i) Autonomy and the need to involve clients in the assessment process; (ii) Trust between clients and health professionals, and transparency in decision-making; and (iii) System barriers, described by health professionals as inadequate referral pathways for clients in distress, and by clients as negative experiences of care, including involuntary admission and not receiving medication (e.g. methadone). Revised assessment guidelines and a tailored safety plan were developed. These resources are also suitable for other alcohol and other drug services. The challenge in managing suicide risk in harm reduction services is balancing duty of care with staff-client relationships and client engagement.

Lessons learned from patients’ weight-related medical encounters: Results from 34 interviews

ObjectivesHow to best care for larger-bodied patients is a complicated issue in modern medicine. The present study seeks to inform current medical practices to ensure the delivery of high-quality and evidence-based care through the examination of higher-weight patients’ experiences with weight-related care. MethodsHigher-weight patients (N = 34) completed semi-structured interviews about their experiences and recommendations for weight-related care. Interviews were coded by two independent coders and harmonized. Findings were organized into broad domains of 1) negative care experiences and 2) positive care experiences and recommendations. ResultsPatients described a range of negative care experiences, including stigmatization from providers (e.g., rude, attacking, or insulting communication about weight), while concurrently expressing insufficient weight management support from providers. Positive care experiences and recommendations included patient-centered care (e.g., physician humility and empathy) and attending to the patient’s weight, which conveyed concern for the patient. ConclusionsOur findings reflect patients’ ambivalent attitudes toward weight-related care: while weight-focused provider communication can be highly stigmatizing, patients simultaneously desire more weight-management support from providers. Practice ImplicationsProviders who wish to move their practices from a weight-loss focus to one targeting healthy living should provide a rationale for these shifts to inform patients’ perceptions of high-quality care.

Extracting big data from the internet to support the development of a new patient-reported outcome measure for breast implant illness: a proof of concept study.

Individuals with health conditions often use online patient forums to share their experiences. These patient data are freely available and have rarely been used in patient-reported outcomes (PRO) research. Web scraping, the automated identification and coding of webpage data, can be employed to collect patient experiences for PRO research. The objective of this study was to assess the feasibility of using web scraping to support the development of a new PRO measure for breast implant illness (BII). Nine publicly available BII-specific web forums were chosen post-consultation with two prominent BII advocacy leaders. The Python Selenium and Pandas packages were used to automate extraction of de-identified text from the individual posts/comments into a spreadsheet. Data were coded using a line-by-line approach and constant comparison was used to create top-level domains and sub-domains. 6362 unique codes were identified and organized into four top-level domains of information needs, symptom experiences, life impact of BII, and care experiences. Information needs of women included seeking/sharing information pre-breast implant surgery, post-breast implant surgery, while contemplating explant surgery, and post-explant surgery. Symptoms commonlydescribed by women included fatigue, brain fog, and musculoskeletal symptoms. Many comments described BII's impact on daily activities and psychosocial wellbeing. Lastly, some comments described negative care experiences and experiences related toadvocating for themselves to providers. This proof-of-concept study demonstrated the feasibility of employing web scraping as a cost-effective, efficient method to understand the experiences of women with BII. These data will be used to inform the development of a BII-specific PROM.

Factors that influence young people’s experiences of emergency suicide care in Australia: a qualitative study

Young people in Australia are increasingly presenting to the emergency department in suicide crisis, where their experiences influence present and future treatment outcomes. Previous research on emergency suicide care has predominantly focused on adults’ experiences. This qualitative study aims to identify the factors that influence perceived positive and negative experiences of emergency suicide care for young people. Semi-structured interviews were conducted with 17 young people aged 16-24 years old (mean age = 18.4 years) who presented to an Australian hospital in the past 12 months for a suicide crisis. Young people reflected on the care they received in the emergency department, and the factors that influenced the quality of care. Data underwent reflexive thematic analysis. Most young people reported a negative hospital experience, attributed to resource constraints and invalidating staff responses, reflecting underlying stigma around suicide. Conversely, when young people reported positive experiences, this was largely attributed to empathetic connections with staff. Our findings highlight the importance of compassionate care from hospital staff for young people’s experience of emergency suicide care. Future research with young people is needed to co-design and trial interventions that promote compassionate care and address the barriers with resource constraints in hospitals.

Exploring the lived experience of receiving mental health crisis care at emergency departments, crisis phone lines and crisis care alternatives.

Mental health crisis care includes emergency departments (EDs), crisis phone lines and crisis alternatives. Currently, there is an overreliance on EDs to provide mental health crisis care, with evidence that responses are often inadequate to meet the needs of people experiencing mental health crises. However, the complexities of how individuals experience crisis care across the varying contexts of EDs, crisis phone lines and crisis alternatives remain underresearched. This study used a hermeneutical phenomenological approach to understand the lived experience of accessing care during a mental health crisis. Thirty-one Australian adults who had accessed crisis services at ED, phone lines and/or crisis alternatives participated in in-depth interviews. The findings are organised across the temporal narratives of participants' experiences from (1) point of contact, (2) positive and negative care experiences and (3) enduring impacts. Several themes were generated during these phases. The findings demonstrate the interrelated nature of care experiences and enduring impacts. With some exceptions, care received within EDs was harmful, resulting in lasting adverse effects. Responses from crisis phone lines were mixed, with participants appreciating the accessibility of after-hour phone support but finding standardised risk assessments unhelpful. Responses from crisis alternatives to ED were promising, aligning with the need for validation and human connection, but were not always accessible or easy to mobilise during a crisis. Notably, across all settings, positive effects were firmly attributed to the quality of the relationship with specific crisis providers. The findings bring into sharp focus the lived experience of people accessing crisis care and contribute to the shortage of literature on subjective experiences. Providers may better meet the needs of those experiencing mental health crises by understanding the enduring impact of these interactions and the role of human connection beyond a focus on risk assessment, thereby providing opportunities for a joint understanding of risk and meaning-making. Furthermore, understanding the subjective experience of crisis care can guide reforms to ED and develop crisis alternatives to better meet the needs of people in crisis. The first author and the third author are in designated lived experience (Consumer) roles. The first author conducted the interviews and was explicit regarding their lived experience when engaging with participants. Service users were involved as advisors to the study and provided input into the design.

Lived experiences of women during induction of labour at a tertiary hospital in Ghana: A qualitative study.

Induction of labour (IOL) has become a major and vital maternal health intervention to facilitate childbirth and minimize the rising caesarean section rates globally. However, there is limited information to facilitate appropriate client counselling, birth preparedness and informed decision making although the procedure has inherent tendency for adverse maternal/perinatal outcomes. Given the need for optimal client education and shared decision making in maternal health, this study explored women's knowledge and their lived experiences of IOL. This qualitative study used in-depth interviews, conducted at the largest teaching hospital in Ghana. Purposive sampling was used to recruit the study participants. Data analysis was performed based on thematic content using inductive framework synthesis. We included 17 women who had undergone IOL, delivered and discharged. Most participants(52.9%) were ≥30 years old, married(88.2%), and 41.1% had no previous childbirth experience. The main indications of IOL were postdate(47%), pre-eclampsia(29%) and gestational diabetes mellitus(11.8%). Data synthesis resulted in three broad themes: women's knowledge on IOL, women's experiences of care and women's difficult experiences including coping mechanisms. We determined mixed responses concerning the themes explored: adequate versus inadequate knowledge; positive versus negative experiences of care and satisfaction. Nearly all women mentioned vaginal examination as their most difficult experience due to severe pain, extreme discomfort, and being psychologically traumatic. The main coping strategy the women developed to navigate the traumatic vaginal examination was by "psyching" themselves. Our study indicates women encounter significant negative and positive experiences during IOL and childbirth in Ghana with vaginal examination cited as the most painful experience. Appropriate antenatal counselling, women empowerment and pre-labour education on childbirth processes and expectations are recommended to enhance birth preparedness and complication awareness. Health system improvement and regular refreshers courses for health workers are urgently required to promote positive women's experiences of care during labour induction and childbirth.

Patient experiences of outpatient hysteroscopy

ObjectivesPatient perspectives have an important role in improving the quality of outpatient hysteroscopy (OPH) services. Understanding women’s experiences can help provide important insights regarding the OPH journey. The purpose of this paper is to share perspectives and reflect on the experiences of women that participated in a national benchmarking OPH survey. In addition, we explore the correlation between women’s experience of OPH and reported pain scores. Material and methodsOver a two-month period, 5151 women took part in the national OPH survey. Free text comments relating to women’s OPH experience, collected as part of the survey, were subjected to qualitative analysis using NVivo 12 software to provide a better understanding of the OPH journey. In addition, correlations were drawn between the qualitative and quantitative data collected for pain scores and satisfaction using SPSS software. Results1720 (33.3%) women provided comments on their OPH experience. Qualitative thematic analysis generated themes that were divided into positive (82%) and negative (7%) experiences of care. Potential areas of improvement in relation to the OPH service were highlighted in 11% of themes. Most women regarded OPH as a safe, tolerable, and well delivered outpatient service. Quantitative analysis showed that 1829 (35.5%) women reported procedural pain between 70 and 100 mm. These women reported equivalent quality of care on a 10 cm visual analogue scale (9.71 [SD1.04] vs. 9.76 [0.73]; P = 0.06) but were more likely to decline having the procedure done in the same way again (19.4% vs. 3.1%; RR 6.30, 95% CI 5.06 to 7.83) compared to women with pain scores < 70 mm. ConclusionQualitative data supports the usefulness, safety, tolerability, and acceptance of hysteroscopy in an outpatient setting by most women. However, the reasons for high procedural pain, poor tolerability and negative experiences warrant review and exploration of both individual patient and relevant institutional factors including training, equipment, and local processes.

Building positive respectful midwifery relationships: An analysis of women’s experiences of continuity of midwifery care in Aotearoa New Zealand

Problem/BackgroundRespectful woman-centred care is an expectation of the Midwifery Standards of Practice within Aotearoa New Zealand. With both the national and international expectations identifying human rights as a priority in maternity care. Mistreatment can be experienced by women in all socio-political contexts. Identifying women’s experiences of their maternity service is vital when assessing the quality of these services. AimTo explore women’s experiences of continuity of midwifery care in Aotearoa NZ, whether they support the expectations within the Standards of Midwifery Practice and identify the characteristics of care that may contribute to positive or negative experiences of care. MethodsA retrospective analysis of women’s formal online feedback to their midwife using a mixed method design. Feedback forms received from the 1st January 2019 to the 31st December 2019 were analysed using descriptive statistics with free text thematically analysed. FindingsA total of 7749 feedback forms were received demonstrating high levels of satisfaction overall. Three overlapping themes were identified as being central to both positive and negative feedback. Building a positive relationship involved three steps. These were the establishment and maintenance of trust, honouring decisions and empowerment. Overall, the existence of these relationship characteristics contributed to a valued woman-midwife relationship.Women who gave negative feedback identified a lack of trust and a failure to honour decisions which led to women feeling disempowered contributing to a lack of being valued in the relationship. Conclusion: Continuity of care in Aotearoa NZ supports the development of a respectful partnership through trust, honouring decisions and empowerment.

Comparison of patient exit interviews with unannounced standardised patients for assessing HIV service delivery in Zambia: a study nested within a cluster randomised trial

ObjectivesTo compare unannounced standardised patient approach (eg, mystery clients) with typical exit interviews for assessing patient experiences in HIV care (eg, unfriendly providers, long waiting times). We hypothesise standardised patients...

The primary care experience of adults with chronic obstructive pulmonary disease (COPD). An interpretative phenomenological inquiry.

Studies of the lived experience of chronic obstructive pulmonary disease (COPD) reveal a number of challenges patients face when interacting with healthcare providers that may be exacerbated by unwillingness or inability to quit smoking. However, none have explored, in-depth, primary care experiences among patients with COPD in community healthcare settings. The study investigated healthcare experiences of patients living independently in the community with COPD who smoked or had recently quit (at most within the last 5 years), seeking care in primary care settings. An Interpretative Phenomenological Analysis (IPA) involving thirteen participants purposively recruited from social media posts in COPD and carer support groups, general community groups, community noticeboards and paid adverts on social media. In-depth interviews were held between February and April 2022 by phone or Zoom™ and explored patient experience of primary care, focusing on how smoking patterns, addiction and stigma impact upon and shape these experiences. Participants were aged between 45 to 75 years. Nine were female and two thirds were current smokers. Problematic experiences including time-constrained consultations, having to self-advocate for care "…go digging myself and then go and see him and say, can we do this, can we do that type of thing?" and guilt about smoking were common. Positive care experiences described non-judgemental interpersonal interactions with doctors, timely referral, proactive care and trust "I have an actual great trust for my GP… they're awesome, they'll look after you". Participants described how their care experience shifted as primary care adapted care delivery during COVID-19. Pro-active, empathetic care from general practitioners is desired from patients living with COPD. Stigma and fear of judgement was an important underlying driver of negative care experiences contributing to delayed help seeking from general practitioners.

Freebirth, the only option for women who do not fit into common practice– A Swedish national interview study

ObjectiveTo explore women’s experience of freebirth, as giving birth without the presence of a skilled healthcare professional such as a midwife. MethodsOnline semi-structured interviews with nine multiparous women in Sweden. A qualitative experiential approach, as described by Burnard, was followed for data analysis. ResultsThe five main categories explored were: (i) previous negative experiences of hospital care as a reason for freebirth; (ii) receiving support for the decision of freebirth was crucial; (iii) longing for individual midwifery-assisted home-birthing support; (iv) to give birth in peace and in self-control, in the safe home environment; and (v) helpful support during labor and birth was appreciated. ConclusionsThe women in the study had a powerful and positive experience of freebirth, but individual midwifery birthing support was also requested. Easily available and respectful midwifery support should be offered to all childbearing women.

A randomised controlled trial of a psychoeducational group intervention for family and friends of young people with borderline personality disorder features.

Preliminary evidence indicates that interventions designed to support family and friends ('carers') of young people with early-stage borderline personality disorder effectively improve carer outcomes. None of these interventions have been tested in a randomised controlled trial. This clustered, partially nested, randomised controlled trial was conducted at Orygen, Melbourne, Australia. Carers of young people (aged 15-25 years) with borderline personality disorder features were randomly assigned as a unit in a 1:1 ratio, balanced for young person's sex and age, to receive a 15-day intervention comprising: (1) the three-session, in-person, Making Sense of BPD (MS-BPD) multi-family group programme, plus two self-directed online psychoeducational modules (MS-BPD + Online, n = 38), or (2) the two self-directed online psychoeducational modules alone (Online, n = 41). The primary outcome was 'negative experiences of care', measured with the Experience of Caregiving Inventory, at the 7-week endpoint. A total of 79 carers were randomised (pool of 281, 197 excluded, 94 declined) and 73 carers (51 females [69.9%], Mage = 43.8 years [standard deviation, SD = 12.9], MS-BPD + Online n = 35 [47.9%], Online n = 38 [52.1%]) provided follow-up data and were included in the intent-to-treat analysis. The intent-to-treat (and per protocol) analyses did not find any significant differences between the groups on the primary (d = -0.32; 95% confidence interval = [-17.05, 3.97]) or secondary outcomes. Regardless of treatment group, caregivers improved significantly in their personality disorder knowledge. Delivering MS-BPD in conjunction with an online psychoeducational intervention was not found to provide additional benefit over and above access to an online intervention alone. In accordance with national guidelines, carer interventions should be routinely offered by youth mental health services as part of early intervention programmes for borderline personality disorder. Further research is warranted into which interventions work for whom, carers' preferences for support and barriers to care.

Provision and experience of care among women with hypertension in pregnancy: a multi-center qualitative study in Ghana

BackgroundHypertensive disorders of pregnancy (HDP) remain a leading global health problem with complex clinical presentations and potentially grim birth outcomes for both mother and fetus. Improvement in the quality of maternal care provision and positive women’s experiences are indispensable measures to reduce maternal and perinatal adverse outcomes.ObjectiveTo explore the perspectives and lived experiences of healthcare provision among women with HDP and the associated challenges.MethodsA multi-center qualitative study using in-depth interviews (IDIs) and focus group discussions (FGDs) was conducted in five major referral hospitals in the Greater Accra Region of Ghana between June 2018 and March 2019. Women between 26 and 34 weeks’ gestation with confirmed HDP who received maternity care services were eligible to participate. Thematic content analysis was performed using the inductive analytic framework approach.ResultsFifty IDIs and three FGDs (with 22 participants) were conducted. Most women were between 20 and 30 years, Akans (ethnicity), married/cohabiting, self-employed and secondary school graduates. Women reported mixed (positive and negative) experiences of maternal care. Positive experiences reported include receiving optimal quality of care, satisfaction with care and good counselling and reassurance from the health professionals. Negative experiences of care comprised ineffective provider–client communication, inappropriate attitudes by the health professionals and disrespectful treatment including verbal and physical abuse. Major health system factors influencing women’s experiences of care included lack of logistics, substandard professionalism, inefficient national health insurance system and unexplained delays at health facilities. Patient-related factors that influenced provision of care enumerated were financial limitations, chronic psychosocial stress and inadequate awareness about HDP.ConclusionWomen with HDP reported both positive and negative experiences of care stemming from the healthcare system, health providers and individual factors. Given the importance of positive women’s experiences and respectful maternal care, dedicated multidisciplinary women-centered care is recommended to optimize the care for pregnant women with HDP.

LGBTQ2S+ Youth Perspectives on Mental Healthcare Provider Bias, Standards of Care, and Accountability

This study explores the experiences of LGBTQ2S+ youth while accessing mental health and substance use care services during the COVID-19 pandemic. Through a series of facilitated virtual meetings, 33 LGBTQ2S+ youth from across Ontario participated in collaborative activities to identify barriers they have experienced when accessing mental health services, as well as potential solutions to these barriers. Discussions were recorded, transcribed, and analyzed using thematic analysis. The study revealed that LGBTQ2S+ youth disproportionately experience bias, discrimination, and heteronormative assumptions when accessing mental health services, resulting in negative care experiences. Youth also reported insufficient availability of quality care, little continuity in care, and a lack of educated providers capable of effectively addressing the needs of the community. Potential solutions proposed by youth include training resources for providers, LGBTQ2S+ specific care centers, better continuity of care, and assessments to ensure care providers are culturally competent. These results show the COVID-19 pandemic has exacerbated the disparities LGBTQ2S+ youth experience when accessing mental health services and highlight the urgent need to implement policies and programs that will advance the standards of care for LGBTQ2S+ youth.