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

Laxsini Murugesu, Olga C. Damman, Marloes E. Derksen, Danielle R. M. Timmermans, Ank de Jonge, Ellen M. A. Smets and Mirjam P. Fransen
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Laxsini Murugesu: Department of Public and Occupational Health, Amsterdam Public Health, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
Olga C. Damman: Department of Public and Occupational Health, Amsterdam Public Health, Amsterdam UMC, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands
Marloes E. Derksen: Department of Public and Occupational Health, Amsterdam Public Health, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
Danielle R. M. Timmermans: Department of Public and Occupational Health, Amsterdam Public Health, Amsterdam UMC, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands
Ank de Jonge: Department of Midwifery Science, AVAG, Amsterdam Public Health, Amsterdam UMC, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands
Ellen M. A. Smets: Department of Medical Psychology, Amsterdam Public Health, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
Mirjam P. Fransen: Department of Public and Occupational Health, Amsterdam Public Health, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands

IJERPH, 2021, vol. 18, issue 3, 1-16

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.

Keywords: decision-making; client participation; maternity care; health literacy; needs assessment (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2021
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