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Qualitative study of evidence based leaflets in maternity care
Helen Stapleton1, Mavis Kirkham, Gwenan Thomas
1Women's Informed Childbearing and Health Research Group, School of Nursing and Midwifery, University of Sheffield, Sheffield S3 7ND. h.stapleton@sheffield.ac.uk
BMJ (Clinical Research Ed.)
|March 16, 2002
Summary
Evidence-based leaflets aim to improve informed choice in maternity care. However, clinical pressures and hierarchical structures limit their effective use, leading to compliance rather than true informed choice.
Area of Science:
- Maternal Health
- Health Services Research
- Shared Decision-Making
Background:
- Informed choice is crucial for women utilizing maternity services.
- Evidence-based leaflets are intended to support informed decision-making during antenatal care.
- Understanding the practical application of these tools in clinical settings is essential.
Purpose of the Study:
- To evaluate the implementation and impact of evidence-based leaflets on informed choice within UK maternity services.
- To explore health professionals' and women's experiences with these decision-aid tools.
Main Methods:
- Non-participant observation of 886 antenatal consultations.
- In-depth interviews with 383 women and healthcare providers across 13 Welsh maternity units.
- Provision of "Informed Choice" leaflets and staff training.
Main Results:
- Healthcare professionals recognized the potential of leaflets but faced challenges due to time constraints and clinical demands.
- Hierarchical structures and a focus on "right" versus "wrong" choices, influenced by litigation concerns, overshadowed genuine informed choice.
- Women often complied with professionally defined choices, rarely questioning or requesting alternatives, with midwives seldom discussing leaflet content.
Conclusions:
- The dissemination strategy and the prevailing clinical culture significantly influenced the effectiveness of leaflets in promoting informed choice.
- The study highlights how existing care norms can lead to informed compliance rather than genuine informed choice in maternity settings.