Assessing and addressing vulnerability in pregnancy: General practitioners perceived barriers and facilitators - a...

Area of Science:

• Public Health
• General Practice
• Maternal Health

Background:

• Vulnerability due to low psychosocial resources affects women of fertile age, increasing risks during pregnancy.
• Undetected vulnerability in pregnancy contributes to maternal health inequalities and adverse outcomes for mother and child.
• General practitioners (GPs) possess knowledge of vulnerability indicators but identify less than 25% of severely vulnerable pregnant women in Danish general practice.

Purpose of the Study:

• To explore general practitioners' (GPs) perceived barriers and facilitators in assessing and addressing vulnerability among pregnant women.
• To identify factors influencing GPs' ability to detect and manage psychosocially vulnerable pregnant patients.

Main Methods:

• A qualitative study involving semi-structured focus group interviews with twenty general practitioners (GPs).
• Data were collected from GPs in urban and rural areas of the Region of Southern Denmark.
• Analysis employed a mixed inductive and deductive strategy, guided by the Theoretical Domains Framework (TDF).

Main Results:

• Five themes emerged, highlighting barriers related to knowledge, professional confidence, incentives, working conditions, and behavioral regulations.
• Key barriers included lack of care continuity, trust issues, time constraints, and insufficient cross-sectoral information.
• Facilitators comprised increased attention to vulnerability, professionalism, and strong doctor-patient relationships; organizational changes supported assessment and addressing vulnerability.

Conclusions:

• The Theoretical Domains Framework (TDF) identified significant barriers, particularly when a strong doctor-patient relationship was absent.
• Behavior change interventions, such as restructuring antenatal care organization, could mitigate GPs' barriers.
• Findings offer guidance for policymakers and commissioners on supporting GPs in providing antenatal care for vulnerable pregnant women.