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Moving beyond good intentions: a qualitative study exploring healthcare professionals' perspectives on delivering
Michelle Peter1,2, Clotilde Abe3, Agnes Agyepong4
1North Thames Genomic Laboratory Hub, Great Ormond Street Hospital for Children NHS Foundation Trust, Level 5, Barclay House, 37 Queen Square, London, WC1N 3BH, UK. michelle.peter@ucl.ac.uk.
Insights
Healthcare professionals (HCPs) aim for equitable prenatal testing but face systemic barriers. Improving care requires system-level changes, not just individual effort, especially with advancing prenatal genomics.
Area of Science:
- Maternal Health
- Genetics
- Healthcare Disparities
Background:
- Prenatal testing is crucial in UK prenatal care, with healthcare professionals (HCPs) guiding parents.
- Black and racially minoritized parents face significant maternal health inequalities.
- Understanding HCPs' experiences in delivering equitable prenatal testing is vital amidst technological advancements.
Purpose of the Study:
- To explore how HCPs navigate delivering equitable prenatal testing care.
- To identify influences on equitable care delivery for parents from diverse backgrounds.
- To gather insights for improving prenatal testing services.
Main Methods:
- Semi-structured interviews with 30 HCPs across England.
- Exploration of experiences discussing prenatal testing with diverse parents.
- Codebook thematic analysis informed by Critical Race Theory.
Main Results:
- HCPs strive for equitable care but face constraints: unequal parental starting points, varied clinical genetics knowledge, inconsistent culturally sensitive care support, and reliance on individual efforts.
- Equitable care is often achieved through personal adaptation rather than systemic support.
- Structural factors significantly shape HCPs' practices in delivering prenatal testing.
Conclusions:
- Equitable prenatal testing cannot depend on individual HCPs' efforts.
- System-level investment in clinical education, service design, and culturally sensitive care is necessary.
- Addressing structural issues is crucial for equitable access to prenatal genomics benefits.
Background:
Prenatal testing (prenatal screening and diagnostic testing) is a central component of prenatal care in the UK. Healthcare professionals (HCPs) play a key role in guiding parents through the testing pathway. Against a backdrop where Black and racially minoritised parents are disproportionately impacted by maternal health inequalities, little is known about how HCPs working in prenatal testing services navigate the delivery of equitable care in everyday practice. Understanding HCP perspectives is essential, especially as prenatal testing technology advances.
Methods:
We conducted semi-structured interviews with 30 HCPs who deliver prenatal testing across England. Interviews explored experiences of discussing prenatal testing with parents from Black and racially minoritised backgrounds, influences on delivering equitable care, and views on service improvement. Data were analysed using codebook thematic analysis informed by Critical Race Theory to examine how structural factors shaped practice.
Results:
HCPs valued equitable care, making deliberate efforts to support parents' varying needs. However, four interrelated themes highlighted constraints on equitable delivery: unequal starting points for parents entering testing discussions; uneven clinical confidence and knowledge of genetics across the workforce; variability in support for culturally sensitive care; and reliance on informal, individual labour to address gaps in service design. These dynamics meant that equitable care was often pursued through personal adaptation rather than consistently supported systems.
Conclusions:
Providing equitable care cannot rely on individual effort. System-level investment in clinical education, service design, and organisational cultures that support culturally sensitive care is needed. With the expansion of prenatal genomics, addressing these structural conditions will be essential for ensuring the benefits of prenatal testing are realised equitably.
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