Perceived Clinician Autonomy Support Before and After the COVID-19 Pandemic Onset in a Pregnancy Cohort

Patient autonomy - the ability to form intentions and undertake actions based upon one's values - is essential to patient-centered care. However, little research has examined patients' perceptions of autonomy support, defined as clinician behaviors that help patients understand options, ask questions, feel heard, and make decisions aligned with their values. This is a critical gap, particularly for pregnant and postpartum populations.

Our objective was to examine a measurable aspect of the patient-clinician relationship that could provide a window into perceived autonomy, specifically, whether patients reported clinician behaviors consistent with autonomy-supportive care. Measured using a subset of responses to the 6-item short-form of the validated Healthcare Climate Survey, we examined whether perceived autonomy support from clinicians shifted from pre- to post-onset of the COVID-19 pandemic and descriptively explored whether patterns appeared to vary by participant characteristics. We analyzed a diverse subset of participants in the Pregnancy, Lifestyle and Environment Study-2 (PETALS-2), a prospective longitudinal cohort study. Participants completed validated surveys at baseline during pregnancy (2017-2019, pre-pandemic onset) and at a study follow-up at 24-36 months postpartum (2020-2021, post-pandemic onset).

In the analytic sample (N = 278), perceived autonomy support decreased over time, both overall (baseline 95% CI = 5.3-5.8 and follow-up 95% CI = 4.8-5.3, p < 0.001). Descriptive subgroup analyses suggested similar directional patterns across several racial/ethnic groups, but subgroup results were interpreted cautiously because the study was not powered to test differences by race/ethnicity. These data therefore do not provide sufficient evidence to draw conclusions about whether changes in perceived autonomy support differed by sociodemographic characteristics or recent perceived discrimination.