Caring for Pregnant Women with Rheumatic Heart Disease: A Qualitative Study of Health Service Provider Perspectives. Issue 1 (22nd December 2021)

• Record Type: Journal Article
• Authors: Vaughan, Geraldine; Dawson, Angela; Peek, Michael; Carapetis, Jonathan; Wade, Vicki; Sullivan, Elizabeth
• Is Part Of: Global heart. Volume 16:Issue 1(2021)
• Publication Date: 2021-12-22
• Subjects: Rheumatic Heart Disease -- pregnancy -- health services; Cardiology -- Periodicals; Heart -- Diseases -- Periodicals; Cardiovascular system -- Diseases -- Prevention -- Periodicals; Cardiovascular system -- Diseases -- Treatment -- Periodicals; Cardiovascular system -- Diseases -- Prevention; Cardiovascular Diseases -- prevention & control -- Periodicals; Cardiovascular Diseases -- Periodicals; Developing Countries -- Periodicals; Electronic journals; Electronic journals; Periodicals; 616.1005
• DOI: 10.5334/gh.1086
• Languages: English
• ISSNs: 2211-8160

Abstract

Background: Rheumatic heart disease (RHD) persists in low-middle-income countries and in high-income countries where there are health inequities. RHD in pregnancy (RHD-P) is associated with poorer maternal and perinatal outcomes. Our study examines models of care for women with RHD-P from the perspectives of health care providers. Methods: A descriptive qualitative study exploring Australian health professionals' perspectives of care pathways for women with RHD-P. Thematic analysis of semi-structured interviews with nineteen participants from maternal health and other clinical and non-clinical domains related to RHD-P. Results: A constellation of factors challenged the provision of integrated women-centred care, related to health systems, workforces and culture. Themes that impacted on the provision of quality woman-centred care included conduits of care – helping to break down silos of information, processes and access; 'layers on layers' – reflecting the complexity of care issues; and shared understandings – factors that contributed to improved understandings of disease and informed decision-making. Conclusions: Pregnancy for women with RHD provides an opportunity to strengthen health system responses, improve care pathways and address whole-of-life health. To respond effectively, structural and cultural changes are required including enhanced investment in education and capacity building – particularly in maternal health – to support a better informed and skilled workforce. Aboriginal Mothers and Babies programs provide useful exemplars to guide respectful effective models of care for women with RHD, with relevance for non-Indigenous women in high-risk RHD communities. For key goals to be met in the context of RHD, maternal health must be better integrated into RHD strategies and RHD better addressed in maternal health.