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A Framework for Describing the Influence of Service Organisation and Delivery on Participation in Fetal Anomaly Screening in England

Objective. The aim of this research was to explore the influence of service organisation and delivery on providers and users' interactions and decision-making in the context of Down's syndrome screening. Methods. A qualitative descriptive study involving online interviews conducted with a...

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Autores principales: Ukuhor, Hyacinth O., Hirst, Janet, Closs, S. José, Montelpare, William J.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Hindawi 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5380857/
https://www.ncbi.nlm.nih.gov/pubmed/28421145
http://dx.doi.org/10.1155/2017/4975091
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author Ukuhor, Hyacinth O.
Hirst, Janet
Closs, S. José
Montelpare, William J.
author_facet Ukuhor, Hyacinth O.
Hirst, Janet
Closs, S. José
Montelpare, William J.
author_sort Ukuhor, Hyacinth O.
collection PubMed
description Objective. The aim of this research was to explore the influence of service organisation and delivery on providers and users' interactions and decision-making in the context of Down's syndrome screening. Methods. A qualitative descriptive study involving online interviews conducted with a purposive sample of 34 community midwives, 35 pregnant women, and 15 partners from two maternity services in different health districts in England. Data were analysed using a combination of grounded theory principles and content analysis and a framework was developed. Results. The main emerging concepts were organisational constraints, power, routinisation, and tensions. Providers were concerned about being time-limited that encouraged routine, minimal information-giving and lacked skills to check users' understanding. Users reported their participation was influenced by providers' attitudes, the ambience of the environment, asymmetric power relations, and the offer and perception of screening as a routine test. Discordance between the national programme's policy of nondirective informed choice and providers' actions of recommending and arranging screening appointments was unexpected. Additionally, providers and users differing perceptions of emotional effects of information, beliefs, and expectations created tensions within them, between them, and in the antenatal environment. Conclusions. A move towards a social model of care may be beneficial to empower service users and create less tension for providers and users.
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spelling pubmed-53808572017-04-18 A Framework for Describing the Influence of Service Organisation and Delivery on Participation in Fetal Anomaly Screening in England Ukuhor, Hyacinth O. Hirst, Janet Closs, S. José Montelpare, William J. J Pregnancy Research Article Objective. The aim of this research was to explore the influence of service organisation and delivery on providers and users' interactions and decision-making in the context of Down's syndrome screening. Methods. A qualitative descriptive study involving online interviews conducted with a purposive sample of 34 community midwives, 35 pregnant women, and 15 partners from two maternity services in different health districts in England. Data were analysed using a combination of grounded theory principles and content analysis and a framework was developed. Results. The main emerging concepts were organisational constraints, power, routinisation, and tensions. Providers were concerned about being time-limited that encouraged routine, minimal information-giving and lacked skills to check users' understanding. Users reported their participation was influenced by providers' attitudes, the ambience of the environment, asymmetric power relations, and the offer and perception of screening as a routine test. Discordance between the national programme's policy of nondirective informed choice and providers' actions of recommending and arranging screening appointments was unexpected. Additionally, providers and users differing perceptions of emotional effects of information, beliefs, and expectations created tensions within them, between them, and in the antenatal environment. Conclusions. A move towards a social model of care may be beneficial to empower service users and create less tension for providers and users. Hindawi 2017 2017-03-22 /pmc/articles/PMC5380857/ /pubmed/28421145 http://dx.doi.org/10.1155/2017/4975091 Text en Copyright © 2017 Hyacinth O. Ukuhor et al. https://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research Article
Ukuhor, Hyacinth O.
Hirst, Janet
Closs, S. José
Montelpare, William J.
A Framework for Describing the Influence of Service Organisation and Delivery on Participation in Fetal Anomaly Screening in England
title A Framework for Describing the Influence of Service Organisation and Delivery on Participation in Fetal Anomaly Screening in England
title_full A Framework for Describing the Influence of Service Organisation and Delivery on Participation in Fetal Anomaly Screening in England
title_fullStr A Framework for Describing the Influence of Service Organisation and Delivery on Participation in Fetal Anomaly Screening in England
title_full_unstemmed A Framework for Describing the Influence of Service Organisation and Delivery on Participation in Fetal Anomaly Screening in England
title_short A Framework for Describing the Influence of Service Organisation and Delivery on Participation in Fetal Anomaly Screening in England
title_sort framework for describing the influence of service organisation and delivery on participation in fetal anomaly screening in england
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5380857/
https://www.ncbi.nlm.nih.gov/pubmed/28421145
http://dx.doi.org/10.1155/2017/4975091
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