Women's satisfaction with maternity health care services in Finland

doi:10.1016/0277-9536(93)90102-A

Social Science & Medicine

Volume 37, Issue 5, September 1993, Pages 633-638

https://doi.org/10.1016/0277-9536(93)90102-A Get rights and content

Abstract

The purpose of this study was to describe the Finnish maternity health care system and to determine the level of satisfaction in general with maternity health care services and specifically with hospital clinic visits in Helsinki, Finland. Information was collected using both interviews (N = 63) and questionnaires (N = 408). Care during pregnancy takes place in maternity centers, and risk pregnancies are referred to hospital clinics for consultation. The maternity hralth care system in Finland is regarded internationally as effective and well functioning. In recent years, however, increasingly more prenatal visits have taken place in hospital clinics. This change may lead to a system similar to Great Britain's where a large part of prenatal care takes place in hospital clinics. Although the women in this study are satisfied in general with the content of maternity health care services and regard them necessary for their well-being during pregnancy, data also indicated that women are more satisfied with visits to maternity centers than with visits to hospital clinics. The factors women complained most about in hospital clinic visits, were long waiting times, unsatisfactory doctor-patient communication, the ‘assembly-line’ routine of the clinic, and seeing a different doctor at each visit. The lack of social and psychological support involved in the care given at hospital clinics was also evident. In planning and evaluating maternity health care, it is important to consider women's views and experiences.

References (33)

M. Reid et al.
Consumer opinion of a hospital antenatal clinic
Soc. Sci. Med.
(1980)
M. Porter et al.
What is, must be rest: a research note on concervative or deferential responses to antenatal care provision
Soc. Sci. Med.
(1984)
E. Hemminki et al.
Prenatal care in Finland: from primary to tertiary health care?
Int. J. Hlth Services
(1990)
National Board of Health 1987
Health Services
(1989)
P. Niemelä
Äitimyytti ja äitiyshuolto
Esitelmä Nainen ja lääketiede- seminaarissa. Tasa-arvoasiain neuvottelukunta
(1982)
I. Karila et al.
Äitiysneuvolapalvelut. Mitä vanhemmat odottivat ja mitä he saivat
Kätilölehti
(1984)
M. Laanti
Asikkaan itsemääräämisoikeus äitiyshuollossa. Analyysi äitien kokemuksista ja heidän halustaan määrätä omasta hoidostaan.
pro gradu-tutkielma, terveydenhuollon koulutusohjelma
(1989)
K. Soiva
Raskauden, synnytyksen ja lapsivuodeajan terveydenhuolto—äitiyshuolto
Kansanterveystiede I
(1976)
Perinatal Status 1975
K. Soiva
Äitiyshuolto tulevaisuuden kuvassa
Kätilölehti
(1971)

H. Pitkänen

Uusia näköaloja

Kätilölehti marraskuu

(1968)

National Board of Health 1982

Health Services

(1984)

M. Malin et al.

Midwives as providers of prenatal care in Finland

Women Hlth

(1992)

H. Kojo-Austin

Women's satisfaction with maternity health care services in Helsinki

E. Hemminki

Obstetric practice in Finland, 1950–1980. Changes in technology and its relation to health

Med. Care

(1983)

A-L Hartikainen-Sorri

Äitiyspoliklinikka ongelmapotilaita varten

Suomen Lääkärilehti

(1978)

Cited by (27)

Exceeding parents' expectations in Ear-Nose-Throat outpatient facilities: The development and analysis of a questionnaire
2012, Evaluation and Program Planning
Citation Excerpt :
It has been reported that parents’ satisfaction is influenced by communication, cost, continuity of service and providers, physical environment of clinic, humanity, information, time spent on the patient, official procedures, doctors gender and nursing care (Bernhart, Wiandyana, Wihardjo, & Pohan, 1999; Delgado, Lopez-Fernandez, & Luna, 1993; Jones, Carnon, Wylie, & Hedley, 1993; McKinley, Manku-Scott, Hastings, French, & Barker, 1997; Tsai et al., 2007). Furthermore, waiting for long periods, having no alternative appointment and possessing insufficient information are the sources of dissatisfaction in outpatient clinics (Bodur, Zdemur, & Kara, 2002; Dufrene, 2000; Kojo-Austin, Malin, & Hemminki, 1993; Kurata, Nogawa, Philips, Hoffman, & Werblun, 1992). Despite these initiatives, assessment of parental satisfaction with outpatient facilities remains a largely neglected area.
The study attempts to develop an outpatient service quality scale by investigating the key dimensions which assess parental satisfaction and provides a recommendation on an improved health service delivery system. The survey was conducted in an Ear–Nose–Throat outpatient clinic of a Greek public pediatric hospital. A total of 127 parents in outpatient waiting areas were chosen; 74.8% of the sampled parents were under 40, and 78% were mothers. A factor analysis was performed; while a Fischer's exact test and multinomial logistic regression analysis was conducted. All Cronbach's α exceeded 0.70 and all factor loadings exceeded 0.50. Twenty-three items were retained through the scale development process and seven factors were formed that appear to be statistically valid and clinically meaningful: access and convenience, doctor's attention, customization, reliability, assurance, satisfaction and loyalty. Findings were discussed in relation to parents’ overall satisfaction and intention of reusing and recommending outpatient clinic. Satisfaction was found to be positively affected by access and convenience and doctors’ attention. Staff attitude and the telephone procedure of scheduling the child's examination found positively correlated to the likelihood of recommending services to friends and relatives. Time and communication in the waiting room influenced parents’ satisfaction. Overall, results reveal the measures that need to be taken in order to improve outpatient service quality.
Aggregation of qualitative studies-From theory to practice: Patient priorities and family medicine/general practice evaluations
2007, Patient Education and Counseling
Aggregation (i.e., meta-ethnography or meta-synthesis) of qualitative studies remains relatively rare and controversial. We have attempted this procedure within an investigation of patient priorities and evaluations of primary care in order to triangulate an instrument development process as well as explore associated dilemmas.
The procedures included a literature search of qualitative research on patient priorities and evaluations and creation of a framework for quality assessment of retrieved papers. The tool for the evaluation of quality in qualitative studies was piloted, refined, and applied to the retrieved literature. The articles were equally distributed between two teams in random fashion, and inter-rater agreement calculated. Finally, we formulated and applied a strategy for aggregation of data from included papers that allowed comparison to a systematic review of quantitative studies on the topic.
Thirty-seven articles met inclusion criteria. Twenty-four of these articles were of sufficient quality to be included in the qualitative aggregation. Inter-rater agreement ranged from 0.22 to 0.77 and 0.38 to 0.60 for pair and assessor comparisons, respectively. The aggregation strategy enabled synthesis within sub-categories of the heterogeneous papers.
We have devised a modestly reliable instrument to assess the quality of qualitative work. The procedure for quality assessment and aggregation appears to be both feasible and potentially useful, though both theoretical and practical problems underline the need for further refinement prior to widespread utilization of this approach.
An instrument to assess the quality of qualitative work within the context of aggregation efforts is described. Calculating inter-rater reliability in this framework can support future quality assessments.
A method of breaking a heterogeneous collection of included papers into sub-categories to enable aggregation of qualitative studies is applied and demonstrates its feasibility and potential usefulness.
Women with primary antibody deficiencies requiring IgG replacement therapy: Their perception of prenatal care during pregnancy
2004, JOGNN - Journal of Obstetric, Gynecologic, and Neonatal Nursing
Citation Excerpt :
However, younger patients have been shown to be less satisfied with the health care that they receive (Hall & Dornan, 1990). Furthermore, factors that have been found to cause dissatisfaction with prenatal care are poor quality of advice (Williamson & Thomson, 1996), poor communication skills (Fraser, 1999), and unsatisfactory doctor-patient communication (KojoAustin, Malin, & Hemminki, 1993). This study should be regarded as a pilot study; however, this group of 9 women is so far the largest group of pregnant PAD women ever included in a study.
To investigate how a group of women with primary antibody deficiencies (PAD) and receiving replacement therapy with IgG experienced the care they received in their prenatal clinics in relation to PAD and IgG therapy.
An exploratory study using a written questionnaire.
The study originates from an immunodeficiency unit but evaluates care experienced at prenatal clinics.
Nine women (25–43 years) attending an immunodeficiency unit and who fulfilled inclusion criteria for simultaneously having PAD, replacement IgG therapy, and full‐term pregnancy (the latter within the past 5 years).
Women's perception of the response of midwives and physicians at their prenatal clinics to their PAD and IgG therapy during pregnancy.
Women perceived that the obstetricians and the midwives had insufficient knowledge about PAD and IgG replacement therapy. Two women reported that their IgG therapy during pregnancy had been questioned. All nine women felt marginalized and unheard by staff regarding their PAD and need for IgG therapy. However, the women were satisfied with the checkups regarding the pregnancy as such.
This study is the first attempt to investigate the prenatal experience of women with PAD (Search of PubMed, 1980 to present, including search terms primary immunodeficiency, pregnancy, and prenatal care). This study demonstrates that increased knowledge about PAD and IgG replacement therapy among midwives and physicians working in prenatal care clinics is needed. This can prevent misleading advice that puts the health of the mother and her fetus at risk. Sensitizing staff about this special group of women can create conditions in which women feel respected, heard, and satisfied with their prenatal care.
A qualitative study of women's perspectives of antenatal care in a rural area of Zimbabwe
2004, Midwifery
to describe the perspectives and experiences of women in their use of antenatal care and in their reasoning on specific antenatal care routines.
two qualitative methods including focus group discussions and individual interviews were combined.
a rural district in Zimbabwe where a randomised control trial had been undertaken to introduce a new antenatal care package.
forty-four women and twenty-four men participated in the study.
women were observed to take actions contrary to those assumed professionally acceptable in antenatal care generally and in some specific changed routines. Visits were to be reduced and weighing was to be omitted, but women, especially younger women, said they preferred more than the stipulated five goal oriented visits. One reason for this was the importance of being assured that the fetus was growing well. They considered that visits spaced too widely would make it difficult for service providers to help, should complications develop. On the other hand, older women (above 35 years old), a group professionally considered to be at high risk, were not so concerned with the visits. All the women said they wanted to be weighed at all the visits. The antenatal care visits are simply known as ‘going for scale’. The health care providers complied by weighing the women without recording. Cultural beliefs had great influence, especially on the time a pregnancy is acknowledged and reported. It is believed that pregnant women and the pregnancy are vulnerable to witchcraft during the early period of pregnancy.
we concluded that, whether in its traditional or new form, antenatal care ignores the experiences and views of women and the way they make sense of pregnancy and the care of pregnancy. The importance of understanding the perspectives of different stakeholders as the key to effective change is underlined.
Finnish women's experiences of antenatal care
2002, Midwifery
Objective: to explore and describe women's experiences of antenatal care.
Design: semi-structured interviews, dialogical interviews and non-participant observation in two phases both during and after pregnancy were analysed according to Colaizzi's phenomenological method.
Setting: four maternity clinics in one rural and one urban primary health care centre and one outpatient maternity clinic at a central hospital in Finland.
Participants: in the first phase a purposive sample of nine women were interviewed at 36 weeks gestation, three weeks, three months and two and a half years after birth. In the second phase, data were collected for further breadth and depth and 31 women, who were going through different stages of pregnancy, delivery and the puerperium participated. Data were collected by means of interviews supplemented by non-participatory observation. In the total sample of 40 Finnish women, one half was primigravidae and the other half multigravidae.
Findings: a main thread running through the women's experiences of antenatal care were their needs and wishes that concerned the health of the unborn baby, but also the health and dignity of themselves and their family. The pregnant women wanted to share their pregnancy and childbirth story in a confident relationship based on humaneness and interest in a peaceful atmosphere. They needed protection safeguarded through scientifically based and humane surveillance, and professional competence was expected. They wanted to continuously participate in the new situations through knowledge in dialogues and they wanted to involve their family in the care on their own terms. The childbirth preparation groups had an important multidimensional role in the care.
Implications for practice: the findings challenge the antenatal care that so far has been focused on the physical health, the needs of the primigravida and a blurred family perspective. The family perspective implies knowing both the pregnant woman and her partner in terms of the pregnancy, the birth and a new parenthood. Humane, scientifically based perinatal care can be developed by innovations from these findings, especially considering the multidimensional role of the parent groups.
Fathers' experiences of childbirth
1998, Midwifery
Objective: to describe how fathers who are present during childbirth experience the event, what they feel during childbirth and how they understand the meaning of childbirth.
Design: survey using questionnaire.
Setting: maternity unit in Finland.
Participants: a non-random sample of fathers (n = 137) who were present at the birth of their baby at one university hospital in Finland. The response rate was 81% (n = 107).
Measurements and findings: young fathers and those expecting their first baby reported feeling uncomfortable during delivery more frequently than others. Almost all said that they had plenty of good experiences, younger fathers more so than older fathers. The fathers expressed their confidence in the staff and described the environment at the hospital as pleasant. They said their presence at delivery was important for their growth into fatherhood. The best experience was the moment that the baby entered the world. The hardest things were the pain experienced by their partner and being unable to help. Most of the fathers were very pleased with current midwifery practices followed in childbirth, however, it was felt that more attention ought to be paid to pain relief and to supporting and providing guidance to the father during delivery.
Implications for practice: the work of midwives should be planned so that fathers can feel secure and comfortable. Further studies are needed into the ability of midwives to support fathers in their fatherhood.

View all citing articles on Scopus

View full text

Women's satisfaction with maternity health care services in Finland

Abstract

Soc. Sci. Med.

Soc. Sci. Med.

Prenatal care in Finland: from primary to tertiary health care?

Int. J. Hlth Services

Health Services

Äitimyytti ja äitiyshuolto

Esitelmä Nainen ja lääketiede- seminaarissa. Tasa-arvoasiain neuvottelukunta

Äitiysneuvolapalvelut. Mitä vanhemmat odottivat ja mitä he saivat

Kätilölehti

Asikkaan itsemääräämisoikeus äitiyshuollossa. Analyysi äitien kokemuksista ja heidän halustaan määrätä omasta hoidostaan.

pro gradu-tutkielma, terveydenhuollon koulutusohjelma

Raskauden, synnytyksen ja lapsivuodeajan terveydenhuolto—äitiyshuolto

Kansanterveystiede I

Perinatal Status 1975

Äitiyshuolto tulevaisuuden kuvassa

Kätilölehti

Uusia näköaloja

Kätilölehti marraskuu

Health Services

Midwives as providers of prenatal care in Finland

Women Hlth

Women's satisfaction with maternity health care services in Helsinki

Obstetric practice in Finland, 1950–1980. Changes in technology and its relation to health

Med. Care

Äitiyspoliklinikka ongelmapotilaita varten

Suomen Lääkärilehti