Lesley Barclay1, Jude Kornelsen2, Jo Longman3, Sarah Robin4, Sue Kruske5, Sue Kildea6, Jennifer Pilcher7, Tanya Martin8, Stefan Grzybowski9, Deborah Donoghue10, Margaret Rolfe11, Geoff Morgan12. 1. University Centre for Rural Health, University of Sydney, PO Box 3074, Lismore, NSW 2480, Australia. Electronic address: lesley.barclay@sydney.edu.au. 2. Centre for Rural Health Research, Department of Family Practice, 3rd Floor David Strangway Building, 5950 University Boulevard, Vancouver, British Columbia, Canada V6T 1Z3. Electronic address: jude.kornelsen@familymed.ubc.ca. 3. University Centre for Rural Health, University of Sydney, PO Box 3074, Lismore, NSW 2480, Australia. Electronic address: jo.longman@ucrh.edu.au. 4. University Centre for Rural Health, University of Sydney, PO Box 3074, Lismore, NSW 2480, Australia. Electronic address: sarah.robin@ucrh.edu.au. 5. School of Nursing, Midwifery and Social Work, The University of Queensland, Level 3, Chamberlain Building, St Lucia, QLD 4072, Australia; Institute for Urban Indigenous Health, PO Box 5638, West End, QLD 4006, Australia. Electronic address: sue.kruske@iuih.org.au. 6. School of Nursing, Midwifery and Social Work, The University of Queensland, Level 3, Chamberlain Building, St Lucia, QLD 4072, Australia; Mater Research Institute, The University of Queensland and Women's Health and Newborn Services (Maternity), Mater Health Service, Level 1, Aubigny Place, Raymond Terrace, South Brisbane, QLD 4101, Australia. Electronic address: sue.kildea@mater.uq.edu.au. 7. University Centre for Rural Health, University of Sydney, PO Box 3074, Lismore, NSW 2480, Australia. Electronic address: jpil2286@uni.sydney.edu.au. 8. Sydney Nursing School, University of Sydney, NSW 2006, Australia. Electronic address: tanya.martin@sydney.edu.au. 9. Centre for Rural Health Research, Department of Family Practice, 3rd Floor David Strangway Building, 5950 University Boulevard, Vancouver, British Columbia, Canada V6T 1Z3. Electronic address: sgrzybow@mail.ubc.ca. 10. University Centre for Rural Health, University of Sydney, PO Box 3074, Lismore, NSW 2480, Australia. Electronic address: deborah.donoghue@ucrh.edu.au. 11. University Centre for Rural Health, University of Sydney, PO Box 3074, Lismore, NSW 2480, Australia. Electronic address: margaret.rolfe@ucrh.edu.au. 12. University Centre for Rural Health, University of Sydney, PO Box 3074, Lismore, NSW 2480, Australia. Electronic address: geoffrey.morgan@ucrh.edu.au.
Abstract
OBJECTIVE: to explore perceptions and examples of risk related to pregnancy and childbirth in rural and remote Australia and how these influence the planning of maternity services. DESIGN: data collection in this qualitative component of a mixed methods study included 88 semi-structured individual and group interviews (n=102), three focus groups (n=22) and one group information session (n=17). Researchers identified two categories of risk for exploration: health services risk (including clinical and corporate risks) and social risk (including cultural, emotional and financial risks). Data were aggregated and thematically analysed to identify perceptions and examples of risk related to each category. SETTING: fieldwork was conducted in four jurisdictions at nine sites in rural (n=3) and remote (n=6) Australia. PARTICIPANTS: 117 health service employees and 24 consumers. MEASUREMENTS AND FINDINGS: examples and perceptions relating to each category of risk were identified from the data. Most medical practitioners and health service managers perceived clinical risks related to rural birthing services without access to caesarean section. Consumer participants were more likely to emphasise social risks arising from a lack of local birthing services. KEY CONCLUSIONS: our analysis demonstrated that the closure of services adds social risk, which exacerbates clinical risk. Analysis also highlighted that perceptions of clinical risk are privileged over social risk in decisions about rural and remote maternity service planning. IMPLICATIONS FOR PRACTICE: a comprehensive analysis of risk that identifies how social and other forms of risk contribute to adverse clinical outcomes would benefit rural and remote people and their health services. Formal risk analyses should consider the risks associated with failure to provide birthing services in rural and remote communities as well as the risks of maintaining services.
OBJECTIVE: to explore perceptions and examples of risk related to pregnancy and childbirth in rural and remote Australia and how these influence the planning of maternity services. DESIGN: data collection in this qualitative component of a mixed methods study included 88 semi-structured individual and group interviews (n=102), three focus groups (n=22) and one group information session (n=17). Researchers identified two categories of risk for exploration: health services risk (including clinical and corporate risks) and social risk (including cultural, emotional and financial risks). Data were aggregated and thematically analysed to identify perceptions and examples of risk related to each category. SETTING: fieldwork was conducted in four jurisdictions at nine sites in rural (n=3) and remote (n=6) Australia. PARTICIPANTS: 117 health service employees and 24 consumers. MEASUREMENTS AND FINDINGS: examples and perceptions relating to each category of risk were identified from the data. Most medical practitioners and health service managers perceived clinical risks related to rural birthing services without access to caesarean section. Consumer participants were more likely to emphasise social risks arising from a lack of local birthing services. KEY CONCLUSIONS: our analysis demonstrated that the closure of services adds social risk, which exacerbates clinical risk. Analysis also highlighted that perceptions of clinical risk are privileged over social risk in decisions about rural and remote maternity service planning. IMPLICATIONS FOR PRACTICE: a comprehensive analysis of risk that identifies how social and other forms of risk contribute to adverse clinical outcomes would benefit rural and remote people and their health services. Formal risk analyses should consider the risks associated with failure to provide birthing services in rural and remote communities as well as the risks of maintaining services.
Authors: Taryn Vian; Jeanette L Kaiser; Thandiwe Ngoma; Allison Juntunen; Kaluba K Mataka; Misheck Bwalya; Viviane I R Sakanga; Peter C Rockers; Davidson H Hamer; Godfrey Biemba; Nancy A Scott Journal: Ann Glob Health Date: 2022-05-24 Impact factor: 3.640