| Description |
A questionnaire study was conducted with the purpose of exploring women's perceptions of their prenatal care. Three research questions were posted: 1. What are the perceptions of women in late pregnancy toward their prenatal care as related to current standards for such care? 2. To what degree do these perceptions accurately reflect care actually provided as noted in the medical record? 3. What effect does care provided have on the satisfaction the patients feels with her care? The prenatal questionnaire consisted of 84 items divided into objective and subjective measures of care, as well as descriptive data. Questionnaire items were based on standards of the American College of Obstetricians and Gynecologists (ACOG) and other criteria as determined by review of current literature. A medical record review was conducted simultaneously in order to verify selected questionnaire items and to obtain additional information. Data were collected using the private patients of eight obstetricians. Questionnaires were completed by 88 women prior to being seen by their physicians during a scheduled prenatal visit. All women were in the last 5 weeks of pregnancy. Thirty-two women were nulliparous; 56 had experienced one to six prior viable pregnancies. The range in age was 17 to 42 years; most women were married and living with a partner. Most women attended prenatal clinic seven to nine times; while there, they spent a range of 2 to 20 minutes with their care provider. Questionnaire items dealing with physical care were consistently rated by respondents as being completed in accordance with ACOG standards. Items pertaining to patient participation in care and decision making, and to information sharing during visits, were not well rated. In most cases, respondents indicated a high degree of psychological support during prenatal visits. Nutritional guidance was indicated as lacking by almost all respondents. There was no evident relationship between restriction of normal salt intake or restricted weight gain, and nutritional assessment or actual weight gain during pregnancy. Chi-square analyses were computed between patients' perceptions of care on 27 questionnaire items and corresponding items on the medial record. Six of these items were not recorded at all by many or all physicians, resulting in significant differences directly related to medical record format. Four other items noted inconsistently on the medical records of three physicians utilizing one central medical records system. Since patients of three physicians consistently rated the items as being performed, significant differences in these cases may have resulted from incomplete retrieval of medical records from the central records system. With the exception of these instances, no chi-square analysis revealed significant differences between patient report and medical record review data, indicating that the patient does provide accurate information about prenatal care. Questionnaire items were grouped and related to specific questionnaire items dealing with satisfaction with care. Nonparametric correlation matrices were computed in order to develop relationships. Items dealing with the sensitivity of the care provider to questions and feelings of the patient correlated highly with patients' satisfaction, as did those dealing with information sharing during prenatal visits. Involvement of the patient in care and decision making also was reflected in increased satisfaction, as was physical contact during return prenatal visits. |
