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Health Care Consumer Information Sources: Lessons for Advocates from a Two-Stage
National Survey
Carol Sakala, PhD, MSPHChildbirth Connection
Consumers United for Evidence-based Healthcare2013 Annual Membership Meeting
July 26, 2013Washington, DC
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Childbirth Connection
• National non-profit organization in New York City
• Since 1918, working to improve maternity care quality on behalf of women and families
• Mission is to improve the quality of maternity care through consumer engagement and health system transformation
Learn more: http://www.childbirthconnection.org/pdfs/90-year-timeline.pdf
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National Listening to Mothers Surveys
All 3 sponsored by Childbirth Connection, conducted by Harris Interactive
Core continuing investigator team: Eugene Declercq, Carol Sakala, Maureen Corry, Sandra Applebaum
Core methodology• online (and in LTM I and LTM II telephone) participation of eligible women• programmed computer interface with quality control checks• data weighting
• propensity score for propensity to be online• using demographic targets derived from national birth certificate files
http://www.childbirthconnection.org/listeningtomothers/http://transform.childbirthconnection.org/reports/listeningtomothers/
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Listening to Mothers Surveys
Surveys collectively provide opportunity to monitor trends over time with core continuing questions and explore timely new subjects
SurveyYear(s) of
birthsNumber of
Participants*Participation
MethodIncluded Settings
Follow-up Survey
LTM I 2001-2002 1583 Online and
phoneAll
settings** No
LTM II 2005 1573 Online and phone
Hospital only Yes
LTM III 2011-2012 2400 Online Hospital
only Yes
* All: 18-45, could participate in English, singleton birth living at time of survey** Included 1% who gave birth in a birth center and 1% who gave birth at home
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Valuing and Trusting Information Sources
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Mothers’ Ratings of Recently Used Pregnancy and Childbirth Information Sources as “Very Valuable,”
by Childbearing Experience
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Value of Selected Online Resources as Sources of Information About Pregnancy and Birth
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Mothers’ Ratings of Trustworthiness of Possible Pregnancy and Childbirth Information Sources
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Electronic Information Channels
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Electronic Devices Used by Mothers During Typical Week, and Ratings as Source of Pregnancy and
Childbirth Information
Device
% using during typical week Base: all mothers
n=2400
Of those using, % rating as
“excellent” source Base: varies
Laptop or desktop computer with Internet access 82% 64%
Smartphone with Internet access 64% 43%Tablet computer with Internet access 35% 46%Regular mobile phone with text messaging capability and Internet access 33% 22%
iPod Touch with Internet access 21% 42%Used none of the above in a typical week 1% n.a.
(choose all that apply)
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Information Sources
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Mothers’ Reasons for Choosing Maternity Care Provider or Group
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Mothers’ Reasons for Choosing Hospital for Giving Birth
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Childbirth Education Classes in Recent and Any Past Pregnancies, by Childbearing Experience
First-time mothers
n=977
Experienced mothers
n=1423
All mothers
n=2400
Yes in current pregnancy 59% 17% 34%
No, not in current pregnancy 41% 83% 66%No, not in current pregnancy but took class before n.a. 32% 19%
No, never took classes 41% 51% 47%
* p < .01 for difference between first-time and experienced mothers
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Provision of Information on Key Topics,by Type of Birth Attendant
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Shared Decision Making after Cesarean?
Base: had had 1-2 c-sections and provider mentioned having repeat c-sectionTalked with maternity care provider about the reasons to schedule another cesarean “some” or “ a lot” 77%
Talked with maternity care provider about the reasons not to schedule another cesarean “some” or “ a lot” 38%
Maternity care provider explained that there were choices in how to give birth after a previous cesarean 73%
Talked with maternity care provider about the option of planning a vaginal birth after cesarean (VBAC) “some” or “a lot” 38%
Maternity care provider expressed an opinion about whether or not to schedule another cesarean 72%
Maternity care provider thought mother should schedule another cesarean (among those who expressed opinion) 88%
Maternity care provider asked whether or not mother wanted to schedule another cesarean 76%
Made the final decision whether or not to schedule another cesarean (% mother’s decision/% provider’s/% shared decision) 40/21/39
Knowing then what you know now, would definitely make the same decision about whether or not to schedule another cesarean 63%
Percent of mothers in series who gave birth by repeat cesarean 93%
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How Much Provider Talked About Reasons to Have and Not to Have Repeat C-Section
Reasons for repeat cesarean Reasons against repeat cesarean
3%
40%20%
23%
35%
18%
43%
20%
A LotSomeA LittleNot At All
Base: had 1 or 2 prior cesareans and provider mentioned possibility of having a repeat cesarean n=322
See: Fowler et al. How patient centered are medical decisions. JAMA Intern Med 2013:1215-21
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Impact of Information
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Impact of Searching Online for Health Information During Pregnancy
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Knowledge Assets and Deficits
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Mothers’ Awareness of Breastfeeding Recommendations from the American Academy
of Pediatrics
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Attitudes Toward Maternity-Related Tests and Treatments
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Mothers’ Identification of Earliest Week in Pregnancy When It Is Safe to Deliver a Baby
Absent Complications Requiring Earlier Delivery
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Mothers’ Knowledge of Cesarean Section Complications
Increases the chance of serious problems with the
placenta in any future pregnancies
n=1200
Lowers the chance that a baby will have
breathing problems at the time of birth
n=1200
Disagree strongly 8% 14%
Disagree somewhat 15% 18%
Not sure 38% 37%
Agree somewhat 24% 18%
Agree strongly 15% 12%
A cesarean section…
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Mothers’ Knowledge of Labor Induction Indication
If a baby appears to be large at the end of pregnancy, it makes sense to
induce laborn=1200
Disagree strongly 12%
Disagree somewhat 17%
Agree somewhat 32%
Agree strongly 24%
Not sure 15%
How much do you agree or disagree with the following statement concerning medical induction of labor, that is, using drugs or other methods to try to cause labor to begin?
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Mothers’ Ratings of U.S. Maternity Care and Health Care Quality
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Knowledge to Action?
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Maternity Care Practices: Information and Choice
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Key Points
There are many dimensions to health care consumer information sources
These may vary across clinical areas and consumer groups
There is great potential flux over time
Valid up-to-date surveys can provide valuable insights
This knowledge is crucial for strategy of advocacy groups
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Thank you
Carol Sakala, PhD, MSPH
Director of Programs
Childbirth Connection
http://transform.childbirthconnection.org/reports/listeningtomothers/