Panel: Where Do We Get Information?- Carol Sakala

transform.childbirthconnection.org | www.childbirthconnection.org

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


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


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/


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


Valuing and Trusting Information Sources


Mothers’ Ratings of Recently Used Pregnancy and Childbirth Information Sources as “Very Valuable,”

by Childbearing Experience


Value of Selected Online Resources as Sources of Information About Pregnancy and Birth


Mothers’ Ratings of Trustworthiness of Possible Pregnancy and Childbirth Information Sources


Electronic Information Channels


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)


Information Sources


Mothers’ Reasons for Choosing Maternity Care Provider or Group


Mothers’ Reasons for Choosing Hospital for Giving Birth


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


Provision of Information on Key Topics,by Type of Birth Attendant


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%


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


Impact of Information


Impact of Searching Online for Health Information During Pregnancy


Knowledge Assets and Deficits


Mothers’ Awareness of Breastfeeding Recommendations from the American Academy

of Pediatrics


Attitudes Toward Maternity-Related Tests and Treatments


Mothers’ Identification of Earliest Week in Pregnancy When It Is Safe to Deliver a Baby

Absent Complications Requiring Earlier Delivery


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…


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?


Mothers’ Ratings of U.S. Maternity Care and Health Care Quality


Knowledge to Action?


Maternity Care Practices: Information and Choice


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


Thank you

Carol Sakala, PhD, MSPH

Director of Programs

Childbirth Connection

[email protected]

http://transform.childbirthconnection.org/reports/listeningtomothers/

mailto:[email protected]

http://transform.childbirthconnection.org/reports/listeningtomothers/

Health & Medicine

Panel: Where Do We Get Information?- Carol Sakala