Dianne Roy

Lessons learnt from attempting to assess the evidence base for a complex intervention introduced into New Zealand general practice

Background and context Currently, in New Zealand general practice, the introduction of new initiatives is such that interventions may be introduced without an evidence base. A critical role is to respond to the challenges of chronic illness with self-management a key component. The ‘Flinders Model’ of self-management collaborative care planning developed in Australia has not been evaluated in New Zealand. A study was designed to assess the usefulness of this ‘Model’ when utilised by nurses in New Zealand general practice. This paper describes the issues and lessons learnt from this study designed to contribute to the evidence base for primary care. Assessment of problems Analysis of interviews with the nurses and the research team allowed documentation of difficulties. These included recruitment of practices and of patients, retention of patients and practice support for the introduction of the ‘new’ intervention. Results of assessment A lack of organisational capacity for introduction of the ‘new’ initiative alongside practice difficulties in understanding their patient population and inadequate disease coding contributed to problems. Undertaking a research study designed to contribute to the evidence base for an initiative not established in general practice resulted in study difficulties. Lessons learnt The need for phased approaches to evaluation of complex interventions in primary care is imperative with exploratory qualitative work first undertaken to understand barriers to implementation. Collaborative partnerships between researchers and general practice staff are essential if the evidence base for primary care is to develop and for ‘new’ interventions to lead to improved health outcomes.

Taking It Into Account: Caring for Disabled Mothers During Pregnancy and Birth

BACKGROUND: Although more disabled women are pursuing motherhood over time, little is known about their needs and experiences in achieving this goal. METHODS: A 3-phase study was designed with the aim of identifying ways for services to be more responsive for women living with physical or sensory impairment during and after pregnancy. This article draws on the qualitative phases of a 3-part mixed method study, which involved individual and focus group interviews with the women and maternity and child health practitioners. RESULTS: Sixty-two mothers with either a physical or a sensory impairment and 28 health practitioners participated in the study. Three themes were identified in relation to the current approaches to service provision: that the women were often responsible for educating the practitioners about their impairment, that they often encountered disabling environments, and that it was not uncommon for them to also encounter disabling attitudes from others. Strategies suggested by our participants to improve the provision of maternity services were for women’s impairments to be taken into account in the structure and process of service provision and for practitioners to problem solve and think ahead of how to meet the needs of disabled mothers. CONCLUSION: The need to take the woman’s impairment into account was an overarching issue and strategy identified by both women and practitioners. This consideration has relevance not only at the practitioner–women interaction level but also for educational, structural service provision and policy levels.

“It’s just so bloody hard”: recommendations for improving health interventions and maternity support services for disabled women

Abstract Purpose: Little is known about the barriers and facilitators to pregnancy, birth and motherhood for disabled women within the New Zealand context. Our study explored this deficit with the aim of improving health care interventions and support for disabled mothers. Methods: This paper reports on the third phase of a mixed-methods study. The first two phases used semi-structured individual and focus group interviews with disabled women, and health professionals, involved in maternity and postnatal care and has been reported elsewhere. Phase 3 utilised a modified Delphi technique with both groups of participants to seek consensus on the prioritisation of recommendations from the study. This article focuses on the disabled women’s recommendations. Results: In all, 20 disabled women took part in the Delphi phase of the study (28% of the cohort from Phase 1). In total, 11 key recommendations were identified by the disabled women, with the top seven discussed in detail here. Conclusions: Health professionals and health systems could, and arguably should, utilise a matrix of these recommendations to facilitate a review of service responsiveness to disabled women. Implications for Rehabilitation Becoming a mother is a potentially relevant and important rehabilitation issue for women of childbearing age who come into contact with rehabilitation services. Disabled women encounter a range of economic, attitudinal and knowledge barriers in relation to becoming mothers. Centralised sites/sources of information have potential to provide accessible and useful information for disabled women and health professionals.