title: Engagement: an indicator of difference in the perceptions of antenatal care for pregnant women from diverse socioeconomic backgrounds.
abstract: BACKGROUND
  Socioeconomically deprived women are at greater risk of adverse pregnancy outcomes. Research tends to focus on access of services. Yet access may not equate with the equity of services for women from different socioeconomic backgrounds.
  
  
  OBJECTIVE
  To determine whether pregnant women's perceptions of antenatal provision differed in relation to their socioeconomic deprivation ranking (determined by the Scottish Index of Multiple Deprivation 2006).
  
  
  METHODS
  A longitudinal, qualitative study with comparative antenatal case studies between January 2007 and April 2009.
  
  
  METHODS
  Cases were primigravida women from 'least deprived' (n=9) and 'most deprived' (n=12) geographical areas within one local authority in Scotland.
  
  
  METHODS
  Data were analysed using case study replication analysis.
  
  
  RESULTS
  There was little difference in access to antenatal services between the 'least' and 'most' deprived groups. Perception of care differed in relation to the level of 'engagement' (defined using constructs of: language and personalization of care; power and relationships; and health literacy). Engagement was evidenced in most of the 'least deprived' cases and almost none of the 'most deprived' cases. Specifically, socioeconomically deprived women described less evidence of personal connection to their own care, effective communication and the opportunity for shared decision making.
  
  
  CONCLUSIONS
  In women from socioeconomically deprived areas, access may be a less useful indicator than engagement when assessing antenatal service quality. As engagement levels may be one method by which to predict and improve health outcomes, a more equitable antenatal service may need to be developed through the early identification of those women at risk of non-engagement.
authors: School of Health, Nursing and Midwifery, University of the West of Scotland, Paisley, UK. angie.docherty@uws.ac.uk
authors: Angie
authors: A
authors: Docherty
authors: Carol
authors: C
authors: Bugge
authors: Andrew
authors: A
authors: Watterson
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