title: Metasynthesis: Experiences of Women with Severe Maternal Morbidity and Their Perception of the Quality of Health Care.
abstract: OBJECTIVE
  To explore the experiences of women with severe maternal morbidity and their perception of the quality of health care.
  
  
  BACKGROUND
  The exploration of factors associated with severe maternal morbidity has emerged as an alternative strategy in reducing maternal mortality. This approach is useful for the evaluation and improvement of maternal health services.
  
  
  METHODS
  Included a comprehensive search, appraisal of reports of qualitative studies, the classification of studies and the synthesis of findings.
  
  
  METHODS
  A literature search was conducted through nine databases for articles published between January 1980 and August 2013.
  
  
  METHODS
  The quality of included studies was assessed with a modified Critical Appraisal Skills Program tool. The synthesis applied a meta-ethnographic approach. It involved (1) identifying and comparing the findings; (2) creating a parsimonious thematic structure and (3) searching for disconfirming data.
  
  
  RESULTS
  Nine studies published between 2005 and 2012, involving 292 women with severe maternal morbidity, were included. Three key themes were identified: 'provision of care', 'severe maternal morbidity' and 'health care seeking behavior'. Barriers to the access and utilization of heath care services were identified.
  
  
  CONCLUSIONS
  The findings appear to suggest that mental and physical health outcomes of women who experienced severe maternal morbidity were poor. There is a need to identify the persistence and severity of these outcomes over a longer period of time. More realistic and less biased information may be obtained in community-based interviews. The impact of potential negative fetal outcomes would be a strong influencing factor for the women. These findings may help to increase awareness of the non-physical components of severe maternal morbidity and provide guidance for professionals regarding preventive measures.
authors.affiliation: Department of Family Medicine, Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia.
authors.forename: Mohd Noor
authors.initials: MN
authors.lastname: Norhayati
authors.affiliation: Department of Community Medicine, Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia.
authors.forename: Sukeri
authors.initials: S
authors.lastname: Surianti
authors.affiliation: Women Health Development Unit, Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia.
authors.forename: Nik Hussain
authors.initials: NH
authors.lastname: Nik Hazlina
mesh_terms: D005260:Female; D006801:Humans; D008428:Maternal Mortality; D017060:Patient Satisfaction / Q000208:ethnology / Q000706:statistics & numerical data*