Disabled women's experiences of accessing and utilising maternity services when they are affected by domestic abuse: a critical incident technique study.
BACKGROUND
Women and their babies are entitled to equal access to high quality maternity care. However, when women fit into two or more categories of vulnerability they can face multiple, compound barriers to accessing and utilising services. Disabled women are up to three times more likely to experience domestic abuse than non-disabled women. Domestic abuse may compromise health service access and utilisation and disabled people in general have suboptimal access to healthcare services. Despite this, little is known about the compounding effects of disability and domestic abuse on women's access to maternity care.


METHODS
The aim of the study was to identify how women approach maternity care services, their expectations of services and whether they are able to get the type of care that they need and want. We conducted a qualitative, Critical Incident Technique study in Scotland. Theoretically we drew on Andersen's model of healthcare use. The model was congruent with our interest in women's intended/actual use of maternity services and the facilitators and barriers impacting their access to care. Data were generated during 2013 using one-to-one interviews.


RESULTS
Five women took part and collectively reported 45 critical incidents relating to accessing and utilising maternity services. Mapped to the underpinning theoretical framework, our findings show how the four domains of attitudes; knowledge; social norms; and perceived control are important factors shaping maternity care experiences.


CONCLUSIONS
Positive staff attitude and empowering women to have control over their own care is crucial in influencing women's access to and utilisation of maternity healthcare services. Moreover these are cyclical, with the consequences and outcomes of healthcare use becoming part of the enabling or disabling factors affecting future healthcare decisions.Further consideration needs to be given to the development of strategies to access and recruit women in these circumstances. This will provide an opportunity for under-represented and silenced voices to be heard.
School of Health and Population Sciences, University of Birmingham, Birmingham, UK. c.bradbury-jones@bham.ac.uk.
Caroline
C
Bradbury-Jones
Scottish Improvement Science Collaborating Centre, University of Dundee, Dundee, UK. j.breckenridge@dundee.ac.uk.
Jenna P
JP
Breckenridge
School of Sociology, Social Policy and Social Work, Queen's University Belfast, Belfast, UK. j.devaney@qub.ac.uk.
John
J
Devaney
Social Dimensions of Health Institute, University of Dundee, Dundee, UK. t.kroll@dundee.ac.uk.
Thilo
T
Kroll
School of Sociology, Social Policy and Social Work, Queen's University Belfast, Belfast, UK. a.lazenbatt@qub.ac.uk.
Anne
A
Lazenbatt
Child Protection Research Unit, NSPCC/University of Edinburgh, Edinburgh, UK. julie.taylor@ed.ac.uk.
Julie
J
Taylor
D001291:Attitude of Health Personnel; D006233:Persons with Disabilities; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility; D006801:Humans; D008427:Maternal Health Services / Q000706:statistics & numerical data*; D010342:Patient Acceptance of Health Care; D010358:Patient Participation; D011209:Power, Psychological; D011247:Pregnancy; D011369:Professional-Patient Relations; D036301:Qualitative Research; D012606:Scotland; D066262:Social Norms; D013179:Spouse Abuse; D013647:Task Performance and Analysis; D006113:United Kingdom; D035862:Vulnerable Populations