ABSTRACT
BACKGROUND: Little is known about physicians' birth experiences and the perceived relation between physicians' professional status and their birth outcomes, particularly in nonsurgical specialties. This study aimed to explore the birth experiences of physicians in Canada and to determine their perception of the relation between their profession, and their birth experiences and obstetric outcomes. METHODS: We undertook a qualitative descriptive study consisting of in-depth interviews with practising physician birthing parents, all members of the Canadian Physician Mothers Group (online Facebook community) who had deliveries between 2016 and 2021. Data were analyzed using conventional content analysis. RESULTS: Fourteen interviews were conducted. Half of the participants worked in primary care specialties. From participants' narratives, we developed 5 themes pertaining to physicians' birth experiences: (negative impact of) professional culture of medicine whereby professional responsibility trumped personal needs; (mixed) impact of medical knowledge whereby participants felt empowered to make decisions and ask questions, but also experienced augmented stress due to knowing what could go wrong; difficulty stepping out of physician role; privileged access to care; and belief in negative impact of physician role on birth outcome. Some participants suggested possible reasons that physicians may have worse birth outcomes than the general public. INTERPRETATION: The professional culture of medicine was largely perceived as a negative, in particular, the pressure to deny one's own needs for the good of patients and colleagues. Physicians' increased access to medical care combined with their higher levels of anticipatory anxiety around childbirth could be exposing them to increased monitoring and surveillance, thus augmenting the likelihood of medical and surgical interventions.
ABSTRACT
Introduction: Diabetes is a highly prevalent chronic disease that frequently coexists with other medical conditions and implies a high burden for patients and the healthcare system. Clinicians currently are challenged to provide effective interventions that are both multidisciplinary and empower patient self-care. The Diabetes Empowerment Group Program (DEGP) was developed with the aims of fostering patient engagement in diabetes self-care through the lens of empowerment and to support the empowerment of patients with diabetes by providing multidisciplinary group-based care. This research's objectives were to: (1) develop a comprehensive description of the DEGP for potential adopters, and (2) explore the factors influencing the feasibility and acceptability of implementing it in other healthcare settings in Montreal. Methods: A qualitative descriptive study was conducted, following a participatory approach. Data were obtained from: (1) semi-structured interviews with 14 patients who participated in the pilot program; (2) from semi-structured group interviews with patient partners, healthcare professionals, and other stakeholders from 4 Montreal family medicine groups, and (3) discussions among the participatory research team during various knowledge translation activities. Inductive content analysis of the data was performed. Results: The DEGP identified seven key elements: medical visit, continuity of care, group-based dynamics, multi-disciplinarity, clinician facilitation, patient-centered agenda, and a theoretical framework of empowerment. The content and organization of the group visits were conceived to address each of these four domains. The empowerment framework comprises four domains of self-care: emotional (attitude), cognitive (knowledge), behavioral (skills), and relational (relatedness). Factors impacting the feasibility and acceptability of implementing the DEGP in other primary care settings were identified. Discussion: The DEGP fits within the discourse around the need for more patient-centered programs for people living with diabetes, following a more comprehensive empowerment model. This research could facilitate the development or adaptation of similar programs in other settings.
ABSTRACT
BACKGROUND: Diabetes is a prevalent chronic condition that poses a major burden for patients and the health care system. Evidence suggests that patient engagement in self-care improves diabetes control and reduces the risk of complications. To provide effective interventions that aim to improve empowerment processes relating to diabetes, a comprehensive and valid measure of empowerment is needed. This article details the development and validation of the McGill Empowerment Assessment-Diabetes (MEA-D). METHODS: The development and validation of the MEA-D questionnaire comprised three steps: item generation, qualitative face validation, and factorial content validation. An initial version was created by combining existing items and inductively generated items. Items were mapped to an empowerment framework with four domains: attitude, knowledge, behavior, and relatedness. Semi-structured interviews were conducted with 21 adults living with diabetes to assess face validity. The questionnaire was revised by a team of clinicians, researchers, and patient-partners. Factorial content validation was then performed using responses from 300 adult Canadians living with type 1 or type 2 diabetes. RESULTS: The final version of the MEA-D contained 28 items. A moderately good item-domain correlation was found between the individual items within the four domains. Cronbach's α was 0.81 (95% CI 0.78-0.85) for attitude, 0.73 (95% CI 0.67-0.79) for knowledge, 0.84 (95% CI 0.81-0.87) for behavior, and 0.81 (95% CI 0.77-0.84) for relatedness. CONCLUSION: The evaluation of diabetes programs demands a validated measure of empowerment. We developed the MEA-D to address this need. The MEA-D may be adapted to measure patients' empowerment regarding other chronic health conditions.
