Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
BMC Pregnancy and Childbirth
Published in: BMC Pregnancy and Childbirth 1/2024

Open Access 01-12-2024 | Research

Assessment of relevance and actual implementation of person-centeredness in healthcare and social support services for women with unintended pregnancy in Germany (CarePreg): results of expert workshops

Authors: Anja Lindig, Stefanie Heger, Jördis Maria Zill

Published in: BMC Pregnancy and Childbirth | Issue 1/2024

Login to get access

Abstract

Introduction

Person-centeredness is a key principle in the German healthcare system. However, access to high-quality care for women with unintended pregnancy is limited due to social stigma and legal restrictions. There is little research on the adoption of person-centeredness in care for women with unintended pregnancy. The aim of this study was to analyze relevance and actual implementation of dimensions of person-centeredness in psycho-social and medical abortion care from the view of abortion care providers.

Methods

Counselors and gynecologist working in psycho-social or medical abortion care participated in one of two digital workshops. Discussions were semi-structured based on the 16 dimensions of an integrative model of person-centeredness, audio-recorded and transcribed verbatim. During qualitative content analysis, deductive categories based on the integrative model of person-centeredness were applied and inductive categories were developed. Additionally, participants rated relevance and actual implementation of the dimensions in an online survey.

Results

The 18 workshop participants most intensively discussed the dimensions “access to care”, “person-centered characteristics of healthcare providers” and “personally tailored information”. Four additional categories on a macro level (“stigmatization of women with unintended pregnancy”, “stigmatization of healthcare providers”, “political and legal aspects” and “corona pandemic”) were identified. Most dimensions were rated as highly relevant but implementation status was described as rather low.

Conclusions

In Germany, high quality person-centered care for women with unintended pregnancy is insufficiently implemented through limited access to information, a lack of abortion care providers, and stigmatization. There is a need for changes in health care structures to enable nationwide person-centered care for women with unintended pregnancy. Those changes include a more easy access to evidence-based information and person-centered abortion care, more education on abortion care for healthcare providers, integration of topics of abortion care in medical schools and promotion of de-stigmatizing actions to enable abortions as part of the general healthcare.
Appendix
Available only for authorised users
Literature
1.
Bearak J, Popinchalk A, Ganatra B, Moller AB, Tunçalp Ö, Beavin C, et al. Unintended pregnancy and abortion by income, region, and the legal status of abortion: estimates from a comprehensive model for 1990–2019. Lancet Glob Heal. 2020;8(9):e1152–61.CrossRef
2.
3.
4.
Hanschmidt F, Kaiser J, Stepan H, Kersting A. The change in attitudes towards abortion in former west and east germany after reunification: a latent class analysis and implications for abortion access. Geburtshilfe Frauenheilkd. 2020;80(1):84–94.CrossRefPubMedPubMedCentral
5.
Levels M, Sluiter R, Need A. A review of abortion laws in Western-European countries. A cross-national comparison of legal developments between 1960 and 2010. Health Policy (New York). 2014;118(1):95–104.CrossRef
6.
7.
8.
Prütz F, Hintzpeter B, Krause L. Abortions in Germany - Current data from the statistics on terminations of pregnancy. J Heal Monit. 2022;7(2):39–47.
9.
10.
11.
12.
World Health Organization. Abortion care guideline. World Health Organization, editor. 2022.
13.
Härter M, Dirmaier J, Scholl I, Donner-Banzhoff N, Dierks M-L, Eich W, et al. The long way of implementing patient-centered care and shared decision making in Germany. Z Evid Fortbild Qual Gesundhwes. 2017;123–124:46–51 2017/05/27.CrossRefPubMed
14.
Hahlweg P, Bieber C, Levke Brütt A, Dierks M-L, Dirmaier J, Donner-Banzhoff N, et al. Moving towards patient-centered care and shared decision-making in Germany. Z Evid Fortbild Qual Gesundhwes. 2022;171:49–57.CrossRefPubMed
15.
Scholl I, Zill JM, Härter M, Dirmaier J. An integrative model of patient-centeredness - a systematic review and concept analysis. PLoS One. 2014;9(9):e107828.CrossRefPubMedPubMedCentral
16.
Scholl I, Zill JM, Härter M, Dirmaier J. An integrative model of patient-centeredness – a systematic review and concept analysis. PLoS One. 2014;9(9):e107828-.CrossRefPubMedPubMedCentral
17.
Zeh S, Christalle E, Hahlweg P, Härter M, Scholl I. Assessing the relevance and implementation of patient-centredness from the patients’ perspective in Germany: results of a Delphi study. BMJ Open. 2019;9(12):e031741.CrossRefPubMedPubMedCentral
18.
Sudhinaraset M, Afulani P, Diamond-Smith N, Bhattacharyya S, Donnay F, Montagu D. Advancing a conceptual model to improve maternal health quality: The person-centered care framework for reproductive health equity. Gates Open Res. 2017;1(1):1–14.CrossRefPubMedPubMedCentral
19.
Altshuler AL, Whaley NS. The patient perspective: Perceptions of the quality of the abortion experience. Curr Opin Obstet Gynecol. 2018;30(6):407–13.CrossRefPubMed
20.
Sudhinaraset M, Landrian A, Montagu D, Mugwanga Z. Is there a difference in women’s experiences of care with medication vs. manual vacuum aspiration abortions? Determinants of person-centered care for abortion services. Gemmill A, editor. PLoS One. 2019;14(11):e0225333.CrossRefPubMedPubMedCentral
21.
Cotter SY, Sudhinaraset M, Phillips B, Seefeld CA, Mugwanga Z, Golub G, et al. Person-centred care for abortion services in private facilities to improve women’s experiences in Kenya. Cult Health Sex. 2021;23(2):224–39.CrossRefPubMed
22.
French VA, Steinauer JE, Kimport K. What women want from their health care providers about pregnancy options counseling: a qualitative study. Women’s Heal Issues. 2017;27(6):715–20.CrossRef
23.
Doran F, Nancarrow S. Barriers and facilitators of access to first-trimester abortion services for women in the developed world: a systematic review. J Fam Plann Reprod Heal Care. 2015;41(3):170–80.CrossRef
24.
Holten L, de Goeij E, Kleiverda G. Permeability of abortion care in the Netherlands: a qualitative analysis of women’s experiences, health professional perspectives, and the internet resource of Women on Web. Sex Reprod Heal Matters. 2021;29(1):162–79.CrossRef
25.
Rahm L, De Zordo S, Mishtal J, Garnsey CL, Gerdts C. Inter-departmental abortion travels in metropolitan France: A mixed-methods analysis of women’s experiences, access, and barriers to abortion care. Ortega JA, editor. PLoS One. 2022;17(10):e0273190.CrossRefPubMedPubMedCentral
26.
Garnsey C, Zanini G, De Zordo S, Mishtal J, Wollum A, Gerdts C. Cross-country abortion travel to England and Wales: results from a cross-sectional survey exploring people’s experiences crossing borders to obtain care. Reprod Health. 2021;18(1):103.CrossRefPubMedPubMedCentral
27.
Zill JM, Lindig A, Reck LM, Scholl I, Härter M, Hahlweg P. Assessment of person-centeredness in healthcare and social support services for women with unintended pregnancy (CarePreg): protocol for a mixed-method study. BMJ Open. 2022;12(9):e066939.CrossRefPubMedPubMedCentral
28.
Krueger RA, Casey MA. Focus groups: A practical guide to applied research. 4th ed. Thousand Oaks: Sage; 2009. p. 219.
29.
Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Heal Care. 2007;19(6):349–57.CrossRef
30.
Flick U, von Kardorff E, Steinke I. A companion to qualitative research [Internet]. London: Sage Publications; 2004. p. 432.
31.
Barbour R. Doing focus groups [Internet]. Thousand Oaks: SAGE Publications; 2007.CrossRef
32.
Christalle E, Zeh S, Hahlweg P, Kriston L, Härter M, Zill J, et al. Development and content validity of the Experienced Patient-Centeredness Questionnaire (EPAT)-A best practice example for generating patient-reported measures from qualitative data. Heal Expect. 2022;25(4):1529–38.CrossRef
33.
Hsieh H-F, Shannon SE. Three approaches to qualitative content analysis. Qual Health Res. 2005;15(9):1277–88.CrossRefPubMed
34.
Vaismoradi M, Turunen H, Bondas T. Content analysis and thematic analysis: Implications for conducting a qualitative descriptive study. Nurs Heal Sci. 2013;15(3):398–405.CrossRef
35.
Crowe M, Inder M, Porter R. Conducting qualitative research in mental health: Thematic and content analyses. Aust N Z J Psychiatry. 2015;49(7):616–23.CrossRefPubMed
36.
Kuckartz U. Qualitative Inhaltsanalyse. Methoden, Praxis, Computerunterstützung. Weinheim: Beltz Juventa; 2012.
37.
38.
Hahlweg P, Lindig A, Frerichs W, Zill J, Hanken H, Müller V, et al. Major influencing factors on routine implementation of shared decision-making in cancer care: qualitative process evaluation of a stepped-wedge cluster randomized trial. BMC Health Serv Res. 2023;23(1):840.CrossRefPubMedPubMedCentral
39.
Summit AK, Lague I, Dettmann M, Gold M. Barriers to and enablers of abortion provision for family physicians trained in abortion during residency. Perspect Sex Reprod Health. 2020;52(3):151–9.CrossRefPubMed
40.
Razon N, Wulf S, Perez C, McNeil S, Maldonado L, Fields AB, et al. Family physicians’ barriers and facilitators in incorporating medication abortion. J Am Board Fam Med. 2022;35(3):579–87.CrossRefPubMed
41.
Statistisches Bundesamt (Destatis). Gesundheit: Schwangerschaftsabbrüche. 2021. Fachserie 12, Reihe 3. Wiesbaden: Destatis; 2022.
42.
Coleman-Minahan K, Alspaugh A. Abortion knowledge among advanced practice clinicians in Colorado. Women’s Heal Issues. 2022;32(5):461–9.CrossRef
43.
Harries J, Constant D. Providing safe abortion services: Experiences and perspectives of providers in South Africa. Best Pract Res Clin Obstet Gynaecol. 2020;62:79–89.CrossRefPubMed
44.
45.
Anderson EM, Cowan SK, Higgins JA, Schmuhl NB, Wautlet CK. Willing but unable: Physicians’ referral knowledge as barriers to abortion care. SSM - Popul Heal. 2022;17:101002.CrossRef
46.
47.
Deutsche Gesellschaft für Gynäkologie und Geburtshilfe (DGGG) e.V. S2k Leitlinienprogramm Schwangerschaftsabbruch im ersten Trimenon. Version 1.0. DGGG e.V., editor. 2022.
48.
49.
50.
51.
Ehrenreich K, Kaller S, Raifman S, Grossman D. Women’s experiences using telemedicine to attend abortion information visits in Utah: a qualitative study. Women’s Heal Issues. 2019;29(5):407–13.CrossRef
52.
Killinger K, Günther S, Gomperts R, Atay H, Margit E. Why women choose abortion through telemedicine outside the formal health sector in Germany: a mixed-methods study. BMJ Sex Reprod Heal. 2022;48:e6-12.CrossRef
53.
Maternowska MC, Mashu A, Moyo P, Withers M, Chipato T. Perceptions of misoprostol among providers and women seeking post-abortion care in Zimbabwe. Reprod Health Matters. 2014;22(sup44):16–25.CrossRef
54.
Okonofua FE, Hammed A, Abass T, Mairiga AG, Mohammed AB, Adewale A, et al. Private medical providers’ knowledge and practices concerning medical abortion in Nigeria. Stud Fam Plann. 2011;42(1):41–50.CrossRefPubMed
55.
56.
RKI. Gesundheitliche Lage der Frauen in Deutschland. Gesundheitsberichterstattung des Bundes. Gemeinsam getragen von RKI und Destatis. Berlin: Robert Koch Institut; 2020.
Metadata
Title
Assessment of relevance and actual implementation of person-centeredness in healthcare and social support services for women with unintended pregnancy in Germany (CarePreg): results of expert workshops
Authors
Anja Lindig
Stefanie Heger
Jördis Maria Zill
Publication date
01-12-2024
Publisher
BioMed Central
Published in
BMC Pregnancy and Childbirth / Issue 1/2024
Electronic ISSN: 1471-2393
DOI
https://doi.org/10.1186/s12884-024-06453-8

Other articles of this Issue 1/2024

BMC Pregnancy and Childbirth 1/2024 Go to the issue

Research

Trends and geospatial distribution of stillbirths in Uganda, 2014–2020

Research

Perinatal depression trajectories and child development at one year: a study in China

Research

Postpartum depression-an exploratory mixed method study for developing an indigenous tool

Research

The effect of educational attainment on birthrate in Japan: an analysis using the census and the vital statistics from 2000 to 2020

Research

Maternal and obstetric outcomes following the transfer of embryos warmed with fatty acid-supplemented solutions

Research

Association of prothrombin time, thrombin time and activated partial thromboplastin time levels with preeclampsia: a systematic review and meta-analysis