Issues That Influence Health During Pregnancy and the Postpartum Period: an International Concept Mapping Study

Our objectives were to: identify issues that individuals with pregnancy experiences (health-service users, HSUs) and pregnancy care providers (healthcare professionals, HCPs) perceive to influence health during pregnancy and the postpartum period; understand how these issues are prioritized; and identify actionable issues to inform pregnancy care, policy and research. This was a concept mapping study, which involved brainstorming sessions with HSUs and HCPs, data synthesis to condense the list of statements, sorting of items based on similarity, rating of items based on three scales (importance, preventability, recognizability), multidimensional scaling and hierarchical cluster analysis to produce concept maps, pattern matching graphs and go zones, and the interpretation of results with HSUs and HCPs. A total of 887 statements identified by 14 HSUs and 19 HCPs, were condensed to 85 unique statements, through several rounds of data synthesis. Participants from 10 high- and middle-income countries (29 HSUs and 33 HCPs) sorted and rated these statements into six clusters - maternal mental health, maternal mortality and physical morbidity, fetal/neonatal complications, unexpected peripartum events, health system challenges, and sociocultural factors (Figure 1). While participants agreed on issues that influence health, HSUs assigned greater importance to fetal/neonatal morbidity and maternal mental health and lower importance to health system issues, while HCPs assigned higher importance to maternal mortality and morbidity and lower importance to maternal mental health (Figure 2). Eleven actionable items were identified as priorities to address, to improve patients' experiences with pregnancy care. HSUs and HCPs recognize that health during and after pregnancy is influenced by factors other than physical morbidity, but they differ in how they prioritize these issues. Addressing actionable items important to patients through multidisciplinary collaboration could improve health outcomes.View Large Image Figure ViewerDownload Hi-res image Download (PPT)