Received Jun 9; Accepted Nov Copyright © The Author s.
This article has been cited by other articles in PMC. Abstract Background Instruments to assess quality of maternity care in Central and Eastern European CEE region are scarce, despite reports of poor doctor-patient communication, titkos társkereső care, and informal cash payments.
We validated and tested an online questionnaire to study maternity care experiences among Hungarian women. Methods Following literature review, we collated validated items and scales from two previous English-language surveys and adapted them to the Hungarian context.
- Не будем беспокоиться заранее, - усмехнулся Ричард.
- Я должна была еще кое-что сказать тебе и Кэти.
- Быть может, я и упрямец, - ответил Макс с довольным видом, - но уж поверьте мне - не глупец.
- Ричард и Элли уже завтракали.
- Я смогу придумать более убедительное изображение Судного дня, который обрушат на людей октопауки, и запугать им наших собратьев-людей.
- A dél- német ismerősök
- Társkereső xvii
- Szerencsés ember keres nőt
An expert panel assessed items for clarity and relevance on a 4-point ordinal scale. We conducted bivariate analysis and thematic analysis of open-ended responses.
Conclusions We developed and validated a comprehensive questionnaire that can be used to evaluate respectful maternity care, evidence-based practice, and informal cash payments in CEE region and beyond.
It is unknown how common these experiences are. In order to quantitatively explore the experience of quality maternity care in Hungary, we assembled a multi-disciplinary expert panel to adapt English-language maternity care surveys to the Hungarian context.
We instructed the experts to think broadly about all aspects of care that may be important to women. Generally, the experts found that English-language surveys could be easily adapted, and they helped us narrow the number of survey questions from to We then tested all questions on two groups of post-partum Hungarian women who use the internet: a random, representative sample and another group recruited from online maternity care forums.
We found that the new questions about informal cash payments made sense to women and that women reported more positive experiences with care when they paid informally.
In conclusion, we developed a survey to comprehensively explore the maternity care experience in Hungary. Our survey process and questions may be useful to explore the maternity systems of surrounding countries. No other survey has explored the connection between informal cash payments and quality of maternity care in the CEE region. Limitations Survey development could have employed more active users of the maternity system.
Ideiglenesen le vagy tiltva
Some care dimensions important to women were not addressed by the survey. Background Person-centered care has been associated with engendering the most optimal relationship between patient and provider in all medical specialties [ 1 ]. Balanced sharing of information, individualized care plans, and continuous emotional support are elements that have been shown to improve birth care outcomes and increase satisfaction with the birth experience [ 23 ].
However, in a systematic review of 65 studies across 34 countries Bohren and colleagues confirmed that few tools exist to measure the experience of respect or mistreatment in maternity care [ 6 ]. While flört hun med mig teszt CEE region demonstrates generally favorable maternal health indicators [ 7 ingyenes hatékony társkereső oldal, Miteniece et al.
Birth care providers are often trained with outdated curricula [ 9 ], resulting in overapplication of non-evidence-based techniques. Doctor-patient communication is often poor, with providers lacking the skills to interpret what mothers need during pregnancy care [ 1011 ]. Women themselves play an important role in the doctor-patient interaction during pregnancy, including uptake of information, optimizing health behaviors, and adherence to care.
However, there is scarce information about whether women in the CEE region have autonomy over their childbearing experiences.
- У меня было достаточно ключей к разгадке.
- Вдруг подумала Элли.
- Быть может, я и упрямец, - ответил Макс с довольным видом, - но уж поверьте мне - не глупец.
- Клайд, мама и я знали, что смерть близка, словом, он сгорел у нас на глазах прямо за несколько недель.
- Удивленный подобным поступком, младенец принялся сопротивляться и разразился недоуменным криком.
- Bizottság nélküli egységes lakás brilon
- Társkereső nádor
- Komoly társkereső ingyenes fogyatékkal
Mitenice et al. To date, there have been conflicting quantitative investigations of the quality of maternity care in Hungary. Informal and formal cash payments may affect quality of maternity care in terms of affordability and accessibility of services.
However, given the lack of representative data to measure and monitor the quality of maternity care, the extent to which women actually benefit from these payments is unknown. Given the existence of high-quality, English-language survey items, we decided to adapt and content validate these items for use in the Hungarian context with the primary aim of creating a comprehensive questionnaire to explore quality maternity care.
Specifically, we examined quality care according to the rates of obstetric procedures, several measures of the experience of care, as well as the prevalence of informal cash payments. Duplicate items and those specific to foreign systems e. We adapted informal payment questions from a cross-country survey on general inpatients [ 21 ].
The Hungarian maternity care system has similarities to Canada and the United States. A national health insurance scheme covers Hungarian maternity services as in Canadaand a Hungarian woman has her choice of private or public prenatal providers as in Canada and the U.
Informal cash payments pose several challenges to quantitative exploration. First, informal cash payments are usually unregistered, and no government data source exists [ 23 ].
Den kommer lørdag
Second, Stepurko et al. Finally, a woman typically pays after her delivery, making it challenging to explore associations with prenatal and birth outcomes that necessarily happen prior to the payment [ 17 ].
Thus, we needed to develop survey items that would be both culturally acceptable and—at least in concept—precede in time the outcomes of interest.
Content validation When designing instruments it is common to undertake a validation process to provide evidence that the instrument is relevant to the regional context. One approach is to have experts judge the relationship between the survey items and the theory on which the instrument is based [ 2526 ].
We invited 31 flört hun med mig teszt and professional maternity care content experts—including active users of the system—to validate the comprehensiveness and regional specificity of our questionnaire [ 27 ]. Experts were identified through purposive sampling of research, professional, and birth-advocacy networks to maximize non-overlapping expertise [ 28 ].
We required all experts to be bilingual in English and Hungarian. Among these, a total of 75 questions collected information on elements of women-centered care and were woven across the above domains. The final questionnaire then underwent 5-way independent translation, as has been first previously used in Hungarian research, consisting of 3 independent translators who worked in parallel, followed by 1 translator who reconciled and assembled these parallel versions, and concluded by 1 final back translation flört hun med mig teszt the reconciled Hungarian version into English [ 30 ].
The final back translation was checked for accuracy by an author who is a native English speaker NR. Four Hungarian maternity care users beta-tested the survey for language, length, clarity, and functionality.
Babel Web Anthology :: Enger, Cecilie: Mors gaver (detalj)
Ipsos maintains a panel of more than 70, members who are representative of Hungarian internet users for age, sex, and geographical location.
Sample Ipsos administered the survey to the target population using a quota system to ensure a representative distribution regarding age, marital status, household size, flört hun med mig teszt level, monthly income, settlement, and marital status.
Balancing the resources available with the sample size needed to conduct a robust analysis, Ipsos stopped the invitations once a representative sample of women was achieved. Recruitment lasted for the month of October All respondents gave informed consent prior to initiating the survey. Analysis The research egyetlen fél stralsund reviewed all numeric and qualitative data supplied by the expert panel.
We assessed inter-rater agreement by using the content validity index CVIsumming the number of experts who rated an item as highly relevant and clear level 3 or 4 and dividing by the total experts. We considered items to be relevant and clear with an I-CVI score greater than 0. We reviewed all comments with equal attention, giving extra weight to repeat themes.
Revisions were done carefully in dialogue between a native English speaker NR and a native Hungarian speaker IS in order to maintain clarity.
We compared demographic characteristics with two-tailed z tests for dummy variables or Pearson Chi2 test for categorical variables. Two authors ZS and ES read through all the responses, categorized the content, and then coded the content by hand in order to determine the frequency of different themes.
Because participation in the study was voluntary and preserved the anonymity of the participants with no invasive sampling techniques, the ethics committee did not require a formal consent process.
Nonetheless, the survey opened with a discussion of risks, benefits, and potential harms, and then stated that by starting the survey a woman consented to participate. Our research was conducted in full accordance with the World Medical Association Declaration of Helsinki. Results Eleven of the 31 invited multi-disciplinary experts completed the entire validation process.
- Kapjon új csapatjáték
- Egyetlen rosenheim
- Agnes keres férfit
- Ты мне, кажется, говорил, что большая часть людей верит в жизнь после смерти.
The final panel consisted of: research and a clinical psychologists [ 2 ]; obstetrician-gynecologists [ 2 ]; a lawyer expert in birth issues [ 1 ]; directors of non-governmental organizations [ 2 ]; a midwife [ 1 ]; a doula [ 1 ]; an epidemiologist [ 1 ]; a mother [ 1 ]. One of the psychologists runs a support group for new mothers, and the NGO directors lead initiatives on expanding pregnancy and birth options. The doula herself is a mother and has supported birthing mothers in Hungary.
Thus, 6 of the 11 experts had personal experiences as, or close relationships with active users of Hungarian maternity care. Figure 1 summarizes the survey development and validation process. Only 3 items scored below the commonly used I-CVI cut off at or below 0. Experts felt this question used harsh language and might turn women away. As a group the informal payment questions received scores I-CVI 0. However, flört hun med mig teszt consistently commented on the lack of relevance to the intrapartum context of questions developed for general inpatients.
Table 1 lists the nine new informal payment questions that we developed with expert input.