What matters for pregnant women with rheumatic heart disease -
perspectives of health service providers: A qualitative study
Abstract
Objective: Rheumatic heart disease (RHD) persists in low-middle-income
countries and in high-income countries where there are health
inequities. RHD in pregnancy (RHD-P) is associated with poorer maternal
and perinatal outcomes. Our study examines health care perspectives of
models of care for women with RHD-P. Design: Descriptive qualitative
study exploring health professionals’ perspectives of care pathways for
women with RHD-P. Setting: Australia Population: Nineteen participants
from maternal health and other clinical and non-clinical domains related
to RHD-P. Methods: Thematic analysis of semi-structured interviews.
Results: A constellation of factors challenged the provision of cohesive
women-centred care, related to health systems, workforces and culture.
Themes included conduits of care - helping to break down silos of
information, processes and access; ‘layers on layers’ – reflecting the
complexity of care issues; and shared understandings – factors that
contributed to improved understandings of disease and informed
decision-making. Conclusions: Pregnancy for women with RHD provides an
opportunity to strengthen health system responses, improve care pathways
and address whole-of-life health. To respond effectively, structural and
cultural changes are required including enhanced investment in education
and capacity building – particularly in maternal health – to support a
better informed and skilled workforce. Aboriginal Mothers and Babies
programs provide useful exemplars to guide respectful effective models
of care for women with RHD, with relevance for non-Indigenous women in
high-risk RHD communities. For key goals to be met in the context of
RHD, maternal health must be better integrated into RHD strategies and
RHD better addressed in maternal health.