Panel: Where Do We Get Information?- Carol Sakala


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Panel: Where Do We Get Information?- Carol Sakala

  1. 1. | Health Care Consumer Information Sources: Lessons for Advocates from a Two-Stage National Survey Carol Sakala, PhD, MSPH Childbirth Connection Consumers United for Evidence-based Healthcare 2013 Annual Membership Meeting July 26, 2013 Washington, DC
  2. 2. | Childbirth Connection • National non-profit organization in New York City • Since 1918, working to improve maternity care quality on behalf of women and families • Mission is to improve the quality of maternity care through consumer engagement and health system transformation Learn more:
  3. 3. | National Listening to Mothers Surveys All 3 sponsored by Childbirth Connection, conducted by Harris Interactive Core continuing investigator team: Eugene Declercq, Carol Sakala, Maureen Corry, Sandra Applebaum Core methodology • online (and in LTM I and LTM II telephone) participation of eligible women • programmed computer interface with quality control checks • data weighting • propensity score for propensity to be online • using demographic targets derived from national birth certificate files
  4. 4. | Listening to Mothers Surveys Surveys collectively provide opportunity to monitor trends over time with core continuing questions and explore timely new subjects Survey Year(s) of births Number of Participants* Participation Method Included Settings Follow-up Survey LTM I 2001-2002 1583 Online and phone All settings** No LTM II 2005 1573 Online and phone Hospital only Yes LTM III 2011-2012 2400 Online Hospital only Yes * All: 18-45, could participate in English, singleton birth living at time of survey ** Included 1% who gave birth in a birth center and 1% who gave birth at home
  5. 5. | Valuing and Trusting Information Sources
  6. 6. | Mothers’ Ratings of Recently Used Pregnancy and Childbirth Information Sources as “Very Valuable,” by Childbearing Experience
  7. 7. | Value of Selected Online Resources as Sources of Information About Pregnancy and Birth
  8. 8. | Mothers’ Ratings of Trustworthiness of Possible Pregnancy and Childbirth Information Sources
  9. 9. | Electronic Information Channels
  10. 10. | Electronic Devices Used by Mothers During Typical Week, and Ratings as Source of Pregnancy and Childbirth Information Device % using during typical week Base: all mothers n=2400 Of those using, % rating as “excellent” source Base: varies Laptop or desktop computer with Internet access 82% 64% Smartphone with Internet access 64% 43% Tablet computer with Internet access 35% 46% Regular mobile phone with text messaging capability and Internet access 33% 22% iPod Touch with Internet access 21% 42% Used none of the above in a typical week 1% n.a. (choose all that apply)
  11. 11. | Information Sources
  12. 12. | Mothers’ Reasons for Choosing Maternity Care Provider or Group
  13. 13. | Mothers’ Reasons for Choosing Hospital for Giving Birth
  14. 14. | Childbirth Education Classes in Recent and Any Past Pregnancies, by Childbearing Experience First-time mothers n=977 Experienced mothers n=1423 All mothers n=2400 Yes in current pregnancy 59% 17% 34% No, not in current pregnancy 41% 83% 66% No, not in current pregnancy but took class before n.a. 32% 19% No, never took classes 41% 51% 47% * p < .01 for difference between first-time and experienced mothers
  15. 15. | Provision of Information on Key Topics, by Type of Birth Attendant
  16. 16. | Shared Decision Making after Cesarean? Base: had had 1-2 c-sections and provider mentioned having repeat c-section Talked with maternity care provider about the reasons to schedule another cesarean “some” or “ a lot” 77% Talked with maternity care provider about the reasons not to schedule another cesarean “some” or “ a lot” 38% Maternity care provider explained that there were choices in how to give birth after a previous cesarean 73% Talked with maternity care provider about the option of planning a vaginal birth after cesarean (VBAC) “some” or “a lot” 38% Maternity care provider expressed an opinion about whether or not to schedule another cesarean 72% Maternity care provider thought mother should schedule another cesarean (among those who expressed opinion) 88% Maternity care provider asked whether or not mother wanted to schedule another cesarean 76% Made the final decision whether or not to schedule another cesarean (% mother’s decision/% provider’s/% shared decision) 40/21/39 Knowing then what you know now, would definitely make the same decision about whether or not to schedule another cesarean 63% Percent of mothers in series who gave birth by repeat cesarean 93%
  17. 17. | How Much Provider Talked About Reasons to Have and Not to Have Repeat C-Section 3% 40% 20% 23% 35% 18% 43% 20% Reasons for repeat cesarean Reasons against repeat cesarean A Lot Some A Little Not At All Base: had 1 or 2 prior cesareans and provider mentioned possibility of having a repeat cesarean n=322 See: Fowler et al. How patient centered are medical decisions. JAMA Intern Med 2013:1215-21
  18. 18. | Impact of Information
  19. 19. | Impact of Searching Online for Health Information During Pregnancy
  20. 20. | Knowledge Assets and Deficits
  21. 21. | Mothers’ Awareness of Breastfeeding Recommendations from the American Academy of Pediatrics
  22. 22. | Attitudes Toward Maternity-Related Tests and Treatments
  23. 23. | Mothers’ Identification of Earliest Week in Pregnancy When It Is Safe to Deliver a Baby Absent Complications Requiring Earlier Delivery
  24. 24. | Mothers’ Knowledge of Cesarean Section Complications Increases the chance of serious problems with the placenta in any future pregnancies n=1200 Lowers the chance that a baby will have breathing problems at the time of birth n=1200 Disagree strongly 8% 14% Disagree somewhat 15% 18% Not sure 38% 37% Agree somewhat 24% 18% Agree strongly 15% 12% A cesarean section…
  25. 25. | Mothers’ Knowledge of Labor Induction Indication If a baby appears to be large at the end of pregnancy, it makes sense to induce labor n=1200 Disagree strongly 12% Disagree somewhat 17% Agree somewhat 32% Agree strongly 24% Not sure 15% How much do you agree or disagree with the following statement concerning medical induction of labor, that is, using drugs or other methods to try to cause labor to begin?
  26. 26. | Mothers’ Ratings of U.S. Maternity Care and Health Care Quality
  27. 27. | Knowledge to Action?
  28. 28. | Maternity Care Practices: Information and Choice
  29. 29. | Key Points There are many dimensions to health care consumer information sources These may vary across clinical areas and consumer groups There is great potential flux over time Valid up-to-date surveys can provide valuable insights This knowledge is crucial for strategy of advocacy groups
  30. 30. | Thank you Carol Sakala, PhD, MSPH Director of Programs Childbirth Connection