Psychosocial climate in maternity hospitals from the perspective of parturients I.
Results from a national survey on perinatal care satisfactionusing a representative sample of 1195 Czech parturients

Overview

Objective:
To assess women’s satisfaction with psychosocial aspects of perinatal care provided in Czech maternity hospitals, to identify areas that need improvement and to compare satisfaction with maternity care between selected subgroups of parturients.

Design:
Original study.

Setting:
Department of Psychology, Faculty of Philosophy, Charles University, Prague.

Methods:
A survey on satisfaction with perinatal care was conducted with a sample of 1195 Czech parturients. The sample was representative of the Czech parturients’ population in terms of educational level, age, parity, and rate of vaginal and caesarean section delivery. The sample was proportionated as regards the number of births at small and large hospitals and at hospitals in different regions as well. All currently existing Czech maternity hospitals were included. For the data collection, the original Czech questionnaire KLI-P was used. The KLI-P measures psychosocial climate of maternity hospitals on following six scales: helpfulness and empathy of caregivers; control and involvement in decision-making; communication of information and availability of caregivers; dismissive attitude and lack of interest; physical comfort and services. In addition, differences in satisfaction rates between different subgroups of respondents were investigated: primiparas/multiparas, women with lower/higher educational status, women who gave birth at smaller/lager hospitals (< 800 / > 800 births per year), women who gave birth at university/other hospitals, women after vaginal delivery/caesarean section, women accommodated in high-standard rooms at after-birth unit, and women who filled the questionnaire within one year after/later than one year after delivery.

Results:
The overall satisfaction with care provided at delivery unit (DU) and after-birth unit (ABU) was 70% and 61%, respectively. The best rated scale at DU was physical comfort and services (69%), the worst evaluation score received the scale control and involvement in decision-making (34%). At ABU, the best rated scale was control and involvement in decision-making (76%) while the lowest evaluation score was found for the scale dismissive attitude and lack of interest (48% – reverse-scored). The items with the best scores referred to the cleanliness at DU and mother-infant contact at ABU, the items with the lowest evaluation scores referred to emotional support provided by physicians at DU, involvement in decision-making concerning the position during the second stage of labour and quality of food. Significantly more satisfied with care provided at DU were multiparas, women who gave birth at non-university hospitals and women who gave birth vaginally. Significantly more satisfied with care at ABU were multiparas, women with lower educational status, women who gave birth at non-university and smaller hospitals (< 800 births per year) and women who evaluated a given hospital within one year after delivery.

Conclusion:
Despite its rather high quality, the Czech perinatal care suffers from several shortcomings as regards its psychosocial aspects. These shortcomings include lack of respect and empathy shown by caregivers, poor communication of information and low involvement of parturients in decision-making. Improving the quality of care at the Czech maternity hospitals requires empowerement of parturients in the system of perinatal care and development of psychological and psychosocial compteneces of health care providers.

Keywords:
maternal-child nursing – psychosocial factors – patient satisfaction – psychosocial climate – medical psychology