Abstracts
Résumé
Contexte : Les personnes enceintes notent un sentiment de perte de contrôle dans leur suivi prénatal depuis plusieurs décennies. Ce sentiment de contrôle, aussi appelé empowerment, qui devrait être encouragé, est pourtant associé à de meilleurs résultats de santé. Face à ces bénéficies potentiels, nous avons souhaité analyser la perception qu’ont ces personnes et leurs prestataires de santé, au Québec, de cet empowerment pour identifier les facteurs qui leur permettent de mettre en place ce processus et ceux qui le freinent. Méthodologie : Des entrevues individuelles semi-structurées ont été réalisées auprès de sept personnes enceintes et deux sages-femmes, suivies d’une analyse thématique des verbatims obtenus. Résultats : Des facteurs facilitants et freinants touchant autant à la relation de soins avec les prestataires de santé, qu’aux caractéristiques personnelles des personnes enceintes ont été identifiés et détaillés. Des outils et des pistes de solutions pour soutenir l’empowerment ont également été partagés. Conclusion : Une volonté d’acquérir davantage de pouvoir est notée par les participantes. Afin de répondre à ce besoin, des mesures et des ajustements pourraient être mis en place tant dans la relation de soin que dans les dynamiques du système de santé ou dans la formation des prestataires de santé pour soutenir l’empowerment de la patientèle.
Mots-clés :
- empowerment,
- personnes enceintes,
- suivi prénatal,
- grossesse,
- bioéthique
Abstract
Background: Pregnant people have been noting a sense of loss of control in their prenatal care for several decades. This sense of control, also known as empowerment, should be encouraged, and it has been associated with better health outcomes. In view of these potential benefits, we set out to analyze the perceptions of empowerment held by pregnant people and their healthcare providers in Quebec, to identify the factors that enable and hinder this process. Methodology: Semi-structured individual interviews were conducted with seven pregnant women and two midwives, followed by a thematic analysis of the verbatims obtained. Results: Facilitating and hindering factors affecting both the care relationship with healthcare providers and the personal characteristics of pregnant people were identified and detailed. Tools and solutions to support empowerment were also shared. Conclusion: A desire to acquire more power was noted by the participants. In order to meet this need, measures and adjustments could be implemented both in the care relationship and in the dynamics of the healthcare system, or in the training of healthcare providers to support patient empowerment.
Keywords:
- empowerment,
- pregnant people,
- prenatal care,
- pregnancy,
- bioethics
Appendices
Bibliographie
- 1. Bacqué MH, Biewener C. L’empowerment, un nouveau vocabulaire pour parler de participation ? Idees economiques et sociales. 2019;173(3):25‑32.
- 2. Bravo P, Edwards A, Barr PJ, Scholl I, Elwyn G, McAllister M. Conceptualising patient empowerment: a mixed methods study. BMC Health Services Research. 2015;15:252.
- 3. Calvès AE. « Empowerment » : généalogie d’un concept clé du discours contemporain sur le développement. Revue Tiers Monde . 2009;200(4):735‑49.
- 4. Morley J. The limits of empowerment: how to reframe the role of mhealth tools in the healthcare ecosystem. Science and Engineering Ethics. 2020;26:1159‑83.
- 5. Borghei NS, Taghipour A, Roudsari RL, Nooghabi J. Investigating the determinants of maternal empowerment during pregnancy: a strategy for prenatal healthcare promotion. 2017;5(3):988‑97.
- 6. Organisation Mondiale de la Santé. Patient empowerment and health care. Dans : WHO Guidelines on Hand Hygiene in Health Care: First Global Patient Safety Challenge Clean Care Is Safer Care. 2009.
- 7. Masella MA, Godard B. L’empowerment en santé reproductive : vers une visée éthique des soins. Éthique Publique. 2024;26(1).
- 8. Mackenzie C, Stoljar N, éditeurs. Relational Autonomy: Feminist Perspectives on Automony, Agency, and the Social Self. New York: Oxford University Press; 2000.
- 9. Mackenzie C. Feminist innovation in philosophy: relational autonomy and social justice. Women’s Studies International Forum. 2019;72:144‑51.
- 10. Sen A. Equality of what? The Tanner Lecture on Human Values. Standford University; 22 mai 1979.
- 11. Sen A. Commodities and Capabilities. 13th impr. Oxford University Press; 2008.
- 12. Nussbaum M, Sen A, éditeurs. The Quality of Life. Oxford University Press; 1993.
- 13. Masella MA, Godard B. The contribution of empowerment to bioethics in the obstetric care context. International Journal of Feminist Approaches to Bioethics. 2024;17(1):73‑92.
- 14. Skolasky RL, Mackenzie EJ, Wegener ST, Riley LH. Patient activation and functional recovery in persons undergoing spine surgery. Journal of Bone and Joint Surgery. 2011;93(18):1665‑71.
- 15. Greenhalgh T. Patient and public involvement in chronic illness: beyond the expert patient. BMJ. 2009;338:b49.
- 16. Remmers C, Hibbard J, Mosen DM, Wagenfield M, Hoye RE, Jones C. Is patient activation associated with future health outcomes and healthcare utilization among patients with diabetes? Journal of Ambulatory Care Management. 2009;32(4):320‑7.
- 17. Jerofke T, Weiss M, Yakusheva O. Patient perceptions of patient‐empowering nurse behaviours, patient activation and functional health status in postsurgical patients with life‐threatening long‐term illnesses. Journal of Advanced Nursing. 2014;70(6):1310‑22.
- 18. Gagnon J. Empowerment. Dans : Formarier M, Jovic L, éditeurs. Les concepts en sciences infirmières. Association de recherche en soins infirmiers; 2012. p. 172‑5.
- 19. Greene J, Hibbard JH, Sacks R, Overton V, Parrotta CD. When patient activation levels change, health outcomes and costs change, too. Health Affairs. 2015;34(3):431‑7.
- 20. Nieuwenhuijze M, Leahy-Warren P. Women’s empowerment in pregnancy and childbirth: A concept analysis. Midwifery. 2019;78:1‑7.
- 21. Klima CS, Vonderheid SC, Norr KF, Park CG. Development of the Pregnancy-related Empowerment Scale. Nursing and Health. 2015;3(5):120‑7.
- 22. Gibson CH. A concept analysis of empowerment. Journal of Advanced Nursing. 1991;16(3):354‑61.
- 23. Ouschan R, Sweeney JC, Johnson LW. Dimensions of patient empowerment: implications for professional services marketing. Health Marketing Quarterly. 2000;18(1‑2):99‑114.
- 24. Institut national de santé publique du Québec. Suivi de grossesse. Dans : Mieux vivre avec notre enfant. 2023.
- 25. The Vanier Institute of the Family. In Context: Understanding Maternity Care in Canada. In Context series; 2017.
- 26. Al-Gailani S, Davis A. Introduction to “Transforming pregnancy since 1900”. Studies in History and Philosophy of Science Part C: Studies in History and Philosophy of Biological and Biomedical Sciences. 2014;47(Part B):229‑32.
- 27. Barker KK. A ship upon a stormy sea : the medicalization of pregnancy. Social Science & Medicine. 1998;47(8):1067‑76.
- 28. Freda MC, Moos MK, Curtis M. The history of preconception care: evolving guidelines and standards. Maternal and Child Health Journal. 2006;10:S43‑52.
- 29. Lu MC, Lu JS. Prenatal Care. In: Haith MM, Benson JB, éditeurs. Encyclopedia of Infant and Early Childhood Development. Academic Press; 2008. p. 591‑604.
- 30. Peahl AF, Howell JD. The evolution of prenatal care delivery guidelines in the United States. American Journal of Obstetrics and Gynecology. 2021;224(4):339‑47.
- 31. Déchamp-Leroux C. Les conséquences de la technicisation de la grossesse. Revue des politiques sociales et familiales. 2003;72(1):91‑7.
- 32. Gagnon R. La grossesse et l’accouchement à l’ère de la biotechnologie : l’expérience de femmes au Québec. Thèse de doctorat en Sciences humaines appliquées. Montréal, Québec : Université de Montréal; 2017.
- 33. Halabi IO, Scholtes B, Voz B, et al. “Patient participation” and related concepts: A scoping review on their dimensional composition. Patient Education and Counseling. 2020;103(1):5‑14.
- 34. Braun V, Clarke V. Using thematic analysis in psychology. Qualitative Research in Psychology. 2006;3(2):77‑101.
- 35. Kiger ME, Varpio L. Thematic analysis of qualitative data: AMEE Guide No. 131. Medical Teacher. 2020;42(8):846‑54.
- 36. Doré N, Le Hénaff D. Mieux vivre avec notre enfant de la grossesse à deux ans : guide pratique pour les parents. Québec: Institut national de santé publique du Québec; 2024.
- 37. Palumbo R. The Bright Side and the Dark Side of Patient Empowerment: Co-creation and Co-destruction of Value in the Healthcare Environment. Cham: Springer; 2017.
- 38. Elwyn G, Edwards A, Thompson R, éditeurs. Shared Decision-Making in Health Care: Achieving Evidence-Based Patient Choice. Third edition. Oxford: Oxford University Press; 2016.
- 39. Aslani P. Patient empowerment and informed decision-making. International Journal of Pharmacy Practice. 2013;21(6):347‑8.
- 40. De Montigny F, Lacharité C. Perceptions des professionnels de leurs pratiques auprès des parents de jeunes enfants. Enfances, Familles, Générations. 2012;16:53‑73.
- 41. Anderson JM. Empowering patients: issues and strategies. Social Science & Medicine. 1996;43(5):697‑705.
- 42. Anderson RM. Patient empowerment and the traditional medical model. A case of irreconcilable differences? Diabetes Care. 1995;18(3):412‑5.
- 43. Gui X, Chen Y, Kou Y, Pine K, Chen Y. Investigating support seeking from peers for pregnancy in online health communities. Proceedings of the ACM on Human-Computer Interaction. 2017;1(CSCW):50.
- 44. Watson J, Hamilton W, Salisbury C, Banks J. Doctor-patient communication about blood tests: qualitative interview study in general practice. Annals of Family Medicine. 2022;20(Suppl 1):2858.
- 45. Nankervis H, Huntley A, Whiting P, et al. Communicating blood test results in primary care: a mixed methods systematic review. British Journal of General Practice. 2025;75(753):e222-e231.
- 46. O’Kane MJ. Direct patient access to test results: implications for the laboratory. Annals of Clinical Biochemistry. 2015;52(5):525‑6.
- 47. Kingma E. Harming one to benefit another: the paradox of autonomy and consent in maternity care. Bioethics. 2021;35(5):456‑64.
- 48. Asch S, Connor SE, Hamilton EG, Fox SA. Problems in recruiting community-based physicians for health services research. Journal of General Internal Medicine. 2000;15(8):591‑9.
- 49. Herber OR, Schnepp W, Rieger MA. Recruitment rates and reasons for community physicians’ non-participation in an interdisciplinary intervention study on leg ulceration. BMC Medical Research Methodology. 2009;9:61.
- 50. Krebs F, Lorenz L, Nawabi F, et al. Recruitment in health services research—a study on facilitators and barriers for the recruitment of community-based healthcare providers. IJERPH. 2021;18(19):10521.
- 51. Salmon P, Peters S, Rogers A, et al. Peering through the barriers in GPs’ explanations for declining to participate in research: the role of professional autonomy and the economy of time. Family Practice. 2007;24(3):269‑75.
- 52. Borgiel AEM, Dunn EV, et al. Recruiting family physicians as participants in research. Family Practice. 1989;6(3):168‑72.
- 53. Sahin D, Yaffe MJ, Sussman T, McCusker J. A mixed studies literature review of family physicians’ participation in research. Family Medicine. 2014;46(7):503‑14.
- 54. Sidani S, Soeren MH, Hurlock-Chorostecki C, Reeves S, Fox MT, Collins LC. Health professionals’ and patients’ perceptions of patient-centered care: a comparison. European Journal for Person Centered Healthcare. 2016;4:641‑9.
- 55. Stretton B, Bacchi S, Thomas J. A scoping review of patient‐led teaching of health professions students. Internal Medicine Journal. 2023;53(4):629‑34.
10.7202/1012801ar