Reconceptualising risk: Perceptions of risk in rural and remote maternity service planning

Lesley Barclay; Jude Kornelsen; Jo Longman; Sarah Robin; Sue Kruske; Sue Kildea; Jennifer Pilcher; Tanya Martin; Stefan Grzybowski; Deborah Donoghue; Margaret Rolfe; Geoff Morgan

doi:10.1016/j.midw.2016.04.007

Reconceptualising risk: Perceptions of risk in rural and remote maternity service planning

Midwifery. 2016 Jul:38:63-70. doi: 10.1016/j.midw.2016.04.007. Epub 2016 Apr 22.

Authors

Lesley Barclay¹, Jude Kornelsen², Jo Longman³, Sarah Robin⁴, Sue Kruske⁵, Sue Kildea⁶, Jennifer Pilcher⁷, Tanya Martin⁸, Stefan Grzybowski⁹, Deborah Donoghue¹⁰, Margaret Rolfe¹¹, Geoff Morgan¹²

Affiliations

¹ University Centre for Rural Health, University of Sydney, PO Box 3074, Lismore, NSW 2480, Australia. Electronic address: [email protected].
² Centre for Rural Health Research, Department of Family Practice, 3rd Floor David Strangway Building, 5950 University Boulevard, Vancouver, British Columbia, Canada V6T 1Z3. Electronic address: [email protected].
³ University Centre for Rural Health, University of Sydney, PO Box 3074, Lismore, NSW 2480, Australia. Electronic address: [email protected].
⁴ University Centre for Rural Health, University of Sydney, PO Box 3074, Lismore, NSW 2480, Australia. Electronic address: [email protected].
⁵ School of Nursing, Midwifery and Social Work, The University of Queensland, Level 3, Chamberlain Building, St Lucia, QLD 4072, Australia; Institute for Urban Indigenous Health, PO Box 5638, West End, QLD 4006, Australia. Electronic address: [email protected].
⁶ School of Nursing, Midwifery and Social Work, The University of Queensland, Level 3, Chamberlain Building, St Lucia, QLD 4072, Australia; Mater Research Institute, The University of Queensland and Women's Health and Newborn Services (Maternity), Mater Health Service, Level 1, Aubigny Place, Raymond Terrace, South Brisbane, QLD 4101, Australia. Electronic address: [email protected].
⁷ University Centre for Rural Health, University of Sydney, PO Box 3074, Lismore, NSW 2480, Australia. Electronic address: [email protected].
⁸ Sydney Nursing School, University of Sydney, NSW 2006, Australia. Electronic address: [email protected].
⁹ Centre for Rural Health Research, Department of Family Practice, 3rd Floor David Strangway Building, 5950 University Boulevard, Vancouver, British Columbia, Canada V6T 1Z3. Electronic address: [email protected].
¹⁰ University Centre for Rural Health, University of Sydney, PO Box 3074, Lismore, NSW 2480, Australia. Electronic address: [email protected].
¹¹ University Centre for Rural Health, University of Sydney, PO Box 3074, Lismore, NSW 2480, Australia. Electronic address: [email protected].
¹² University Centre for Rural Health, University of Sydney, PO Box 3074, Lismore, NSW 2480, Australia. Electronic address: [email protected].

PMID: 27162166
DOI: 10.1016/j.midw.2016.04.007

Abstract

Objective: to explore perceptions and examples of risk related to pregnancy and childbirth in rural and remote Australia and how these influence the planning of maternity services.

Design: data collection in this qualitative component of a mixed methods study included 88 semi-structured individual and group interviews (n=102), three focus groups (n=22) and one group information session (n=17). Researchers identified two categories of risk for exploration: health services risk (including clinical and corporate risks) and social risk (including cultural, emotional and financial risks). Data were aggregated and thematically analysed to identify perceptions and examples of risk related to each category.

Setting: fieldwork was conducted in four jurisdictions at nine sites in rural (n=3) and remote (n=6) Australia.

Participants: 117 health service employees and 24 consumers.

Measurements and findings: examples and perceptions relating to each category of risk were identified from the data. Most medical practitioners and health service managers perceived clinical risks related to rural birthing services without access to caesarean section. Consumer participants were more likely to emphasise social risks arising from a lack of local birthing services.

Key conclusions: our analysis demonstrated that the closure of services adds social risk, which exacerbates clinical risk. Analysis also highlighted that perceptions of clinical risk are privileged over social risk in decisions about rural and remote maternity service planning.

Implications for practice: a comprehensive analysis of risk that identifies how social and other forms of risk contribute to adverse clinical outcomes would benefit rural and remote people and their health services. Formal risk analyses should consider the risks associated with failure to provide birthing services in rural and remote communities as well as the risks of maintaining services.

Keywords: Birthing centres; Health; Health planning; Risk; Risk assessment; Rural health.

MeSH terms

Australia
Birthing Centers / supply & distribution*
Cesarean Section
Cultural Competency
Female
Focus Groups
Health Facility Closure
Health Knowledge, Attitudes, Practice*
Health Planning / trends*
Health Services Accessibility
Humans
Interviews as Topic
Maternal Health Services / supply & distribution*
Patient Safety
Pregnancy
Qualitative Research
Risk Assessment
Rural Health Services / economics
Rural Health Services / organization & administration*
Rural Population*