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Subject: search.filters.subject.Maternity services

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    Consumer participation in maternity service development in New Zealand in the 1990s : an applied model for use in health service planning and evaluation : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Health Management at Massey University
    (Massey University, 2001) Christison, Joy Heather
    In New Zealand throughout the 1990s, primary maternity services were the subject of considerable debate. The funders of public health services clearly signaled early in the decade that a reconfiguration of the framework for funding primary maternity services was imminent, and proceeded to involve both health professionals and consumers in discussions about the emerging new framework. The chief feature of the new framework which was implemented in 1996 was the concept of the lead maternity carer - a health professional nominated by each pregnant woman to provide and co-ordinate her care throughout the maternity episode. The body of research work which is the main focus of this thesis commenced prior to the 1996 implementation of the new framework. It took the form of a sampling frame for consumer perceptions of maternity services, with data collection periods in 1995, 1997, and 1999. Throughout this period, approximately 70 women were interviewed and over 3,000 responded to surveys. The main objectives for this sampling activity were to ascertain whether or not women's satisfaction with maternity services changed following implementation of the new framework, and to identify particular aspects of service delivery where changing levels of satisfaction were evident. In general, the new style of maternity service delivery was evaluated positively by research participants. Satisfaction with most aspects of primary maternity care remained constant and high for each data collection period. The core objectives evolved as the study progressed to include the proposition of a model for best ensuring consumer participation in health service development during periods of major change. The model consists of prospective and retrospective consultation, consumer representation during the process of detailed and final decision making, and a longitudinal sampling frame for consumer perceptions which includes pre and post implementation phases. The application of this model to the reform of primary maternity services in the 1990s enabled consumers to exert influence over the nature of the changes and to be instrumental in the validation and retention of those changes. The model proposed here has broader applicability to major reviews of other health services. Decision makers in the health arena will come to rely on mechanisms such as the model outlined in this thesis in order to plan effectively, educate and inform the public, and achieve decision making which is sanctioned by communities, against the backdrop of inevitable fiscal constraint, burgeoning demand and competing priorities for public health funding.
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    Self-reported oral health and access to dental care among pregnant women in Wellington : a thesis presented in fulfilment of the requirements for the degree of Master of Public Health at Massey University, Wellington, New Zealand
    (Massey University, 2009) Claas, Bianca Muriel
    Pregnancy can have important effects on oral health and pregnant women are a population group requiring special attention with regard to their oral health and their babies? health. International research shows that oral health care for pregnant women has been inadequate, especially in relation to education and health promotion and there is some evidence of disparities by SES and ethnicity. Improving oral health is one of the health priorities in the New Zealand Health Strategy (Ministry of Health, 2000) and the Ministry of Health (Ministry of Health, 2006a) has recently identified a need for more information on the oral health and behaviour of pre-natal women. The aims of this study were to gain an understanding of pregnant women?s oral health care practices, access to oral health care information and use of dental care services and to identify any difference by ethnicity and socio-economic position. A self-reported questionnaire was completed by 405 pregnant women (55% response rate) who attended antenatal classes in the Wellington region. The questionnaire was broadly divided into four parts: (1) care of the teeth when the woman was not pregnant; (2) care of the teeth and diet during the pregnancy; (3) sources of oral health information during pregnancy and; (4) demographic information . Data were analysed by age, ethnicity, education and income and odds ratios (OR) and 95% confidence intervals (95%CI) were calculated using logistic regression. The majority of women in this survey were pakeha (80.2%), compared to 19.7% „Others? (8.8% Maori, 1.9% Pacific, 8.6% other). Most of the subjects were aged 31-35 years (34.5%), of high SES (household income and education level). Half of the women reported having regular visits to the dentist previous pregnancy while a significant percentage of women saw a dentist basically when they had problems. The usual dental hygiene habits were maintained during pregnancy. However, during pregnancy more than 60% of women reported bleeding gums. Just 32% of women went to see the dentist during pregnancy and less than half had access to oral health information related to pregnancy. „Others? (OR 0.38, 95% CI 0.15-0.91) and low income (OR 0.27, 95% CI 0.10-0.76) groups were significantly less likely to report access to oral health information compared to pakeha and high income groups (respectively). Women who went to see the dentist during pregnancy were more likely to receive information on dental health. However, low income women were more likely to report the need to see a dentist (OR 2.55, CI 1.08-5.99). Information on dental health and access to oral care should be prioritised to low income women, Maori, Pacific and other ethnic groups. Little attention has previously been given to oral health for pregnant women in New Zealand and there is a need to increase awareness of the importance of this area amongst health practitioners particularly Lead Maternity Carers and Plunket and tamariki ora nurses.