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Group Counseling for Shared Decision‐Making (GCSDM) about Birth after Cesarean for Haitian Creole‐Speaking Women: A MixedMethods Study
Author(s) -
Chinkam Somphit,
SteerMassaro Courtney,
Shorten Allison
Publication year - 2020
Publication title -
journal of midwifery and women's health
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.543
H-Index - 62
eISSN - 1542-2011
pISSN - 1526-9523
DOI - 10.1111/jmwh.13179
Subject(s) - curriculum , creole language , medical education , focus group , medicine , psychology , health care , family medicine , pedagogy , political science , sociology , linguistics , philosophy , anthropology , law
Redesigning care to meet the needs of diverse groups of women in high‐volume urban settings is challenging. In particular, providing services for women from diverse cultural and linguistic backgrounds requires greater insight into unique needs and preferences. Background Haitian women in Massachusetts have high rates of cesareans and low rates of vaginal birth after cesarean (VBAC), despite evidence suggesting many are eligible for a labor after cesarean. Limited reading comprehension in English and Haitian Creole, as well as cultural norms including minimizing questions, may lead to ineffectiveness of written educational material and misunderstandings with counseling. Purpose The purpose was to develop culturally appropriate group counseling sessions about modes of birth after cesarean for Haitian Creole‐speaking women. The Health Belief Model (HBM) and information from the focus groups and individual interviews were used to develop the group counseling curriculum. Hypothesis The Group Counseling and Shared Decision‐Making (GCSDM) program's integration of key elements of Haitian culture and values, and facilitation by Haitian Creole‐speaking health care providers will promote informed decision‐making among targeted women. Methodology This was a pilot mixed‐methods 3‐phase project: (1) identifying key information needs for mode of birth after cesarean decision from Haitian Creole‐speaking women and their providers; (2) development of GCSDM curriculum; and (3) testing the curriculum. Results In Phase One, 4 themes emerged: (1) cultural beliefs influence mode of birth decisions; (2) more information is needed regarding birth options; (3) importance of family and friends in the decision‐making process; and (4) pain as a major influencer. Phase Two involved creating the GCSDM curriculum session loosely based on the CenteringPregnancy model of group prenatal care and information from Phase One. In Phase Three, 10 Haitian Creole‐speaking women attended a GCSDM session. After the session, there was a 50% increase in women planning to labor after cesarean (pre‐session, n = 3; post‐session, n = 6; one participant was lost to follow‐up); 90% of women (n = 9) stated the session gave them enough information to confidently decide about their mode of birth, and all 10 women were “very satisfied” with the session and recommended it. Discussion The GCSDM session was accepted by Haitian Creole‐speaking women with a history of cesarean as a method to improve mode of birth decision‐making. The GCSDM appears feasible and effective, and could be integrated to improve shared decision‐making discussions for other women who do not speak English.