Impact of health literacy and primary language on the decision to pursue trial of labor after prior cesarean delivery.

IF 2.7 2区 医学 Q1 OBSTETRICS & GYNECOLOGY
Daisy Leon-Martinez, Christine Dehlendorf, Molly Zeme, W John Boscardin, Anjali J Kaimal, William A Grobman, Miriam Kuppermann
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引用次数: 0

Abstract

Background: Both a trial of labor after cesarean (TOLAC) and elective repeat cesarean delivery (ERCD) are reasonable choices after a cesarean delivery, with differing risks and benefits. This study explores the impact of patient health literacy and primary language on the decision to pursue a TOLAC and on decision quality.

Methods: This is a secondary analysis of the Prior Cesarean Decision (PROCEED) trial, which examined the effect of a patient-centered decision support tool on rates of TOLAC and decision quality. Logistic regression was performed to estimate the association of limited health literacy (Newest Vital Sign score ≤4/6) and non-English primary language (NEPL) with TOLAC. Decision quality was assessed by calculating mean scores for decision-quality scales and using linear regression to estimate adjusted mean differences (aMD) by health literacy and NEPL.

Results: Among 1455 participants, 44.6% underwent TOLAC, and 71.0% of those with a TOLAC had a vaginal birth after cesarean (VBAC). Limited health literacy was associated with lower odds of TOLAC (aOR 0.60, 95% CI [0.38, 0.93]). For decision quality, limited health literacy was associated with similar scores for decisional conflict, shared decision-making, decision self-efficacy and decision satisfaction, but lower knowledge scores (3.9 vs. 5.4; aMD -0.7, 95% CI [-1.0, -0.5]). Compared to participants whose primary language was English (n=1043), those with NEPL (n=255) had similar odds of TOLAC (aOR 1.08, 95% CI [0.69, 1.68]), but greater decisional conflict (20.9 vs. 16.7; aMD 3.9, 95% CI [1.4, 6.3]) and lower decision self-efficacy (88.6 vs. 90.9; aMD -3.3, 95% CI [-5.6, -1.1]) and decision satisfaction (4.6 vs. 4.7; aMD -0.1, 95% CI [-0.2, 0.0]).

Conclusions: In this study of pregnant people with a prior cesarean and no prior VBAC, those with limited health literacy had lower odds of TOLAC and lower knowledge scores about risks and benefits of TOLAC vs. ERCD. While those with NEPL had similar odds of TOLAC, they had lower decision quality scores compared to those with those with English as a primary language. These findings indicate factors that may result in less effective counseling related to delivery options after prior cesarean and may contribute to differences in approach to delivery and decision quality.

健康素养和主要语言对先前剖宫产后进行试产决定的影响。
背景:剖宫产后试产(TOLAC)和选择性重复剖宫产(ERCD)都是剖宫产后的合理选择,但风险和获益不同。本研究探讨患者健康素养和主要语言对追求TOLAC决策和决策质量的影响。方法:这是对先前剖宫产决定(PROCEED)试验的二次分析,该试验检验了以患者为中心的决策支持工具对TOLAC率和决策质量的影响。采用Logistic回归估计有限健康素养(最新生命体征评分≤4/6)和非英语主要语言(NEPL)与TOLAC的关系。通过计算决策质量量表的平均得分,并使用线性回归估计健康素养和NEPL的调整平均差异(aMD)来评估决策质量。结果:在1455名参与者中,44.6%接受了TOLAC, 71.0%的TOLAC患者在剖宫产后阴道分娩(VBAC)。有限的健康素养与较低的TOLAC发生率相关(aOR 0.60, 95% CI[0.38, 0.93])。在决策质量方面,有限的健康素养与决策冲突、共同决策、决策自我效能和决策满意度的得分相似,但知识得分较低(3.9比5.4;aMD -0.7, 95% CI[-1.0, -0.5])。与主要语言为英语的参与者(n=1043)相比,NEPL患者(n=255)有相似的TOLAC几率(aOR 1.08, 95% CI[0.69, 1.68]),但更大的决策冲突(20.9比16.7;aMD 3.9, 95% CI[1.4, 6.3])和较低的决策自我效能感(88.6比90.9;aMD -3.3, 95% CI[-5.6, -1.1])和决策满意度(4.6 vs. 4.7;aMD -0.1, 95% CI[-0.2, 0.0])。结论:在这项研究中,有过剖宫产史且没有VBAC史的孕妇,健康素养有限的人TOLAC的几率较低,TOLAC与ERCD的风险和益处的知识得分较低。虽然那些患有NEPL的人患TOLAC的几率相似,但他们的决策质量得分比那些以英语为主要语言的人低。这些发现表明,可能导致先前剖宫产后分娩选择咨询效果较差的因素,可能导致分娩方法和决策质量的差异。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
BMC Pregnancy and Childbirth
BMC Pregnancy and Childbirth OBSTETRICS & GYNECOLOGY-
CiteScore
4.90
自引率
6.50%
发文量
845
审稿时长
3-8 weeks
期刊介绍: BMC Pregnancy & Childbirth is an open access, peer-reviewed journal that considers articles on all aspects of pregnancy and childbirth. The journal welcomes submissions on the biomedical aspects of pregnancy, breastfeeding, labor, maternal health, maternity care, trends and sociological aspects of pregnancy and childbirth.
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