Better Care for Pregnant Women With RHD: What Works?

Abstract

Background: Rheumatic heart disease (RHD) persists globally as a chronic disease of inequity with added impact in pregnancy. This research aims to identify and examine gaps and facilitators in models of care for women with RHD with a focus on health services.

Methods: A qualitative study explored models of care pathways, using thematic analysis of semi-structured interviews with 19 Australian health professionals.

Results: Provision of cohesive women-centred care was challenged by a series of factors. Themes arising included conduits of care - helping to break down system blocks to improve access to care; ‘layers on layers’ – reflecting complexity of care issues and underlying ‘causes of the causes’; and shared understandings – identifying factors that built improved understandings of disease, agency in informed decision-making for women, and the importance of family and community in that decision-making. Collaborative, cross-disciplinary partnerships were embedded in models of care such as Aboriginal maternal infant health services and elements of RHD programs that described facilitators of optimal care.

Discussion: This is the first known study to explore gaps and facilitators of models of care for women with RHD in pregnancy with a focus on health services.

Despite often complex care requirements in challenging environments, pregnancy for women with RHD provides an opportunity at a critical juncture to strengthen health system responses, improve care pathways, address whole-of-life health and ultimately reduce the burden of RHD. To respond effectively, structural and cultural change is required to improve care pathways for women with RHD.