General practitioners’ perceived indicators of vulnerability in pregnancy- A qualitative interview study

Abstract

Objective To explore general practitioners’ (GPs’) perceived indicators of vulnerability among pregnant women in primary care. Design A qualitative study with semi-structured in-depth focus group interviews. Setting General practices located in a mixture of urban, semi-urban and rural practices throughout the Region of Southern Denmark Subjects Twenty GPs. Main outcome measures Through qualitative analysis with systematic text condensation of the interview data, the following themes emerged: (1) obvious indicators of vulnerability—i.e. somatic or psychological illnesses, or complex social problems and 2) intangible indicators of vulnerability – i.e. identification depended on the GPs’ gut-feeling. From the GPs’ perspective, the concept of vulnerability in pregnancy were perceived as the net result of risk factors and available individual and social resources, with a psychosocial etiology as the dominant framework. Conclusions The GPs demonstrated a broad variety of perceived indicators of vulnerability in pregnancy; most importantly, the GPs were aware of a group of pregnant women with intangible vulnerability mainly representing low resilience. Despite not fitting into the GPs' perceived concept of vulnerability, the GPs had a strong gut feeling that these women might be vulnerable. Misjudging the resources of pregnant women due to their physical appearance could delay the GPs’ identification of vulnerability. Future studies should explore the challenges GPs experiences when assessing vulnerability among pregnant women.

Assessing and addressing vulnerability in pregnancy: General practitioners perceived barriers and facilitators - a qualitative interview study

“…This study covers a broader perspective, since the concept of vulnerability includes more than perinatal mental health – e.g. social factors and somatic diseases [ 9 , 26 ]. To our knowledge, this study is the first to apply behavioral change theory with the TDF to analyze GPs’ barriers and facilitators for assessing and addressing vulnerability in pregnancy Since the purpose of the TDF is to identify behavioral domains that warrant further investigation [ 39 , 42 , 52 ], findings from this study can possibly facilitate the generation of future intervention strategies optimizing antenatal care, such as recommended behavioral changes for assessing vulnerable pregnant women in general practice.…”

“…This illustrates how GPs’ professionalism can be challenged by their dual role, balancing the interests of both the woman, the coming child and the health care authorities. Professionalism also reflects employing judgement and coping with uncertainty [ 57 ], which can be challenging in cases where vulnerability can only be detected by the GPs impression [ 26 ]. Despite this, GPs were aware of the importance of maintaining their professional role when addressing vulnerability.…”

“…In Denmark, all pregnant women are offered a first early pregnancy consultation with their GP for the purpose of assessing the pregnant women's comorbid risks and psychosocial resources [ 2 ]. Danish GPs’ have a broad understanding of indicators of vulnerability in pregnancy [ 26 ]. However, less than 25% of pregnant women with severe vulnerability are identified in Danish general practice [ 27 ], and only half of the pregnant women with perinatal depression and anxiety are identified in primary care in the UK [ 28 ].…”

“…Studies have explored GPs’ perceived barriers for assessing perinatal mental health disease(s) [ 29 – 31 ], while barriers for assessing vulnerability, as a broader concept and a predictor of perinatal mental health disease(s) remain unexplored. Indicators of vulnerability are often hidden and vague [ 26 ], and GPs’ diagnostic reasoning is often guided by their gut feelings in unclear situations- e.g. pattern recognition from their patient acquaintance, causing senses of alarm indicating that something is wrong despite lacking objective arguments [ 32 – 35 ].…”

“…We had experienced how lacking interchange of information on social support needs and substance use treatments between sectors could impede the possibility of assessing vulnerability. The GPs attitudes and understandings of indicators of vulnerability were explored in a separate study [ 26 ]. The aim of this study is to explore GPs’ attitudes, experiences and perceived barriers and facilitators for assessing and addressing vulnerability among pregnant women.…”