Schulich school of Medicine and Dentistry Prenatal Health Project

Health Service Use

Postpartum health services consumption and information resource use by mothers and their infants: A pilot study: Elizabeth Loney's MSc thesis under supervision of Drs. Campbell, Speechley, and Hoch

Main findings: Where most postpartum women access health information, their abilities to access health and community services, and their information and service gaps. 

Summary: The purpose of this study was to test the feasibility of contacting mothers at two months postpartum, and collected data on how mothers use health and community services, as well as information resources.  The outcomes of this study showed that high response rates can be assumed in a future study when contacting women at two months postpartum.  The study also was able to collect valuable information related to health service use in postpartum women.  It found that 30% of women had difficulty accessing available services, with the most common issue being inability to make an appointment with a family doctor.  The most cited sources of health information were family members and books.  The study also found that more than 50% of mothers reported that they required more information on at least one topic.  Also, more than 50% of mothers identified that there was an area about which they had received conflicting information.  Of note was that 94% of mothers identified that they initiated breastfeeding, while 65% breastfed for at least six months.  Also important is that at the time of the interview, only 35% of mothers were breastfeeding exclusively.  Some of the premature weaning is thought to be related to hospital supplementation.  The most frequently asked questions from the mothers in this study were related to infant feeding and, in particular, breastfeeding.

Do maternal anxiety and depressive symptoms predict health care use and met/unmet needs in postpartum families: Laura Anderson's MSc thesis under supervision of Drs. Campbell, da Silva, Freeman, and Xie 

Main findings: Maternal anxiety and depression were not associated with access to primary health care, and identified which factors affect health service use.  

Summary: The purpose of this study was to look at the use of health care services by new mothers and infants, and the effect that a mother’s depression and anxiety have on the health services that their infants use.  Depression symptoms were measured using the Center for Epidemiological Studies Depression Scale.  This study found that maternal anxiety and depression were not associated with their infant’s walk-in-clinic, emergency room or primary health care provider use.  Strong factors that were found to impact infant emergency room use were infant age, having a single mother, and access difficulties.  Access difficulties included long appointment wait times, inability to get an appointment, and/or limited hours of operation.  Also of note is that maternal use of health services is related to infant use of health services in all areas except use of the emergency use.  This could be for a number of reasons, including: increased access, good relationship with health care provider, decreased maternal coping or increased caregiver burden.  This study also found that enabling factors and infant age have a greater effect on use of services than need-based factors.  Enabling factors make it easier for individuals or populations to change their behavior or environment, and emphasis on the importance of these factors could influence new health care policy priorities.

Maternal marital status and children’s health service use: Su Yuan's MSc thesis under supervision of Drs. Campbell, Xie, and Thind 

Main findings: Single women were more likely to experience barriers than married or common law women, and children of full time employed mothers were more likely to use health services than children of part-time or non-working mothers. 

Summary: The purpose of this study was to describe barriers to health service access and unmet health care needs in mothers and children. It was hoped to determine whether maternal marital status and other factors influence a child’s use of health services. The health services that were found to be impacted by barriers were primary health care providers, walk-in clinics, and specialist physicians. It was found that single women were more likely to experience barriers than married or common law women, though the study had a relatively small sample of single women. Most children in this study had a regular health care provider, and it was found that their access did not differ by maternal marital status. Some factors that influenced access of health services were distance to healthcare provider, and previous negative experiences with health services. An interesting finding was that children of single mothers were more likely to use multiple health services, and their overall use of health services was greater than children of married or common law couples. Other factors that impacted child health service use included; maternal age and child age, as well as maternal employment status. Children of full time employed mothers were more likely to use health services and to use multiple services than children of part-time employed mothers and non-working mothers.