Capitulo V. Conclusiones
2. Cumplimiento de los objetivos de investigación
The main findings indicate no statistically significant, or clinically significant association between overall satisfaction with care and PPWR. As the overall satisfaction score can range from 6-30, the patients who are very satisfied (a score of 30), compared to those who are very dissatisfied (a score of 6) with their health care encounter, would only have a 1 kg reduction in PPWR. This indicates a negligible association between satisfaction with health care experiences and PPWR. Although there was a statistically significant association between the two individual dimensions of satisfaction
(information received and involvement in decision making) on PPWR when adjusting for all potential confounders, the magnitude of effect is not clinically significant. Increasing satisfaction of information received, or decision-making from the lowest to highest score (4 point increase) reduces PPWR by less than 1 kg.
The small effect sizes could suggest that high weight retention is more strongly influenced by other factors, rather than satisfaction with health care. It has been
suggested that women who have higher decision authority in the workplace have lower obesity rates.110 This association could be translated to the thesis’ findings in the sense that women who are normal weight may have different characteristics in terms of taking control of their behaviours and personality traits that decrease their likelihood of
76
stronger predictors of PPWR, suggesting that it would be more effective to target patients at risk for overweight or obesity before their first prenatal health care encounter.
Although the thesis findings do not support the theory that satisfactory
experiences influence a patient’s health behaviours, pregnancy has been identified as a teachable moment,20,63 and may be an important opportunity for HCPs to understand the challenges of their patients regarding weight gain, and to provide them with the
knowledge and support needed to achieve a healthy weight. Further, HCPs may be able to utilize this teachable moment to indirectly influence the weight trajectory of the infant, by emphasizing the importance of healthy nutritional behaviours to mothers.
Future studies should aim to identify reliable and validated tools for measuring satisfaction with care, and to further determine its influence on maternal health
behaviours. Qualitative measures may prove to be highly valuable for gathering a comprehensive understanding of how to measure health care experiences by giving the quantitative measures context of patient values and experiences. Lastly, given the high proportion of pre-pregnancy overweight and obese women, it may be more important to research the influence of health care experiences on facilitating maternal health habits to assist the mother with tools to achieve a healthy weight, rather than to return to her pre- pregnancy weight.
77
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Appendices
Appendix A: Literature Review
Table A.1 Literature Review Summary of Relevant Studies
Topic
Study Type/
Sample Size Analysis/ Methods Relevant Findings Reference
Satisfaction with HC encounters and outcomes among women with high BMI
Longitudinal Cohort Study N=919 women Binary logistic regression Measure of Satisfaction: very satisfied, satisfied,