Questions and concerns of a multiethnic patient population regarding labor analgesia: Guidelines for the creation of an educational video
Abstract Number: S-39
Abstract Type: Original Research
The Jackson Memorial Hospital (Miami, FL) obstetric patient population is multi-ethnic and mainly low-income; patients are given minimal information antenatally about their options for labor analgesia. Poor education and socioeconomic status has been implicated in patient refusal for labor epidurals; also implicated are patient mistrust, partner preference and cultural influences.
We hypothesized that providing culturally specific educational material in video format and multiple languages, will improve patient knowledge, acceptance and satisfaction with pain control for labor. In this, the first of a 2-part study, patients were surveyed to determine relevant and culturally specific concerns to guide the content of the video.
Methods: A 30-item questionnaire was developed based on the Theory of Reasoned Action and the Theory of Planned Behavior, theoretical constructs related to individual motivational factors which are predictive of a specific behavior. Questions were grouped according to attitude, subjective norms and perceived control over the behavior.
Sample size was based on the rule of thumb of 10 subjects per item included in the multivariate analyses. Validation of the questionnaire was first carried out with 20 patients. Attendees of the out-patient antenatal clinic were randomly selected to participate. Verbal consent was given.
Results: See Table. Three hundred women were surveyed. The median age was 27 yrs (14 – 44) and mean parity was 2 (0-6).
Conclusion: The majority of our patients do not comfortably read or speak English and have limited information about labor analgesia options. They uniformly prefer to receive information in their primary language and learn best with written and audio-visual materials.
Most plan to attempt to avoid having an epidural. Greatest concerns are the risk of back pain and paralysis across groups. Unlike previous reports, spouse preference is not an important factor in the decision to accept an epidural. Patients are interested in receiving detailed information about epidurals from an Anesthesiologist and would like to see video of an actual procedure.
Guided by the responses from the survey, short educational videos in English, Spanish and Creole have been produced. The videos will be aired in the out-patient clinics and childbirth classes. In the 2nd phase of the study we aim to evaluate the impact of the videos on patient choices, knowledge and satisfaction with labor analgesia.