Data Analysis Process
The researcher chose van Manen (2016) approach as the preferred approach to analyzing the qualitative data collected in the study, titled ‘The lived experiences of African American women regarding their prenatal care experience’. The researcher preferred to use a van Manen (2016) approach to analyze the collected data from the ten interviewees, which included ten African American women who have undergone at least one pregnancy, ages 18–50, in regards to their prenatal care experiences in Southern New York.
Six steps for analysis was developed from hermetic and phenomenological principles (van Manen, 2016).
The first step was immersion in which the researcher organized the dataset into texts (van Manen, 2016). This is accomplished by the iterative reading of the texts, while preliminarily interpretations were made to facilitate coding. According to van Manen, (2016) authenticity must be maintained, so interpretation does not mean making assumptions about the meaning of the text.
The second step was understanding, meaning identifying the participants’ constructs while maintaining faithfulness in the original text (van Manen, 2016). This step was done using NVivo software for accuracy and speed. Here is a sample of some initial codes obtained from this step.
Initial Codes
No. of participants
Coding Refrences
Overall satisfaction with childbirth experience
3
3
Overcrowded hospital environment
1
1
Overwhelmed towards the end of pregnancy due to frequent hospital visits and procedures
1
1
Pre-natal care was sataisfactory given the limited resources the hospital had
1
1
Rushed interactions with the doctor by the healthcare staff
1
1
Unproblematic child birth experience
2
2
Acknowledges a limitation in resources despite the doctors and nurses trying their best to provide the best prenatal care
1
1
Care given healthcare quality being influenced by the insurance cover
2
2
Constant cancellation of appointments due to doctor’s unavailability
1
1
Dissatisfied with the doctor’s punctuality
1
1
Limitations in healthcare due to hospital business and overwrking of nurses
1
1
Long waiting times for appointments
2
2
The third step is an abstraction that consists of identifying the constructs made by the researcher. The constructs are then organized into sub-themes (van Manen, 2016). Here is a sample of some sub themes obtained during this step.
Subthmes
No of participants
Coding References
1. Experiences during pre-natal care
10
23
2. Care received during your prenatal appointments
10
20
3. Discrimination from prenatal healthcare providers
10
11
4. Dicrimination from other healthcare staff during pre-natal appointments
10
11
5. Ideal birth experience
10
15
6. Fear in any situation related to healthcare and pregnancy
9
10
7. Stress experienced during pregnancy
10
12
8. Discimination and prejudice continue to be a barrier to the healthcare of Black women
8
8
9. Experience of verbal or physical abuse from healthcare providers
10
12
10. Forced or withheld treatments by healthcare providers
9
12
11. Further information about prenatal care
1
1
The fourth step is a synthesis, and the development of the themes (van Manen, 2016). The sub-themes are grouped into themes. Here is a table showing the grouping together of different subthemes to form the main themes.
Theme / Subthemes
No. of participants
Coding References
Theme #1 Prenatal experience, assessment of whether best care was received and ideal birth experience
10
57
1.1 Prenatal experience
10
29
1.2 Prenatal best care experience
9
12
1.3 Ideal birth experience
10
15
1.4 Suggested strategies to improve prenatal experience
1
1
Theme #2 Discrimination and Prejudice experiences and barriers to healthcare
10
29
2.1 Provider discrimination experience
10
11
2.2 Other healthcare staff discrimination experience
10
10
2.3 Discrimination and prejudice experienced as barriers to healthcare
8
8
Theme #3 Negative emotions during pregnancy
10
36
3.1 Fear experience during pregnancy
9
12
3.2 Stress experience during pregnancy
10
24
Theme #4 Abuse experiences during prenatal care
10
21
4.1 Verbal or physical abuse from provider experience
10
10
4.2 Forced or withheld treatment experience
9
11
Following the fourth step of van Manen, (2016) data analysis approach, further elaboration on the themes can now take place while simultaneously maintaining authenticity by reflecting in the journal.
The fifth step is the illumination and illustration of the phenomena (van Manen, 2016). This is where the themes that were identified in step four are linked with passages from prior literature for support, understanding, and clarification purposes. The aim is to reconstruct the interpretations into story narratives. The stories need to be clear and understandable, while prior literature is used to illustrate, endorse, and advocate for the original text. This forms the reports of the findings that will be discussed in chapter four.
Findings
The main themes that emerged from the analysis included:
Prenatal experience, assessment of whether the best care was received and ideal birth experience
Discrimination and Prejudice experiences and barriers to healthcare
Negative emotions during pregnancy
Abuse experiences during prenatal care.
The table below shows the description of each of the four main themes.
Theme
Description
Theme #1: Prenatal experience, assessment of whether best care was received and ideal birth experience
This theme represents the prenatal experiences shared by the interviewees and the views of the interviewees on whether they received the best care possible during their prenatal appointments.
Theme #2 :Discrimination and Prejudice experiences and barriers to healthcare
This theme represents interviewees’ experiences with discrimination and prejudice from providers and other healthcare staff and the barriers associated with such discrimination in healthcare
Theme #3 :Negative emotions during pregnancy
This theme represents negative emotions such as fear and stress experienced by the interviewees during pregnancy and the causes of such emotions
Theme #4 :Abuse experiences during prenatal care
This theme represents different forms of abuse experienced by the interviewees during prenatal care including verbal or physical abuse and forced or withheld treatment
Theme #1: Prenatal experience, assessment of whether best care was received and ideal birth experience
This theme represented the different experiences, assessments of whether the best care was received, and the ideal birth experience by the interviewed respondents. The different sub themes that contributed to the development of this theme are shown in the table below
Theme / Subtheme
No. of participants
Coding References
Theme #1 Prenatal experience, assessment of whether best care was received and ideal birth experience
10
57
1.1 Prenatal experience
10
29
1.2 Prenatal best care experience
9
12
1.3 Ideal birth experience
10
15
1.4 Suggested strategies to improve the prenatal experience
1
1
1.1 Prenatal Experience
After going through the data analysis process, a pattern of shared meaning emerged among the codes hence contributing to the development of the subtheme of prenatal experience. This subtheme represented the different experiences of African American women during prenatal care. This subtheme had three more subcategories that aided in explaining the different prenatal care experiences of the interviewees as shown in the table below.
Subtheme, subcategories &codes
No.of Participants
Coding References
1.1 Prenatal experience (Subtheme)
10
29
1.1.1 Childbirth experience(Subcategory)
5
9
Challenging childbirth experience (Codes)
1
1
The feeling of being compelled to adhere to certain standards during childbirth
1
1
Mixed experiences during childbirth
1
1
Satisfaction with childbirth experience
4
4
Unproblematic childbirth experience
2
2
1.1.2 Experience with hospital visits (Subcategory)
5
14
Cancellation of appointments due to doctor’s unavailability (Codes)
1
1
The feeling of being burdened by multiple hospital visits toward the end of pregnancy
1
1
Long waiting appointment times
4
7
Overcrowded hospital environment
2
2
Rushed interactions with healthcare professionals
3
3
1.1.3 Communication issues and lack of concern from healthcare staff (subcategory)
3
5
Dissatisfied with communication from healthcare staff (codes)
2
2
Unconcerned healthcare providers
3
3
Experienced healthcare issues during pregnancy
1
1
1.1.1 Childbirth experience
This subcategory represented the experiences of the interviewees when giving birth. The interviewees shared diverse experiences when giving birth.
From the analysis, it was evident that the majority of the interviwed African American Women were satisfied with their childbirth experience as four of the interviwed women stated that:
P3
My giving birth was fine. I did not have. Much complain.
P4
but. I think it was overall fine. Thank you.
P8
My prenatal care was ok, the doctor and nurses did the best with the limited resources they had at that time.
P9
My experience of giving birth to my child was ok no problem
From the qualitative thematic analysis, it was evident that two of the women from the interview had unproblematic childbirth experiences as they stated:
P9
My experience of giving birth to my child was ok no problem.
P10
My experience of giving birth to my child was ok no problem
Only one respondent was unsure about her childbirth experience hence the mixed reactions as she stated:
P4
Pregnancy was fine. Giving birth was a little challenging. The healthcare providers were helpful.
From the analysis, it was evident from one respondent that she was made to adhere to certain hospital-given standards through her statement which states:
P4
However, at times I feel that given birth I was forced to adhere to certain standards,
1.1.2 Experience with hospital visits
This subcategory represented experiences of the interviewees during their hospital visits for prenatal care. This was the most prominent subcategory under the prenatal experience subtheme with 14 coding references from 5 interviewees.
One of the main experiences highlighted by the interviwees related to hospital visits during appointments was long wait times with four respondents stating that:
P1
waiting to see the doctor was very long
P2
The stress I felt was because of the long waiting time the doctors was always busy
P6
And I guess they knew that I was always annoyed because the wait time also was very lengthy. So it made me very uneasy having to sit and wait for so long.
At best, or for the most part, because again, I am pregnant and I have to wait. For a long time to see the. Doctor or to be registered? Or whatever is going on. So I was always annoyed.
P7
the time the appointment time was long and loud
Another prominent experience with hospital visits highlighted by three of the interviewees was rushed interactions with healthcare professionals
P1:
yes the interaction what the healthcare professional spell rushed at all times
P2
the staff is always rushing me around
P4:
I did feel rushed always because the clinic was always crowded.
Two of the interviewees also identified the overcrowded hospital environment as a major experience during hospital visits.
P1
the clinic was always over crowded
P2
The hospital is always very crowded
Other experiences with hospital visits identified by the interviewees included:
Cancellation of appointments due to doctor’s unavailability
P6
Yes, my appointments were oftentimes. Twice a week, I would have to canceled because the doctor had other deliveries. So times my appointment was cancelled by the nurses because the doctor was out of the office.
The feeling of being burdened by multiple hospital visits toward the end of pregnancy
P7
at the end of the pregnancy I was always at the hospital for something or the other labs sons gram nutritional classes the specialist it was just too much
1.1.3 Communication issues and lack of concern from healthcare staff
This subcategory represented interviewees experiences with communication issues and lack of concern from the healthcare staff during their prenatal care. After going through the qualitative analysis process, a pattern of shared meaning emerged from the codes that contributed to the development of the communication issues and lack of concern from the healthcare staff subcategory.
The subcategory was visually presented in the following hierarchy chart to show the most dominant code distribution.
Three of the interviewees indicated that they experienced unconcerned healthcare providers stating:
P1
Yes, my experience giving birth in southern Queens is not of the best I believe the staff could have been a little bit more helpful in me understanding my prenatal care my schedule my doctor time and availability.’
P5
Believe that you know the hospital could. Be bitter. The cleanliness of the hospital, I believe. The staff during my previous up here, the staff there. Was a strike. Or something was going on at the hospital. So, they everyone was preoccupied and somewhat distracted.
P6
My experience of giving birth my experience of giving birth was. Not of the best. The healthcare provider, I believe was not concerned about my complaints that I experience to them my pregnancy. I did not feel this they were listening to me as a pregnant patient. My complaints were not being heard. As such, my delivery was very difficult I think hours. In the labor and delivery.
From the analysis, it was evident that two of the interviewees were dissatisfied with communication from the healthcare staff stating:
P1
Yes, my experience giving birth in southern Queens is not of the best I believe the staff could have been a little bit more helpful in me understanding my prenatal care my schedule my doctor time and availability.’
P6
My experience of giving birth my experience of giving birth was. Not of the best. The healthcare provider, I believe was not concerned about my complaints that I experience to them my pregnancy. I did not feel this they were listening to me as a pregnant patient. My complaints were not being heard. As such, my delivery was very difficult I think hours. In the labor and delivery.
1.1.4 Experienced healthcare issues during pregnancy
Another prenatal experience by the interviwees was healthcare issues during pregnancy as stated below by one of the respondents:
P7
It was not fun I was not well during my pregnancy I had gustation diabetes and my leg was swollen and it was during the summer
1.2 Prenatal best care experience
From the qualitative analysis, a pattern also emerged from the codes in the data to form the prenatal best care experience subtheme. This subtheme represented thoughts of the interviwees on whether they received the best prenatal care during appointments.
Four of the interviewees acknowledged that there was a limitation of resources in hospitals despite the doctors and nurses trying their best to provide the best prenatal care
P2
They needed another doctor to help with all the pregnant patient.
P3
Best care possible under the circumstances yes with the hospital being so busy and the nurses being overworked
P5
Best care possible yes you get what is available to you in your neighborhood the hospital needed a lot of improvement.
P8
As I mentioned the doctors and nurses did their best with the limited resources that they had it could have been better.
From the qualitative thematic analysis, it was evident that the quality of prenatal care the Black women received was entirely dependent on the kind of insurance cover they had as two of the interviewees responded:
P3
yes, you get what your insurance is paying for.
P7
The best care possible under the circumstances yes with the hospital being so busy and the nurses being overworked yes you get what your insurance is paying for.
Two of the respondents said that they were satisfied with the prenatal care as is evidenced by their statements that they had the best prenatal experience from the below excerpts:
P9
Ah, it was fine
P10
Ah, it was fine.
Two of the respondents reported their birth experience as being unsatisfactory based on the following statements:
P2
No, if the doctor is always late or is tending to another patient in the delivery room then the pregnant women is constantly waiting for her.
P6
My interaction with the healthcare professional was Not professional because I was pregnant and I was annoyed because I was not feeling well most of the time. And I guess they knew that I was always annoyed because the wait time also was very lengthy. So it made me very uneasy having to sit and wait for so long.
One of the interviewees noted that there is a need for additional medical staff to cover the deficit that is there to better the childbirth experience as evidenced by the following excerpt:
P2
They needed another doctor to help with all the pregnant patients.
From the analysis, it was discovered that one of the respondents said that she experienced suboptimal prenatal care due to busy healthcare staff as she stated:
P4
Overall, I believe the care I received could have been better given the situation all of the nurses were very busy trying to help everyone.
1.3 Ideal birth experience
From the analysis, the codes with similar semantics and meaningfulness were merged to come up with the ideal birth experience subtheme. This subtheme represented interviwees responses in regards to what their ideal birth experience would be or look like. The table below shows the codes contributing to the emergence of this subtheme
Subtheme/codes
No. of participants
Coding References
1.3 Ideal birth experience
10
15
Concern about medical staff compensation and workload
1
1
Cost concerns about home birth
1
1
Desire for adequate staffing during birth
1
1
Desire to be surrounded by understanding & considerate people towards pregnant women
1
1
Desire to give birth in a better hospital with better care
6
6
Low expectations and contented with what the hospital has hence does not fancy an ideal birth
1
1
Preference for home birth with own personal healthcare team
2
2
Prefers to have her birth in a different hospital
2
2
From the analysis, it is depicted by six interviewees on how they feel about what their ideal childbirth experience would look like. The majority of the respondents from the interview desired to have their ideal birth in a better hospital with better care as depicted in the following excerpts to support the findings:
P1
I cannot say because I have lived all my life in this neighborhood, but I think that would be a better hospital with better staff
P10
I would probably have had my baby in a better hospital that provides better care.
P3
I believe my ideal birth experience would have been to have my baby in a better area and a better hospital.
P4
My ideal birth experience would not have been much just a better hospital
P6
It would look like probably having a hospital in a better neighborhood with better doctors. Better staff.
P9
I would probably have had my baby in a better hospital that provided better care.
From the analysis, it was also discovered that two of the respondents described their ideal childbirth experience would be if they had their birth at home with their healthcare team to tend to them. This is evident from the following excerpts from the text data:
P1
or an at home birth with my own doctor and nurse.
P7
It would have been to have my baby in a better area and a better hospital.
Further from the analysis, it was discovered that two of the respondents described their ideal birth experience would be giving birth in a different hospital as stated by the two respondents in the following excerpts:
P2
My ideal birth experiences would be to have my baby at a private hospital with lots of doctors and nurses who is not under paid and overworked.
P5
It would have been at another hospital.
Other ideal birth experiences shared by the respondents included
Low expectations and contented with what the hospital has hence does not fancy an ideal birth
P8
I do not and did not expect much from the hospital in this life you get what you get
Desire to be surrounded by understanding & considerate people towards pregnant women
P6
People that understood that when you’re pregnant, you cannot be just sitting and waiting for hours. That would be my ideal experience.
Desire for adequate staffing during birth
P2
My ideal birth experiences would be to have my baby at a private hospital with lots of doctors and nurses who is not under paid and overworked
1.4 Suggested strategies to improve the prenatal experience
This subtheme related to suggestions to improve the prenatal care experience by the interviwees.
From the analysis, only one interviewees suggested a strategy to improve the prenatal care experience stating that there was need for more healthcare professionals in hospitals
P2
No, I believe the hospital needs more nurses and doctors, thank you for doing this research
Theme #2: Discrimination and Prejudice experiences and barriers to healthcare
This theme represented the interviewees’ experiences with discrimination from healthcare providers and other healthcare staff and the barriers associated with such discrimination in the healthcare system. The different sub themes that led to the development of this theme included: provider discrimination experience, other healthcare discrimination experience, and discrimination and prejudice as barriers to healthcare as depicted in the following mind map.
2.1 Provider discrimination experience
After reviewing the codes, the researcher was able to bring together codes that had the same semantic and interpretative meaningfulness that enabled the researcher to develop the provider discrimination experience subtheme. This subtheme represented discrimination experienced by the Black women from the healtcare providers during their hospital visits for pre-natal care.
From the analysis, the researcher found out that the majority of the interviewed women (seven) did not experience any discrimination from the healthcare providers as evidenced in the following excerpts:
P1
I did not experience any discrimination from anyone
P10
No discrimination from my doctor no.
P2
No discrimination from anyone
P3
No. I did not experience any discrimination from my providers.
P7
No. I did not experience any discrimination from my providers.
P8
No discrimination
P9
No discrimination from my doctor no
On the other hand two of the interviewees said that they experienced discrimination from their healthcare provider through uncomfortable comments and remarks as stated below:
P4
Yes she sometimes said why are you having this baby how are you going to care for this baby and then she would say it as though she was making a joke with me but her comments made me very uncomfortable
P5
Yes, very settled discrimination comments about not having proper insurance to cover the cost of the care I was receiving.
Other provider discrimination experiences identified by the interviewees included:
Perception of mutual hostility and dismissiveness with the healthcare professional
P6
Discrimination by healthcare professionals. The healthcare professionals always thought that I had an attitude and I always thought that they had an attitude. So it was, you know, the feeling, I guess it was always mutual. And because we were not happy with each other so it appeared as though we were always angry at each other or they were very settled. And somewhat dismissive. And I was angry.
Feeling that pregnancy-related conditions are not put into consideration
P1
However, I believe they must take into consideration the women’s condition of being pregnant and they are unwell from time to time.
The above excerpts and codes can be summarised using the below hierarchy chart to show the distribution of the codes under the provider discrimination subtheme.
2.2 Other healthcare staff discrimination experience
This subtheme represented discrimination experienced by the Black women from the healtcare staff during their hospital visits for pre-natal care. The table below shows the different codes under this subtheme.
Subtheme/ codes
No . of participants
Coding References
2.2 Other healthcare staff discrimination experience
10
10
Absence of discrimination from healthcare staff
5
5
Experienced discriminatory comments from the healthcare staff
2
2
Perception of not being listened to due to dissatisfaction
1
1
Presence of discrimination based on the kind of insurance coverage
2
2
This is the most occurring code in this subtheme as evidenced by the following excerpts from the data showing that most of the interviwees did not experience discrimination from other healthcare staff.
P1
No, I did not experience any discrimination from my the healthcare staff.
P2
No no discrimination from anyone else
P3
No. I did not experience any discrimination from my providers.
P7
No. I did not experience any discrimination from my providers.
P8
No discrimination from other healthcare staff.
Based on data analysis, it was evident to the researcher that two of the respondents from the interview stated that they experienced discrimination from healthcare staff based on their kind of insurance coverage as stated below:
P9
Yes, sometimes I did think because of my insurance does not pay much for my care so you get what you are paying for?
Two of the interviewees also indicated that they experienced discriminatory comments from the healthcare staff stating:
P4
Discrimination yes she would make comments about my insurance being paid by the state and they do not pay much to the doctor for the care she was providing and that she was working too hard to help the black community.
P5
Yest question about my baby father is he working why am I always alone a my visits
The thematic analysis showed that one respondent experienced discrimination through her not being heard while she was pregnant as shown in the excerpt below:
P6
No, I do not think I was listening to it because again. I was very a very unhappy pregnant person.
2.3 Discrimination and prejudice experienced as barriers to healthcare
This subtheme represented interviewees belief about discrimination and prejudice as a barrier to healthcare of Black women. The following table is a representation of the codes that contributed to the development of this subtheme.
Subtheme/codes
No. of participants
Coding References
2.3 Discrimination and prejudice experienced as barriers to healthcare
8
8
Lack of knowledge regarding discrimination and prejudice in healthcare for Black women
1
1
Persistent discrimination as a barrier to healthcare for Black women
7
7
Seven of the interviewees perceived persistent discrimination as a barrier to healthcare for Black women. The following excerpts from the data show this:
P1
I believed discrimination and prejudice continue to be a problem in America society as it relates to black women and black people in general.
P3
Discrimination will always be a problem for black people and especially women because the other race is always trying to keep us down.
P4
Yes discrimination and prejudice will always be a problem in America because of the racist white people we have to interact with everyday some are very settled and some are very bold with the level of discrimination
P5
Discrimination would always be a problem in this country.
P6
Discrimination and prejudice goes handin hand I do not think that it is a big problem but it is happening sometimes for everyone not only black women.
P7
Discrimination will always be a problem for black people and especially women because the other race is always trying to keep us down.
P8
Discrimination, yes but life was and continues to be the way it was designed.
From the analysis, it was discovered that one of the respondents lacked knowledge about whether discrimination and prejudice remained a barrier to health care as she stated:
P2
I really cannot answer that question I do not know what to say about that.
Theme #3 : Negative Emotions During Pregnancy
This theme represented the negative emotions such as fear and stress that the interviewees experienced during their pregnancy and the causes of such emotions. The main subthemes contributing to the development of this theme included: fear experience during pregnancy and stress experience during pregnancy as shown in the mind map below.
3.1 Fear Experienced During Pregnancy
This sub theme represented interviewees fears related to healthcare and their pregnancy. The table below shows the codes that contributed to the development of this subtheme. The codes represent the direct responses of the participants.
Subtheme
No. of participants
Coding References
3.1 Fear Experienced During Pregnancy
9
12
Absence of fear or feeling of being unsafe
5
5
Experience of being scolded and having an attitude toward the staff
1
1
Fear of having a baby
2
2
Fear related to safety concerns during hospital visits
1
1
Financial strain
2
2
Unsure if she experienced discrimination
1
1
Most of the interviewed women expressed a lack of fear and never feeling unsafe during their pregnancy as they they stated:
P1
not never felt unsafe or fear
P10
No discrimination no fear this is the people we see daily because they work in our neighborhood
P4
Fear no I did not feel fear during my pregnancy.
P5
No I did not feel feer
P8
No, I did not feel any fear
Of the interviewed women, two acknowledged that they had fear of having a baby as they stated:
P3
Yes, bringing a new life into this crazy world was fearful for me
P7
Yes, bringing a new life into this world finances and better housing and family support was fearful for me
From the interviews, two of the interviewees indicated that they had a fear resulting from them lacking money as there was an incoming baby.
P3
a lack of finances at that time needing better housing and family support was fearful for me.
P7
Yes, bringing a new life into this world finances and better housing and family support was fearful for me
One of the interviewed women felt fear when she was making her hospital visits as she stated:
P2
Well sometimes I did feel fear because of the drug addicts who were coming to the same hospital for treatment I walked from my house to the hospital and in the snow I feared sometimes that I would fall in the snow
3.2 Stress Experienced During Pregnancy
This sub theme represented the causes of stress among the interviewees during their pregnancy .
Motherhood journey
The motherhood journey in general was highlighted as a source of stress among the interviewees. The interviewees identified different elements of the motherhood journey as a source of stress including:
Stress of having a baby
Majority of the women in the interview at some point when pregnant faced the stress of having a baby. This is evident through the following excerpts:
P1
and so distress was you know somewhat intense at times.
P10
I experience alot of stress because of the unknwn a new baby
P3
Again, bringing a new life into this crazy world was fearful for me
P5
Stress of the unknown and of having a baby is stressful managing work and other children as well.
P7
Again, bringing a new life into this crazy world was fearful for me
P9
I experience a lot of stress because of the unknown a new baby my living situation
Handling Multiple Responsibilities During Pregnancy
The researcher also discovered from analysis that, at some point during pregnancy, two of the interviewed women faced stress arising from having to handle multiple responsibilities in the house during pregnancy. The following excerpts from the data clearly show this:
P4
The stress was real having to manage other children my job my doctors’ appointments was very stressful.
P5
The stress of the unknown and of having a baby is stressful managing work and other children as well.
Becoming a mother
One of the interviewees expressed that she was stressed during pregnancy as she was afraid of becoming a mother she stated:
P1
The stress and distress I felt during my pregnancy was intense because of the certainty of being a mother having a baby and so distress was you know somewhat intense at times.
Four interviewees viewed their state of finances as a stressing factor when they were pregnant as they stated:
P10
I experience alot of stress because of the unknwn a new baby my living situation my family situation my finances that was very stressful
P3
a lack of finances at that time needing better housing and family support was fearful for me.
P7
a lack of finances at that time needing better housing and family support was fearful for me
P9
I experienced a lot of stress because of the unknown a new baby my living situation my family situation my finances that was very stressful.
Two of the interviewees indicated that the need for better housing conditions were a significant cause of stress during their pregnancy.
P3
a lack of finances at that time needing better housing and family support was fearful for me.
P7
a lack of finances at that time needing better housing and family support was fearful for me
Again, the researcher discovered from the analysis that two of the interviewed women had stress as a result of them seeing the need to improve or change their current living situation since there was an incoming baby as they stated:
P9
I experience alot of stress because of the unknwn a new baby my living situation
P10
I experience a lot of stress because of the unknown a new baby my living situation
One of the interviewees indicated that they experienced stress during their pregnancy because of being ignored by healthcare providers.
P2
I felt stressed because she did not have enough time to listen to my problems related to my pregnancy.
Again from the analysis, the researcher discovered that one of the intervieweed women was stressed during pregnancy due to the way the society treats Black women in any situation even when they are pregnant as she stated:
P6
Black women are treated very poorly when they’re pregnant, even when they’re not pregnant. We are treated poorly by our family by society by our spouses that can cause a lot of stress also having a new baby is stressful.
One of the interviewed African-American women stated that during her pregnancy she did not experience any stress and continued with her normal life as usual as she stated:
P8
I did not experience any stress. My life back then was my life I took one step at a time to make it better so no stress.
Theme #4 : Abuse Experiences During Prenatal Care
This theme represented the different forms of abuse experienced by the interviewees during their prenatal care including verbal or physical abuse, and forced or withheld treatment by their healthcare provider or other healthcare staff. The two main sub themes that contributed to the emergence of this theme are shown the table below.
Theme/ subthemes
No. of participants
Coding References
Abuse experiences during prenatal care
10
21
4.1 Verbal or physical abuse from provider experience
10
10
4.2 Forced or withheld treatment experience
9
11
4.1 Verbal or physical abuse from provider experience
This subtheme focused on whether the interviewees experienced any form of abuse when pregnant during their hospital visits. All the interviewed women did not experience any for of abuse while at the hospital either from their healthcare provider or other healthcare staff. The following excerpts show what they stated:
P1
No, I did not experience any verbal or physical abuse.
P10
Like what no verbal or physical abuse is that a thing no not at allI.
P2
No I did not experienced and physical abuse
P3
No verbal or physical abuse from anyone.
P4
No verbal or physical abuse.
P5
No
P6
No not physical abuse however I felt as though the provider was always talking to me about my anger and the staff was not happy with me.
P7
No verbal or physical abuse from anyone.
P8
No verbal or physical abuse.
P9
No physical or verbal abuse
4.2 Forced or withheld treatment experience
This sub-theme focused on the interviewees views of whether any medical treatments were forced or withheld from them by their healthcare providers during prenatal care.
Subtheme
No. of participants
Coding References
4.2 Forced or withheld treatment experience
9
11
Did not experience forced or withheld treatment from healthcare providers
5
5
Experienced differing medication approaches by the healthcare provider
1
1
Forced medical operation
3
3
Forced treatment through prescriptions by the healthcare provider
2
2
Five of the interviewees stated that they did not experience forced or withheld treatment from healthcare providers.
P1
No I do not think so I tried to everything they asked me to do just for the health of my baby
P10
I don’t think so.
P2
No treatment was ever forced or withheld from me.
P5
No
P9
I don’t think so.
In contrast, three of the interviewed women stated that they had forced medical operations by healthcare providers.
P3
I believe we could have waited a while longer before opting for a c section
P4
a C-section were forced on me
P7
I believe we could have waited a while longer before opting for a C-section
Two of the women shared that they were forced to take unnecessary medications that they thought they did not necessarily need as they stated:
P3
Yes, I believe I did not need the vitamins the doctor prescribed for me
P7
Yes, I believe I did not need the vitamins the doctor prescribed for me
References
Braun, V., & Clarke, V. (2019). Reflecting on reflexive thematic analysis. Qualitative research in sport, exercise and health, 11(4), 589-597.
Byrne, D. (2022). A worked example of Braun and Clarke’s approach to reflexive thematic analysis. Quality & quantity, 56(3), 1391-1412.
Labra et al. (2020). Thematic analysis in social work: A case study. Global social work-cutting edge issues and critical reflections, 10(6), 1-20.
Van Manen, M. (2016). Researching lived experience: Human science for an action sensitive pedagogy. Routledge.
Appendices
Appendix 1 Code Book
Name
Description
Theme #1 Prenatal experience, assessment of whether best care was received and ideal birth experience
This theme represents the prenatal experiences shared by the interviewees and the views of the interviewees on whether they received the best care possible during their prenatal appointments.
1.1 Prenatal experience
Experiences of the interviewees during their prenatal care
1.1 Childbirth experience
Experiences of the interviewees when giving birth
Challenging childbirth experience
The feeling of being compelled to adhere to certain standards during childbirth
Mixed experiences during childbirth
Satisfaction with childbirth experience
Unproblematic childbirth experience
1.2 Experience with hospital visits
Experiences faced by the interviewees during their hospital visits for prenatal care
Cancellation of appointments due to doctor’s unavailability
The feeling of being burdened by multiple hospital visits toward the end of pregnancy
Feeling burdened by the multitude of hospital visits, ranging from labs, ultrasounds, and nutritional classes, towards the end of pregnancy
Long waiting appointment times
Overcrowded hospital environment
Rushed interactions with healthcare professionals
1.3 Communication issues and lack of concern from healthcare staff
Communication and concerns between the interviewees and the healthcare staff during their prenatal care
Dissatisfied with communication from healthcare staff
Unconcerned healthcare providers
Experienced healthcare issues during pregnancy
1.2 Prenatal best care experience
Thoughts of the interviewees on whether they received the best prenatal care appointments
Limited pre-natal care resources in the hospital
Acknowledges a limitation in resources despite the doctors and nurses trying their best to provide the best prenatal care
Need for additional medical staff to accommodate all the patients
The quality of prenatal care received is influenced by the type of insurance coverage
Satisfied with the prenatal care received
Suboptimal prenatal care due to busy healthcare staff
Unsatisfied with pre-natal care received
1.3 Ideal birth experience
Interviewees responses in regards to what their ideal birth experience would be or look like
Concern about medical staff compensation and workload
Cost concerns about home birth
Desire for adequate staffing during birth
Desire to be surrounded by understanding & considerate people towards pregnant women
Desire to give birth in a better hospital with better care
Low expectations and contented with what the hospital has hence does not fancy an ideal birth
Preference for home birth with own personal healthcare team
Prefers to have her birth in a different hospital
1.4 Suggested strategies to improve the prenatal experience
Suggestions by the interviewees to improve the prenatal care experience
Need for more healthcare professionals in hospitals
Theme #2 Discrimination and Prejudice experiences and barriers to healthcare
This theme represents interviewees’ experiences with discrimination and prejudice from providers and other healthcare staff and the barriers associated with such discrimination in healthcare
2.1 Provider discrimination experience
Discrimination experienced by Black women from the healthcare providers during their hospital visits for prenatal care.
Absence of any discrimination experience
Experienced uncomfortable comments and remarks from the healthcare provider
Feeling that pregnancy-related conditions are not put into consideration
Perception of mutual hostility and dismissiveness with the healthcare professional
2.2 Other healthcare staff discrimination experience
Discrimination experienced by Black women from the healthcare staff during their hospital visits for prenatal care.
Absence of discrimination from healthcare staff
Experienced discriminatory comments from the healthcare staff
Perception of not being listened to due to dissatisfaction
The presence of discrimination based on the kind of insurance coverage
2.3 Discrimination and prejudice experienced as barriers to healthcare
Interviewees believe that discrimination and prejudice a barriers to healthcare for Black women.
Lack of knowledge regarding discrimination and prejudice in healthcare for Black women
Persistent discrimination as a barrier to healthcare for Black women
Theme #3 Negative emotions during pregnancy
This theme represents negative emotions such as fear and stress experienced by the interviewees during pregnancy and the causes of such emotions
3.1 Fear Experienced During Pregnancy
Interviewees’ fears related to healthcare and their pregnancy.
Absence of fear or feeling of being unsafe
Experience of being scolded and having an attitude toward the staff
Fear of having a baby
Fear related to safety concerns during hospital visits
Financial strain
Unsure if she experienced discrimination
3.2 Stress Experienced During Pregnancy
Interviewees’ cause of stress experience during their pregnancy?
Absence of feeling any stress during pregnancy
Better housing conditions
Current living situation
The feeling of being unheard during appointments
Financial strains
Motherhood journey
Stress from the interviewees resulting the responsibilities of motherhood
Becoming a mother
Handling multiple responsibilities during pregnancy
The stress of having a baby
Societal treatment of Black women even when pregnant
Support from family
Theme #4 Abuse experiences during prenatal care
This theme represents different forms of abuse experienced by the interviewees during prenatal care including verbal or physical abuse and forced or withheld treatment
4.1 Verbal or physical abuse from provider experience
Interviewees’ perception of whether or not they have experienced any verbal or physical abuse from their healthcare providers.
Did not experience physical or verbal abuse
4.2 Forced or withheld treatment experience
Interwees beliefs and perceptions of whether any medical treatments were forced or withheld from them by their healthcare providers.
Did not experience forced or withheld treatment from healthcare providers
Experienced differing medication approaches by the healthcare provider
Forced medical operation
Forced treatment through prescriptions by the healthcare provider
26
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