Trusting parent-professional relationships in interprofessional interventions for expectant and new parents in vulnerable positions: A realist evaluation

ABSTRACT

Interprofessional collaboration and trusting parent-professional relationships can be key to delivering interprofessional care to meet the needs of expectant and new parents in vulnerable positions. This, however, presents challenges. This study aimed to gain deeper understanding of how and under what circumstances trusting parent-professional relationships develop and work within interprofessional team-based care for this group, from the professionals’ perspectives. Realist evaluation was undertaken based on 14 semi-structured, realist interviews with midwives and health visitors and 11 observations. Multiple interrelated mechanisms were identified including patient/family-centered care, timely and relevant interprofessional involvement in care, gentle interprofessional bridging, transparency of intervention roles and purposes, and relational continuity. Good interprofessional collaboration was a primary condition for these mechanisms. Developed, trusting relationships supported parents’ engagements with interprofessional care and constituted a supportive safety net that promoted parenting skills and coping abilities. We identified harmful mechanisms: distanced encounters, uncertainty of interprofessional involvement, and compromising the safe space. These mechanisms caused distrust and disengagement. Ensuring trusting parent-professional relationships within interprofessional team-based care demands each professional involved competently engages in relational work and interprofessional collaboration. Uncontrollability is thus influenced regarding interpersonal connection and potentially gives an explanation when trust-building efforts fail.

KEYWORDS:

• Interprofessional care
• maternity care
• patient/family-centered care
• realist evaluation
• trusting relationships
• vulnerability

Acknowledgments

We owe our deep felt thanks to the midwives, health visitors, family therapists, social worker and expectant parents who made this research possible. A grant from Danish Regions Fund for research in disease prevention is thankfully acknowledged.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This work was supported by the [Danish Regions Funds for Research in Health Promotion and Illness Prevention] under Grant [number A3293]. Funders and stakeholders had no role in the research design, analysis and interpretation of data, preparation of the manuscript or the decision to submit the manuscript for publication.

Notes on contributors

Pernille Gram

Pernille Gram is a research assistant in the research team for Women’s, Child & Family Health at Aalborg University and has a background in Global Nutrition & Health and Public Health. Her research interests include development and evaluation of complex interventions and research with vulnerable populations.

Louise Lund Holm Thomsen

Louise Lund Holm Thomsen is a sociologist and post doc researcher in the research team for Women’s, Child & Family Health and Community Based and Cross Sectoral Health Services at Aalborg University. She is the project manager for the overall realist evaluation of a cross sectoral intervention to support pregnant woman and families in vulnerable positions in the North Denmark Region. She specialises in qualitative research methods, realist evaluation and research with vulnerable groups.

Clara Graugaard Andersen

Clara Graugaard Andersen is a research assistant in the research team for Women’s, Child & Family Health at Aalborg University and has a background in Psychomotor Therapy and Public Health. Her research interests include development and evaluation of complex interventions and research with vulnerable populations.

Charlotte Overgaard

Charlotte Overgaard is a professor of Public Health with a multidisciplinary background in health science and social science. She leads a multidisciplinary program of research focusing on women’s, child & family health and community based and cross sectoral health services at Aalborg University and the University of Southern Denmark. She specialises in intervention research, stakeholder involvement and research collaboration with municipalities, hospitals, civil sector organisations, user groups and private companies.