Patricia Janssen

 
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Professor

Research Classification

Lifestyle Determinants and Health
Social Determinants of Health
Perinatal Period
Gestation / Parturition

Research Interests

maternal child health
health of marginalized women
mobile health for pregnancy and parenting

Relevant Degree Programs

 

Biography

I am a perinatal epidemiologist with a clinical background in obstetrical nursing. I undertake clinical trials to evaluate methods of pregnancy and labour management and interventions for mothers at particularly high risk for experiencing adverse perinatal outcomes. I use the British Columbia Reproductive Care Program Perinatal Registry linked to Ministry of Health data to evaluate outcomes and cost of specific methods of delivering obstetrical care.

Research Methodology

Randomized Controlled Trials
cohort studies
Screening tools
Population-based studies
Predictive models

Graduate Student Supervision

Doctoral Student Supervision (Jan 2008 - May 2019)
Birth after caesarean : an investigation of decision-making for mode of delivery (2016)

Background: Clinical practice guidelines indicate that over 80% of women with a previous caesarean should be offered a planned vaginal birth after caesarean (VBAC), however only one third of eligible women choose to plan a VBAC. Shared decision-making (SDM) interventions support women to make choices based on their informed preferences. To facilitate implementation of SDM it is necessary to understand the patient (micro), health services (meso), and policy (macro) factors that influence decision-making. Objectives: My objective is to explore attitudes toward and experiences with decision-making for mode of birth after caesarean section in British Columbia (BC) to identify factors that influence implementation of SDM. Methods: In-depth, semi-structured interviews were conducted with women eligible for VBAC, care providers, and health service decision makers recruited from three rural and two urban BC communities. Integrated knowledge translation (iKT) principles guided study design, while constructivist grounded theory informed iterative data collection and analysis. Findings were interpreted using complex adaptive systems theory (CAS). Results: Analysis of interviews (n=57) and CAS interpretation revealed that the factors influencing decisions resulted from interactions between the micro, meso, and macro levels of the health care system. Women formed early preferences for mode of delivery (after the primary caesarean) through careful deliberation of the social risks and benefits of mode of delivery. Physicians acted as information providers of clinical risks and benefits, with limited discussion of patient preferences. Decision makers serving large hospitals revealed concerns related to liability and patient safety. These stemmed from limited access to surgical resources, which had resulted from budget constraints. To facilitate mutual understanding among stakeholder groups, iKT activities included policy dialogues and the creation of a policy brief. Conclusion: To facilitate the effective implementation of SDM in clinical practice for mode of delivery after a previous caesarean section, it is necessary to address the needs of women, care providers, and decision makers. These include initiating decision support immediately after the primary caesarean, assisting women to address the social risks that influence their preferences, managing perceptions of risk related to patient safety and litigation among physicians, and access to surgical resources.

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An investigation of the impact of expanding access to Highly Active Antiretroviral Therapy (HAART) on sexual and reproductive decision-making and behaviours of women in high HIV prevalence settings in sub-Saharan Africa (2010)

Background: Given a paucity of information regarding the impact of expanding access to highly active antiretroviral therapy (HAART) on sexual and reproductive decision-making and behaviours of women in high HIV prevalence settings in sub-Saharan Africa, the objectives of thesis were: To assess whether use and duration of HAART was associated with (1) recent sexual activity among HIV-positive women across three high HIV prevalence settings; (2) fertility intentions and (3) contraceptive use and method mix patterns among women in Soweto, South Africa. And, (4) to develop a reliable HAART optimism scale for use among HIV-positive women and to test the scale’s validity against measures of sexual and reproductive decision-making and behaviours among women in Mbarara, Uganda.Methods: Quantitative data were drawn from surveys and medical record reviews conducted among 751 women attending the Perinatal HIV Research Unit in Soweto, South Africa (253 HAART-experienced, 249 HAART-naïve, and 249 HIV-negative) and 540 HIV-positive women (half of whom were receiving HAART) attending Mbarara University’s HIV clinic in Uganda. Surveys assessed socio-demographics, HIV status and HAART history, sexual and reproductive health decision-making and behaviours, HIV-related clinical assessments, and HAART optimism.Results: The analyses revealed that HIV-positive women receiving HAART are more likely to use contraception overall and dual protection in particular, with minimal differences in fertility intentions or sexual activity relative to their HAART-naïve counterparts. Moreover, optimism about the effects of HAART, rather than actual use or non-use, may be a more important predictor of fertility intentions and sexual activity of HIV-positive women. Overall, HIV-positive women are less likely to report fertility intentions and more likely to use contraception (and condoms in particular) relative to HIV-negative women from the same community.Conclusions: The findings highlight the potential great value and urgent need for improved integration between HIV prevention, testing, and HAART services and sexual and reproductive health (SRH) programming to address the diverse SRH needs of HIV-infected and –affected women in HIV endemic settings. Such integration is essential to better support the rights of all women to be sexually active and safely achieve their reproductive goals, while minimizing HIV transmission risks.

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Master's Student Supervision (2010 - 2018)
Outcomes of primary maternity care in Fort Smith, Northwest Territories (2014)

Introduction:In northern Canada women residing in rural communities without local access to maternity care must evacuate at 36-37 weeks gestation to await labour in a city with a regional hospital. Midwifery services are expanding to rural areas of Canada, yet there are few studies that evaluate the safety of rural and remote midwifery compared to routine evacuation for birth. The purpose of this study is to assess the safety of the Fort Smith Midwifery Program in the Northwest Territories, and to understand the experiences of, and the meaning of, community birth with midwives among the women of Fort Smith.Methods:A retrospective cohort study was conducted to compare birth outcomes from the Fort Smith Midwifery Program (n=281) to: 1) the Inuulitsivik Midwifery Program in northern Quebec (n=1388), and 2) the community of Hay River where women evacuate at 37 weeks to receive intrapartum care elsewhere (n=143). Maternal and newborn outcomes were compared among the three comparison groups using univariate and multivariate logistic regression. Focus groups were held with women from Fort Smith who had used the midwifery program to understand their experiences of using the midwifery service and what it means to have access to community birth. Purposive sampling was used to invite Aboriginal and non-Aboriginal participants who gave birth in the community and elsewhere. Results: There were no statistically significant differences in the odds of 5-minute APGAR scores less than 7. The odds of 1-minute APGAR scores below 7 in Fort Smith were increased compared to the Hudson coast communities, however the rate was similar to those of newborns of women who reside in Hay River and delivered in Yellowknife. Two themes emerged from the focus groups: 1) the midwifery model of care in the community leads to positive experiences of maternity care, and 2) the benefits of and reasons for giving birth in the community. Women spoke positively about their experiences of using the midwifery service whether or not they delivered in the community.Discussion: The findings of this thesis support the development and evaluation of midwife-led models of maternity care in rural and remote communities.

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Adherence to complementary feeding guidelines as a predictor of better health outcomes in infants six to twenty four months of age in Cambodia (2013)

Rates of child malnutrition in Cambodia have continued to rise throughout the last ten years despite marginal improvements in food security. After 6 months of age, when complementary feeding often begins, rates of stunting in Cambodia increase from 16% to 42% (CDHS, 2010). Given that the first two years of life are the most important for physical and cognitive development, addressing the health consequences that result from malnutrition is a priority. In the current thesis, I hypothesized that a) infants whose caregivers adhered to at least 80% of Cambodia’s complementary feeding guidelines were less likely to have had diarrhea in the last two weeks, to be anemic or to be stunted and b) infants whose caregivers adhered to at least 80% of the guidelines would have greater dietary diversity than infants whose caregivers did not adhere. To test these hypotheses, I utilized data from a cross sectional survey conducted by The Joint Program for Children, Food Security, and Nutrition in Cambodia. Infant caregivers were defined as adhering to the guidelines if they complied with at least 80% of each one of Cambodia’s five complementary feeding recommendations. I utilized logistic regression to estimate the risk of diarrhea, anemia and stunting among infants whose caregivers adhered compared to those whose caregivers did not adhere to the guidelines. Only 36 (5.1%) caregivers adhered to at least 80% of Cambodia’s complementary feeding guidelines. I did not observe any excess risk for diarrhea in the preceding two weeks, anemia or stunting among infants whose caregivers did not adhere to the feeding guidelines. There was minimal difference in dietary diversity between the two groups. Consumption of meat, grains, legumes, dairy, and vitamin A rich foods varied by at most 13% between infants whose caregivers adhered and did not adhere to the guidelines. My results indicate that the overwhelming majority of families in Cambodia are not adhering to Cambodia’s current complementary feeding guidelines. Furthermore, adherence is not associated with greater dietary diversity or better pediatric health outcomes. Future studies should consider testing the utility of guidelines that incorporate recommendations for dietary diversity to improve health outcomes.

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News Releases

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Publications

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