Reconceptualising risk: perceptions of risk in rural and remote maternity service planning

Barclay, Lesley, Kornelsen, Jude, Longman, Jo, Robin, Sarah, Kruske, Sue, Kildea, Sue, Pilcher, Jennifer, Martin, Tanya, Grzybowski, Stefan, Donoghue, Deborah, Rolfe, Margaret and Morgan, Geoff (2016) Reconceptualising risk: perceptions of risk in rural and remote maternity service planning. Midwifery, 38 63-70. doi:10.1016/j.midw.2016.04.007

Author Barclay, Lesley
Kornelsen, Jude
Longman, Jo
Robin, Sarah
Kruske, Sue
Kildea, Sue
Pilcher, Jennifer
Martin, Tanya
Grzybowski, Stefan
Donoghue, Deborah
Rolfe, Margaret
Morgan, Geoff
Title Reconceptualising risk: perceptions of risk in rural and remote maternity service planning
Journal name Midwifery   Check publisher's open access policy
ISSN 0266-6138
Publication date 2016-07
Year available 2016
Sub-type Article (original research)
DOI 10.1016/j.midw.2016.04.007
Open Access Status DOI
Volume 38
Start page 63
End page 70
Total pages 8
Place of publication London, United Kingdom
Publisher Churchill Livingstone
Collection year 2017
Language eng
Formatted abstract
Objective: To explore perceptions and examples of risk related to pregnancy and childbirth in rural and remote Australia and how these influence the planning of maternity services.

Design: Data collection in this qualitative component of a mixed methods study included 88 semi-structured individual and group interviews (n=102), three focus groups (n=22) and one group information session (n=17). Researchers identified two categories of risk for exploration: health services risk (including clinical and corporate risks) and social risk (including cultural, emotional and financial risks). Data were aggregated and thematically analysed to identify perceptions and examples of risk related to each category.

Setting: Fieldwork was conducted in four jurisdictions at nine sites in rural (n=3) and remote (n=6) Australia.

Participants: 117 health service employees and 24 consumers.

Measurements and findings: Examples and perceptions relating to each category of risk were identified from the data. Most medical practitioners and health service managers perceived clinical risks related to rural birthing services without access to caesarean section. Consumer participants were more likely to emphasise social risks arising from a lack of local birthing services.

Key conclusions: Our analysis demonstrated that the closure of services adds social risk, which exacerbates clinical risk. Analysis also highlighted that perceptions of clinical risk are privileged over social risk in decisions about rural and remote maternity service planning.

Implications for practice: A comprehensive analysis of risk that identifies how social and other forms of risk contribute to adverse clinical outcomes would benefit rural and remote people and their health services. Formal risk analyses should consider the risks associated with failure to provide birthing services in rural and remote communities as well as the risks of maintaining services.
Keyword Birthing centres
Health planning
Risk assessment
Rural health
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Mater Research Institute-UQ (MRI-UQ)
HERDC Pre-Audit
School of Nursing, Midwifery and Social Work Publications
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