Are women's expectations and preferences for intrapartum care affected by the model of care on offer?

Objective To investigate the effect of service provision on consumer preferences, in particular, whether women who have access to systems of care which offer particular attributes (such as continuity of carer) value these attributes more highly than women for whom the attributes are not a realistic option. Design Simple rating scales and a discrete choice experiment were used to assess the importance to women of different aspects of intrapartum care. Sample and setting The sample consisted of 301 women at low obstetric risk, identified from three geographical areas, each with a different system of maternity care provision. Methods Midwives gave an anonymous, self-completed questionnaire to the women at the booking visit. Categorical data from the rating scales were analysed using the chi(2) test. Analysis of the discrete choice experiment was conducted using random effect probit regression. Main outcome measures Women's preference for different attributes of intrapartum care. Results From the rating scales, it appeared that women in the area with least continuity rated this aspect of care significantly lower than women in other areas (P = 0.007). Although the discrete choice experiment appeared to confirm this, the difference was not statistically significant. Conclusions The findings from this study suggest that the systems of care on offer do influence women's preferences for aspects of intrapartum care. Women in areas where continuity of carer was a realistic option appeared to value this aspect of care more highly. The tendency for preferences to be influenced not only by previous experience of a service but also by knowledge of its availability has important implications for the inclusion of consumers' values in deciding whether to introduce innovations in care. It has been suggested that greater consumer involvement may be a useful means of challenging the accepted view of what is important in health services and of facilitating change. However, the findings from this study suggest that consumer views may have the opposite effect. If consumers do prefer what they know, then a policy of tailoring health services to local preferences will simply reinforce current provision of services, reinforcing existing inequalities in the provision of care.