The respondents from Southwest Finland were not entirely satisfied with the MHC services and many aspects of the service were evaluated as remarkably poor. The model of the MHC service seems to influence both women’s and partners’ experiences with several aspects of the service. Participating women were generally more satisfied with combined MHC & CHCs’ services than with those of the separate MHCs.
Participants’ poor experiences were contradictory to Viljamaa’s [26
] and Perälä et al.’s [27
] survey in which Finnish parents evaluated MHC and CHC work as good - measured partly by similar questions posed in the present study. One explanation for this could be that present study focused only on the content and the amount of the MHC services whereas the above mentioned researchers explored also parents’ experiences regarding the action of the public health nurse and the atmosphere of the MHCs and CHCs which were evaluated as very good in both studies. However, also critical views have been expressed by the parents. Recent Finnish studies focusing solely on maternity care services are qualitative, and they describe more censorious vision of both the women’s [30
] and the men’s experiences [31
]. Because of the varying study designs, the results of these studies should be compared objectively. Inconsistent findings reached by different methodological approaches uphold the existing demand for comprehensive national study focused on parents’ expectations and experiences with MHC and CHC services.
Regardless of the parents’ weak general appraisal of the MHC services in the present study, MHCs obviously have strength in supportive counselling. Especially women, but also their partners, get sufficiently supportive information from the MHCs, and professional information was conceived the most preferable form of support. This is encouraging because research shows that women expect reliable information from antenatal care providers [34
] and adequate supportive information is related to positive experiences with maternity care [36
]. On the other hand, MHC does not always seem to be the primary source of information regarding pregnancy and delivery-related topics for the expectant mothers. According to previous research, women prefer to prepare for the delivery by discussing it with friends and female relatives [37
], and they actively seek information on the Internet [38
]. The staff in the antenatal care should recognize and advance their role, not only as reliable information-givers, but also as professional “mirrors” for the information that parents receive from other sources, such as media and peers.
It could also be concluded that MHCs’ services are based on traditional basic elements (e.g. antenatal health check-ups and screening, health promoting counselling) and modern services, such as group appointments or diverse parental group-activities, were limited. For example, over a half of the participants in the present study reported the amount of all parental group activities as “none or very little”. Our findings regarding sparse parental group activities agree with a recent national study [27
]. This is not in line with the guidelines that recommend MHCs and CHCs to arrange groups for childbearing and child rearing families [39
The results found here show that combined MHC & CHCs might serve parents better than the separated model. Women’s higher satisfaction with combined MHC & CHCs occurred both in general and aspect-targeted assessments, whereas men reported better experiences with particular aspects of the service, such as group-based information and support with health problems. One explanation for this could be the continuing relationship with the nurse of the combined MHC & CHC that was founded during the pregnancy and will proceed until the child is at school age. Perhaps the familiarity with the nurse and the awareness of continuity of care could have made the parents evaluate the antenatal care more positively after delivery. This is supported by former national evidence indicating that parents wish to have the same nurse during pregnancy and in the CHC [26
It also seems that the lack of continuity in MHCs and CHCs might impact the communication between the family and the care provider. According to the study of Tammentie et al. [40
], the mothers whose PHN was changed after the birth of the child experienced difficulties in describing their mood and problems to an unfamiliar PHN in a CHC. In the study of Örtenstrand and Waldenström [41
] Swedish women had described that their own needs, especially when there were depressive symptoms, were commonly disregarded in the CHC where they were taken care of by a different nurse than during pregnancy in the MHC. In the light of these studies, it could be speculated that parents might benefit from the continuity based service model where the same nurse will take care of them, both during pregnancy and after the birth of the child. This conclusion is supported by the multidisciplinary review of Haggerty et al. [42
] which suggested that the continuity of care can improve the quality of care, regardless of the context. The relational continuity that comprises of the ongoing relationship between a patient/client and the care provider, including the shared history and future, is valued especially in primary health care settings [42
]. In Finnish primary health care, this has been made possible in the combined MHC & CHCs. The results of our study could be interpreted as a manifestation of beneficial continuity in primary health care settings.
In the combined MHC & CHCs, credit should be given particularly to the home visits that provide multi-beneficial support for the families during pregnancy or postnatal period [43
]. Women who had used the combined MHC & CHCs reported receiving home visits after delivery “much” or “very much”, nearly three times more often than women who had used the separate MHCs. Also the amount of received peer-support was reported greater by women who had used the combined MHC & CHCs. It is notable that a recent Finnish Decree on primary maternity and child health care presupposes that at least one home visit and peer support by an antenatal training group should be provided for the first-time parents [45
]. The combined MHC & CHCs might be more in line with recent guidelines regarding these aspects of MHC service than the separate MHCs. However, more evidence is required to establish whether the model of the MHC is crucial for parents’ good experiences with the MHC service.
The development and optimization of the MHC services have been discussed extensively in Finland [13
], but scarce evidence exists which model of the MHC services produces the best results in terms of parents’ experiences. The strength of this comparative study is that it has produced one of the first national reports from the perspective of both parents, and also information about parents’ poor experiences and defects in particular aspects of the MHC work. All of this could be used as a useful basis for future research and family-centered development of the MHC services.
The participation rate of the STEPS-study was low (18.3%). One main reason for this might be the challenging recruitment process; the workload of the nurses at MHCs was heavy and they did not offer the opportunity to take part in a study to all pregnant women. Moreover, the study protocol was extensive and required families’ commitment for many years which might have decreased the parents’ willingness. Despite the low participation rate of the STEPS-study, the comparison between the obstetric background characteristics of the study group and a similar non-study group from the Finnish Medical Birth Register suggests that our study effectively encompassed the parturients in the area of Turku University Hospital. Differences were found regarding women’s age, marital status, profession, and parity. However, logistic analyses showed that background variables were not notable explainers of the differences between the groups. It is known that health selection distribution caused by the low participation rate might decrease generalizability of prevalence estimates, however the associations between the studied variables could be interpreted without bias [48
The similarity between participating and non-participating men could not be described due to the incomplete comparable background characteristics of men. The questionnaire was part of a remarkably wide research project, and questions regarding MHC services were included in a multidisciplinary questionnaire containing several thematic parts. These details could account for the limitations of the study.