PhD defence M. (Michael) van der Voorden

Below is a brief summary of the dissertation:

This thesis examines the extent to which patient participation is implemented and how it can be strengthened within value‑based maternity care in hospitals in the southwestern Netherlands, with the aim of making care more patient‑centered. The current level of maturity regarding patient participation appears low. Although this research focused on one region and one specialty, existing literature provides no indication that these challenges are unique to this area or type of care.
Chapter 2 presents a systematic literature review on patient participation at the organizational level. Of 2,915 articles, 21 met the inclusion criteria. Most studies showed participation at the ‘consultation’ level, primarily through interviews and questionnaires. Higher forms of participation, such as co‑design or advisory roles, were rarely reported.
Chapter 3 explored patient participation in patient safety within obstetric care. Sixteen interviews revealed five forms of participation, and all four previously described negative effects were confirmed, including reduced trust, relational tension, excessive responsibility for patients, and increased time demands for professionals.
Chapter 4 identified 18 actions to mitigate these negative effects, organized into five categories (structure, culture, education, emotional, technology). Many actions were still formulated mainly from a professional perspective.
Chapter 5 used Q‑methodology to identify four perspectives among pregnant women: a personal approach, an empowering approach, an expert‑oriented approach, and a needs‑based approach. Respect and clear information were universally valued.
Chapter 6 showed that women living in deprived areas and those with low social support reported less positive experiences. This highlights the need to reduce inequities through targeted interventions.