Obstetric care under the military health system: An analysis of active-duty women’s and female spouses’ online discussions

Submitted: 6 May 2024
Accepted: 27 December 2024
Published: 22 January 2025
Abstract Views: 171
PDF: 110
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

Authors

This research undertakes a thematic analysis of discussion threads on social media forums to determine women’s perceptions of quality of obstetric care under TRICARE Prime and TRICARE Select. Following an open coding process and thematic analysis, themes arose regarding obstetric care as experienced by active-duty women as well as female spouses of active-duty members. Themes surrounding active-duty perceptions of quality of obstetric care concerned proximity to care deferred deliveries, lack of care options, deficient on-base care, better civilian care experiences, and lamenting having less options than spouses. Spouses generated themes of positive connotation with TRICARE Select, including low costs, freedom of choice, and proximity to care and negative connotation with TRICARE Prime, such as difficulty getting care, process bureaucracy, and deficient care. Ample evidence pointed to a strong spouse preference for TRICARE Select over TRICARE Prime, but there was not enough evidence to indicate if active-duty women were pursuing out-of-pocket care to circumvent TRICARE Prime restrictions. Overall, women’s discussions point to a need to improve the Military Health System and concerningly suggest active-duty women are confined to care within a system plagued with issues that impact obstetric care.

Dimensions

Altmetric

PlumX Metrics

Downloads

Download data is not yet available.

Citations

Anhang Price, R., Elliott, M. N., Zaslavsky, A. M., Hays, R. D., Lehrman, W. G., Rybowski, L., Edgman-Levitan, S., & Cleary, P. D. (2014). Examining the role of patient experience surveys in measuring health care quality. Medical Care Research and Review. 71(5), 522-554. DOI: https://doi.org/10.1177/1077558714541480
Burnard P. (1991). A method of analysing interview transcripts in qualitative research. Nurse Education Today, 11(6), 461–466. DOI: https://doi.org/10.1016/0260-6917(91)90009-Y
Cavanagh, S. (1997). Content analysis: concepts, methods and applications. Nurse Researcher, 4, 5–16. DOI: https://doi.org/10.7748/nr.4.3.5.s2
Congressional Research Service. (2021). Defense primer: Military Health System (IF 10530,
Version 10). Congressional Research Service. Available from: https://crsreports.congress.gov/product/pdf/IF/IF10530/10
de Silva, A., & Valentine, N. (2000). Measuring responsiveness: results of a key informants Survey in 35 countries. Geneva, Switzerland: World Health Organization. Available from: https://iris.who.int/handle/10665/67781.
Department of Defense (2022). 2022 demographics profile of the military community. Available from: https://www.militaryonesource.mil/data-research-and-statistics/military-community-demographics/2022-demographics-profile/
Donabedian, A. (1988). The quality of care, how can it be assessed? JAMA, 260(12), 1743-1748. DOI: https://doi.org/10.1001/jama.260.12.1743
Donabedian, A. (2005). Evaluating the quality of medical care. The Milbank Quarterly, 83(4), DOI: https://doi.org/10.1111/j.1468-0009.2005.00397.x
-729.
Elo, S., & Kyngas, H. (2008). The qualitative content analysis process. Leading Global Nursing Research, 62(1), 107-115. DOI: https://doi.org/10.1111/j.1365-2648.2007.04569.x
Frakes, M. D., Gruber, J., & Justicz, T. (2020). Public and private options in practice: The DOI: https://doi.org/10.3386/w28256
Military health system. American Economic Journal: Economic Policy, 15(4), 37-74.
Garcia, V., Meyer, E., & Witkop, C. (2022). Risk factors for postpartum depression in active-duty women. Military Medicine, 187(5-6), e562-e566. DOI: https://doi.org/10.1093/milmed/usab161
Graneheim, U. H., Lindgren, B.M., & Lundman, B. (2017). Methodological challenges in qualitative content analysis: A discussion paper. Nurse Education Today, 56, 29–34. DOI: https://doi.org/10.1016/j.nedt.2017.06.002
Graneheim, U. H., & Lundman, B. (2004). Qualitative content analysis in nursing research: Concepts, procedures and measures to achieve trustworthiness. Nurse Education Today, 24(2), 105-112. DOI: https://doi.org/10.1016/j.nedt.2003.10.001
Harriott, E. M., Williams, T. V., & Peterson, M. R. (2005). Childbearing in US military
Hospitals: Dimensions of care affecting women’s perceptions of quality and satisfaction. Birth Issues in Prenatal Care, 32(1), 4-10. DOI: https://doi.org/10.1111/j.0730-7659.2005.00342.x
Heaman, M. I., Sword, W. A., Akhtar-Danesh, N., Bradford, A., Tough, S., Janssen, P. A., Young, D. C., Kingston, D. A., Hutton, E. K., & Helewa, M. E. (2014). Quality of prenatal care questionnaire: instrument development and testing. BMC Pregnancy and Childbirth, 14, 188. DOI: https://doi.org/10.1186/1471-2393-14-188
Hsieh, H.-F., & Shannon, S. E. (2005). Three approaches to qualitative content analysis. Qualitative Health Research, 15(9), 1277–1288. DOI: https://doi.org/10.1177/1049732305276687
Hussein, M., & Haddad, M. (2021).Infographic: US military presence around the world. Al Jazeera. Available from: https://www.aljazeera.com/news/2021/9/10/infographic-us-military-presence-around-the-world-interactive
Krippendorff, K. (2019). Content analysis: an introduction to its methodology (4th edition). SAGE Publications, Incorporated. DOI: https://doi.org/10.4135/9781071878781
Lobst, S. E., Phillips, A. K., & Wilson, C. (2022). Shared decision-making during labor and birth among low-risk, active-duty women in the U.S. Military. Military Medicine. 187(5-6), e747-e756. DOI: https://doi.org/10.1093/milmed/usab486
Naeem, M., Ozuem, W., Howell, K., & Ranfagni, S. (2023). A step-by-step process of thematic analysis to develop a conceptual model in qualitative research. International Journal of Qualitative Methods, 22. DOI: https://doi.org/10.1177/16094069231205789
Ranjit, A., Jiang, W., Haider, A. H., Witkop, C. T., Little, S. E., & Robinson, J. N. (2016). Obstetric care in the US military: Comparison of direct and purchased care system within TRICARE [11R]. Obstetrics & Gynecology, 127, 150S. DOI: https://doi.org/10.1097/01.AOG.0000483599.78314.ad
Ranjit, A., Jiang, W., Zhan, T., Kimsey, L., Staat, B., Witkop, C. T., ... & Robinson, J. N. (2017). Intrapartum obstetric care in the United States military: Comparison of military and civilian care systems within TRICARE. Birth, 44(4), 337-344. DOI: https://doi.org/10.1111/birt.12298
Recame, M. A. (2016). Exploring women’s lived experiences and expectations with in-patient
Maternity care within the U.S. military healthcare system. Walden Dissertations and Doctoral Studies, 2755, https://scholarworks.waldenu.edu/dissertations/2755.
Scriven, M. (1991). Pros and cons about goal-free evaluation. Evaluation Practice, 12(1), 55–63. DOI: https://doi.org/10.1016/0886-1633(91)90024-R
Sword, W., Heaman, M. I., Brooks, S., Tough, S., Janssen, P. A., Young, D., Kingston, D., Helewa, M. E., Akhtar-Danesh, N., & Hutton, E. (2012). Women's and care providers' perspectives of quality prenatal care: A qualitative descriptive study. BMC Pregnancy and Childbirth, 12, 29. DOI: https://doi.org/10.1186/1471-2393-12-29
TRICARE. (2024). Health Plan Costs. TRICARE. Available from: https://tricare.mil/Costs/HealthPlanCosts/TS/ADFM
Weber, R. P. (1990). Basic content analysis (2nd ed., Vol. 49). SAGE Publications Inc. DOI: https://doi.org/10.4135/9781412983488
Vanitha, J. and Ecker, J. (2010) Quality in obstetric care: Measuring what matters. Obstetrics & Gynecology, 116(3), 728-732. DOI: https://doi.org/10.1097/AOG.0b013e3181ea4d4f
U.S. Department of Defense. (2022). Department of defense releases annual demographics report —Upward trend in number of women serving continues. U.S. Department of Defense. Available from: https://www.defense.gov/News/Releases/Release/Article/3246268/department-of-defense-releases-annual-demographics-report-upward-trend-in-numbe/#:~:text=In%202021%2C%20women%20made%20up,of%20the%20Guard%20and%20reserve
U.S. Department of Defense. (2022a). 2022 Demographics: Profile of the military community. U.S. Department of Defense. Available from: https://download.militaryonesource.mil/12038/MOS/Reports/2022-demographics-report.pdf.
U.S. Government Accountability Office. (2022). Defense health care, prevalence of and efforts to screen and treat mental health conditions in prenatal and postpartum TRICARE beneficiaries (Report No. GAO-22-105136). Available from: https://www.gao.gov/assets/gao-22-105136.pdf

How to Cite

Rebhi, Amanda M. 2025. “Obstetric Care under the Military Health System: An Analysis of Active-Duty women’s and Female spouses’ Online Discussions”. Qualitative Research in Medicine and Healthcare 8 (3). https://doi.org/10.4081/qrmh.2024.12641.