The Ontario Mother and Infant Study (TOMIS) III: A multi-site cohort study of the impact of delivery method on health, service use, and costs of care in the first postpartum year

Abstract Background The caesarean section rate continues to rise globally. A caesarean section is inarguably the preferred method of delivery when there is good evidence that a vaginal delivery may unduly risk the health of a woman or her infant. Any decisions about delivery method in the absence of clear medical indication should be based on knowledge of outcomes associated with different childbirth methods. However, there is lack of sold evidence of the short-term and long-term risks and benefits of a planned caesarean delivery compared to a planned vaginal delivery. It also is important to consider the economic aspects of caesarean sections, but very little attention has been given to health care system costs that take into account services used by women for themselves and their infants following hospital discharge. Methods and design The Ontario Mother and Infant Study III is a prospective cohort study to examine relationships between method of delivery and maternal and infant health, service utilization, and cost of care at three time points during the year following postpartum hospital discharge. Over 2500 women were recruited from 11 hospitals across the province of Ontario, Canada, with data collection occurring between April 2006 and October 2008. Participants completed a self-report questionnaire in hospital and structured telephone interviews at 6 weeks, 6 months, and 12 months after discharge. Data will be analyzed using generalized estimating equation, a special generalized linear models technique. A qualitative descriptive component supplements the survey approach, with the goal of assisting in interpretation of data and providing explanations for trends in the findings. Discussion The findings can be incorporated into patient counselling and discussions about the advantages and disadvantages of different delivery methods, potentially leading to changes in preferences and practices. In addition, the findings will be useful to hospital- and community-based postpartum care providers, managers, and administrators in guiding risk assessment and early intervention strategies. Finally, the research findings can provide the basis for policy modification and implementation strategies to improve outcomes and reduce costs of care

From Gatekeeping to Engagement: A Multicontextual, Mixed Method Study of Student Academic Engagement in Introductory STEM Courses

The lack of academic engagement in introductory science courses is considered by some to be a primary reason why students switch out of science majors. This study employed a sequential, explanatory mixed methods approach to provide a richer understanding of the relationship between student engagement and introductory science instruction. Quantitative survey data were drawn from 2,873 students within 73 introductory science, technology, engineering, and mathematics (STEM) courses across 15 colleges and universities, and qualitative data were collected from 41 student focus groups at eight of these institutions. The findings indicate that students tended to be more engaged in courses where the instructor consistently signaled an openness to student questions and recognizes her/his role in helping students succeed. Likewise, students who reported feeling comfortable asking questions in class, seeking out tutoring, attending supplemental instruction sessions, and collaborating with other students in the course were also more likely to be engaged. Instructional implications for improving students’ levels of academic engagement are discussed