Furthering understanding of the lived experience of hyperemesis gravidarum: a meta-ethnography of qualitative research focused on first-hand experience and an interpretative phenomenological analysis of first hyperemesis gravidarum experiences

Abstract

BACKGROUND: Hyperemesis gravidarum (HG) is a rare complication of pregnancy involving severe nausea and/or vomiting, having a profound physiological, psychological, social, and occupational impact on the individual. This thesis aims to improve understanding of HG by studying lived experiences so that services can be designed to provide effective care and support.

AIM: The first chapter of this thesis consists of a systematic review and meta-ethnography seeking to explore and synthesise the existing published qualitative research drawing on perspectives of those with lived experience of HG. The second chapter comprises of an interpretative phenomenological analysis (IPA) focused on first encounters with HG and what others contribute to that lived experience.

METHODS: For the systematic review, an updated version of Noblit and Hare’s (1988) seven-step approach to meta-ethnography was utilised. MEDLINE, PsycINFO, Embase, CINAHL, and ProQuest were searched electronically. The Critical Appraisal Skills Programme checklist was utilised for quality appraisal. For the empirical project, lived experiences of HG were explored using IPA. Eight women were recruited via social media. Video interviews were performed remotely and transcribed verbatim.

RESULTS: The meta-ethnography included synthesis of twelve qualitative studies. Three main themes emerged: “…one of the hardest things I have ever gone through”; ‘Trying to make sense’; and ‘What does and doesn’t help?’ The IPA included an overarching theme; ‘Journey to understanding’, which encapsulated four main themes: “What’s wrong with me?”, ‘(How) Can we get through this?’, ‘What others bring to the HG experience’, and ‘Looking back, looking ahead’.

CONCLUSION: This thesis contributes to the existing literature by deepening understanding of HG and highlighting that individuals lacking an illness prototype are more vulnerable to dismissive and misinformed interactions which can contribute to self-blame and isolation. The severe, multifaceted impact of HG was highlighted and explored in depth, demonstrating a need for understanding and support from professionals and individual support networks. Existing HG research has contributed to a partial understanding of the phenomena and has informed guidelines; however, the IPA findings suggest said guidelines are not being uniformly implemented. Roles for clinical psychologists are proposed to support with the psychological impact during and after HG experiences and with the development of psychologically informed services. Suggestions for future research and clinical improvements follow based on the meta-ethnography and IPA.