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Alelign YA, Melesse MF, Beka E, Alemu AA, Ejigu Meskele N, Asres CG. Person-centered maternity care during childbirth and associated factors among mothers who gave birth at public health institutions of Debre Markos town, Northwest Ethiopia, 2022: A cross-sectional study. SAGE Open Med 2024; 12:20503121231225352. [PMID: 38249947 PMCID: PMC10798133 DOI: 10.1177/20503121231225352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 12/18/2023] [Indexed: 01/23/2024] Open
Abstract
Background Person-centered maternity care is a crucial scheme for a positive childbirth experience. It enhances facility-based delivery, improves patient-provider communication, and increases women's satisfaction. However, there is limited evidence on the magnitude of person-centered care and certain variables were missed in Ethiopia. Therefore, this study assessed the magnitude of person-centered maternity care during childbirth and associated factors at health institutions of Debre Markos town, Ethiopia. Methods Institution-based cross-sectional study was conducted at public health institutions of Debre Markos town. Participants were enrolled using systematic random sampling technique. Data were collected through face-to-face exit interviews, cleaned, coded, and entered into Epi-Data version 3.1 then exported to SPSS version 25 for analysis. After generating simple linear regression analysis, variables with p-value ⩽ 0.25 were fitted into multivariable linear regression model and p-value < 0.05 was declared statistically significant with 95% CI for β. Finally, study findings were presented using texts, tables, and figures. Results In this study, 380 women participated, with a response rate of 98.19%. The respondent's mean person-centered maternity care score was 56.83 with 95% CI: (55.83, 57.83). Mean score for sub-scale was 15.08 for dignity and respect, 14.42 for communication and autonomy, and 27.33 for supportive care. Commencing antenatal care during third trimester (β = -4.86, 95% CI: -8.22, -1.49), caesarean delivery (β = -5.78, 95% CI: -7.68, -3.87), college and above educational level of women (β = 3.75, 95% CI: 1.11, 6.39), being multiparous (β = 3.69, 95% CI: 1.85, 5.55), and health center delivery (β = 6.59, 95% CI: 4.17, 9.02) were factors significantly associated with person-centered maternity care. Conclusion This study showed person-centered maternity care was low compared with World Health Organization standards. This informs local policymakers, district health offices, institutional healthcare administrators, and healthcare professionals of the discrepancies in achieving international standards of quality care.
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Affiliation(s)
- Yaregal Admasu Alelign
- Department of Midwifery, School of Health Sciences, Madda Walabu University, Bale Robe, Ethiopia
| | - Misganaw Fikrie Melesse
- Department of Midwifery, College of Medicine and Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Endihnew Beka
- Department of Midwifery, College of Medicine and Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Addisu Alehegn Alemu
- Department of Midwifery, College of Medicine and Health Sciences, Debre Markos University, Debre Markos, Ethiopia
- School of Women’s and Children’s Health, University of New South Wales, Sydney, NSW, Australia
| | - Neway Ejigu Meskele
- Department of Midwifery, School of Health Sciences, Madda Walabu University, Bale Robe, Ethiopia
| | - Chernet Getnet Asres
- Department of Midwifery, School of Health Sciences, Madda Walabu University, Bale Robe, Ethiopia
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Afulani PA, Oboke EN, Ogolla BA, Getahun M, Kinyua J, Oluoch I, Odour J, Ongeri L. Caring for providers to improve patient experience (CPIPE): intervention development process. Glob Health Action 2023; 16:2147289. [PMID: 36507905 PMCID: PMC9754039 DOI: 10.1080/16549716.2022.2147289] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 11/10/2022] [Indexed: 12/15/2022] Open
Abstract
A growing body of research has documented disrespectful, abusive, and neglectful treatment of women in facilities during childbirth, as well as the drivers of such mistreatment. Yet, little research exists on effective interventions to improve Person-Centred Maternal Care (PCMC)-care that is respectful and responsive to individual women's preferences, needs, and values. We sought to extend knowledge on interventions to improve PCMC, with a focus on two factors - provider stress and implicit bias - that are driving poor PCMC and contributing to disparities in PCMC. In this paper we describe the process towards the development of the intervention. The intervention design was an iterative process informed by existing literature, behaviour change theory, formative research, and continuous feedback in consultation with key stakeholders. The intervention strategies were informed by the Social Cognitive Theory, Trauma Informed System framework, and the Ecological Perspective. This process resulted in the 'Caring for Providers to Improve Patient Experience (CPIPE)' intervention, which has 5 components: provider training, peer support, mentorship, embedded champions, and leadership engagement. The training includes didactic and interactive content on PCMC, stress, burnout, dealing with difficult situations, and bias, with some content integrated into emergency obstetric and neonatal care (EmONC) simulations to enable providers apply concepts in the context of managing an emergency. The other components create an enabling environment for ongoing individual behavior and facility culture change. The pilot study is being implemented in Migori County, Kenya. The CPIPE intervention is an innovative theory and evidence-based intervention that addresses key drivers of poor PCMC and centers the unique needs of vulnerable women as well as that of providers. This intervention will advance the evidence base for interventions to improve PCMC and has great potential to improve equity in PCMC and maternal and neonatal health.
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Affiliation(s)
- Patience A. Afulani
- Epidemiology and Biostatistics Department, University of California, San Francisco (UCSF), San Francisco, CA, USA
- Institute for Global Health Sciences, University of California, San Francisco, San Francisco CA, USA
| | - Edwina N. Oboke
- Research Department, Global Programs for Research and Training, Nairobi, Kenya
| | - Beryl A. Ogolla
- Research Department, Global Programs for Research and Training, Nairobi, Kenya
| | - Monica Getahun
- Institute for Global Health Sciences, University of California, San Francisco, San Francisco CA, USA
| | - Joyceline Kinyua
- Center for Virus Research, Kenya Medical Research Institute, Nairobi, Kenya
| | | | - James Odour
- Migori County Referral Hospital, Migori, Kenya
| | - Linnet Ongeri
- Center for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
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Kapula N, Shiboski S, Dehlendorf C, Ouma L, Afulani PA. Examining socioeconomic status disparities in facility-based childbirth in Kenya: role of perceived need, accessibility, and quality of care. BMC Pregnancy Childbirth 2022; 22:804. [PMID: 36324136 PMCID: PMC9628025 DOI: 10.1186/s12884-022-05111-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Accepted: 10/06/2022] [Indexed: 11/07/2022] Open
Abstract
Background Giving birth in health facilities with skilled birth attendants (SBAs) is one of the key efforts promoted to reduce preventable maternal deaths in sub-Saharan Africa. However, research has revealed large socioeconomic status (SES) disparities in facility-based childbirth. We seek to extend the literature on the factors underlying these SES disparities. Drawing on the Disparities in Skilled Birth Attendance (DiSBA) framework, we examined the contribution of three proximal factors—perceived need, accessibility, and quality of care—that influence the use of SBAs. Methods We used data from a survey conducted in Migori County, Kenya in 2016, among women aged 15–49 years who gave birth nine weeks before the survey (N = 1020). The primary outcome is facility-based childbirth. The primary predictors are wealth, measured in quintiles calculated from a wealth index based on principal component analysis of household assets, and highest education level attained. Proposed mediating variables include maternal perceptions of need, accessibility (physical and financial), and quality of care (antenatal services received and experience of care). Logistic regression with mediation analysis was used to investigate the mediating effects. Results Overall, 85% of women in the sample gave birth in a health facility. Women in the highest wealth quintile were more likely to give birth in a facility than women in the lowest quintile, controlling for demographic factors (adjusted odds ratio [aOR]: 2.97, 95% CI: 1.69–5.22). College-educated women were five times more likely than women with no formal education or primary education to give birth in a health facility (aOR: 4.96; 95% CI: 1.43–17.3). Women who gave birth in health facilities had higher perceived accessibility and quality of care than those who gave birth at home. The five mediators were estimated to account for between 15% and 48% of the differences in facility births between women in the lowest and higher wealth quintiles. Conclusion Our results confirm SES disparities in facility-based childbirth, with the proximal factors accounting for some of these differences. These proximal factors – particularly perceived accessibility and quality of care – warrant attention due to their relationship with facility-birth overall, and their impact on inequities in this care. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-022-05111-1.
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Affiliation(s)
- Ntemena Kapula
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA.
| | - Stephen Shiboski
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | - Christine Dehlendorf
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA.,Department of Family and Community Medicine, University of California, San Francisco, San Francisco, CA, USA.,Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, CA, USA
| | - Linet Ouma
- Center for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Patience A Afulani
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA.,Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, CA, USA.,Department of Global Health Sciences, University of California, San Francisco, San Francisco, CA, USA
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Sripad P, Merritt MW, Kerrigan D, Abuya T, Ndwiga C, Warren CE. Determining a Trusting Environment for Maternity Care: A Framework Based on Perspectives of Women, Communities, Service Providers, and Managers in Peri-Urban Kenya. Front Glob Womens Health 2022; 3:818062. [PMID: 35528311 PMCID: PMC9069110 DOI: 10.3389/fgwh.2022.818062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 03/17/2022] [Indexed: 11/18/2022] Open
Abstract
Trust in health service providers and facilities is integral to health systems accountability. Understanding determinants of trust, a relational construct, in maternity settings necessitates exploring hierarchical perspectives of users, providers, and influencers in the care environment. We used a theoretically driven qualitative approach to explore trust determinants in a maternity setting across patient-provider, inter-provider, and community-policymaker interactions and relationships in peri-urban Kenya. Focus groups (n = 8, N = 70) with women who recently gave birth (WRB), pregnant women, and male partners, and in-depth-interviews (n = 33) with WRB, health care providers and managers, and community health workers (CHWs) were conducted in 2013, soon after the national government's March 2013 introduction of a policy mandate for "Free Maternity Care." We used thematic coding, memo writing, and cross-perspective triangulation to develop a multi-faceted trust determinants framework. We found that determinants of trust in a maternity setting can be broadly classified into six types of factors, where each type of factor represents a cluster of determinants that may each positively or negatively influence trust: patient, provider, health facility, community, accountability, and structural. Patient factors are prior experiences, perceived risks and harms, childbirth outcomes, and maternal health literacy. Provider factors are empathy and respect, responsiveness, and perceived capability of providers. Health facility factors are "good services" as perceived by patients, physical environment, process navigability, provider collaboration and oversight, discrimination, and corruption. Community factors are facility reputation and history, information channels, and maternal health literacy. Accountability factors are alignment of actions with expectations, adaptations to policy changes, and voice and feedback. Structural factors are institutional hierarchies and policies in the form of professional codes. Trust determinants are complex, nuanced and reflect power dynamics across relationships. Findings offer insight into socio-political maternity norms and demand a more equitable care interface between users and providers.
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Affiliation(s)
- Pooja Sripad
- Population Council, Washington, DC, United States
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Maria W. Merritt
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
- Johns Hopkins Berman Institute of Bioethics, Baltimore, MD, United States
| | - Deanna Kerrigan
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, United States
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