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Afulani PA, Getahun M, Okiring J, Ogolla BA, Oboke EN, Kinyua J, Oluoch I, Odiase O, Ochiel D, Mendes WB, Ongeri L. Mixed methods evaluation of the Caring for Providers to Improve Patient Experience intervention. Int J Gynaecol Obstet 2024; 165:487-506. [PMID: 38146777 PMCID: PMC11021171 DOI: 10.1002/ijgo.15301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 11/09/2023] [Accepted: 11/29/2023] [Indexed: 12/27/2023]
Abstract
OBJECTIVE To assess the impact of the Caring for Providers to Improve Patient Experience (CPIPE) intervention, which sought to improve person-centered maternal care (PCMC) by addressing two key drivers: provider stress and bias. METHODS CPIPE was successfully piloted over 6 months in two health facilities in Migori County, Kenya, in 2022. The evaluation employed a mixed-methods pretest-posttest nonequivalent control group design. Data are from surveys with 80 providers (40 intervention, 40 control) at baseline and endline and in-depth interviews with 20 intervention providers. We conducted bivariate, multivariate, and difference-in-difference analysis of quantitative data and thematic analysis of qualitative data. RESULTS In the intervention group, average knowledge scores increased from 7.8 (SD = 2.4) at baseline to 9.5 (standard deviation [SD] = 1.8) at endline for stress (P = 0.001) and from 8.9 (SD = 1.9) to 10.7 (SD = 1.7) for bias (P = 0.001). In addition, perceived stress scores decreased from 20.9 (SD = 3.9) to 18.6 (SD = 5.3) (P = 0.019) and burnout from 3.6 (SD = 1.0) to 3.0 (SD = 1.0) (P = 0.001), with no significant change in the control group. Qualitative data indicated that CPIPE had an impact at multiple levels. At the individual level, it improved provider knowledge, skills, self-efficacy, attitudes, behaviors, and experiences. At the interpersonal level, it improved provider-provider and patient-provider relationships, leading to a supportive work environment and improved PCMC. At the institutional level, it created a system of accountability for providing PCMC and nondiscriminatory care, and collective action and advocacy to address sources of stress. CONCLUSION CPIPE impacted multiple outcomes in the theory of change, leading to improvements in both provider and patient experience, including for the most vulnerable patients. These findings will contribute to global efforts to prevent burnout and promote PCMC and equity.
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Affiliation(s)
- Patience A. Afulani
- Epidemiology and Biostatistics Department, University of California, San Francisco, USA
- Institute for Global Health Sciences, University of California, San Francisco, USA
| | - Monica Getahun
- Institute for Global Health Sciences, University of California, San Francisco, USA
| | - Jaffer Okiring
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | | | | | | | | | - Osamuedeme Odiase
- Institute for Global Health Sciences, University of California, San Francisco, USA
| | - Dan Ochiel
- County Health Directorate, Migori, Kenya
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Odiase O, Akinyi B, Kinyua J, Afulani P. Community Perceptions of Person-Centered Maternity Care in Migori County, Kenya. Front Glob Womens Health 2021; 2:668405. [PMID: 34816219 PMCID: PMC8593945 DOI: 10.3389/fgwh.2021.668405] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 09/02/2021] [Indexed: 11/24/2022] Open
Abstract
Background: Community perceptions of quality of maternal healthcare services-including Person-centered maternity care (PCMC)-influences the health-seeking behavior of women. Yet few studies have examined this quantitatively. This study aims to examine community perceptions of PCMC and its associated factors. Materials and Methods: We used data from a survey on community perceptions of PCMC in Migori County, Kenya conducted in August 2016. Community members were relatives or friends of women aged 15 to 49 years who gave birth in the 9 wk preceding the survey (N = 198). PCMC was measured using a 30-item scale with three sub-scales for dignity and respect, communication and autonomy, and supportive care. PCMC scores were standardized to range from 0 to 100, with higher scores indicative of higher PCMC. Descriptive, bivariate, and multivariate analyses were performed in STATA (version 14). Results: The average total PCMC score was 62 (SD = 15.7), with scores of 74, 63, and 53 for dignity and respect, supportive care, and communication and autonomy, respectively. Controlling for other factors, respondents who were employed and literate had higher PCMC perception scores than those who were less literate and unemployed. Respondents who rated their health as very good had higher PCMC perception scores than those who rated their health as poor. Female respondents who previously gave birth at a health facility had lower perceptions of dignity and respect than those with no prior facility birth. Conclusion: The findings imply that community perceptions of PCMC, particularly related to communication and autonomy, are poor. Given the effects of these perceptions on use of maternal health services, there is a need to improve PCMC.
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Affiliation(s)
- Osamuedeme Odiase
- Institute for Global Health Sciences, University of California, San Francisco, San Francisco, CA, United States
| | - Beryl Akinyi
- Global Programs for Research and Training, Nairobi, Kenya
| | | | - Patience Afulani
- Institute for Global Health Sciences, University of California, San Francisco, San Francisco, CA, United States
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, United States
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Afulani PA, Nutor JJ, Agbadi P, Gyamerah AO, Musana J, Aborigo RA, Odiase O, Getahun M, Ongeri L, Malechi H, Madadi MO, Arhinful B, Kelly AM, Awoonor-Williams JK. Job satisfaction among healthcare workers in Ghana and Kenya during the COVID-19 pandemic: Role of perceived preparedness, stress, and burnout. PLOS Glob Public Health 2021; 1:e0000022. [PMID: 36962085 PMCID: PMC10021773 DOI: 10.1371/journal.pgph.0000022] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 09/15/2021] [Indexed: 12/19/2022]
Abstract
The COVID-19 pandemic has affected job satisfaction among healthcare workers; yet this has not been empirically examined in sub-Saharan Africa (SSA). We addressed this gap by examining job satisfaction and associated factors among healthcare workers in Ghana and Kenya during the COVID-19 pandemic. We conducted a cross-sectional study with healthcare workers (N = 1012). The two phased data collection included: (1) survey data collected in Ghana from April 17 to May 31, 2020, and (2) survey data collected in Ghana and Kenya from November 9, 2020, to March 8, 2021. We utilized a quantitative measure of job satisfaction, as well as validated psychosocial measures of perceived preparedness, stress, and burnout; and conducted descriptive, bivariable, and multivariable analysis using ordered logistic regression. We found high levels of job dissatisfaction (38.1%), low perceived preparedness (62.2%), stress (70.5%), and burnout (69.4%) among providers. High perceived preparedness was positively associated with higher job satisfaction (adjusted proportional odds ratio (APOR) = 2.83, CI [1.66,4.84]); while high stress and burnout were associated with lower job satisfaction (APOR = 0.18, CI [0.09,0.37] and APOR = 0.38, CI [0.252,0.583] for high stress and burnout respectively). Other factors positively associated with job satisfaction included prior job satisfaction, perceived appreciation from management, and perceived communication from management. Fear of infection was negatively associated with job satisfaction. The COVID-19 pandemic has negatively impacted job satisfaction among healthcare workers. Inadequate preparedness, stress, and burnout are significant contributing factors. Given the already strained healthcare system and low morale among healthcare workers in SSA, efforts are needed to increase preparedness, better manage stress and burnout, and improve job satisfaction, especially during the pandemic.
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Affiliation(s)
- Patience A Afulani
- Department of Epidemiology & Biostatistics, University of California, San Francisco, San Francisco, California, United States of America
- Institute for Global Health Sciences, University of California, San Francisco, San Francisco, California, United States of America
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, San Francisco, California, United States of America
| | - Jerry John Nutor
- Department of Family Health Care Nursing, University of California, San Francisco, San Francisco, California, United States of America
| | - Pascal Agbadi
- Department of Sociology and Social Policy, Lingnan University, Tuen Mun, Hong Kong, SAR
| | - Akua O Gyamerah
- Department of Community Health Systems, University of California, San Francisco, San Francisco, California, United States of America
| | - Joseph Musana
- Department of Obstetrics and Gynecology, The Aga Khan University Hospital, Nairobi, Kenya
| | | | - Osamuedeme Odiase
- Institute for Global Health Sciences, University of California, San Francisco, San Francisco, California, United States of America
| | - Monica Getahun
- Institute for Global Health Sciences, University of California, San Francisco, San Francisco, California, United States of America
| | - Linnet Ongeri
- Centre for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
| | | | - Moses Obimbo Madadi
- Department of Human Anatomy, Obstetrics and Gynecology, The University of Nairobi, Nairobi, Kenya
| | - Benedicta Arhinful
- School of Public Health, Johns Hopkins University, Baltimore, MD, United States of America
| | - Ann Marie Kelly
- Sidney Kimmel Medical College, Philadelphia, PA, United States of America
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