Self-reported provision of person-centred maternity care among providers in Kenya and Ghana: scale validation and examination of associated factors

Afulani, Patience A.; Aborigo, Raymond; Nutor, Jerry John; Okiring, Jaffer; Kuwolamo, Irene; Ogolla, Beryl A.; Oboke, Edwina N.; Dorzie, John Baptist K.; Odiase, Osamuedeme; Steinauer, Jody; Walker, Dilys

doi:10.1136/bmjgh-2021-007415

Cited by 19 publications

(36 citation statements)

References 39 publications

(104 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…56,57 The frequent exposure of maternity providers to adverse events necessitates the availability of mental health support that is accessible and responsive. Of note, only 13% of providers in our study reported ever participating in a stress management training, 27 while only a few providers reported physical exercise, meditation, taking deep breaths or other coping mechanisms. Providers need to be introduced to evidence-based coping mechanisms and dissuaded from adapting negative coping behaviors.…”

Section: Discussionmentioning

confidence: 64%

“…26,44,45 Concurrent with these findings, our quantitative findings have demonstrated that high stress and burnout are associated with low self-reported provision person-centred maternity care. 27 In our published quantitative analysis using validated psychosocial measures of stress, nearly all the providers (96%) had moderate to high levels of stress and more than 80% had some level of burnout, with 20% having high levels of burnout indicative of burnout of clinical concern. 20 Our findings, concurrent with previous findings, also underscore the longstanding dissatisfaction among health care providers which remains unresolved.…”

Section: Discussionmentioning

confidence: 90%

“…preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in The copyright holder for this this version posted September 29, 2022. ; https://doi.org/10.1101/2022.09. 27.22280433 doi: medRxiv preprint…”

Section: Research Teammentioning

confidence: 99%

“…[19][20][21] The adverse impact of stress and burnout on patient experience and other patient outcomes have also been well documented. [22][23][24][25][26][27] Addressing stress and burnout in maternal health is thus an opportunity to promote person-centred maternal care, and improve health outcomes. 20 Although most of the daily stressors within maternity work settings are unavoidable, the ability of providers to cope and manage these stressors can directly influences their mental health status.…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Sources of Stress and Coping Mechanisms: Experiences of Maternal Health Care Providers in Western Kenya

Getahun

Oboke

Ogolla

et al. 2022

Preprint

Self Cite

View full text Add to dashboard Cite

The dynamic and complex nature of care provision predisposes healthcare workers to stress, including physical, emotional, or psychological fatigue due to individual, interpersonal, or organizational factors. We conducted a convergent mixed-methods study with maternity providers to understand their sources of stress and coping mechanisms they adopt. Data were collected in Migori County in western Kenya utilizing quantitative surveys with n=101 maternity providers and in-depth interviews with a subset of n=31 providers. We conducted descriptive analyses for the quantitative data. For qualitative data, we conducted thematic analysis, where codes were deductively developed from interview guides, iteratively refined based on emergent data, and applied by a team of five researchers using Dedoose software. Code queries were then analysed to identify themes and organized using the socioecological (SE) framework. Providers reported stress due to high workloads (61%); lack of supplies (37%), poor salary (32%), attitudes of colleagues and superiors (25%), attitudes of patients (21%), and adverse outcomes (16%). Themes from the qualitative analysis mirrored the quantitative analysis with more detailed information on the factors contributing to each and how these sources of stress affect providers and patient outcomes. Coping mechanisms adopted by providers are captured under three themes: addressing stress by oneself, reaching out to others, and seeking help from a higher power. Findings underscore the need to address organizational, interpersonal, and individual level stressors. Strategies are needed to support staff retention, provide adequate resources and incentives for providers, and ultimately improve patient outcomes. Interventions should support and leverage the positive coping mechanisms identified.

show abstract

Section: Discussionmentioning

confidence: 64%

Section: Discussionmentioning

confidence: 90%

Section: Research Teammentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Sources of Stress and Coping Mechanisms: Experiences of Maternal Health Care Providers in Western Kenya

Getahun

Oboke

Ogolla

et al. 2022

Preprint

Self Cite

View full text Add to dashboard Cite

show abstract

“…The data are from a cross-sectional study with healthcare providers who work in maternity units in the Upper East region (UER) of Ghana. The setting and data collection procedures have been previously described [47] and are brie y summarized here. A total of 150 Providers were recruited from 19 high volume delivery health facilities (an average of 75 births per month in the prior year) across the 15 districts in the region from October 2020 to January 2021.…”

Section: Design Participants Setting and Data Collectionmentioning

confidence: 99%

Provider implicit and explicit bias in person-centered maternity care: a cross-sectional study with maternity providers in Northern Ghana

Afulani

Okiring

Aborigo

et al. 2022

Preprint

Self Cite

View full text Add to dashboard Cite

Background Person-centered maternity care (PCMC) has become a priority in the global health discourse on the quality of care due to the high prevalence of disrespectful and lack of responsive care during facility-based childbirth. Although PCMC is generally sub-optimal, there are significant disparities. On average, women of low socioeconomic status (SES) tend to receive poorer PCMC than women of higher SES. Yet few studies have explored factors underlying these inequities. In this study, we examined provider implicit and explicit biases that could lead to inequities PCMC based on SES. Methods Data are from a cross-sectional survey with 150 providers recruited from 19 health facilities in the Upper East region of Ghana from October 2020 to January 2021. Explicit SES bias was assessed using situationally-specific vignettes (low SES and high SES characteristics) on providers’ perceptions of women’s expectations, attitudes, and behaviors. Implicit SES bias was assessed using an Implicit Association Test (IAT) that measures associations between women’s SES characteristics and providers’ perceptions of women as ‘difficult’ or ‘good’. Analysis included descriptive statistics, mixed-model ANOVA, and bivariate and multivariate linear regression. Results The average explicit bias score was 18.1 out of 28 (SD = 3.60) for the low SES woman vignette and 16.9 out of 28 (SD = 3.15) for the high SES woman vignette (p < 0.001), suggesting stronger explicit bias towards the lower SES woman. These biases manifested in higher agreement to statements such as the low SES woman in the vignette is not likely to expect providers to introduce themselves and is not likely to understand explanations. The average IAT score was 0.80 (SD = 0.34), indicating a significant bias in associating positive characteristics with high SES women and negative characteristics with low SES women. Providers with higher education and years of experience had significantly lower explicit bias scores than those with lower education and experience. Providers in private facilities had higher IAT scores than those in government hospitals. Conclusions The findings provide evidence of both implicit and explicit SES bias among maternity providers. These biases need to be addressed in interventions to achieve equity in PCMC and to improve PCMC for all women.

show abstract

Mixed methods evaluation of the Caring for Providers to Improve Patient Experience intervention

Afulani,

Getahun,

Okiring

et al. 2023

Intl J Gynecology & Obste

Self Cite

View full text Add to dashboard Cite

ObjectiveTo 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.MethodsCPIPE 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.ResultsIn 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.ConclusionCPIPE 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.

show abstract

Self-reported provision of person-centred maternity care among providers in Kenya and Ghana: scale validation and examination of associated factors

Cited by 19 publications

References 39 publications

Sources of Stress and Coping Mechanisms: Experiences of Maternal Health Care Providers in Western Kenya

Sources of Stress and Coping Mechanisms: Experiences of Maternal Health Care Providers in Western Kenya

Provider implicit and explicit bias in person-centered maternity care: a cross-sectional study with maternity providers in Northern Ghana

Mixed methods evaluation of the Caring for Providers to Improve Patient Experience intervention

Contact Info

Product

Resources

About