Strengthening Interpersonal Relationships in Maternal and Child Health Care in Rural Tanzania: Protocol for a Human-Centered Design Intervention

Abstract

Background Evidence indicates that clients’ dissatisfaction with providers’ competencies within maternal and child health (MCH) continues to impact trust in formal health care systems, service uptake, continuity with care, and MCH outcomes. A major problem with existing interventions is the failure to address all the complexities of provider-client relationships necessitating targeted, contextualized, innovative solutions that place providers and clients at the forefront as agents of change in optimizing intervention design and implementation. To improve the provider-client relationship, the Aga Khan University is piloting a human-centered design (HCD) intervention where MCH nurses and clients are invited to partner with researchers in the intervention design and evaluation process. Objective The objective of this research is to co-design an intervention package (prototype) for improving nurse-client relationships in the rural Shinyanga region of Tanzania using a series of iterative HCD steps, involving key stakeholders to tailor solutions for complex problems impacting provider-client interactions in MCH care. Methods The following 5-step HCD approach will be implemented: (1) community-driven discovery through qualitative descriptive research methods using focus group discussions and key informant interviews; (2) co-design of an intervention package through consultative ideation and cocreation meetings with nurses, clients, and other stakeholders; (3) prototype validation through qualitative insight gathering using focus group discussions; (4) refinement and adaptation meeting; and (5) documentation and sharing of lessons learned before the final prototype is tested and validated in a broader community. Results A prototype characterized by a package of interventions for improving nurse-client relationships in MCH care in rural contexts is expected to be developed from the co-design process. Conclusions An HCD approach provides a novel entry point for strengthening provider-client relationships, where clients are invited to partner with providers in the design of acceptable and feasible interventions. International Registered Report Identifier (IRRID) DERR1-10.2196/37947

Factors shaping good and poor nurse-client relationships in maternal and child care: a qualitative study in rural Tanzania

“…The HCD protocol with a description of this inquiry has been recently published elsewhere [ 33 ]. Briefly, a Qualitative descriptive study design was employed.…”

“…Qualitative descriptive design was selected because is a well-accepted design within the qualitative domain for answering the questions of ‘what’ are the drivers of poor-nurse client relationships in MCH care [ 34 ]. Although a mixed method and/or a theory-driven inquiry was also considered, it was deemed impractical for this inquiry because a focus was on generating rich perspectives on nurse-client relationship to guide further HCD steps [ 33 ].…”

The role and effectiveness of patient feedback system in strengthening patient-provider relationships in rural Tanzania

“…This paper examines the ndings of 9 FGDs and 12KIIs [33][34] whose accounts included issues pertaining to PFS. Among the participants 90% were Female, 50% were aged 31-40 years and the majority of clients (61%) had primary or no formal education (Table 1).…”

“…The paper draws from the ndings of a recent qualitative descriptive study on patient-provider relationships in rural Tanzania. The study employed a human-centred design approach to co-create an intervention package for improving nursepatient relationships between January and September 2022 [33][34]. A qualitative descriptive approach is appropriate for this inquiry as it aimed to develop an understanding and describe nurse-patient relationships without testing an existing theory [35].…”

The perceived role and effectiveness of patient feedback system in strengthening therapeutic relationships in rural Tanzania

“…This paper draws from a study that utilised a human-centred design approach to co-design an intervention package for improving nurse-client relationships in which examining the factors shaping therapeutic relationships in MCH care was one of its objectives [33][34]. Issues related to PFS emerged as some of the ndings in this study but were not examined in detail in previous publications emerging from the study.…”