The Case for Using a Behavior Change Model to Design Interventions to Promote Respectful Maternal Care

Diamond‐Smith, Nadia; Walker, Dilys; Afulani, Patience A.; Donnay, F; Lin, Sunny; Peca, Emily; Stanton, Mary Ellen

doi:10.9745/ghsp-d-22-00278

Cited by 7 publications

(7 citation statements)

References 33 publications

(44 reference statements)

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“…Second, given the role of bias in healthcare inequities and the dearth of evidence on effective ways to address it [15,17,33], the CPIPE intervention will be valuable in efforts to promote health equity through bias awareness and mitigation. Third, there is still a major gap in theory and evidence-based interventions to promote responsive, compassionate, and respectful maternity care [91,106]. This work thus extends the limited research on interventions to improve PCMC, with the added strength of addressing equity and provider wellbeing and experience.…”

Section: Discussionmentioning

confidence: 84%

Mixed Methods Evaluation of the ‘Caring for Providers to Improve Patient Experience’ intervention

Afulani,

Getahun,

Okiring

et al. 2023

Preprint

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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-non-equivalent-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(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); 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 CPIPE had 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.Clinical trial registrationClinicalTrials.gov Identifier:NCT05019131https://www.clinicaltrials.gov/study/NCT05019131?term=Afulani&checkSpell=false&rank=1

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Section: Discussionmentioning

confidence: 84%

Mixed Methods Evaluation of the ‘Caring for Providers to Improve Patient Experience’ intervention

Afulani,

Getahun,

Okiring

et al. 2023

Preprint

Self Cite

View full text Add to dashboard Cite

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“…The positive attitude of HCPs is crucial, even in attracting mothers to utilize health facility childbirth [ 10 , 17 ]. Supportive leadership is key to successful RMC practices [ 17 , 35 – 37 ].…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, a complaints redress mechanism should be implemented [ 10 , 41 ]. It was proved that multiple interventions are more effective in improving RMC compared to a single intervention [ 15 , 35 – 37 , 42 ].…”

Section: Discussionmentioning

confidence: 99%

Healthcare providers’ perspectives on sustaining respectful maternity care appreciated by mothers in five hospitals of Rwanda

Muhayimana,

Kearns

2024

BMC Nurs

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Background Childbirth reserves respect, as emphasized by the World Health Organization in 2018, and the focus towards the need for positive, dignified delivery experiences has become an integral aspect of Respectful Maternity Care (RMC). It is a known fact that RMC is pivotal for favourable birth outcomes and contributes to the satisfaction of maternity care. The absence of RMC negatively affects women's and newborns’ rights. The study aimed to explore healthcare providers’ perspectives on sustaining RMC actions that mothers previously reported. Methodology This study was conducted in five hospitals in the Eastern province of Rwanda, involving 5 Focus Group Discussions (FGDs) with midwives and nurses. For interviews, we purposively selected 5-unit managers and five physicians. Additionally, 40 midwives and nurses were recruited for the FGDs. The research utilized the Dream phase of Appreciative Inquiry (AI) for interviews and Focus Groups. Data collection aimed to gain insights into Healthcare Providers’ perceptions of how RMC is provided and how to establish and sustain RMC in Rwandan health facilities. Nvivo 12 was employed for organizing codes and creating a codebook, and thematic analysis was applied. Results Four themes with sub-themes emerged. Namely, 1) Women-centered care, with Compassionate care, Privacy and confidentiality maintenance, Information provision and Liberty in decision making, Effective communication, Family involvement, Cleanliness, and Equality care. 2) Professionalism compliance with Motivated staff, Teamwork, Continuous development, Quality work provision, and Community trust. 3) RMC encounters 4) RMC sustenance. Conclusion and recommendations The continuous pursuit of high RMC standards in Rwanda involves improving childbirth experiences through utilizing existing resources, ongoing improvement, and sustaining achievements. Key recommended actions in this study for sustaining RMC encompass promoting women-centred care, enhancing healthcare provider attitudes, ensuring professionalism, building community trust, maintaining conducive health facility environments, and involving leadership.

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“…The recent review on RMC interventions reported that adopting multi-faceted strategies can successfully reduce the mistreatment of women during maternity care and improve the RMC provision. These comprehensive strategies address a range of factors, including the attitudes and conduct of healthcare personnel, staff morale, community engagement, and the removal of barriers in healthcare facilities and systems (21) (10). Interventions beyond a sole focus, like staff training, are more likely to bring about meaningful change (21), (9).…”

Section: Figure 3 Types Of Disrespect and Abusementioning

confidence: 99%

Disrespectful Care Towards Mothers Giving Birth at Selected Hospital of Kigali/Rwanda

Muhayimana,

Kearns,

Nkurunziza

et al. 2024

Preprint

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Background Over the past decade, global public health has increasingly focused on studying mistreatment of women during facility-based childbirth. However, in Rwanda, research on disrespectful care experienced by mothers during childbirth remains limited, indicating the necessity for further studies. Methods We conducted a cross-sectional study in a selected district hospital in Kigali, Rwanda. We employed systematic random sampling to select 246 mothers who had recently delivered at the study site and were discharged from the hospital but still on the premises. Descriptive statistics were utilized, and a summation score of nine items of disrespect was calculated to determine our outcome of interest. Subsequently, we dichotomized the outcome. Additionally, we employed chi-square analysis and logistic regression to identify predictors of disrespect. Results The prevalence of disrespect was found to be 61.38%, with 28.86% of participants reporting experiencing disrespect once, and 32.52% reporting experiencing it two to eight times. Participants experienced disrespect between one and eight times. The most prevalent forms of disrespect experienced were undignified care (30.89%), abandonment (30.49%), and lack of information on received care (26.42%). Conclusion and Recommendations Disrespect remains a significant issue in our study setting, emphasizing the need for interventions to mitigate this problem by enhancing accountability mechanisms among healthcare providers working in maternity services.

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The Case for Using a Behavior Change Model to Design Interventions to Promote Respectful Maternal Care

Cited by 7 publications

References 33 publications

Mixed Methods Evaluation of the ‘Caring for Providers to Improve Patient Experience’ intervention

Mixed Methods Evaluation of the ‘Caring for Providers to Improve Patient Experience’ intervention

Healthcare providers’ perspectives on sustaining respectful maternity care appreciated by mothers in five hospitals of Rwanda

Disrespectful Care Towards Mothers Giving Birth at Selected Hospital of Kigali/Rwanda

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