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Afulani PA, Buback L, McNally B, Mbuyita S, Mwanyika-Sando M, Peca E. A Rapid Review of Available Evidence to Inform Indicators for Routine Monitoring and Evaluation of Respectful Maternity Care. GLOBAL HEALTH, SCIENCE AND PRACTICE 2020; 8:125-135. [PMID: 32234844 PMCID: PMC7108935 DOI: 10.9745/ghsp-d-19-00323] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 02/11/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND Some opportunities to routinely capture and improve respectful maternity care (RMC) during facility-based childbirth include quality improvement (QI) initiatives, community-based monitoring efforts through community score cards (CSC), and performance-based financing (PBF) initiatives. But there is limited guidance on which types of RMC indicators are best suited for inclusion in these initiatives. We sought to provide practical evidence-based recommendations on indicators that may be used for routine measurement of RMC in programs. METHODS We used a rapid review approach, which included (1) reviewing existing documents and publications to extract RMC indicators and identify which have or can be used in facility-based QI, CSCs, and PBF schemes; (2) surveying RMC and maternal health experts to rank indicators, and (3) analyzing survey data to select the most recommended indicators. RESULTS We identified 49 indicators spanning several domains of RMC and mistreatment including dignified/nondignified care, verbal and physical abuse, privacy/confidentiality, autonomy/loss of autonomy, supportive care/lack thereof, communication, stigma, discrimination, trust, facility environment/culture, responsiveness, and nonevidence-based care. Based on the analysis of the survey data, we recommend 33 indicators (between 2 and 6 indicators for each RMC domain) that may be suited for incorporation in both facility-based QI and CSC-related monitoring efforts. CONCLUSION Integrating RMC indicators into QI and CSC initiatives, as well as in other maternal and neonatal health programs, could help improve RMC at the facility and community level. More research is needed into whether RMC can be integrated into PBF initiatives. Integration of RMC indicators into programs to improve quality of care and other health system outcomes will facilitate routine monitoring and accountability around experience of care. Measurement and improvement of women's experiences will increase maternal health service utilization and improve quality of care as a means of reducing maternal and neonatal morbidity and mortality.
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Affiliation(s)
- Patience A Afulani
- Institute for Global Health Sciences, University of California San Francisco, San Francisco, CA, USA.
| | - Laura Buback
- Institute for Global Health Sciences, University of California San Francisco, San Francisco, CA, USA
| | - Brienne McNally
- Institute for Global Health Sciences, University of California San Francisco, San Francisco, CA, USA
| | | | | | - Emily Peca
- University Research Co., LLC, Chevy Chase, MD, USA
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Montagu D, Landrian A, Kumar V, Phillips BS, Singhal S, Mishra S, Singh S, Cotter SY, Singh VP, Kajal F, Sudhinaraset M. Patient-experience during delivery in public health facilities in Uttar Pradesh, India. Health Policy Plan 2020; 34:574-581. [PMID: 31419287 PMCID: PMC6794568 DOI: 10.1093/heapol/czz067] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2019] [Indexed: 11/12/2022] Open
Abstract
In India, most women now delivery in hospitals or other facilities, however, maternal and neonatal mortality remains stubbornly high. Studies have shown that mistreatment causes delays in care-seeking, early discharge and poor adherence to post-delivery guidance. This study seeks to understand the variation of women’s experiences in different levels of government facilities. This information can help to guide improvement planning. We surveyed 2018 women who gave birth in a representative set of 40 government facilities from across Uttar Pradesh (UP) state in northern India. Women were asked about their experiences of care, using an established scale for person-centred care. We asked questions specific to treatment and clinical care, including whether tests such as blood pressure, contraction timing, newborn heartbeat or vaginal exams were conducted, and whether medical assessments for mothers or newborns were done prior to discharge. Women delivering in hospitals reported less attentive care than women in lower-level facilities, and were less trusting of their providers. After controlling for a range of demographic attributes, we found that better access, higher clinical quality, and lower facility-level, were all significantly predictive of patient-centred care. In UP, lower-level facilities are more accessible, women have greater trust for the providers and women report being better treated than in hospitals. For the vast majority of women who will have a safe and uncomplicated delivery, our findings suggest that the best option would be to invest in improvements mid-level facilities, with access to effective and efficient emergency referral and transportation systems should they be needed.
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Affiliation(s)
- Dominic Montagu
- School of Medicine, Department of Epidemiology and Biostatistics, University of California, San Francisco, Mission Hall 550 16th St. 3rd Floor, San Francisco, CA, USA
| | - Amanda Landrian
- Jonathan and Karin Fielding School of Public Health, University of California, 650 Charles E. Young Dr. South, Los Angeles, CA, USA
| | | | - Beth S Phillips
- School of Medicine, Department of Epidemiology and Biostatistics, University of California, San Francisco, Mission Hall 550 16th St. 3rd Floor, San Francisco, CA, USA
| | - Shreya Singhal
- Community Empowerment Lab, Lucknow, Uttar Pradesh, India
| | | | | | - Sun Yu Cotter
- School of Medicine, Department of Epidemiology and Biostatistics, University of California, San Francisco, Mission Hall 550 16th St. 3rd Floor, San Francisco, CA, USA
| | | | - Fnu Kajal
- National Health Mission, Lucknow, Uttar Pradesh, India
| | - May Sudhinaraset
- Jonathan and Karin Fielding School of Public Health, University of California, 650 Charles E. Young Dr. South, Los Angeles, CA, USA
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Afulani PA, Aborigo RA, Walker D, Moyer CA, Cohen S, Williams J. Can an integrated obstetric emergency simulation training improve respectful maternity care? Results from a pilot study in Ghana. Birth 2019; 46:523-532. [PMID: 30680785 DOI: 10.1111/birt.12418] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 12/28/2018] [Accepted: 12/28/2018] [Indexed: 01/28/2023]
Abstract
BACKGROUND Few evidence-based interventions exist on how to improve respectful maternity care (RMC) in low-resource settings. We sought to evaluate the effect of an integrated simulation-based training on provision of RMC. METHODS The pilot project was in East Mamprusi District in northern Ghana. We integrated specific components of RMC, emphasizing dignity and respect, communication and autonomy, and supportive care, into a simulation training to improve identification and management of obstetric and neonatal emergencies. Forty-three providers were trained. For evaluation, we conducted surveys at baseline (N = 215) and endline (N = 318) 6 months later, with recently delivered women to assess their experiences of care using the person-centered maternity care scale. Higher scores on the scale represent more respectful care. RESULTS Compared to the baseline, women in the endline reported more respectful care. The average person-centered maternity care score increased from 50 at baseline to 72 at endline, a relative increase of 43%. Scores on the subscales also increased between baseline and endline: 15% increase for dignity and respect, 87% increase for communication and autonomy, and 55% increase for supportive care. These differences remained significant in multivariate analysis controlling for several potential confounders. CONCLUSIONS The findings suggest that integrated provider trainings that give providers the opportunity to learn, practice, and reflect on their provision of RMC in the context of stressful emergency obstetric simulations have the potential to improve women's childbirth experiences in low-resource settings. Incorporating such trainings into preservice and in-service training of providers will help advance global efforts to promote RMC.
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Affiliation(s)
- Patience A Afulani
- School of Medicine, Institute for Global Health Sciences, University of California, San Francisco, California
| | | | - Dilys Walker
- School of Medicine, Institute for Global Health Sciences, University of California, San Francisco, California.,PRONTO International, Seattle, Washington
| | | | - Susanna Cohen
- PRONTO International, Seattle, Washington.,College of Nursing, University of Utah, Salt Lake City, Utah
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Sudhinaraset M, Giessler K, Golub G, Afulani P. Providers and women's perspectives on person-centered maternity care: a mixed methods study in Kenya. Int J Equity Health 2019; 18:83. [PMID: 31182105 PMCID: PMC6558853 DOI: 10.1186/s12939-019-0980-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 05/08/2019] [Indexed: 11/24/2022] Open
Abstract
Background Globally, there has been increasing attention to women’s experiences of care and calls for a person-centered care approach. At the heart of this approach is the patient-provider relationship. It is necessary to examine the extent to which providers and women agree on the care that is provided and received. Studies have found that incongruence between women’s and providers’ perceptions may negatively impact women’s compliance, satisfaction, and future use of health facilities. However, there are no studies that examine patient and provider perspectives on person-centered care. Methods To fill this gap in the literature, we use cross-sectional data of 531 women and 33 providers in seven government health facilities in Kenya to assess concordance and discordance in person-centered care measures. Additionally, we analyze 41 in-depth interviews with providers from three of these facilities to examine why differences in reporting may occur. Descriptive statistical methods were used to measure the magnitude of differences between reports of women and reports of providers. Thematic analyses were conducted for provider surveys. Results Our findings suggest high discordance between women and providers’ perspectives in regard to person-centered care experiences. On average, women reported lower levels of person-centered care compared to providers, including low respectful and dignified care, communication and autonomy, and supportive care. Providers were more likely to report higher rates of poor health facility environment such as having sufficient staff. We summarize the overarching reasons for the divergence in women and provider reports as: 1) different understanding or interpretation of person-centered care behaviors, and 2) different expectations, norms or values of provider behaviors. Providers rationalized abuse towards women, did not allow a companion of choice, and blamed women for poor patient-provider communication. Women lacked assurance in privacy and confidentiality, and faced challenges related to the health facility environment. Providers attributed poor person-centered care to both individual and facility/systemic factors. Conclusions Implications of this study suggests that providers should be trained on person-centered care approaches and women should be counseled on understanding patient rights and how to communicate with health professionals.
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Affiliation(s)
- May Sudhinaraset
- University of California, Los Angeles, Jonathan and Karin Fielding School of Public Health, Los Angeles, USA. .,School of Medicine, University of California, San Francisco, USA.
| | - Katie Giessler
- School of Medicine, University of California, San Francisco, USA
| | | | - Patience Afulani
- School of Medicine, University of California, San Francisco, USA
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Larson E, Sharma J, Bohren MA, Tunçalp Ö. When the patient is the expert: measuring patient experience and satisfaction with care. Bull World Health Organ 2019; 97:563-569. [PMID: 31384074 PMCID: PMC6653815 DOI: 10.2471/blt.18.225201] [Citation(s) in RCA: 167] [Impact Index Per Article: 33.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 05/10/2019] [Accepted: 05/15/2019] [Indexed: 12/02/2022] Open
Abstract
In 2018, three independent reports were published, emphasizing the need for attention to, and improvements in, quality of care to achieve effective universal health coverage. A key aspect of high quality health care and health systems is that they are person-centred, a characteristic that is at the same time intrinsically important (all individuals have the right to be treated with dignity and respect) and instrumentally important (person-centred care is associated with improved health-care utilization and health outcomes). Following calls to make 2019 a year of action, we provide guidance to policy-makers, researchers and implementers on how they can take on the task of measuring person-centred care. Theoretically, measures of person-centred care allow quality improvement efforts to be evaluated and ensure that health systems are accountable to those they aim to serve. However, in practice, the utility of these measures is limited by lack of clarity and precision in designing and by using measures for different aspects of person-centeredness. We discuss the distinction between two broad categories of measures of patient-centred care: patient experience and patient satisfaction. We frame our discussion of these measures around three key questions: (i) how will the results of this measure be used?; (ii) how will patient subjectivity be accounted for?; and (iii) is this measure validated or tested? By addressing these issues during the design phase, researchers will increase the usability of their measures.
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Affiliation(s)
- Elysia Larson
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, 655 Huntington Ave. Building II, 4th floor, Boston, MA 02115, United States of America (USA)
| | - Jigyasa Sharma
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, USA
| | - Meghan A Bohren
- Centre for Health Equity, University of Melbourne School of Population and Global Health, Melbourne, Australia
| | - Özge Tunçalp
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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Afulani PA, Phillips B, Aborigo RA, Moyer CA. Person-centred maternity care in low-income and middle-income countries: analysis of data from Kenya, Ghana, and India. LANCET GLOBAL HEALTH 2019; 7:e96-e109. [PMID: 30554766 PMCID: PMC6293963 DOI: 10.1016/s2214-109x(18)30403-0] [Citation(s) in RCA: 121] [Impact Index Per Article: 24.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 06/16/2018] [Accepted: 08/16/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND Several qualitative studies have described disrespectful, abusive, and neglectful treatment of women during facility-based childbirth, but few studies document the extent of person-centred maternity care (PCMC)-ie, responsive and respectful maternity care-in low-income and middle-income countries. In this Article, we present descriptive statistics on PCMC in four settings across three low-income and middle-income countries, and we examine key factors associated with PCMC in each setting. METHODS We examined data from four cross-sectional surveys with 3625 women aged 15-49 years who had recently given birth in Kenya, Ghana, and India (surveys were done from August, 2016, to October, 2017). The Kenya data were collected from a rural county (n=877) and from seven health facilities in two urban counties (n=530); the Ghana data were from five rural health facilities in the northern region (n=200); and the India data were from 40 health facilities in Uttar Pradesh (n=2018). The PCMC measure used was a previously validated scale with subscales for dignity and respect, communication and autonomy, and supportive care. We analysed the data using descriptive statistics and bivariate and multivariate regressions to examine predictors of PCMC. FINDINGS The highest mean PCMC score was found in urban Kenya (60·2 [SD 12·3] out of 90), and the lowest in rural Ghana (46·5 [6·9]). Across sites, the lowest scores were in communication and autonomy (from 8·3 [3.3] out of 27 in Ghana to 15·1 [5·9] in urban Kenya). 3280 (90%) of the total 3625 women across all countries reported that providers never introduced themselves, and 2076 (57%) women (1475 [73%] of 1980 in India) reported providers never asked permission before performing medical procedures. 120 (60%) of 200 women in Ghana and 1393 (69%) of 1980 women in India reported that providers did not explain the purpose of examinations or procedures, and 116 (58%) women in Ghana and 1162 (58%) in India reported they did not receive explanations on medications they were given; additionally, 104 (52%) women in Ghana did not feel able to ask questions. Overall, 576 (16%) women across all countries reported verbal abuse, and 108 (3%) reported physical abuse. PCMC varied by socioeconomic status and type of facility in three settings (ie, rural and urban Kenya, and India). INTERPRETATION Regardless of the setting, women are not getting adequate PCMC. Efforts are needed to improve the quality of facility-based maternity care. FUNDING Bill & Melinda Gates Foundation, Marc and Lynne Benioff, and USAID Systems for Health.
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Affiliation(s)
- Patience A Afulani
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA; Institute for Global Health Sciences, University of California, San Francisco, CA, USA.
| | - Beth Phillips
- Institute for Global Health Sciences, University of California, San Francisco, CA, USA
| | - Raymond A Aborigo
- Population and Reproductive Health unit, Navrongo Health Research Centre, Navrongo, Ghana
| | - Cheryl A Moyer
- Department of Learning Health Sciences and Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA
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Afulani PA, Feeser K, Sudhinaraset M, Aborigo R, Montagu D, Chakraborty N. Toward the development of a short multi‐country person‐centered maternity care scale. Int J Gynaecol Obstet 2019; 146:80-87. [DOI: 10.1002/ijgo.12827] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 12/17/2018] [Accepted: 04/18/2019] [Indexed: 11/09/2022]
Affiliation(s)
- Patience A. Afulani
- Epidemiology and Biostatistics School of Medicine University of California San Francisco CA USA
| | - Karla Feeser
- Research and Technical Assistance Metrics for Management Oakland CA USA
| | - May Sudhinaraset
- Epidemiology and Biostatistics School of Medicine University of California San Francisco CA USA
| | - Raymond Aborigo
- Department of Public Health Navrongo Health Research Center Navrongo Ghana
| | - Dominic Montagu
- Epidemiology and Biostatistics School of Medicine University of California San Francisco CA USA
- Research and Technical Assistance Metrics for Management Oakland CA USA
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Measuring what matters for maternal and newborn health. THE LANCET GLOBAL HEALTH 2019; 7:e544-e545. [DOI: 10.1016/s2214-109x(19)30149-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 03/04/2019] [Indexed: 10/27/2022] Open
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Kassa ZY, Husen S. Disrespectful and abusive behavior during childbirth and maternity care in Ethiopia: a systematic review and meta-analysis. BMC Res Notes 2019; 12:83. [PMID: 30760318 PMCID: PMC6375170 DOI: 10.1186/s13104-019-4118-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 02/06/2019] [Indexed: 11/17/2022] Open
Abstract
Objective Disrespectful and abusive behavior during childbirth and maternity care is violation of fundamental right of women and unborn child. There is scarce of data on disrespectful and abusive behavior during childbirth and maternity care in Ethiopia. The aim of this study was to determine disrespectful and abusive behavior during childbirth and maternity care in Ethiopia. Results Seven studies were included in this meta-analysis of disrespectful and abusive behavior during childbirth and maternity care. The pooled prevalence of disrespect and abuse care during childbirth and maternity care was 49.4% (95% CI 30.9–68.1). Whereas physical abuse was 13.6% (95% CI 5.2–31.2), non-confidential care was 14.1% (95% CI 7.3–25.4), abandonment care was 16.4% (95% CI 14.7–18.2), and detention was 3.2% (95% CI 0.9–11.5). This study showed that disrespectful and abusive behavior during child birth and maternity care is high. Whereas, abandonment care is high. This study indicates that health care providers shall not leave women during childbirth and maternity care and listen women, federal minister of health and regional health bureau also identifying root of cause disrespect and abuse and to alleviate mistreatment during childbirth and maternity care. Electronic supplementary material The online version of this article (10.1186/s13104-019-4118-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Zemenu Yohannes Kassa
- Department of Midwifery, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia.
| | - Siraj Husen
- School of Medical Laboratory Science, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
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