Do Interventions that Promote Awareness of Rights Increase Use of Maternity Care Services? A Systematic Review.
Do Interventions that Promote Awareness of Rights Increase Use of Maternity Care Services? A Systematic Review.
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DOI：
10.1371/journal.pone.0138116
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发表时间：
2015
期刊：
影响因子：
3.7
通讯作者：
Portela A
中科院分区：
文献类型：
--
作者：
George AS;Branchini C;Portela A
在各国政府承认妇女安全怀孕和分娩的权利20年后，我们评估了提高对这些权利的认识以增加孕产妇保健服务使用的干预措施的效果。使用同行评审方案中定义的纳入和排除标准，我们从一个孕产妇健康研究数据库、两个搜索引擎、一个互联网搜索和与专家联系中检索已发表和灰色文献。在所发现的707份独特文件中，219份提到权利，22份详细介绍了提高对孕产妇和新生儿健康权利认识的干预措施。其中只有四项评估了对健康结果的影响。虽然所有四项干预措施都促进了对权利的认识，但它们的方式不同。干预措施包括高度照本宣科的分发会议，提供教育材料和其他视觉辅助工具，采取参与性办法，将提高对权利的认识与改善服务问责制结合起来，并扩大多方利益攸关方改善孕产妇健康的努力。研究质量从弱到强不等。测量的健康结果包括增加产前护理和设施分娩。还报告了在不同程度上改善人权成果的情况，如护理的可提供性、可接受性、可获得性、质量以及权利持有人和责任承担人的能力。关于成本的信息很少，几乎没有关于危害或风险的信息。尽管搜索了多种信息来源，但一些研究报告确实报告了提高对权利的认识的活动，但很少有详细说明这些活动是如何开展的，也很少衡量对健康结果的影响。提高对权利的认识是妇女在怀孕、分娩和产后对高质量产妇保健服务的需求和利用不断增加的一个因素。到目前为止，文献和方案理论、过程和成本都没有很好地记录这些努力，更不用说对健康的影响了。
Twenty years after the rights of women to go through pregnancy and childbirth safely were recognized by governments, we assessed the effects of interventions that promote awareness of these rights to increase use of maternity care services. Using inclusion and exclusion criteria defined in a peer-reviewed protocol, we searched published and grey literature from one database of studies on maternal health, two search engines, an internet search and contact with experts. From the 707 unique documents found, 219 made reference to rights, with 22 detailing interventions promoting awareness of rights for maternal and newborn health. Only four of these evaluated effects on health outcomes. While all four interventions promoted awareness of rights, they did so in different ways. Interventions included highly-scripted dissemination meetings with educational materials and other visual aids, participatory approaches that combined raising awareness of rights with improving accountability of services, and broader multi-stakeholder efforts to improve maternal health. Study quality ranged from weak to strong. Measured health outcomes included increased antenatal care and facility birth. Improvements in human rights outcomes such as availability, acceptability, accessibility, quality of care, as well as the capacity of rights holders and duty bearers were also reported to varying extents. Very little information on costs and almost no information on harms or risks were described. Despite searching multiple sources of information, while some studies did report on activities to raise awareness of rights, few detailed how they did so and very few measured effects on health outcomes. Promoting awareness of rights is one element of increasing demand for and use of quality maternity care services for women during pregnancy, birth and after birth. To date efforts have not been well documented in the literature and the program theories, processes and costs, let alone health effects have not been well evaluated.