Applying the COM-B Model to Understand the Drivers of Mistreatment During Childbirth: A Qualitative Enquiry Among Maternity Care Staff.
Applying the COM-B Model to Understand the Drivers of Mistreatment During Childbirth: A Qualitative Enquiry Among Maternity Care Staff.
复制标题
DOI：
10.9745/ghsp-d-22-00267
复制
发表时间：
2023-02-28
期刊：
影响因子：
--
通讯作者：
Avan BI
中科院分区：
文献类型：
--
作者：
Asim M;Hameed W;Khan B;Saleem S;Avan BI
促进尊重产妇护理需要解决虐待的驱动因素，并加强产妇护理工作人员提供尊重和基于权利的产妇护理的能力。分娩期间虐待的主要驱动因素之一包括缺乏对工作人员的人际交往技巧和社会心理支持的培训，这导致提供者不了解患者的权利还包括公平、尊重和满意，而不仅仅是获得高质量临床护理的权利。提供者根据自己的文化偏好和舒适度限制陪产同伴的存在，特别是男性，从而剥夺了妇女在分娩时的支持来源。提供者对患者，特别是低种姓和少数民族患者的身体和语言虐待、忽视和遗弃，是对患者缺乏合作和依从的回应，是常见和合理的。更强有力的绩效监测系统和患者反馈机制将有助于使工作人员对虐待负责，并有助于改善尊重产妇的护理。这些发现要求采取综合干预措施，提高工作人员对尊重和基于权利的产妇护理的知识和积极态度。在卫生设施一级，需要采取干预措施，加强治理、绩效监测和监督、问责机制和整合反馈，以不断改善产妇护理和服务。分娩期间尊重产妇护理是护理质量的一个组成部分。然而，妇女遭受虐待的经历在许多低收入和中等收入国家普遍存在。这是一个复杂的现象，还没有从行为科学的角度进行很好的探索。我们旨在了解巴基斯坦信德省公共卫生机构的产科护理人员在分娩期间受到虐待的行为驱动因素。应用COM-B（能力-机会-导致行为改变的动机）模型，我们对巴基斯坦信德省塔塔和苏贾瓦尔的公共卫生机构的临床和非临床工作人员进行了半结构化的深度访谈。数据采用主题演绎分析法进行分析，结果采用COM-B模型进行综合。我们发现了分娩过程中虐待的几个行为驱动因素：(1)缺乏关于RMC和培训机会的制度指南，导致提供者缺乏知识和技能；(2)医院缺乏保障患者隐私和保密的基础设施，不允许男性陪产；(3)缺乏医疗服务提供者绩效监控系统和患者反馈机制，导致医疗服务提供者感觉不被欣赏和认可。工作人员对低种姓患者的偏见导致了对患者的虐待和虐待。临床和非临床工作人员的观点在分娩过程中虐待的潜在驱动因素重叠。解决分娩期间的虐待问题需要提高产科工作人员关于RMC和社会心理支持的知识和能力，以增强他们对RMC的理解。在卫生设施一级，需要改进工作人员日常监督和监测方面的治理和问责机制。在提供满足患者偏好和需求的产科护理服务时，应结合患者的反馈，不断改进。
The promotion of respectful maternity care requires addressing the drivers of mistreatment and strengthening the capacity of maternity care staff to provide respectful and rights-based maternity care. One of the major drivers of mistreatment during childbirth includes the lack of staff training on interpersonal skills and psychosocial support, which resulted in providers lacking the understanding that patients’ rights also include equity, respect, and satisfaction—and not only the right to high-quality clinical care. Providers restricted the presence of birth companions, particularly males, based on providers’ own cultural preferences and comfort, thus denying women a source of support during childbirth. Provider’s physical and verbal abuse, neglect, and abandonment of patients, particularly of those from lower castes and minority ethnic groups, in response to patients’ lack of cooperation and compliance was common and justified. Stronger performance monitoring systems and patient feedback mechanisms would help hold staff accountable for mistreatment and contribute to improving respectful maternity care. These findings call for a comprehensive intervention that enhances staff members’ knowledge of and positive attitude toward respectful and rights-based maternity care. At the health facility level, interventions are needed to strengthen governance, performance monitoring and supervision, accountability mechanisms, and integration of feedback to continually improve maternity care and services. Respectful maternity care (RMC) during childbirth is an integral component of quality of care. However, women’s experiences of mistreatment are prevalent in many low- and middle-income countries. This is a complex phenomenon that has not been well explored from a behavioral science perspective. We aimed to understand the behavioral drivers of mistreatment during childbirth among maternity care staff at public health facilities in the Sindh province of Pakistan. Applying the COM-B (capability–opportunity–motivation that leads to behavior change) model, we conducted semistructured in-depth interviews among clinical and nonclinical staff in public health facilities in Thatta and Sujawal, Sindh, Pakistan. Data were analyzed using thematic deductive analysis, and findings were synthesized using the COM-B model. We identified several behavioral drivers of mistreatment during childbirth: (1) institutional guidelines on RMC and training opportunities were absent, resulting in a lack of providers’ knowledge and skills; (2) facilities lacked the infrastructure to maintain patient privacy and confidentiality and did not permit males as birth companions; (3) lack of provider performance monitoring system and patient feedback mechanism contributed to providers not feeling appreciated or recognized. Staff bias against patients from lower castes contributed to patient abuse and mistreatment. The perspectives of clinical and nonclinical staff overlapped regarding potential drivers of mistreatment during childbirth. Addressing mistreatment during childbirth requires improving the knowledge and capacity of maternity staff on RMC and psychosocial support to enhance their understanding of RMC. At the health facility level, governance and accountability mechanisms in routine supervision and monitoring of staff need to be improved. Patients’ feedback should be incorporated for continuous improvement in providing maternity care services that meet patients’ preferences and needs.