Understanding the Mechanisms of Change in the Supportive and Respectful Maternity Care Intervention in Sindh, Pakistan: Provider Perspectives.
Understanding the Mechanisms of Change in the Supportive and Respectful Maternity Care Intervention in Sindh, Pakistan: Provider Perspectives.
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DOI：
10.9745/ghsp-d-23-00216
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发表时间：
2023-12-22
期刊：
影响因子：
--
通讯作者：
Siddiqi S
中科院分区：
文献类型：
--
作者：
Avan BI;Hameed W;Khan B;Asim M;Saleem S;Siddiqi S
作者确定了支持性和尊重性的孕产妇保健干预措施是通过沿着多种途径实施的，并与各种卫生系统组成部分协调一致，以实现孕产妇团队的积极过程和行为改变。通过以旨在提供尊重的护理和心理社会支持的行为取代现有的有害做法，加强了提供者的RMC能力，帮助提供者更好地了解妇女的需求和偏好，并更好地与她们互动。振兴产妇团队的概念，包括所有临床和非临床工作人员在提供个性化的护理和支持的作用，改善了护理和工作人员的沟通的连续性。征求妇女对其分娩经历的反馈意见，并将S-RMC纳入现有的业绩审查机制，有助于提供者了解差距，使他们能够在采取纠正行动时相互支持。我们确定了几个潜在的机制，负责提供支持和尊重产妇护理（S-RMC）的变化：除了评估促进尊重产妇护理和积极分娩体验的干预措施的有效性外，了解变化的机制对于在卫生系统中嵌入S-RMC组件的扩大战略至关重要。这些证据应辅之以关于S-RMC有效性和能力的大规模研究，以使其能够满足不同环境中的需求。我们进行了定性调查，以探讨在巴基斯坦信德省的支持和尊重产妇护理干预（S-RMC）所产生的提供尊重的护理的变化机制。我们采用了描述性解释性研究设计的现实主义评价方法的原则。我们进行了深入的采访，在二级公共卫生设施，S-RMC实施了6个月的36个孕产妇保健提供者。该战略的主要组成部分包括产科团队的能力建设和公共卫生设施内改善治理和问责制的系统性变革。使用演绎内容分析法对数据进行分析。我们确定了改变的机制，按S-RMC组成部分分类：（1）S-RMC培训：洞察妇女的感受和权利，实现非临床工作人员可以发挥的价值，理解团队协调，在产妇护理的心理社会组成部分的方向;（2）评估妇女的心理社会脆弱性：确定妇女的差异需要超出常规护理，以提供以妇女为中心的护理;（3）心理社会支持：与妇女和产科团队有效接触，定制以妇女和陪伴为重点的护理;（4）护理协调：改善临床和非临床工作人员之间的协调，以提供个性化护理和心理社会支持，并进行适当的交接，以确保护理的连续性;（5）评估护理质量：根据妇女的反馈确定服务差距;及（6）表现检讨及问责：每月举行表现检讨会议，以建立团队成员的沟通，系统地了解产科团队的表现及挑战，并实施集体纠正措施。我们的研究结果指出，S-RMC沿着沿着多条路径工作，并与各种卫生系统组成部分协调一致，以实现产科团队的积极过程和行为改变。
The authors identify ways that a supportive and respectful maternity care intervention was implemented along multiple pathways–and concertedly with various health system components–to enable positive processes and behavioral change in maternity teams. Strengthening providers' capacity of RMC by replacing existing harmful practices with behaviors designed to provide respectful care and psychosocial support helped providers better understand women's needs and preferences and better engage with them. Revitalizing the notion of the maternity team to include all clinical and nonclinical staff as having a role in providing personalized care and support improved the continuity of care and staff communication. Soliciting women's feedback about their birthing experience and embedding S-RMC in the existing performance review mechanism helped providers understand gaps and enabled them to support each other in implementing corrective actions. We identified several underlying mechanisms that were responsible for changes in providing supportive and respectful maternity care (S-RMC): Beyond assessing the effectiveness of an intervention that promotes respectful maternity care and a positive birthing experience, understanding the mechanisms of change is vital to inform the scale-up strategy for embedding S-RMC components within the health system. Such evidence should be complemented by large-scale research on S-RMC effectiveness and competencies to enable its responsiveness to needs in diverse settings. We conducted this qualitative investigation to explore the mechanisms of change in providing respectful care resulting from the supportive and respectful maternity care intervention (S-RMC) in Sindh, Pakistan. We applied the principles of realist evaluation methodology with a descriptive explanatory research design. We conducted in-depth interviews with 36 maternity care providers at secondary-level public health facilities where S-RMC was implemented for 6 months. The S-RMC broad components included capacity-building of maternity teams and systemic changes for improvements in governance and accountability within public health facilities. Data were analyzed using a deductive content analysis approach. We identified mechanisms of change, categorized by the S-RMC components: (1) S-RMC training: insight into women's feelings and rights, realization of the value that nonclinical staff can play, understanding of team coordination, orientation in psychosocial components of maternity care; (2) assessment of women's psychosocial vulnerabilities: identification of women's differential needs beyond routine care to provide woman-centered care; (3) psychosocial support: effective engagement with women and within maternity teams and the customization of woman- and companion-focused care; (4) care coordination: improved coordination among clinical and nonclinical staff to provide personalized care and psychosocial support and proper handover to ensure continuity of care; (5) assessment of quality of care: identification of service gaps from women's feedback; and (6) performance review and accountability: monthly performance review meetings to establish team member communication, systematic awareness of the maternity team's performance and challenges, and implementation of collective corrective actions. Our findings pointed to S-RMC working along multiple pathways—and concertedly with various health system components—to enable positive processes and behavioral change in maternity teams.
影响因子：
3.7
作者：
Avan BI;Hameed W;Khan B;Asim M;Saleem S;Siddiqi S
通讯作者：
Siddiqi S
DOI：
10.1371/journal.pgph.0000550
发表时间：
2022
期刊：
PLOS global public health
影响因子：
--
作者：
Hameed, Waqas;Khan, Bushra;Siddiqi, Sameen;Asim, Muhammad;Avan, Bilal Iqbal
通讯作者：
Avan, Bilal Iqbal
影响因子：
3.7
作者：
Hameed W;Uddin M;Avan BI
通讯作者：
Avan BI