Mitigating disrespect and abuse during childbirth in Tanzania: an exploratory study of the effects of two facility-based interventions in a large public hospital
Mitigating disrespect and abuse during childbirth in Tanzania: an exploratory study of the effects of two facility-based interventions in a large public hospital
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DOI：
10.1186/s12978-016-0187-z
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发表时间：
2016-07-18
影响因子：
3.4
通讯作者：
McDonald, Kathleen P.
中科院分区：
文献类型：
--
作者：
Ratcliffe, Hannah L.;Sando, David;McDonald, Kathleen P.
背景：越来越多的证据表明，在世界各国，设施分娩期间的不尊重和虐待（D&A）很普遍，是实现良好孕产妇健康结果的障碍。然而，在确定有效的干预措施以预防和消除设施分娩期间的D&A方面仍有许多工作要做。本文描述了在坦桑尼亚达累斯萨拉姆的一家大型转诊医院进行的一项探索性研究，该研究试图衡量D&A，引入一揽子干预措施以减少其发生率，并评估其有效性。方法：在与关键选区广泛协商后，实施了两项独立的干预措施：(1)开放生育日（OBD），一项生育准备和产前保健教育计划，以及(2)基于卫生工作者变革课程的医疗保健提供者研讨会。每项干预措施都旨在提高对患者权利和分娩准备的认识；增加和改善患者-提供者和提供者-管理员的沟通；并改善妇女的经验和提供者的态度。使用岗前设计和一系列工具评估干预措施的效果：OBD参与者岗前问卷调查和讲习班参与者岗前问卷调查；与医疗保健提供者和管理人员进行结构化访谈；与在研究机构分娩的妇女进行结构化访谈；在分娩和分娩过程中直接观察病人和医生之间的互动。结果：干预前后的比较显示，患者和提供者在多个维度上对用户权利的了解有所增加，妇女对分娩和分娩过程的了解也有所增加。妇女报告说，她们为分娩做了更好的准备，提供者对她们的态度也有所改善，提供者报告说，他们对所服务的妇女的同情程度更高，人际关系也更好。患者和医疗服务提供者报告沟通有所改善，直接观察证实了这一点。此外，据报道，女性在分娩过程中感到更有力量和自信。提供者的工作满意度从基线水平大幅提高，用户报告的满意度和对护理质量的看法也是如此。结论：总的来说，本研究的结果表明，经过测试的干预措施有可能成功地促进结果，这是减少不尊重和虐待的先决条件。然而，需要进行更严格的评估，以确定这些干预措施的全面影响。
Background: There is emerging evidence that disrespect and abuse (D&A) during facility-based childbirth is prevalent in countries throughout the world and a barrier to achieving good maternal health outcomes. However, much work remains in the identification of effective interventions to prevent and eliminate D&A during facility-based childbirth. This paper describes an exploratory study conducted in a large referral hospital in Dares Salaam, Tanzania that sought to measure D&A, introduce a package of interventions to reduce its incidence, and evaluate their effectiveness.Methods: After extensive consultation with critical constituencies, two discrete interventions were implemented: (1) Open Birth Days (OBD), a birth preparedness and antenatal care education program, and (2) a workshop for healthcare providers based on the Health Workers for Change curriculum. Each intervention was designed to increase knowledge of patient rights and birth preparedness; increase and improve patient-provider and provider-administrator communication; and improve women's experience and provider attitudes. The effects of the interventions were assessed using a pre-post design and a range of tools: pre-post questionnaires for OBD participants and pre-post questionnaires for workshop participants; structured interviews with healthcare providers and administrators; structured interviews with women who gave birth at the study facility; and direct observations of patient-provider interactions during labor and delivery.Results: Comparisons before and after the interventions showed an increase in patient and provider knowledge of user rights across multiple dimensions, as well as women's knowledge of the labor and delivery process. Women reported feeling better prepared for delivery and provider attitudes towards them improved, with providers reporting higher levels of empathy for the women they serve and better interpersonal relationships. Patients and providers reported improved communication, which direct observations confirmed. Additionally, women reported feeling more empowered and confident during delivery. Provider job satisfaction increased substantially from baseline levels, as did user reports of satisfaction and perceptions of care quality.Conclusions: Collectively, the outcomes of this study indicate that the tested interventions have the potential to be successful in promoting outcomes that are prerequisite to reducing disrespect and abuse. However, a more rigorous evaluation is needed to determine the full impact of these interventions.