Attitudes and behaviours of maternal health care providers in interactions with clients: a systematic review.
Attitudes and behaviours of maternal health care providers in interactions with clients: a systematic review.
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DOI：
10.1186/s12992-015-0117-9
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发表时间：
2015-08-15
影响因子：
10.8
通讯作者：
Luchters S
中科院分区：
文献类型：
--
作者：
Mannava P;Durrant K;Fisher J;Chersich M;Luchters S
孕产妇死亡率和发病率居高不下，这在很大程度上是由于无法获得及时和高质量的保健。孕产妇保健提供者的态度和行为影响寻求保健和保健质量。检索了5个电子数据库中1990年1月至2014年12月的研究。纳入的研究报告的类型或影响MHCP的态度和行为对他们的客户，或影响这些态度和行为的因素。报告中没有提到与艾滋病毒感染有关的态度和行为，也没有提到对正规保健系统以外的保健提供者，如传统助产士的研究。在筛选的967个标题和412个摘要中，审查了125篇全文论文，纳入了81篇。大约三分之二的人使用定性方法，一半以上的人研究公共部门的设施。大多数研究在非洲（n = 55），其次是亚洲和太平洋（n = 17）。58项研究仅涉及消极的态度或行为，少数研究描述了积极的提供者行为，如关心、尊重、同情和帮助。消极的态度和行为通常包括言语虐待（n = 45），粗鲁，如忽视或辱骂患者（n = 35），或忽视（n = 32）。研究还记录了对妇女的身体虐待、提供者缺勤或不在、腐败、不尊重隐私、沟通不畅、不愿意接受传统做法以及专制或令人恐惧的态度。这些行为受到提供者工作量、患者态度和行为、提供者信念和偏见以及MHCP之间的优越感的影响。总的来说，消极的态度和行为破坏了寻求保健的机会，影响了病人的福祉。该综述记录了影响患者健康、护理满意度和寻求护理的广泛的消极MHCP态度和行为。报告的负面患者互动远远超过积极的。影响保健工作者态度和行为的因素的性质表明，加强保健系统和劳动力发展，包括交流和咨询技能的发展，是重要的。为了妇女和保健提供者的利益，在改善产妇保健的努力中，需要更多地关注产妇保健专业人员的态度和行为。本文的在线版本（doi：10.1186/s12992-015-0117-9）包含补充材料，可供授权用户使用。
High maternal mortality and morbidity persist, in large part due to inadequate access to timely and quality health care. Attitudes and behaviours of maternal health care providers (MHCPs) influence health care seeking and quality of care. Five electronic databases were searched for studies from January 1990 to December 2014. Included studies report on types or impacts of MHCP attitudes and behaviours towards their clients, or the factors influencing these attitudes and behaviours. Attitudes and behaviours mentioned in relation to HIV infection, and studies of health providers outside the formal health system, such as traditional birth attendants, were excluded. Of 967 titles and 412 abstracts screened, 125 full-text papers were reviewed and 81 included. Around two-thirds used qualitative methods and over half studied public-sector facilities. Most studies were in Africa (n = 55), followed by Asia and the Pacific (n = 17). Fifty-eight studies covered only negative attitudes or behaviours, with a minority describing positive provider behaviours, such as being caring, respectful, sympathetic and helpful. Negative attitudes and behaviours commonly entailed verbal abuse (n = 45), rudeness such as ignoring or ridiculing patients (n = 35), or neglect (n = 32). Studies also documented physical abuse towards women, absenteeism or unavailability of providers, corruption, lack of regard for privacy, poor communication, unwillingness to accommodate traditional practices, and authoritarian or frightening attitudes. These behaviours were influenced by provider workload, patients’ attitudes and behaviours, provider beliefs and prejudices, and feelings of superiority among MHCPs. Overall, negative attitudes and behaviours undermined health care seeking and affected patient well-being. The review documented a broad range of negative MHCP attitudes and behaviours affecting patient well-being, satisfaction with care and care seeking. Reported negative patient interactions far outweigh positive ones. The nature of the factors which influence health worker attitudes and behaviours suggests that strengthening health systems, and workforce development, including in communication and counselling skills, are important. Greater attention is required to the attitudes and behaviours of MHCPs within efforts to improve maternal health, for the sake of both women and health care providers. The online version of this article (doi:10.1186/s12992-015-0117-9) contains supplementary material, which is available to authorized users.