D'Ambruoso Lucia, Abbey Mercy, Hussein Julia
IMMPACT, University of Aberdeen, Aberdeen, UK.
BMC Public Health. 2005 Dec 22;5:140. doi: 10.1186/1471-2458-5-140.
This study was undertaken to investigate women's accounts of interactions with health care providers during labour and delivery and to assess the implications for acceptability and utilisation of maternity services in Ghana.
Twenty-one individual in-depth interviews and two focus group discussions were conducted with women of reproductive age who had delivered in the past five years in the Greater Accra Region. The study investigated women's perceptions and experiences of care in terms of factors that influenced place of delivery, satisfaction with services, expectations of care and whether they would recommend services.
One component of care which appeared to be of great importance to women was staff attitudes. This factor had considerable influence on acceptability and utilisation of services. Otherwise, a successful labour outcome and non-medical factors such as cost, perceived quality of care and proximity of services were important. Our findings indicate that women expect humane, professional and courteous treatment from health professionals and a reasonable standard of physical environment. Women will consciously change their place of delivery and recommendations to others if they experience degrading and unacceptable behaviour.
The findings suggest that inter-personal aspects of care are key to women's expectations, which in turn govern satisfaction. Service improvements which address this aspect of care are likely to have an impact on health seeking behaviour and utilisation. Our findings suggest that user-views are important and warrant further investigation. The views of providers should also be investigated to identify channels by which service improvements, taking into account women's views, could be operationalised. We also recommend that interventions to improve delivery care should not only be directed to the health professional, but also to general health system improvements.
本研究旨在调查女性对分娩期间与医护人员互动的描述，并评估其对加纳产妇服务可接受性和利用率的影响。
对大阿克拉地区在过去五年内分娩的育龄妇女进行了21次个人深入访谈和两次焦点小组讨论。该研究从影响分娩地点、对服务的满意度、护理期望以及是否会推荐服务等因素方面调查了女性的护理观念和经历。
对女性而言似乎非常重要的一个护理要素是工作人员的态度。这一因素对服务的可接受性和利用率有相当大的影响。此外，顺利的分娩结果以及诸如费用、感知到的护理质量和服务距离等非医疗因素也很重要。我们的研究结果表明，女性期望医护人员给予人道、专业且礼貌的对待，以及合理的物理环境标准。如果女性经历了有辱人格且不可接受的行为，她们会有意识地改变分娩地点并向他人推荐不同的地方。
研究结果表明，护理的人际方面是女性期望的关键，而这些期望反过来又决定了满意度。解决这一护理方面问题的服务改进可能会对就医行为和利用率产生影响。我们的研究结果表明，用户观点很重要，值得进一步调查。还应调查提供者的观点，以确定考虑到女性观点的服务改进实施途径。我们还建议，改善分娩护理的干预措施不仅应针对医护人员，还应针对整个卫生系统的改进。
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