Srivastava Aradhana, Avan Bilal I, Rajbangshi Preety, Bhattacharyya Sanghita
Public Health Foundation of India, Plot no. 47, Sector 44, Institutional Area, Gurgaon, Haryana, 122002, India.
Faculty of infectious and tropical diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
BMC Pregnancy Childbirth. 2015 Apr 18;15:97. doi: 10.1186/s12884-015-0525-0.
Developing countries account for 99 percent of maternal deaths annually. While increasing service availability and maintaining acceptable quality standards, it is important to assess maternal satisfaction with care in order to make it more responsive and culturally acceptable, ultimately leading to enhanced utilization and improved outcomes. At a time when global efforts to reduce maternal mortality have been stepped up, maternal satisfaction and its determinants also need to be addressed by developing country governments. This review seeks to identify determinants of women's satisfaction with maternity care in developing countries.
The review followed the methodology of systematic reviews. Public health and social science databases were searched. English articles covering antenatal, intrapartum or postpartum care, for either home or institutional deliveries, reporting maternal satisfaction from developing countries (World Bank list) were included, with no year limit. Out of 154 shortlisted abstracts, 54 were included and 100 excluded. Studies were extracted onto structured formats and analyzed using the narrative synthesis approach.
Determinants of maternal satisfaction covered all dimensions of care across structure, process and outcome. Structural elements included good physical environment, cleanliness, and availability of adequate human resources, medicines and supplies. Process determinants included interpersonal behavior, privacy, promptness, cognitive care, perceived provider competency and emotional support. Outcome related determinants were health status of the mother and newborn. Access, cost, socio-economic status and reproductive history also influenced perceived maternal satisfaction. Process of care dominated the determinants of maternal satisfaction in developing countries. Interpersonal behavior was the most widely reported determinant, with the largest body of evidence generated around provider behavior in terms of courtesy and non-abuse. Other aspects of interpersonal behavior included therapeutic communication, staff confidence and competence and encouragement to laboring women.
Quality improvement efforts in developing countries could focus on strengthening the process of care. Special attention is needed to improve interpersonal behavior, as evidence from the review points to the importance women attach to being treated respectfully, irrespective of socio-cultural or economic context. Further research on maternal satisfaction is required on home deliveries and relative strength of various determinants in influencing maternal satisfaction.
发展中国家每年的孕产妇死亡人数占全球的99%。在增加服务可及性并维持可接受的质量标准的同时，评估孕产妇对护理的满意度以使其更具响应性且符合文化习惯，最终提高利用率并改善结局，这一点很重要。在全球加大努力降低孕产妇死亡率之际，发展中国家政府也需要关注孕产妇满意度及其决定因素。本综述旨在确定发展中国家妇女对孕产妇护理满意度的决定因素。
本综述遵循系统综述的方法。检索了公共卫生和社会科学数据库。纳入了涵盖产前、产时或产后护理的英文文章，涉及家庭分娩或机构分娩，报告了来自发展中国家（世界银行列出的国家）的孕产妇满意度，无年份限制。在154篇入围摘要中，54篇被纳入，100篇被排除。研究被提取到结构化格式中，并采用叙述性综合方法进行分析。
孕产妇满意度的决定因素涵盖护理的各个维度，包括结构、过程和结果。结构要素包括良好的物理环境、清洁度以及充足的人力资源及药品和物资供应。过程决定因素包括人际行为、隐私、及时性、认知护理、感知到的提供者能力和情感支持。与结果相关的决定因素是母亲和新生儿的健康状况。可及性、成本、社会经济地位和生育史也影响了感知到的孕产妇满意度。护理过程在发展中国家孕产妇满意度的决定因素中占主导地位。人际行为是报告最广泛的决定因素，关于提供者行为在礼貌和不虐待方面的证据最多。人际行为的其他方面包括治疗性沟通、工作人员的信心和能力以及对分娩妇女的鼓励。
发展中国家的质量改进工作可以侧重于加强护理过程。需要特别关注改善人际行为，因为综述的证据表明，无论社会文化或经济背景如何，妇女都重视受到尊重的待遇。需要进一步研究家庭分娩的孕产妇满意度以及各种决定因素对孕产妇满意度影响的相对强度。
