Probandari Ari, Arcita Akhda, Kothijah Kothijah, Pamungkasari Eti Poncorini
Department of Public Health, Faculty of Medicine, Universitas Sebelas Maret, Jl. Ir. Sutami 36A, Surakarta, 57126, Indonesia.
Master Program of Public Health, Graduate School, Universitas Sebelas Maret, Surakarta, Indonesia.
BMC Health Serv Res. 2017 Aug 7;17(1):541. doi: 10.1186/s12913-017-2490-y.
Maternal health remains a persisting public health challenge in Indonesia. Postnatal complications, in particular, are considered as maternal health problems priority that should be addressed. Conducting adequate care for postnatal complications will improve the quality of life of mothers and babies. With the universal health coverage implementation, the Indonesian government provides free maternal and child health services close to clients at the village level, which include postnatal care. Our study aimed to explore barriers to utilization of postnatal care at the village level in Klaten district, Central Java Province, Indonesia.
A qualitative study was conducted in March 2015 - June 2016 in Klaten district, Central Java, Indonesia. We selected a total of 19 study participants, including eight mothers with postnatal complications, six family members, and five village midwives for in-depth interviews. We conducted a content analysis technique on verbatim transcripts of the interviews using open code software.
This study found three categories of barriers to postnatal care utilization in villages: mother and family members' health literacy on postnatal care, sociocultural beliefs and practices, and health service responses. Most mothers did not have adequate knowledge and skills regarding postnatal care that reflected how they lacked awareness and practice of postnatal care. Inter-generational norms and myths hindered mothers from utilizing postnatal care and from having adequate nutritional intake during the postnatal period. Mothers and family members conducted unsafe self-treatment to address perceived minor postnatal complication. Furthermore, social power from extended family influenced the postnatal care health literacy for mother and family members. Postnatal care in the village lacked patient-centered care practices. Additionally, midwives' workloads and capacities to conduct postnatal information, education and counseling were also issues.
Despite the government's efforts to provide free postnatal care closer to mothers' homes, other barriers to postnatal care utilization remained. Specifically, among mothers, community, and health services. An innovative approach to increase the health literacy on postnatal care is required. In particular, improving the capacity of midwives to conduct patient-centered care. In addition, village midwives' tasks should be evaluated and reoriented.
孕产妇健康仍是印度尼西亚持续存在的公共卫生挑战。尤其是产后并发症，被视为应优先解决的孕产妇健康问题。对产后并发症进行充分护理将改善母婴的生活质量。随着全民健康覆盖的实施，印度尼西亚政府在村级为客户提供免费的母婴健康服务，其中包括产后护理。我们的研究旨在探讨印度尼西亚中爪哇省克拉滕区村级产后护理利用的障碍。
2015年3月至2016年6月在印度尼西亚中爪哇省克拉滕区进行了一项定性研究。我们共选取了19名研究参与者，包括8名有产后并发症的母亲、6名家庭成员和5名乡村助产士进行深入访谈。我们使用开放式编码软件对访谈的逐字记录进行了内容分析技术。
本研究发现村级产后护理利用存在三类障碍：母亲和家庭成员对产后护理的健康素养、社会文化信仰和习俗以及卫生服务反应。大多数母亲对产后护理没有足够的知识和技能，这反映出她们缺乏产后护理的意识和实践。代际规范和神话阻碍母亲利用产后护理以及在产后期间获得足够的营养摄入。母亲和家庭成员进行不安全的自我治疗以应对感知到的轻微产后并发症。此外，大家庭的社会权力影响了母亲和家庭成员的产后护理健康素养。村里的产后护理缺乏以患者为中心的护理实践。此外，助产士的工作量以及提供产后信息、教育和咨询的能力也是问题。
尽管政府努力在离母亲家更近的地方提供免费产后护理，但产后护理利用的其他障碍仍然存在。具体而言，存在于母亲、社区和卫生服务之中。需要一种创新方法来提高对产后护理的健康素养。特别是，提高助产士提供以患者为中心护理的能力。此外，应对乡村助产士的任务进行评估和重新定位。
