UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Reproductive Health and Research, World Health Organization, 1211, Geneva, Switzerland.
Gender and Women's Health Unit, Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, VIC, 3053, Australia.
BMC Med Res Methodol. 2018 Nov 15;18(1):132. doi: 10.1186/s12874-018-0603-x.
Efforts to improve maternal health are increasingly focused on improving the quality of care provided to women at health facilities, including the promotion of respectful care and eliminating mistreatment of women during childbirth. A WHO-led multi-country research project aims to develop and validate two tools (labor observation and community survey) to measure how women are treated during facility-based childbirth. This paper describes the development process for these measurement tools, and how they were implemented in a multi-country study (Ghana, Guinea, Myanmar and Nigeria).
An iterative mixed-methods approach was used to develop two measurement tools. Methodological development was conducted in four steps: (1) initial tool development; (2) validity testing, item adjustment and piloting of paper-based tools; (3) conversion to digital, tablet-based tools; and (4) data collection and analysis. These steps included systematic reviews, primary qualitative research, mapping of existing tools, item consolidation, peer review by key stakeholders and piloting.
The development, structure, administration format, and implementation of the labor observation and community survey tools are described. For the labor observations, a total of 2016 women participated: 408 in Nigeria, 682 in Guinea, and 926 in Ghana. For the community survey, a total of 2672 women participated: 561 in Nigeria, 644 in Guinea, 836 in Ghana, and 631 in Myanmar. Of the 2016 women who participated in the labor observations, 1536 women (76.2%) also participated in the community survey and have linked data: 779 in Ghana, 425 in Guinea, and 332 in Nigeria.
An important step to improve the quality of maternity care is to understand the magnitude and burden of mistreatment across contexts. Researchers and healthcare providers in maternal health are encouraged to use and implement these tools, to inform the development of more women-centered, respectful maternity healthcare services. By measuring the prevalence of mistreatment of women during childbirth, we will be able to design and implement programs and policies to transform maternity services.
提高孕产妇健康的努力越来越关注改善卫生机构向妇女提供的护理质量，包括促进尊重护理和消除分娩过程中对妇女的虐待。世卫组织牵头的一个多国研究项目旨在开发和验证两项工具（产程观察和社区调查），以衡量妇女在医疗机构分娩过程中的待遇。本文介绍了这些测量工具的开发过程，以及它们如何在多国研究（加纳、几内亚、缅甸和尼日利亚）中实施。
采用迭代混合方法开发了两种测量工具。方法学开发分四个步骤进行：（1）初步工具开发；（2）有效性测试、项目调整和纸质工具试点；（3）转换为数字、基于平板电脑的工具；（4）数据收集和分析。这些步骤包括系统评价、主要定性研究、现有工具映射、项目合并、主要利益攸关方的同行审查和试点。
描述了产程观察和社区调查工具的开发、结构、管理格式和实施情况。在产程观察中，共有 2016 名妇女参加：尼日利亚 408 名，几内亚 682 名，加纳 926 名。在社区调查中，共有 2672 名妇女参加：尼日利亚 561 名，几内亚 644 名，加纳 836 名，缅甸 631 名。在参加产程观察的 2016 名妇女中，有 1536 名（76.2%）妇女还参加了社区调查，并具有关联数据：加纳 779 名，几内亚 425 名，尼日利亚 332 名。
提高孕产妇保健质量的重要一步是了解不同背景下虐待行为的严重程度和负担。鼓励孕产妇保健领域的研究人员和医疗保健提供者使用和实施这些工具，为更以妇女为中心、尊重妇女的产妇保健服务提供信息。通过衡量分娩过程中妇女遭受虐待的发生率，我们将能够设计和实施方案和政策，以改变产妇服务。
