Merriel Abi, Dembo Zione, Hussein Julia, Larkin Michael, Mchenga Allan, Tobias Aurelio, Lough Mark, Malata Address, Makwenda Charles, Coomarasamy Arri
Institute for Metabolism and Systems Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.
Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
Pilot Feasibility Stud. 2021 Jan 29;7(1):34. doi: 10.1186/s40814-021-00774-7.
Globally too many mothers and babies die during childbirth; 98% of maternal deaths are avoidable. Skilled clinicians can reduce these deaths; however, there is a world-wide shortage of maternity healthcare workers. Malawi has enough to deliver 20% of its maternity care. A motivating work environment is important for healthcare worker retention. To inform a future trial, we aimed to assess the feasibility of implementing a motivational intervention (Appreciative Inquiry) to improve the working lives of maternity healthcare workers and patient satisfaction in Malawi.
Three government hospitals participated over 1 year. Its effectiveness was assessed through: a monthly longitudinal survey of working life using psychometrically validated instruments (basic psychological needs, job satisfaction and work-related quality of life); a before and after questionnaire of patient satisfaction using a patient satisfaction tool validated in low-income settings with a maximum score of 80; and a qualitative template analysis encompassing ethnographic data, semi-structured interviews and focus groups with staff.
The intervention was attended by all 145 eligible staff, who also participated in the longitudinal study. The general trend was an increase in the scores for each scale except for the basic psychological needs score in one site. Only one site demonstrated strong evidence for the intervention working in the work-related quality of life scales. Pre-intervention, 162 postnatal women completed the questionnaire; post-intervention, 191 postnatal women participated. Patient satisfaction rose in all three sites; referral hospital 4.41 rise (95% CI 1.89 to 6.95), district hospital 10.22 (95% CI 7.38 to 13.07) and community hospital 13.02 (95% CI 10.48 to 15.57). The qualitative data revealed that staff felt happier, that their skills (especially communication) had improved, behaviour had changed and systems had developed.
We have shown that it is possible to implement Appreciative Inquiry in government facilities in Malawi, which has the potential to change the way staff work and improve patient satisfaction. The mixed methods approach revealed important findings including the importance of staff relationships. We have identified clear implementation elements that will be important to measure in a future trial such as implementation fidelity and inter-personal relationship factors.
在全球范围内，有太多的母亲和婴儿在分娩期间死亡；98%的孕产妇死亡是可以避免的。技术娴熟的临床医生能够减少这些死亡；然而，全球范围内都存在产科医护人员短缺的问题。马拉维现有的医护人员仅能提供该国20%的产科护理服务。一个具有激励作用的工作环境对于留住医护人员至关重要。为了给未来的试验提供参考依据，我们旨在评估实施一项激励干预措施（赏识性探询）以改善马拉维产科医护人员的工作生活及患者满意度的可行性。
三家政府医院参与了为期一年的研究。通过以下方式评估其效果：使用经过心理测量学验证的工具（基本心理需求、工作满意度和工作相关生活质量）对工作生活进行每月一次的纵向调查；使用在低收入环境中验证过的患者满意度工具，在干预前后分别进行患者满意度问卷调查，该工具的最高分为80分；以及进行定性模板分析，包括人种志数据、与工作人员的半结构化访谈和焦点小组访谈。
所有145名符合条件的工作人员都参与了干预措施，他们也参与了纵向研究。总体趋势是，除了一个地点的基本心理需求得分外，每个量表的得分都有所增加。只有一个地点有强有力的证据表明干预措施在工作相关生活质量量表中起作用。干预前，162名产后妇女完成了问卷调查；干预后，191名产后妇女参与了调查。所有三个地点的患者满意度都有所提高；转诊医院提高了4.41分（95%置信区间为1.89至6.95），地区医院提高了10.22分（95%置信区间为7.38至13.07），社区医院提高了13.02分（95%置信区间为10.48至15.57）。定性数据显示，工作人员感到更快乐，他们的技能（尤其是沟通能力）有所提高，行为发生了改变，制度也得到了完善。
我们已经表明，在马拉维的政府医疗机构中实施赏识性探询是可行的，这有可能改变工作人员的工作方式并提高患者满意度。混合方法研究揭示了重要的发现，包括工作人员关系的重要性。我们已经确定了在未来试验中进行测量时至关重要的明确实施要素，如实施保真度和人际关系因素。
