ideas42, 80 Broad St Fl 30, New York, NY, 10004, USA.
Population Council, 4301 Connecticut Avenue NW, Washington, DC, 20008, USA.
BMC Pregnancy Childbirth. 2021 Apr 22;21(1):320. doi: 10.1186/s12884-021-03801-w.
Postpartum hemorrhage (PPH) is the leading cause of maternal mortality in low-income countries, and is the most common direct cause of maternal deaths in Madagascar. Studies in Madagascar and other low-income countries observe low provider adherence to recommended practices for PPH prevention and treatment. Our study addresses gaps in the literature by applying a behavioral science lens to identify barriers inhibiting facility-based providers' consistent following of PPH best practices in Madagascar.
In June 2019, we undertook a cross-sectional qualitative research study in peri-urban and rural areas of the Vatovavy-Fitovinany region of Madagascar. We conducted 47 in-depth interviews in 19 facilities and five communities, with facility-based healthcare providers, postpartum women, medical supervisors, community health volunteers, and traditional birth attendants, and conducted thematic analysis of the transcripts.
We identified seven key behavioral insights representing a range of factors that may contribute to delays in appropriate PPH management in these settings. Findings suggest providers' perceived low risk of PPH may influence their compliance with best practices, subconsciously or explicitly, and lead them to undervalue the importance of PPH prevention and monitoring measures. Providers lack clear feedback on specific components of their performance, which ultimately inhibits continuous improvement of compliance with best practices. Providers demonstrate great resourcefulness while operating in a challenging context with limited equipment, supplies, and support; however, overcoming these challenges remains their foremost concern. This response to chronic scarcity is cognitively taxing and may ultimately affect clinical decision-making.
Our study reveals how perception of low risk of PPH, limited feedback on compliance with best practices and consequences of current practices, and a context of scarcity may negatively affect provider decision-making and clinical practices. Behaviorally informed interventions, designed for specific contexts that care providers operate in, can help improve quality of care and health outcomes for women in labor and childbirth.
产后出血（PPH）是低收入国家产妇死亡的主要原因，也是马达加斯加产妇死亡的最常见直接原因。马达加斯加和其他低收入国家的研究观察到，提供者对预防和治疗 PPH 的建议做法的遵守率较低。我们的研究通过应用行为科学视角来解决文献中的空白，以确定在马达加斯加的医疗机构中妨碍提供者一致遵循 PPH 最佳实践的障碍。
在 2019 年 6 月，我们在马达加斯加瓦托瓦维-菲托凡尼纳地区的城市周边和农村地区进行了一项横断面定性研究。我们在 19 个设施和 5 个社区中进行了 47 次深入访谈，受访者包括医疗机构中的医疗保健提供者、产后妇女、医疗监督人员、社区卫生志愿者和传统助产妇，并对转录本进行了主题分析。
我们确定了七个关键的行为洞察，代表了一系列可能导致这些环境中适当 PPH 管理延迟的因素。研究结果表明，提供者对 PPH 风险的感知可能会影响他们对最佳实践的遵守，无论是潜意识的还是明确的，并使他们低估 PPH 预防和监测措施的重要性。提供者缺乏对其绩效具体组成部分的明确反馈，这最终抑制了对最佳实践的持续改进。提供者在设备、用品和支持有限的挑战性环境中表现出极大的足智多谋；然而，克服这些挑战仍然是他们的首要关注点。这种对慢性短缺的应对认知上是费力的，最终可能会影响临床决策。
我们的研究揭示了 PPH 风险感知低、对最佳实践合规性的反馈有限以及当前实践的后果、以及稀缺性的背景如何可能对提供者的决策和临床实践产生负面影响。针对提供者所处的特定环境设计的基于行为的干预措施可以帮助提高产妇分娩期间的护理质量和健康结果。
