Sripad Pooja, Merritt Maria W, Kerrigan Deanna, Abuya Timothy, Ndwiga Charity, Warren Charlotte E
Population Council, Washington, DC, United States.
Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States.
Front Glob Womens Health. 2022 Apr 21;3:818062. doi: 10.3389/fgwh.2022.818062. eCollection 2022.
Trust in health service providers and facilities is integral to health systems accountability. Understanding determinants of trust, a relational construct, in maternity settings necessitates exploring hierarchical perspectives of users, providers, and influencers in the care environment. We used a theoretically driven qualitative approach to explore trust determinants in a maternity setting across patient-provider, inter-provider, and community-policymaker interactions and relationships in peri-urban Kenya. Focus groups ( = 8, = 70) with women who recently gave birth (WRB), pregnant women, and male partners, and in-depth-interviews ( = 33) with WRB, health care providers and managers, and community health workers (CHWs) were conducted in 2013, soon after the national government's March 2013 introduction of a policy mandate for "Free Maternity Care." We used thematic coding, memo writing, and cross-perspective triangulation to develop a multi-faceted trust determinants framework. We found that determinants of trust in a maternity setting can be broadly classified into six types of factors, where each type of factor represents a cluster of determinants that may each positively or negatively influence trust: patient, provider, health facility, community, accountability, and structural. Patient factors are prior experiences, perceived risks and harms, childbirth outcomes, and maternal health literacy. Provider factors are empathy and respect, responsiveness, and perceived capability of providers. Health facility factors are "good services" as perceived by patients, physical environment, process navigability, provider collaboration and oversight, discrimination, and corruption. Community factors are facility reputation and history, information channels, and maternal health literacy. Accountability factors are alignment of actions with expectations, adaptations to policy changes, and voice and feedback. Structural factors are institutional hierarchies and policies in the form of professional codes. Trust determinants are complex, nuanced and reflect power dynamics across relationships. Findings offer insight into socio-political maternity norms and demand a more equitable care interface between users and providers.
对医疗服务提供者和机构的信任是卫生系统问责制的核心。了解信任这一关系性概念在产科环境中的决定因素，需要探究护理环境中使用者、提供者和影响者的层级视角。我们采用理论驱动的定性方法，在肯尼亚城郊地区，从患者与提供者、提供者之间以及社区与政策制定者的互动和关系这几个方面，探究产科环境中信任的决定因素。2013年，在国家政府于当年3月出台“免费产科护理”政策指令后不久，我们对近期分娩的妇女（WRB）、孕妇及其男性伴侣进行了焦点小组访谈（n = 8，70人），并对WRB、医疗保健提供者和管理人员以及社区卫生工作者（CHW）进行了深度访谈（n = 33）。我们运用主题编码、撰写备忘录和跨视角三角互证法，构建了一个多层面的信任决定因素框架。我们发现，产科环境中信任的决定因素大致可分为六种类型的因素，每种类型的因素代表一组可能对信任产生积极或消极影响的决定因素：患者、提供者、医疗机构、社区、问责制和结构。患者因素包括既往经历、感知到的风险和危害、分娩结果以及孕产妇健康素养。提供者因素包括同理心和尊重、响应能力以及提供者的感知能力。医疗机构因素包括患者所感知的“优质服务”、物理环境、流程便利性、提供者协作与监督、歧视和腐败。社区因素包括机构声誉和历史、信息渠道以及孕产妇健康素养。问责制因素包括行动与期望的一致性、对政策变化的适应以及发言权和反馈。结构因素是以专业规范形式存在的机构层级和政策。信任决定因素复杂、微妙，反映了各关系间的权力动态。研究结果为社会政治产科规范提供了见解，并要求在使用者和提供者之间建立更公平的护理界面。
