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关爱提供者以改善患者体验(CPIPE):干预措施开发过程。

Caring for providers to improve patient experience (CPIPE): intervention development process.

机构信息

Epidemiology and Biostatistics Department, University of California, San Francisco (UCSF), San Francisco, CA, USA.

Institute for Global Health Sciences, University of California, San Francisco, San Francisco CA, USA.

出版信息

Glob Health Action. 2023 Dec 31;16(1):2147289. doi: 10.1080/16549716.2022.2147289.

Abstract

A growing body of research has documented disrespectful, abusive, and neglectful treatment of women in facilities during childbirth, as well as the drivers of such mistreatment. Yet, little research exists on effective interventions to improve Person-Centred Maternal Care (PCMC)-care that is respectful and responsive to individual women's preferences, needs, and values. We sought to extend knowledge on interventions to improve PCMC, with a focus on two factors - provider stress and implicit bias - that are driving poor PCMC and contributing to disparities in PCMC. In this paper we describe the process towards the development of the intervention. The intervention design was an iterative process informed by existing literature, behaviour change theory, formative research, and continuous feedback in consultation with key stakeholders. The intervention strategies were informed by the Social Cognitive Theory, Trauma Informed System framework, and the Ecological Perspective. This process resulted in the intervention, which has 5 components: provider training, peer support, mentorship, embedded champions, and leadership engagement. The training includes didactic and interactive content on PCMC, stress, burnout, dealing with difficult situations, and bias, with some content integrated into emergency obstetric and neonatal care (EmONC) simulations to enable providers apply concepts in the context of managing an emergency. The other components create an enabling environment for ongoing individual behavior and facility culture change. The pilot study is being implemented in Migori County, Kenya. The CPIPE intervention is an innovative theory and evidence-based intervention that addresses key drivers of poor PCMC and centers the unique needs of vulnerable women as well as that of providers. This intervention will advance the evidence base for interventions to improve PCMC and has great potential to improve equity in PCMC and maternal and neonatal health.

摘要

越来越多的研究记录了在分娩期间医疗机构中对女性的不尊重、虐待和忽视行为,以及这种虐待行为的驱动因素。然而,关于改善以患者为中心的产妇护理(PCMC)的有效干预措施的研究甚少,PCMC 是指对女性个体的偏好、需求和价值观予以尊重和响应的护理。我们旨在扩展有关改善 PCMC 的干预措施的知识,重点关注两个因素——提供者压力和内隐偏见,这两个因素正在导致 PCMC 不佳,并导致 PCMC 中的差异。在本文中,我们描述了干预措施的开发过程。干预设计是一个迭代过程,以现有文献、行为改变理论、形成性研究为依据,并在与主要利益攸关方协商时不断提供反馈。干预策略以社会认知理论、创伤知情系统框架和生态视角为依据。这一过程产生了干预措施,该措施有 5 个组成部分:提供者培训、同伴支持、指导、核心支持者和领导力参与。培训包括 PCMC、压力、倦怠、应对困难情况和偏见方面的理论和实践内容,一些内容整合到紧急产科和新生儿护理(EmONC)模拟中,以便提供者能够在管理紧急情况的背景下应用这些概念。其他组成部分为持续的个人行为和医疗机构文化变革创造有利环境。试点研究正在肯尼亚米戈里县实施。CPIPE 干预措施是一种创新的理论和循证干预措施,可解决 PCMC 不佳的关键驱动因素,并关注弱势妇女以及提供者的独特需求。该干预措施将为改善 PCMC 的干预措施提供证据基础,并具有改善 PCMC 公平性以及母婴健康的巨大潜力。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b78f/9754039/2319fd702699/ZGHA_A_2147289_F0001_OC.jpg

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