Dickinson Fiona M, Madaj Barbara, Muchemi Onesmus M, Ameh Charles
Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom.
Department of International Public Health, Liverpool School of Tropical Medicine, Nairobi, Kenya.
PLOS Glob Public Health. 2022 Mar 15;2(3):e0000062. doi: 10.1371/journal.pgph.0000062. eCollection 2022.
Globally, low and middle-income countries bear the greatest burden of maternal and newborn mortality. To reduce these high levels, the quality of care provided needs to be improved. This study aimed to develop a patient reported outcome measure for use in maternity services in low and middle-income countries, to facilitate improvements in quality of care. Semi-structured interviews and focus groups discussions were conducted with women who had recently given birth in selected healthcare facilities in Malawi and Kenya. Transcripts of these were analysed using a thematic approach and analytic codes applied. Draft outcomes were identified from the data, which were reviewed by a group of clinical experts and developed into a working copy of the Maternity Patient Reported Outcome Measure (MPROM). A further sample of new mothers were asked to evaluate the draft MPROM during cognitive debriefing interviews, and their views used to revise it to produce the final proposed measure. Eighty-three women were interviewed, and 44 women took part in 10 focus group discussions. An array of outcomes was identified from the data which were categorised under the domains of physical and psychological symptoms, social issues, and baby-related health outcomes. The draft outcomes were configured into 79 questions with answers provided using a five-point Likert scale. Minor revisions were made following cognitive debriefing interviews with nine women, to produce the final proposed MPROM. In conjunction with women from the target population and clinical experts, this study has developed what is believed to be the first condition-specific PROM suitable for assessing care quality in maternity services in low and middle-income countries. Following further validation studies, it is anticipated that this will be a useful tool in facilitating improvements in the quality of care provided to women giving birth in healthcare facilities in these settings.
在全球范围内，低收入和中等收入国家承受着孕产妇和新生儿死亡的最大负担。为了降低这些高死亡率，所提供的护理质量需要提高。本研究旨在开发一种患者报告结局指标，用于低收入和中等收入国家的产科服务，以促进护理质量的提高。对在马拉维和肯尼亚选定医疗机构中近期分娩的妇女进行了半结构化访谈和焦点小组讨论。使用主题方法对这些访谈和讨论的记录进行了分析，并应用了分析代码。从数据中确定了初步结局指标，由一组临床专家进行审查，并形成了孕产妇患者报告结局指标（MPROM）的工作版本。在认知性深入访谈中，要求另一组新妈妈对MPROM草案进行评估，并根据她们的意见对其进行修订，以产生最终的拟议指标。对83名妇女进行了访谈，44名妇女参加了10次焦点小组讨论。从数据中确定了一系列结局指标，这些指标被归类为身体和心理症状、社会问题以及与婴儿相关的健康结局等领域。初步结局指标被整理成79个问题，并采用五点李克特量表提供答案。在对9名妇女进行认知性深入访谈后进行了细微修订，以产生最终的拟议MPROM。本研究与目标人群中的妇女以及临床专家合作，开发出了据信是首个适用于评估低收入和中等收入国家产科服务护理质量的特定疾病患者报告结局指标。经过进一步的验证研究后，预计这将成为促进改善这些环境中医疗机构为分娩妇女提供护理质量的有用工具。
