Kamuzu University of Health Sciences, P.O. Box 360, Blantyre, Malawi.
University of Malawi, P.O. Box 280, Zomba, Malawi.
BMC Pregnancy Childbirth. 2023 May 27;23(1):390. doi: 10.1186/s12884-023-05722-2.
One of the factors affecting quality of care is that clients do not demand care practises during antenatal, intrapartum and postnatal care. This study aimed to identify care practices that can be demanded by the mother in the continuum of care from antenatal to postnatal.
The study respondents included 122 mothers, 31 health workers and 4 psychologists. The researchers conducted 9 Key Informant Interviews with service providers and psychologists, 8 Focus Group Discussions with 8 mothers per group, and 26 vignettes with mothers and service providers. Data was analysed using Interpretative Phenomenological Analysis (IPA) where themes were identified and categorised.
During antenatal and postnatal care, mothers demanded all recommended services presented to them. Some services seen as demandable during labour and delivery included 4-hourly assessments of vital signs and blood pressure, emptying of the bladder, swabbing, delivery counselling, administration of oxytocin, post-delivery palpation, and vaginal examination. For the child mothers demanded head to toe assessment, assessment of vital signs, weighing, cord stamp and eye antiseptics, and vaccines. Women observed that they could demand birth registration even though it was not among the recommended services. Respondents proposed empowerment of mothers with cognitive, behavioural and interpersonal skills to demand services e.g., knowledge of service standards and health benefits in addition to improved self-confidence and assertiveness. In addition, efforts have to be made to address perceived or real health worker attitudes, mental health for the client and the service provider, service provider workload, and availability of supplies.
The study found that if a mother is informed in simple language about services that she is supposed to receive, she can demand numerous services in the continuum of care from antenatal to postnatal. However, demand cannot be a standalone solution for improving quality of care. What the mother can ask for is a step in the guidelines, but she cannot probe deeper to influence quality of the procedure. In addition, empowerment of mothers needs to be coupled with services and systems strengthening in support of health workers.
影响护理质量的因素之一是客户在产前、产时和产后护理期间不要求护理实践。本研究旨在确定母亲在产前至产后连续护理中可以要求的护理实践。
研究对象包括 122 名母亲、31 名卫生工作者和 4 名心理学家。研究人员对服务提供者和心理学家进行了 9 次关键知情人访谈，对每组 8 名母亲进行了 8 次焦点小组讨论，并对母亲和服务提供者进行了 26 次情景模拟。使用解释现象学分析（IPA）对数据进行分析，确定并分类主题。
在产前和产后护理期间，母亲要求向她们提供所有推荐的服务。在分娩和分娩期间被视为可要求的一些服务包括每 4 小时评估生命体征和血压、排空膀胱、拭子检查、分娩咨询、催产素给药、产后触诊和阴道检查。对于孩子，母亲要求从头到脚评估、生命体征评估、称重、脐带标记和眼部消毒剂以及疫苗接种。女性观察到，即使出生登记不在推荐服务之列，她们也可以要求进行出生登记。受访者提出赋予母亲认知、行为和人际交往技能，以要求提供服务，例如了解服务标准和健康益处，以及增强自信和果断。此外，必须努力解决服务提供者的感知或真实态度、客户和服务提供者的心理健康、服务提供者的工作量以及供应品的可用性等问题。
本研究发现，如果母亲用简单的语言了解她应该接受的服务，她可以在产前至产后连续护理中要求许多服务。然而，需求不能成为提高护理质量的唯一解决方案。母亲可以要求的是指南中的一个步骤，但她不能深入探究以影响程序的质量。此外，必须将母亲的赋权与服务和系统加强相结合，以支持卫生工作者。
