Department of Medicine, Division of Prevention Science, University of California, San Francisco, CA, USA.
, 550 16th St., 3rd Floor, San Francisco, CA, 94158, USA.
BMC Pregnancy Childbirth. 2024 Jun 13;24(1):425. doi: 10.1186/s12884-024-06611-y.
Despite research that has shown that the presence of support persons during maternity care is associated with more respectful care, support persons are frequently excluded due to facility practices or negative attitudes of providers. Little quantitative research has examined how integrating support persons in maternity care has implications for the quality of care received by women, a potential pathway for improving maternal and neonatal health outcomes. This study aimed to investigate how integrating support persons in maternity care is associated with multiple dimensions of the quality of maternity care.
We used facility-based cross-sectional survey data from women (n = 1,138) who gave birth at six high-volume facilities in Nairobi and Kiambu counties in Kenya and their support persons (n = 606) present during the immediate postpartum period. Integration was measured by the Person-Centered Integration of Support Persons (PC-ISP) items. We investigated quality of care outcomes including person-centered care outcomes (i.e., Person-Centered Maternity Care (PCMC) and Satisfaction with care) and clinical outcomes (i.e., Implementation of WHO-recommended clinical practices). We used fractional regression with robust standard errors to estimate associations between PC-ISP and care outcomes.
Compared to low integration, high integration (≥four woman-reported PC-ISP experiences vs. <4) was associated with multiple dimensions of quality care: 3.71%-point (95% CI: 2.95%, 4.46%) higher PCMC scores, 2.76%-point higher (95% CI: 1.86%, 3.65%) satisfaction with care scores, and 4.43%-point (95% CI: 3.52%, 5.34%) higher key clinical practices, controlling for covariates. PC-ISP indicators related to communication with providers showed stronger associations with quality of care compared to other PC-ISP sub-constructs. Some support person-reported PC-ISP experiences were positively associated with women's satisfaction and key practices.
Integrating support persons, as key advocates for women, is important for respectful maternity care. Practices to better integrate support persons, especially improving communication between support persons with providers, can potentially improve the person-centered and clinical quality of maternity care in Kenya and other low-resource settings.
尽管有研究表明，在产妇护理中存在支持人员与更尊重护理相关，但由于设施实践或提供者的负面态度，支持人员经常被排除在外。很少有定量研究探讨将支持人员纳入产妇护理如何影响妇女接受护理的质量，这是改善母婴健康结果的潜在途径。本研究旨在调查将支持人员纳入产妇护理与产妇护理质量的多个维度之间的关联。
我们使用了肯尼亚内罗毕和基安布县六家大容量设施中分娩的妇女（n=1138）及其在产后期间在场的支持人员（n=606）的基于设施的横断面调查数据。整合程度通过以人为中心的支持人员整合（PC-ISP）项目来衡量。我们调查了护理质量结果，包括以人为中心的护理结果（即以人为中心的产妇护理（PCMC）和对护理的满意度）和临床结果（即实施世卫组织推荐的临床实践）。我们使用分数回归和稳健标准误差来估计 PC-ISP 与护理结果之间的关联。
与低整合相比，高整合（≥4 名妇女报告的 PC-ISP 经历<4）与多个维度的护理质量相关：PCMC 评分高 3.71 个百分点（95%CI：2.95%，4.46%），对护理的满意度高 2.76 个百分点（95%CI：1.86%，3.65%），关键临床实践高 4.43 个百分点（95%CI：3.52%，5.34%），控制了协变量。与提供者沟通相关的 PC-ISP 指标与护理质量的关联比其他 PC-ISP 子结构更强。一些支持人员报告的 PC-ISP 经历与妇女的满意度和关键实践呈正相关。
将支持人员作为妇女的主要倡导者纳入进来，对于尊重产妇护理很重要。在肯尼亚和其他资源匮乏的环境中，更好地整合支持人员的实践，特别是改善支持人员与提供者之间的沟通，可以潜在地提高以人为中心和临床产妇护理的质量。
