Eshetu Tigist, Fekadu Eshcolewyine, Abdella Ahmed, Mulushoa Adiyam, Medhin Girmay, Belina Merga, Alem Atalay, Keynejad Roxanne, Robbins Tanya, Seward Nadine, Shennan Andrew, Howard Louise M, Prince Martin, Sandall Jane, Hanlon Charlotte
Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
Department of Obstetrics and Gynaecology, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
BMC Pregnancy Childbirth. 2025 Jan 30;25(1):85. doi: 10.1186/s12884-024-07116-4.
Person-centred maternal care is associated with positive experiences in high-income countries. Little is known about the transferability of this concept to non-Western, low-income settings. We aimed to explore women's experiences of care and investigate satisfaction with antenatal care (ANC) in relation to person-centred care and unmet psychosocial needs in rural Ethiopia.
Design: facility-based, convergent mixed-method study. A cross-sectional survey included 2079 consecutive women attending ANC at eight health centres. Service satisfaction was measured using a 21-item validated measure.
[1] person-centred care (1A: receipt of information; 1B: perceived adequacy of health worker responses) and [2] unmet psychosocial needs (2A: Patient Health Questionnaire for depressive symptoms; 2B: screening questionnaire for intimate partner violence (IPV)). Linear mixed effect regression assessed hypothesized associations between person-centred care/unmet psychosocial needs and service satisfaction, accounting for clustering at the health centre level. A linked qualitative study comprised eight in-depth interviews with women accessing ANC. Structured observations of ANC consultations rated health worker competencies (n = 65) and adherence to guidance promoting person-centred care (n = 53). Qualitative data were analysed thematically and triangulated with quantitative and observational data.
Women reported lowest satisfaction in relation to family involvement (71.5% dissatisfied) and continuity of care (65.7% dissatisfied). As hypothesised, satisfaction increased with more information received (adjusted regression coefficient (ARC) 0.96 95%CI 0.71,1.20) but reported adequacy of help from health workers did not show a dose-response relationship (test-for-trend p = 0.157). Undetected depressive symptoms (ARC - 0.21 95%CI -0.27,-0.15) and IPV (ARC - 1.52; 95%CI -2.43,-0.61) were associated with lower service satisfaction scores. Most observed consultations scored low on most indicators of person-centred care. In qualitative interviews, women valued respectful and responsive communication from health workers, which affected their willingness to disclose psychosocial problems. Triangulation of findings indicated a mismatch between what women valued about care, their reported satisfaction with care and the actual care they were observed to receive.
Systems strengthening interventions to support person-centred maternal care appear contextually relevant but need to increase women's expectations of care and agency to demand change. Prioritization of person-centred care could improve women's experience of maternal care and better address psychosocial needs.
在高收入国家，以患者为中心的孕产妇护理与积极体验相关。对于这一概念能否应用于非西方低收入环境，人们知之甚少。我们旨在探讨埃塞俄比亚农村地区妇女的护理体验，并调查她们对与以患者为中心的护理及未满足的心理社会需求相关的产前护理（ANC）的满意度。
设计：基于设施的收敛性混合方法研究。一项横断面调查纳入了在8个健康中心连续接受产前护理的2079名妇女。使用经过验证的21项指标来衡量服务满意度。
[1] 以患者为中心的护理（1A：信息接收情况；1B：对医护人员反应充分性的感知）和 [2] 未满足的心理社会需求（2A：用于评估抑郁症状的患者健康问卷；2B：亲密伴侣暴力筛查问卷（IPV））。线性混合效应回归评估了以患者为中心的护理/未满足的心理社会需求与服务满意度之间的假设关联，并考虑了健康中心层面的聚类情况。一项关联定性研究包括对接受产前护理的妇女进行的8次深入访谈。对产前护理咨询的结构化观察对医护人员的能力（n = 65）以及对促进以患者为中心的护理指南的遵循情况（n = 53）进行评分。定性数据采用主题分析法进行分析，并与定量和观察数据进行三角互证。
妇女对家庭参与（71.5%不满意）和护理连续性（65.7%不满意）的满意度最低。正如假设的那样，随着获得的信息增多，满意度有所提高（调整后的回归系数（ARC）为0.96，95%置信区间为0.71, 1.20），但报告的医护人员提供帮助的充分性未显示出剂量反应关系（趋势检验p = 0.157）。未被检测出的抑郁症状（ARC -0.21，95%置信区间为-0.27，-0.15）和亲密伴侣暴力（ARC -1.52；95%置信区间为-2.43，-0.61）与较低的服务满意度得分相关。大多数观察到的咨询在以患者为中心的护理的大多数指标上得分较低。在定性访谈中，妇女重视医护人员尊重且及时的沟通，这影响了她们披露心理社会问题的意愿。研究结果的三角互证表明，妇女对护理重视的方面、她们报告的护理满意度与观察到她们实际接受的护理之间存在不匹配。
加强支持以患者为中心的孕产妇护理的系统干预措施似乎与具体情境相关，但需要提高妇女对护理的期望以及要求改变的能动性。将以患者为中心的护理作为优先事项可以改善妇女的孕产妇护理体验，并更好地满足心理社会需求。
