Kandeya Bianca, Chimwaza-Manda Wanangwa, Kaira Princess, Hanson Claudia, Henriksson Dorcus Kiwanuka, Stones William, Alvesson Helle Molsted, Chipeta Effie
Center for Reproductive Health, Kamuzu University of Health Sciences, Blantyre, Malawi.
Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
BMC Pregnancy Childbirth. 2025 Apr 8;25(1):410. doi: 10.1186/s12884-025-07525-z.
Responsiveness and professionalism are essential components of high-quality maternity care. Responsiveness involves effective communication, respectful interactions, and consideration of the emotional, physical, and cultural needs of women, while professionalism encompasses clinical competence, ethical adherence, and respectful engagement with patients and colleagues. However, various workplace factors, including managerial structures, resource constraints, and institutional culture, influence the extent to which maternity care providers uphold these principles. This study aims to explore how organizational culture, management styles, and resource availability influence responsiveness and professionalism in Malawian maternity care settings, with the goal of identifying strategies to enhance provider motivation and improve maternal healthcare delivery.
A qualitative study was conducted in two maternity care units in Malawi. Data were collected using Twelve semi-structured interviews, two focus group discussions and sixteen observations with maternity care providers in one faith-based hospital and one government-owned hospital, sampled purposively. Transcripts were imported into NVIVO 14 software, and a reflexive thematic analysis was conducted.
The study found that limited physical space, resource shortages, and heavy workloads constrained providers' ability to deliver responsive care. Rigid managerial structures, lack of professional recognition, and restricted autonomy contributed to low morale and reluctance to take initiative. Hierarchical power dynamics and inadequate institutional support further discouraged collaboration and accountability. Despite these challenges, providers highlighted the importance of teamwork, mutual support, and a positive work environment in fostering professionalism and responsiveness. Unpredictable work schedules and poor work-life balance also emerged as key concerns, impacting provider well-being and engagement.
The study provides insights into the complex interplay of systemic, managerial, and interpersonal factors affecting responsiveness and professionalism in maternity care. Addressing these challenges requires targeted interventions that can strengthen resource allocation, supportive leadership, and policies that promote provider well-being and motivation which can in turn enhance maternal and newborn outcomes.
响应性和专业性是高质量产科护理的重要组成部分。响应性包括有效的沟通、尊重的互动以及考虑女性的情感、身体和文化需求，而专业性则涵盖临床能力、道德操守以及与患者和同事的尊重互动。然而，各种工作场所因素，包括管理结构、资源限制和机构文化，都会影响产科护理提供者坚持这些原则的程度。本研究旨在探讨组织文化、管理风格和资源可用性如何影响马拉维产科护理环境中的响应性和专业性，目标是确定提高提供者积极性和改善孕产妇医疗服务的策略。
在马拉维的两个产科护理单位进行了一项定性研究。通过对一家教会医院和一家政府医院的产科护理提供者进行12次半结构化访谈、2次焦点小组讨论和16次观察，有目的地进行抽样收集数据。将访谈记录导入NVIVO 14软件，并进行反思性主题分析。
研究发现，有限的物理空间、资源短缺和繁重的工作量限制了提供者提供响应性护理的能力。僵化的管理结构、缺乏专业认可和自主权受限导致士气低落和不愿主动采取行动。等级权力动态和机构支持不足进一步阻碍了协作和问责制。尽管存在这些挑战，提供者强调团队合作、相互支持和积极的工作环境在培养专业性和响应性方面的重要性。不可预测的工作时间表和糟糕的工作与生活平衡也成为关键问题，影响了提供者的幸福感和参与度。
该研究深入了解了影响产科护理中响应性和专业性的系统、管理和人际因素的复杂相互作用。应对这些挑战需要有针对性的干预措施，以加强资源分配、支持性领导以及促进提供者幸福感和积极性的政策，这反过来可以改善孕产妇和新生儿的结局。
