Development, implementation, and evaluation of a respectful maternal and newborn care bundle: A mixed-methods study in Malawi and Tanzania, version 1.0
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Date
2022-06-15
Authors
Journal Title
Journal ISSN
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Publisher
Kamuzu University of Health Sciences
Abstract
Type of research study
Prospective implementation study that will use mixed methods: Quasi
experimental and Qualitative
Problem statement
In many settings, women and their babies fail to receive respectful care during
pregnancy, labour and childbirth, and the postnatal period. Mistreatment
presents as physical, sexual and/or verbal abuse, stigma and discrimination,
poor standards of care, poor rapport between women and providers and health
system conditions and constraints. Although condemned for decades, few
studies have tested interventions to reduce disrespectful care.
The broad objective
To determine whether implementation of a sustainable Respectful Care Bundle,
co-produced with stakeholders, including health workers, and service users
across primary, secondary, and tertiary maternity facilities in Malawi and
Tanzania, decreases woman-reported episodes of disrespectful care.
Specific objectives
The specific objectives of this study are to: evaluate the effectiveness of the care
bundle by healthcare workers, women and managers; assess the acceptability,
sustainability and impact of the maternal and newborn care bundle roll -out.
Methodology
We will use a positive organisational approach (appreciative inquiry) alongside
the Behaviour Change Wheel (BCW), a theory-based method for the design of
interventions. Our study has 3 related phases: pre-implementation,
implementation and evaluation. We will use mixed methods, including an
interrupted time series (ITS), community surveys, process audit, resource
utilization questionnaires, in-depth interviews, and structured observations. TheITS will cover more than 30,000 births in each country. Six hundred women will
be included in each community survey: before and following intervention
implementation. This study will be conducted in Malawi and Tanzania with three
sites per country. In Malawi, the study will be conducted at Bwaila, Ethel
Mutharika and Mitundu Hospitals. Observations will be conducted at each of
the six sites at five time periods. Approximately 80-120 interviews with women,
healthcare workers and hospital managers will be conducted representing 60 in
each country. A primary outcome (woman-reported episodes of disrespectful
care) analysis will take an interrupted time-series approach to allow for possible
underlying changes in the rate of respectful care over the course of the study.
Disrespectful care rates will be compared between time points in a centrematched
analysis. For the qualitative component, interviews and focus group
discussions will be taped, transcribed verbatim and analysed through the
framework approach. Observations will be analysed descriptively, providing
information on occurrence of disrespect in relation to the different typologies.
Routinely collected clinical data on pregnancy outcomes will be aggregated
monthly and analysed using an analogous time series approach to the primary
outcome.
Expected findings and their dissemination
It is expected that findings from this study will reduce the incidence of
disrespectful care at in Mitundu, Bwaila and Ethel Mutharika hospitals with a
high probability of successful roll-out at national level as well as to other lowand
middle-income settings. Active dissemination will include conference
presentations and publications in academic peer reviewed open access journals
balanced with publicly accessible sources. The results will also be disseminated
to the College of Medicine Research Ethics committee (COMREC).
Description
Keywords
Respectful maternal care bundle