The influence of client demand on care practices during ANC, labour and postnatal care
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Date
2020-09-16
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Kamuzu University of Health Sciences
Abstract
Type of Study: Quasi-experimental study (implementation science research).
Background: Quality of care is affected by a wide spectrum of bottlenecks that
range from human resource deficiency, inadequate drugs/equipment, and suboptimal
clinical practice. On the demand side, clients are not aware of their right to demand
care practices and they do not have knowledge about the care that has to be provided
to them during ANC, labour and postnatal care. In addition, mothers lack selfesteem, self-efficacy and skills to demand care from service providers. In the
absence of such, service providers continue to skip clinical guidelines even in cases
where necessary supplies are available. This study aims to explore the extent to
which care practices can change if clients are empowered to demand services in the
continuum of care from ANC to postnatal.
Objectives: The specific objectives of this study are to: i) identify care practices that
can be demanded by the mother in the continuum of care from ANC to PNC, ii)
develop an intervention package (tools) to improve mothers’ knowledge of care
practices and promote demand the practices from service providers, iii) assess
improvement in terms of mothers’ knowledge of care practices offered during ANC,
labour and PNC after being exposed of the tools, iv) assess improvement in terms of
mothers’ demand for care practices during ANC, labour and PNC after being
exposed to the tools, and v) measure effectiveness of the intervention in terms of
actual provision of the care practices by health workers during ANC, labour and
PNC. Methodology: The research will combine qualitative and quantitative methods for
data collection. The study will be conducted in Kasungu district where intervention
and control sites will be selected. The target population for the study includes a)
pregnant mothers b) mothers with children not more than three months c) service
providers at health centre level d) health specialists (RHD, NGOs) and e)
psychologists. A two-staged approach will be used in sampling, whereby health
centres will be systematically selected based on their service readiness and finally
selected randomly to arrive at the final research sites. Willing mothers will be
randomly selected to achieve sample size. The research undertakes to study a
minimum of 326 women in antenatal, post-partum and postnatal care to establish
with confidence if client demand for services can increase adherence to
recommended practices by at least 15%. Quantitative data will be collected using
structured questionnaires for the mother while a checklist for vignettes will be used
to observe adherence to standards during contacts. Qualitative data will be collected
using FGD guides and guides for vignettes which will be used in simulations to
explore demandable services at the point of care.
Qualitative data will be analysed using Atlas software to code emerging themes
while quantitative data will be analysed using Stata to generate percentiles and
correlation between outcomes of interest and independent variables.
Expected findings and their dissemination: This work hypothesises that when
individuals are empowered with knowledge and skills to demand, they can influence
care practices in the continuum of care from ANC to postnatal care. Findings of the
study will be disseminated through national and international conferences, as well
as publications.
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Research Subject Categories::MEDICINE