'I am happy to be listened to': co-creation of a simple tool to measure women's experiences of respectful maternity care in urban Tanzania.

IF 2.2 3区医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Global Health Action Pub Date : 2024-12-31 Epub Date: 2024-09-24 DOI:10.1080/16549716.2024.2403972

Brenda Sequeira D'mello, Natasha Housseine, Hussein Lesio Kidanto, Nanna Maaløe, Jos van Roosmalen, Dan Wolf Meyrowitsch, Thomas van den Akker, Zainab Muniro, Evance Polin, Nuswe Ambokile, Charles Festo, Jane Brandt Sørensen, David Sando

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引用次数: 0

Abstract

Background: Rights-based Respectful Maternity Care (RMC) is crucial for quality of care and improved birth outcomes, yet RMC measurements are rarely included in facility improvement initiatives. We aimed to (i) co-create a routine RMC measurement tool (RMC-T) for congested maternity units in Dar es Salaam, Tanzania, and (ii) assess the RMC-T's acceptability among women and healthcare stakeholders.

Method: We employed a participatory approach utilizing multiple mixed methods. This included a scoping review, stakeholder engagement involving postnatal women, healthcare providers, health leadership, and global researchers through interviews, focus groups, and two surveys involving 201 and 838 postnatal women. Cronbach's alpha and factor analysis were conducted for validation using Stata 15. Theories of social practice and Thematic Framework of Acceptability guided the assessment of stakeholder priorities and tool acceptability.

Results: The multi-phased iterative co-creation process produced the 25-question RMC-T that measures satisfaction, communication, mistreatment (including physical, verbal, and sexual abuse; neglect; discrimination; lack of privacy; unconsented care; post-birth clean-up; informal payments; and denial of care), supportive care (such as food intake and mobility), birth companionship, post-procedure pain relief, bed-sharing, and newborn respect. The pragmatic validation process prioritized stakeholder feedback over strict statistics, lowering Cronbach's alpha from 0.70 in version 1 to 0.57 for the RMC-T. Women valued the opportunity to share their experiences.

Conclusions: The RMC-T is contextualized, validated, and acceptable for measuring women's experiences of RMC. Routine use in facility-based quality improvement initiatives, along with targeted actions to address gaps, will advance rights-based RMC. Further validation and community-based studies are needed.

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我很高兴被倾听"：共同创造一种简单的工具，用于衡量坦桑尼亚城市妇女在尊重产妇的护理方面的体验。

背景：以权利为基础的尊重产妇护理（RMC）对提高护理质量和改善分娩结果至关重要，但 RMC 测量很少被纳入设施改进计划。我们的目标是：(i) 为坦桑尼亚达累斯萨拉姆的拥挤产科共同创建一个常规 RMC 测量工具（RMC-T）；(ii) 评估妇女和医疗保健利益相关者对 RMC-T 的接受程度：我们采用了参与式方法，使用了多种混合方法。方法：我们采用了参与式方法，使用了多种混合方法，包括范围界定审查、利益相关者参与（包括产后妇女、医疗保健提供者、卫生领导和全球研究人员）、访谈、焦点小组以及两项调查（分别涉及 201 名和 838 名产后妇女）。使用 Stata 15 进行了 Cronbach's alpha 和因子分析验证。社会实践理论和可接受性主题框架指导了对利益相关者优先事项和工具可接受性的评估：多阶段迭代共创过程产生了 25 个问题的 RMC-T，用于测量满意度、沟通、虐待（包括身体、语言和性虐待；忽视；歧视；缺乏隐私；未经同意的护理；产后清理；非正式付款；拒绝护理）、支持性护理（如食物摄入和行动能力）、分娩陪伴、术后疼痛缓解、分床和新生儿尊重。务实的验证过程优先考虑利益相关者的反馈，而非严格的统计数据，从而将 Cronbach's alpha 从第一版的 0.70 降至 RMC-T 的 0.57。妇女们非常重视分享经验的机会：结论：RMC-T 符合实际情况，经过验证，可用于测量妇女的 RMC 体验。在以医疗机构为基础的质量改进计划中常规使用该工具，同时采取有针对性的行动来弥补差距，将推动基于权利的生殖健康管理。还需要进一步验证和基于社区的研究。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Global Health Action PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH-

CiteScore

5.10

自引率

3.80%

发文量

108

审稿时长

16 weeks

期刊介绍： Global Health Action is an international peer-reviewed Open Access journal affiliated with the Unit of Epidemiology and Global Health, Department of Public Health and Clinical Medicine at Umeå University, Sweden. The Unit hosts the Umeå International School of Public Health and the Umeå Centre for Global Health Research. Vision: Our vision is to be a leading journal in the global health field, narrowing health information gaps and contributing to the implementation of policies and actions that lead to improved global health. Aim: The widening gap between the winners and losers of globalisation presents major public health challenges. To meet these challenges, it is crucial to generate new knowledge and evidence in the field and in settings where the evidence is lacking, as well as to bridge the gaps between existing knowledge and implementation of relevant findings. Thus, the aim of Global Health Action is to contribute to fuelling a more concrete, hands-on approach to addressing global health challenges. Manuscripts suggesting strategies for practical interventions and research implementations where none already exist are specifically welcomed. Further, the journal encourages articles from low- and middle-income countries, while also welcoming articles originated from South-South and South-North collaborations. All articles are expected to address a global agenda and include a strong implementation or policy component.