评估 "关爱医护人员,改善患者体验 "干预措施对肯尼亚和加纳以人为本的孕产妇护理的影响的分组随机对照试验:研究方案

P. Afulani, Monica Getahun, L. Ongeri, Raymond A Aborigo, J. Kinyua, Beryl A Ogolla, Jaffer Okiring, Ali Moro, Iscar Oluoch, Maxwell Dalaba, Osamuede Odiase, Jerry Nutor, Wendy Berry Mendes, Dilys Walker, Torsten B. Neilands
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We describe the protocol for a trial to test the effectiveness of the “Caring for Providers to Improve Patient Experience” (CPIPE) intervention, which includes five strategies for provider behavior change, targeting provider stress and bias as intermediate factors to improve PCMC and to address inequities. Methods The trial will assess the effect of CPIPE on PCMC, as well as on intermediate and distal outcomes, using a two-arm cluster randomized controlled trial in 40 health facilities in Migori and Homa Bay Counties in Kenya and Upper East and Northeast Regions in Ghana. Twenty facilities in each country will be randomized to 10 intervention and 10 control sites. The primary intervention targets are all healthcare workers who provide maternal health services. The intervention impact will also be assessed first among providers, and then among women who give birth in health facilities. 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引用次数: 0

摘要

摘要 背景 以人为本的孕产妇护理(PCMC)不完善,直接或间接地导致孕产妇死亡率和发病率居高不下,其原因是缺乏护理、护理延误、护理不充分、护理不必要或有害。在过去十年中,有关以人为本的孕产妇护理(PCMC)不良率以及不公平现象的证据有所增加,但在以证据为基础的干预措施方面仍存在巨大差距。我们介绍了 "关爱医护人员,改善患者体验"(CPIPE)干预试验的方案,其中包括五项改变医护人员行为的策略,将医护人员的压力和偏见作为改善 PCMC 和解决不平等问题的中间因素。方法 该试验将在肯尼亚米戈里和霍马湾县以及加纳上东部和东北部地区的 40 家医疗机构开展双臂分组随机对照试验,评估 CPIPE 对 PCMC 以及中间和远端结果的影响。每个国家的 20 家医疗机构将被随机分配到 10 个干预地点和 10 个对照地点。主要干预对象是所有提供孕产妇保健服务的医护人员。干预效果也将首先在医疗服务提供者中进行评估,然后在医疗机构的产妇中进行评估。主要结果是使用 PCMC 量表测量 PCMC,在基线(干预前)、中线(干预开始后 6 个月)和终点(基线后 12 个月)对研究机构中前 12 周分娩的母亲进行多次横断面调查(每个时间点两国的调查人数均为 2000 人)。此外,还将在基线、中线和终点对两国研究机构的 400 名医疗服务提供者进行纵向跟踪,以评估中间结果。该试验采用混合方法设计;调查数据与对医疗机构领导、医疗服务提供者和母亲的深入访谈(IDI)相结合,从定性角度探讨影响结果的因素。最后,我们还将收集过程和成本数据,以评估干预的忠实性和成本效益。讨论 该试验将是首次对改善 PCMC 的干预措施进行严格评估,以解决提供者的压力和偏见问题,并将推进改善 PCMC 的干预措施的证据基础,促进孕产妇和新生儿健康的公平性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
A cluster randomized controlled trial to assess the impact of the ‘Caring for Providers to Improve Patient Experience’ intervention on person-centered maternity care in Kenya and Ghana: Study Protocol
Abstract Background Poor person-centered maternal care (PCMC) contributes to high maternal mortality and morbidity, directly and indirectly, through lack of, delayed, inadequate, unnecessary, or harmful care. While evidence on poor PCMC prevalence, as well as inequities, expanded in the last decade, there is still a significant gap in evidence-based interventions to address PCMC. We describe the protocol for a trial to test the effectiveness of the “Caring for Providers to Improve Patient Experience” (CPIPE) intervention, which includes five strategies for provider behavior change, targeting provider stress and bias as intermediate factors to improve PCMC and to address inequities. Methods The trial will assess the effect of CPIPE on PCMC, as well as on intermediate and distal outcomes, using a two-arm cluster randomized controlled trial in 40 health facilities in Migori and Homa Bay Counties in Kenya and Upper East and Northeast Regions in Ghana. Twenty facilities in each country will be randomized to 10 intervention and 10 control sites. The primary intervention targets are all healthcare workers who provide maternal health services. The intervention impact will also be assessed first among providers, and then among women who give birth in health facilities. The primary outcome is PCMC measured with the PCMC scale, via multiple cross-sectional surveys of mothers who gave birth in the preceding 12 weeks in study facilities at baseline (prior to the intervention), midline (6 months after intervention start), and endline (12 months post-baseline) (N = 2000 across both countries at each time point). Additionally, 400 providers in the study facilities across both countries will be followed longitudinally at baseline, midline, and endline, to assess intermediate outcomes. The trial incorporates a mixed-methods design; survey data alongside in-depth interviews (IDIs) with healthcare facility leaders, providers, and mothers to qualitatively explore factors influencing the outcomes. Finally, we will collect process and cost data to assess intervention fidelity and cost-effectiveness. Discussion This trial will be the first to rigorously assess an intervention to improve PCMC that addresses both provider stress and bias and will advance the evidence base for interventions to improve PCMC and contribute to equity in maternal and neonatal health.
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