Thursday, 10 September 2015

SPHPM researchers investigate the role of the attitudes of maternal health care providers and quality of care

Professor Jane Fisher, Adjunct Associate Professor Stanley Luchters and researchers from The Burnet Institute and the University of Witwatersrand have co-authored a systematic review on attitudes and behaviour of various maternal health care providers and how this plays a role on seeking health care and the quality of care provided.

Past studies have investigated maternal health care provider attitudes towards women in low to middle income countries however, there have been few syntheses or systematic reviews of their findings. Those available focused on specific attitudes or behaviours (for example disrespect) or looked at only one time-period (labour). A broader review of all attitudes and behaviours within low and middle income countries which covers the full maternity period can provide valuable data to improving the quality and utilisation of maternal health services.

The authors of the review used systematic methods to review a broad range of peer-reviewed literature and identify various behaviours and attitudes of maternal health care providers towards patients within low and middle income countries.  Five different databases were utilised to find studies from January 1990 to December 2014. The included studies that discussed the impacts of maternal health care provider attitudes on their patients, as well as any factors which may impact these attitudes. Excluded topics were behaviours associated with HIV infections and any studies of providers conducted outside of the formal health care system, such as traditional birth attendants.

The field of maternal health care has seen several developments, on a global scale, in effort to reduce the rates of maternal mortality. However, these improvements are not moving at a fast enough rate to reach the United Nations’ Fifth Millennium Development Goal. This goal sought to reduce the maternal mortality ratio by three quarters by 2015. The second target of the Millennium Development Goal was to provide universal access to reproductive health services by 2015. Current statistics indicate that 273,500 women die during or after pregnancy and childbirth every year. Ten million women also are affected by an illness associated with pregnancy, depression or a disability each year.

Most pregnancy-related death and disability occurs in low and middle income countries and often, these can be prevented. However, there are several barriers that are limiting easy access to necessary maternal health care services. These include gender discrimination, cultural practices, ignoring woman’s needs, lack of knowledge regarding the symptoms of various illnesses, the expenses involved, and mediocre quality of care. The issue of quality of care has been identified as a crucial issue in the rates of maternal mortality and morbidity, given that the rates remain high, regardless of significant increases in the reach and coverage of maternal health services.

The term quality of care has no common consensus or accepted meaning. It can be argued that the term ‘quality of care’ applies to a wide range of practices such as safety, the clinical efficacy and the experience of the patient. However, specifically to reproductive health care, quality of care encompasses six concepts. These include the information given to the patient, choice, technical competence, interpersonal relations, the use of follow-up and community components, and an array of services.

Further, the manners, behaviour and attitude of maternal health care providers are a crucial component to the quality of care delivered to the patient. This can have both positive and negative impacts on not only the woman but her intimate partner and wider family. Without considerate and respectful care from providers, patients can be not only disappointed with the system of care, but this can lead to them not accessing antenatal and postnatal services. These are imperative elements in improving maternal health outcomes and enabling women to have a consistent access to a high standard of care.

One hundred and twenty five articles were reviewed and 81 papers were included in this study. About two-thirds of the studies incorporated qualitative methodology and over half of the papers studied public sector services. Most were undertaken in Africa with Asia and the Pacific following. Fifty eight of these studies also only discussed negative attitudes with minimal articles exploring positive attitudes such as sympathetic, helpful and caring behaviours. Articles also noted that there were instances of abuse inflicted towards patients, the lack of access to health care providers, invasion of privacy, lack of communication and a reluctance to account for traditional practices.

The authors conclude that the review gathered a sufficient amount of data regarding negative attitudes of maternal health care providers and their role in adversely impacting the patient’s satisfaction with their level of care, their efforts to search for care options and their overall well-being to identify this as a significant public health problem. The review also demonstrates that negative experiences are reported more than positive experiences. These various experiences highlight there is a need to better the existing health systems as well as improve the workforce on multiple levels such as providers’ communication and counselling abilities. These aspects are imperative to ensure that females receive the highest standard of maternal care everywhere including in low and middle-income countries. 

You can read the paper here

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