scholarly journals Yes, no, maybe so: the importance of cognitive interviewing to enhance structured surveys on respectful maternity care in northern India

2019 ◽  
Author(s):  
Kerry Scott ◽  
Dipanwita Gharai ◽  
Manjula Sharma ◽  
Namrata Choudhury ◽  
Bibha Mishra ◽  
...  
Keyword(s):  
Rural Women ◽  
Maternity Care ◽  
Critical Discussion ◽  
Respectful Maternity Care ◽  
Cognitive Interviews ◽  
Survey Question ◽  
Response Options ◽  
Survey Tool ◽  
Northern India ◽  
Survey Questions

Abstract Quantitative survey findings are important in measuring health-related phenomena, including on sensitive topics such as respectful maternity care (RMC). But how well do survey results truly capture respondent experiences and opinions? Quantitative tool development and piloting often involve translating questions from other settings and assessing the mechanics of implementation, which fails to deeply explore how respondents understand survey questions and response options. To address this gap, we conducted cognitive interviews on survey questions (n = 88) adapted from validated RMC instruments used in Ethiopia, Kenya and elsewhere in India. Cognitive interviews with rural women (n = 21) in Madhya Pradesh, India involved asking the respondent the survey question, recording her response, then interviewing her about what the question and response options meant to her. We analysed the interviews to revise the tool and identify question failures, which we grouped into six areas: issues with sequencing, length and sensitivity; problematic response options; inappropriate vocabulary; temporal and spatial confusion; accessing different cognitive domains; and failure to resonate with the respondent’s worldview and reality. Although women tended to provide initial answers to the survey questions, cognitive interviews revealed widespread mismatch between respondent interpretation and question intent. Likert scale response options were generally incomprehensible and questions involving hypothetical scenarios could be interpreted in unexpected ways. Many key terms and concepts from the international RMC literature did not translate well and showed low resonance with respondents, including consent and being involved in decisions about one’s care. This study highlights the threat to data quality and the validity of findings when translating quantitative surveys between languages and cultures and showcases the value of cognitive interviews in identifying question failures. While survey tool revision can address many of these issues, further critical discussion is needed on the use of standardized questions to assess the same domains across contexts.

scholarly journals Development of a Phone Survey Tool to Measure Respectful Maternity Care During Pregnancy and Childbirth in India: Study Protocol (Preprint)

2018 ◽  
Author(s):  
Amnesty E LeFevre ◽  
Kerry Scott ◽  
Diwakar Mohan ◽  
Neha Shah ◽  
Aarushi Bhatnagar ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Maternity Care ◽  
Quality Data ◽  
Respectful Maternity Care ◽  
Validity And Reliability ◽  
Survey Tool ◽  
Face To Face ◽  
Pregnancy And Childbirth ◽  
Phone Survey

BACKGROUND Respectful maternity care (RMC) is a key barometer of the underlying quality of care women receive during pregnancy and childbirth. Efforts to measure RMC have largely been qualitative, although validated quantitative tools are emerging. Available tools have been limited to the measurement of RMC during childbirth and confined to observational and face-to-face survey modes. Phone surveys are less invasive, low cost, and rapid alternatives to traditional face-to-face methods, yet little is known about their validity and reliability. OBJECTIVE The primary objective of this study was to develop validated face-to-face and phone survey tools for measuring RMC during pregnancy and childbirth for use in India and other low resource settings. The secondary objective was to optimize strategies for improving the delivery of phone surveys for use in measuring RMC. METHODS To develop face-to-face and phone surveys for measuring RMC, we describe procedures for assessing content, criterion, and construct validity as well as reliability analyses. To optimize the delivery of phone surveys, we outline plans for substudies, which aim to assess the effect of survey modality, and content on survey response, completion, and attrition rates. RESULTS Data collection will be carried out in 4 districts of Madhya Pradesh, India, from July 2018 to March 2019. CONCLUSIONS To our knowledge, this is the first RMC phone survey tool developed for India, which may provide an opportunity for the rapid, routine collection of data essential for improving the quality of care during pregnancy and childbirth. Elsewhere, phone survey tools are emerging; however, efforts to develop these surveys are often not inclusive of rigorous pretesting activities essential for ensuring quality data, including cognitive, reliability, and validity testing. In the absence of these activities, emerging data could overestimate or underestimate the burden of disease and health care practices under assessment. In the context of RMC, poor quality data could have adverse consequences including the naming and shaming of providers. By outlining a blueprint of the minimum activities required to generate reliable and valid survey tools, we hope to improve efforts to develop and deploy face-to-face and phone surveys in the health sector. INTERNATIONAL REGISTERED REPOR DERR1-10.2196/12173

Narratives of Response Error From Cognitive Interviews of Survey Questions About Normative Behavior

2015 ◽  
Vol 46 (3) ◽  
pp. 540-564 ◽  
Author(s):  
Philip S. Brenner
Keyword(s):  
Research Literature ◽  
Cognitive Interviews ◽  
Actual Behavior ◽  
Religious Behavior ◽  
Religious Service Attendance ◽  
Survey Question ◽  
Normative Behavior ◽  
Survey Questions ◽  
Shed Light ◽  
Service Attendance

That rates of normative behaviors produced by sample surveys are higher than actual behavior warrants is well evidenced in the research literature. Less well understood is the source of this error. Twenty-five cognitive interviews were conducted to probe responses to a set of common, conventional survey questions about one such normative behavior: religious service attendance. Answers to the survey questions and cognitive probes are compared both quantitatively and qualitatively. Half of the respondents amended their answer during cognitive probing, all amendments indicating a lower rate of attendance than originally reported, yielding a statistically significant reduction in reported attendance. Narrative responses shed light onto the source of bias, as respondents pragmatically interpreted the survey question to allow themselves to include other types of religious behavior, to report on a more religious past, and discount current constraints on their religious behavior, in order to report aspirational or normative religious identities.

scholarly journals Development of a Phone Survey Tool to Measure Respectful Maternity Care During Pregnancy and Childbirth in India: Study Protocol

10.2196/12173 ◽  
2019 ◽  
Vol 8 (4) ◽  
pp. e12173
Author(s):  
Amnesty E LeFevre ◽  
Kerry Scott ◽  
Diwakar Mohan ◽  
Neha Shah ◽  
Aarushi Bhatnagar ◽  
...  
Keyword(s):  
Study Protocol ◽  
Maternity Care ◽  
Respectful Maternity Care ◽  
Survey Tool ◽  
Pregnancy And Childbirth ◽  
Phone Survey

scholarly journals Toward improving respectful maternity care: a discrete choice experiment with rural women in northeast Nigeria

2020 ◽  
Vol 5 (3) ◽  
pp. e002135 ◽  
Author(s):  
Nasir Umar ◽  
Matthew Quaife ◽  
Josephine Exley ◽  
Abdulrahman Shuaibu ◽  
Zelee Hill ◽  
...  
Keyword(s):  
Discrete Choice Experiment ◽  
Discrete Choice ◽  
Rural Women ◽  
Maternity Care ◽  
Choice Experiment ◽  
Stated Preferences ◽  
Respectful Maternity Care ◽  
Birth Experience ◽  
Place Of Delivery ◽  
Facility Birth

IntroductionThere is a limited understanding of the importance of respectful maternity care on utilisation of maternal and newborn health services. This study aimed to determine how specific hypothetical facility birth experience of care attributes influenced rural Nigerian women’s stated preferences for hypothetical place of delivery.MethodsAttributes were identified through a comprehensive review of the literature. These attributes and their respective levels were further investigated in a qualitative study. We then developed and implemented a cross-sectional discrete choice experiment with a random sample of 426 women who had facility-based childbirth to elicit their stated preferences for facility birth experience of care attributes. Women were asked to choose between two hypothetical health facilities or home birth for future delivery. Choice data were analysed using multinomial logit and mixed multinomial logit models.ResultsComplete data for the discrete choice experiment were available for 425 of 426 women. The majority belonged to Fulani ethnic group (60%) and were married (95%). Almost half (45%) had no formal education. Parameter estimates were all of expected signs suggesting internal validity. The most important influence on choice of place of delivery was good health system condition, followed by absence of sexual abuse, then absence of physical and verbal abuse. Poor facility culture, including an unclean birth environment with no privacy and unclear user fee, was associated with the most disutility and had the most negative impact on preferences for facility-based childbirth.ConclusionThe likelihood of poor facility birth experiences had a significant impact on stated preferences for place of delivery among rural women in northeast Nigeria. The study findings further underline the important relationship between facility birth experience and utilisation. Achieving universal health coverage would require efforts toward addressing poor facility birth experiences and promoting respectful maternity care, to ensure women want to access the services available.

scholarly journals An innovative intervention to improve respectful maternity care in three Districts in Ethiopia

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Birkety Mengistu ◽  
Haregeweyni Alemu ◽  
Munir Kassa ◽  
Meseret Zelalem ◽  
Mehiret Abate ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Maternity Care ◽  
Regression Coefficient ◽  
Interrupted Time Series ◽  
The Other ◽  
Respectful Maternity Care ◽  
Experience Of Care ◽  
National Initiative ◽  
Care Training

Abstract Background Mistreatment of women during facility-based childbirth is a major violation of human rights and often deters women from attending skilled birth. In Ethiopia, mistreatment occurs in up to 49.4% of mothers giving birth in health facilities. This study describes the development, implementation and results of interventions to improve respectful maternity care. As part of a national initiative to reduce maternal and perinatal mortality in Ethiopia, we developed respectful maternity care training module with three core components: testimonial videos developed from key themes identified by staff as experiences of mothers, skills-building sessions on communication and onsite coaching. Respectful maternity care training was conducted in February 2017 in three districts within three regions. Methods Facility level solutions applied to enhance the experience of care were documented. Safe Childbirth Checklist data measuring privacy and birth companion offered during labor and childbirth were collected over 27 months from 17 health centers and three hospitals. Interrupted time series and regression analysis were conducted to assess significance of improvement using secondary routinely collected programmatic data. Results Significant improvement in the percentage of births with two elements of respectful maternal care—privacy and birth companionship offered— was noted in one district (with short and long-term regression coefficient of 18 and 27% respectively), while in the other two districts, results were mixed. The short-term regression coefficient in one of the districts was 26% which was not sustained in the long-term while in the other district the long-term coefficient was 77%. Testimonial videos helped providers to see their care from their clients’ perspectives, while quality improvement training and coaching helped them reflect on potential root causes for this type of treatment and develop effective solutions. This includes organizing tour to the birthing ward and allowing cultural celebrations. Conclusion This study demonstrated effective way of improving respectful maternity care. Use of a multipronged approach, where the respectful maternity care intervention was embedded in quality improvement approach helped in enhancing respectful maternity care in a comprehensive manner.

scholarly journals The development of the WHO Labour Care Guide: an international survey of maternity care providers

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Veronica Pingray ◽  
Mercedes Bonet ◽  
Mabel Berrueta ◽  
Agustina Mazzoni ◽  
María Belizán ◽  
...  
Keyword(s):  
Decision Making ◽  
Maternity Care ◽  
Health Personnel ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Research Network ◽  
Respectful Maternity Care ◽  
Care Providers ◽  
Skilled Health Personnel ◽  
Skilled Health

Abstract Background The partograph is the most commonly used labour monitoring tool in the world. However, it has been used incorrectly or inconsistently in many settings. In 2018, a WHO expert group reviewed and revised the design of the partograph in light of emerging evidence, and they developed the first version of the Labour Care Guide (LCG). The objective of this study was to explore opinions of skilled health personnel on the first version of the WHO Labour Care Guide. Methods Skilled health personnel (including obstetricians, midwives and general practitioners) of any gender from Africa, Asia, Europe and Latin America were identified through a large global research network. Country coordinators from the network invited 5 to 10 mid-level and senior skilled health personnel who had worked in labour wards anytime in the last 5 years. A self-administered, anonymous, structured, online questionnaire including closed and open-ended questions was designed to assess the clarity, relevance, appropriateness of the frequency of recording, and the completeness of the sections and variables on the LCG. Results A total of 110 participants from 23 countries completed the survey between December 2018 and January 2019. Variables included in the LCG were generally considered clear, relevant and to have been recorded at the appropriate frequency. Most sections of the LCG were considered complete. Participants agreed or strongly agreed with the overall design, structure of the LCG, and the usefulness of reference thresholds to trigger further assessment and actions. They also agreed that LCG could potentially have a positive impact on clinical decision-making and respectful maternity care. Participants disagreed with the value of some variables, including coping, urine, and neonatal status. Conclusions Future end-users of WHO Labour Care Guide considered the variables to be clear, relevant and appropriate, and, with minor improvements, to have the potential to positively impact clinical decision-making and respectful maternity care.

scholarly journals Midwives’ experiences of implementing respectful maternity care knowledge in daily maternity care practices after participating in a four-day RMC training

BMC Nursing ◽  
2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Veronica Millicent Dzomeku ◽  
Adwoa Bemah Boamah Mensah ◽  
Emmanuel Kweku Nakua ◽  
Pascal Agbadi ◽  
Jody R. Lori ◽  
...  
Keyword(s):  
Maternity Care ◽  
Positive Impact ◽  
Good Practice ◽  
Healthcare Facility ◽  
Positive Influence ◽  
Respectful Maternity Care ◽  
Training Workshop ◽  
Care Practices ◽  
The Impact ◽  
Childbearing Women

Abstract Background In Ghana, studies documenting the effectiveness of evidence-based specialized training programs to promote respectful maternity care (RMC) practices in healthcare facilities are few. Thus, we designed a four-day RMC training workshop and piloted it with selected midwives of a tertiary healthcare facility in Kumasi, Ghana. The present paper evaluated the impact of the training by exploring midwives’ experiences of implementing RMC knowledge in their daily maternity care practices 4 months after the training workshop. Methods Through a descriptive qualitative research design, we followed-up and conducted 14 in-depth interviews with participants of the RMC training, exploring their experiences of applying the acquired RMC knowledge in their daily maternity care practices. Data were managed and analysed using NVivo 12. Codes were collapsed into subthemes and assigned to three major predetermined themes. Results The findings have been broadly categorized into three themes: experiences of practising RMC in daily maternity care, health facility barriers to practising RMC, and recommendations for improving RMC practices. The midwives mentioned that applying the newly acquired RMC knowledge has positively improved their relationship with childbearing women, assisted them to effectively communicate with the women, and position them to recognize the autonomy of childbearing women. Despite the positive influence of the training on clinical practice, the midwives said the policy and the built environment in the hospital does not support the exploration of alternative birthing positions. Also, the hospital lacked the required logistics to ensure privacy for multiple childbearing women in the open labour ward. The midwives recommended that logistics for alternative birthing positions and privacy in the ward should be provided. Also, all midwives and staff of the hospital should be taken through the RMC training program to encourage good practice. Conclusion Despite the report of some RMC implementation challenges, the midwives noted that the 4-day RMC training has had a positive impact on their maternity caregiving practice in the hospital. Policies and programs aimed at addressing the issue of disrespect and abusive practices during maternity care should advocate and include the building of facilities that support alternative birthing positions and privacy of childbearing women during childbirth.

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