Health workers’ perspectives on informed consent for caesarean section in Southern Malawi

Abstract Objective Informed consent is a prerequisite for caesarean section, the commonest surgical procedure in low- and middle-income settings, but not always acquired to an appropriate extent. Exploring perceptions of health care workers may aid in improving clinical practice around informed consent. We aim to explore health workers’ beliefs and experiences related to principles and practice of informed consent. Methods Qualitative study conducted between January and June 2018 in a rural 150-bed mission hospital in Southern Malawi. Clinical observations, semi-structured interviews and a focus group discussion were used to collect data. Participants were 22 clinical officers, nurse-midwives and midwifery students involved in maternity care. Data were analysed to identify themes and construct an analytical framework. Results Definition and purpose of informed consent revolved around providing information, respecting women’s autonomy and achieving legal protection. Due to fear of blame and litigation, health workers preferred written consent. Written consent requires active participation by the consenting individual and was perceived to transfer liability to that person. A woman’s refusal to provide written informed consent may pose a dilemma for the health worker between doing good and respecting autonomy. To prevent such refusal, health workers said to only partially disclose surgical risks in order to minimize women's anxiety. Commonly perceived barriers to obtain a fully informed consent were labour pains, language barriers, women’s lack of education and their dependency on others to make decisions. Conclusions Health workers are familiar with the principles around informed consent and aware of its advantages, but fear of blame and litigation, partial disclosure of risks and barriers to communication hamper the process of obtaining informed consent. Findings can be used to develop interventions to improve the informed consent process.

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Mental illness in Bwindi, Uganda: Understanding stakeholder perceptions of benefits and barriers to developing a community-based mental health programme

African Journal of Primary Health Care & Family Medicine ◽

10.4102/phcfm.v9i1.1462 ◽

2017 ◽

Vol 9 (1) ◽

Cited By ~ 1

Author(s):

Kristen L. Sessions ◽

Lydia Wheeler ◽

Arya Shah ◽

Deenah Farrell ◽

Edwin Agaba ◽

...

Keyword(s):

Mental Health ◽

Mental Illness ◽

Health Workers ◽

Psychiatric Disease ◽

Structured Interviews ◽

Community Members ◽

Community Based ◽

Significant Treatment ◽

Middle Income ◽

Wide Range

Background: Mental illness has been increasingly recognised as a source of morbidity in low- and middle-income countries and significant treatment gaps exist worldwide. Studies have demonstrated the effectiveness of task sharing through community-based treatment models for addressing international mental health issues.Aim: This paper aims to evaluate the perceptions of a wide range of mental health stakeholders in a Ugandan community regarding the benefits and barriers to developing a community-based mental health programme.Setting: Bwindi Community Hospital (BCH) in south-west Uganda provides services through a team of community health workers to people in the Kanungu District.Methods: Thematic analysis of 13 semi-structured interviews and 6 focus group discussions involving 54 community members and 13 mental health stakeholders within the BCH catchment area.Results: Stakeholders perceived benefits to a community-based compared to a hospital-based programme, including improved patient care, lower costs to patients and improved community understanding of mental illness. They also cited barriers including cost, insufficient workforce and a lack of community readiness.Conclusions: Stakeholders express interest in developing community-based mental health programmes, as they feel that it will address mental health needs in the community and improve community awareness of mental illness. However, they also report that cost is a significant barrier to programme development that will have to be addressed prior to being able to successfully establish such programming. Additionally, many community members expressed unique sociocultural beliefs regarding the nature of mental illness and those suffering from a psychiatric disease.

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LEGAL PROTECTION OF DOCTORS IN PROVIDING HEALTH SERVICES

International Journal of Law Reconstruction ◽

10.26532/ijlr.v4i1.9634 ◽

2020 ◽

Vol 4 (1) ◽

pp. 24

Author(s):

Bambang Tri Bawono

Keyword(s):

Informed Consent ◽

Health Services ◽

Medical Malpractice ◽

Medical Service ◽

Health Workers ◽

Legal Protection ◽

Professional Standards ◽

The Public ◽

Library Research ◽

Service Standards

Cases of alleged malpractice committed by doctors or health workers have become an interesting issue that has been widely discussed by the public. Malpractice is basically due to the emergence of differences in perception between patients and doctors or health workers. The research method used in this study is library research, library research limits its activities to library collections. While the approach used in this study is normative juridical, the results of the study mentioned that the standards that must be met by doctors to obtain legal protection are professional standards, operational procedures standards, and medical service standards. These three standards, doctors are also obliged to make informed consent as part of health service standards, and carry out the obligations as contained in Article 51 of Law No. 29 of 2004 concerning Medical Practice. In addition, doctors can be free from allegations of medical malpractice when providing health services in accordance with professional standards and operational procedures, providing medical services based on informed consent and the principle of non-vit inura volenti law or the assumption of risk, respectable minority rules and error of in judgment, as well as contribution negligence.

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Does the gap between health workers’ expectations and the realities of implementing a Performance-Based Financing project in Mali create frustration?

10.21203/rs.3.rs-54170/v2 ◽

2020 ◽

Author(s):

Tony ZITTI ◽

Amandine FILLOL ◽

Julia LOHMANN ◽

Abdourahmane COULIBALY ◽

Valéry RIDDE

Keyword(s):

Health Workers ◽

Health Financing ◽

Structured Interviews ◽

Middle Income ◽

Saturation Field ◽

Performance Based Financing ◽

District Hospitals ◽

Implementation Period ◽

Distribution Process ◽

Region Data

Abstract Background: Low- and middle-income countries (LMICs) have seen a shift in the health financing architecture in recent years, particularly in Africa. Performance-Based Financing (PBF) is one of these recent initiatives. Motivating health workers is one of the mechanisms through which PBF is assumed to improve the quality of care. Our study therefore offers a unique opportunity to identifiesy and understand how health workers’ expectations related to their experiences of the first cycle of payment of PBF subsidies, and how it this affected their motivation and sentiments towards the intervention.Our study offers the opportunity to identify and understand, from the first days of implementation of PBF in Mali, how the expectations of health workers related to implementation realities of the first cycle of PBF subsidy payment, and how correspondences and discrepancies affected health worker motivation.Methods: We adopted a qualitative approach using multiple explanatory and contrasting case studies with nested levels of analysis. For our study, we chose three district hospitalsDHs (DH 1, 2 and 3) in three health districts (district 1, 2 and 3) among the ten in the Koulikoro region. Our cases correspond to the three DHs. We followed the principle of data source triangulation. The different data sources used are: the 53 semi-directive interviews conducted with health workers, following the principle of saturation;, field notes, a;and documents relating to the distribution grids of subsidies for each DH.We conducted 53 semi-structured interviews with health workers in three of ten district hospitals in the Koulikoro region Data was analyzed in a mixed deductive and inductive manner.Results: The results show that the PBF subsidies initially led to health workers feeling more motivated to perform their tasks overall. Beyond financial motivation, this was primarily due to PBF allowing them to work better. However, respondents perceived a discrepancy between the efforts made and the subsidies received. The fact that their expectations were not met led to a sense of frustration and disappointment. This, in turn, decreased motivation. Similarly, the way in which the subsidies were distributed and the lack of transparency in the distribution process led to feelings of unfairness among the vast majority of respondents. The results show that frustrations can build up in the early days of the intervention.Conclusion: The PBF implementation in Mali left health workers with initial frustrations. The short overall implementation period did not allow actors to adjust their initial expectations and motivational responses, neither positive and negative. This result underlines how short-term interventions might not just only lack impact, but also instill negative sentiments likely to carry on into the future.

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Pre-post implementation survey of a multicomponent intervention to improve informed consent for caesarean section in Southern Malawi

BMJ Open ◽

10.1136/bmjopen-2019-030665 ◽

2020 ◽

Vol 10 (1) ◽

pp. e030665

Author(s):

Siem Zethof ◽

Wouter Bakker ◽

Felix Nansongole ◽

Kelvin Kilowe ◽

Jos van Roosmalen ◽

...

Keyword(s):

Informed Consent ◽

Caesarean Section ◽

Maternity Care ◽

Linear Models ◽

Health Workers ◽

Secondary Outcome ◽

Respectful Maternity Care ◽

Multicomponent Intervention ◽

Resource Setting ◽

Essential Components

ObjectiveSurgical informed consent is essential prior to caesarean section, but potentially compromised by insufficient communication. We assessed the association between a multicomponent intervention and women’s recollection of information pertaining to informed consent for caesarean section in a low-resource setting, thereby contributing to respectful maternity care.DesignPre-post implementation survey, conducted from January to June 2018, surveying women prior to discharge.SettingRural 150-bed mission hospital in Southern Malawi.ParticipantsA total of 160 postoperative women were included: 80 preimplementation and 80 postimplementation.InterventionBased on observed deficiencies and input from local stakeholders, a multicomponent intervention was developed, consisting of a standardised checklist, wall poster with a six-step guide and on-the-job communication training for health workers.Primary and secondary outcome measuresIndividual components of informed consent were: indication, explanation of procedure, common complications, implications for future pregnancies and verbal enquiry of consent, which were compared preintervention and postintervention using χ2test. Generalised linear models were used to analyse incompleteness scores and recollection of the informed consent process.ResultsThe proportion of women who recollected being informed about procedure-related risks increased from 25/80 to 47/80 (OR 3.13 (95% CI 1.64 to 6.00)). Recollection of an explanation of the procedure changed from 44/80 to 55/80 (OR 1.80 (0.94 to 3.44)), implications for future pregnancy from 25/80 to 47/80 (1.69 (0.89 to 3.20)) and of consent enquiry from 67/80 to 73/80 (OR 2.02 (0.73 to 5.37)). After controlling for other variables, incompleteness scores postintervention were 26% lower (Exp(β)=0.74; 95% CI 0.57 to 0.96). Recollection of common complications increased with 0.25 complications (β=0.25; 95% CI 0.01 to 0.49). Recollection of the correct indication did not differ significantly.ConclusionRecollection of informed consent for caesarean section changed significantly in the postintervention group. Obtaining informed consent for caesarean section is one of the essential components of respectful maternity care.

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PERLINDUNGAN HUKUM BAGI DOKTER DAN PASIEN DALAM MELAKUKAN INFORMED CONSENT PADA TINDAKAN C-SECTION TANPA INDIKASI MEDIS

Jurnal Hukum dan Pembangunan Ekonomi ◽

10.20961/hpe.v8i2.49769 ◽

2021 ◽

Vol 8 (2) ◽

pp. 188

Author(s):

Yohana Rosita Dewi Mariyani

Keyword(s):

Informed Consent ◽

Caesarean Section ◽

Legal Protection ◽

Medical Conditions ◽

Medical Risk ◽

Medical Indication

Abstract In recent years, Caesarean section without medical indication seems to be a trend of medical action that occurs in society. Many factors cause this to happen. Among them, so that the fetus can be born according to the desired date of the parents, or based on other factors outside of medical conditions. In the implementation of a Caesarean section, medical consent before the Caesarean section is performed is still very necessary to minimize the medical risk that the patient is suspected of experiencing. In addition, with the existence of medical approval before the Caesarean section is carried out, it is hoped that it will also be able to provide legal protection to patients and doctors both preventively and repressively. Abstrak Beberapa tahun belakangan ini, tindakan Operasi Caesar tanpa indikasi medis seolah menjadi sebuah trend tindakan medis yang terjadi didalam masyarakat. Banyak faktor yang menyebabkan hal demikian terjadi. Diantaranya, agar janin bisa dilahirkan sesuai tanggal keinginan dari orang tua, ataupun berdasarkan faktor lainnya diluar ketentuan medis. Dalam pelaksanaan upaya Operasi Caesar, tindakan persetujuan medis sebelum upaya Operasi Caesar ini dilakukan masih sangat diperlukan guna meminimalisir resiko medis yang diduga akan dialami oleh pasien. Selain itu, dengan adanya tindakan persetujuan medis sebelum upaya operasi Caesar ini dilaksanakan, diharapkan juga turut mampu memberi perlindungan hukum pada pasien dan dokter baik secara preventif maupun represif.

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Does the Gap Between Health Workers’ Expectations and the Realities of Implementing a Performance-Based Financing Project in Mali Create Frustration?

10.21203/rs.3.rs-54170/v1 ◽

2020 ◽

Author(s):

Tony ZITTI ◽

Amandine FILLOL ◽

Julia LOHMANN ◽

Abdourahmane COULIBALY ◽

Valéry RIDDE

Keyword(s):

Health Workers ◽

Health Financing ◽

Structured Interviews ◽

Middle Income ◽

Middle Income Countries ◽

Performance Based Financing ◽

District Hospitals ◽

Implementation Period ◽

Distribution Process ◽

Region Data

Abstract Background: Low- and middle-income countries (LMICs) have seen a shift in the health financing architecture in recent years, particularly in Africa. Performance-Based Financing (PBF) is one of these recent initiatives. Motivating health workers is one of the mechanisms through which PBF is assumed to improve the quality of care. Our study offers the opportunity to identify and understand, from the first days of implementation of PBF in Mali, how the expectations of health workers related to implementation realities of the first cycle of PBF subsidy payment, and how correspondences and discrepancies affected health worker motivation.Methods: We adopted a qualitative approach using multiple explanatory and contrasting case studies with nested levels of analysis. We conducted 53 semi-structured interviews with health workers in three of ten district hospitals in the Koulikoro region. Data was analyzed in a mixed deductive and inductive manner.Results: The results show that the PBF subsidies led to health workers feeling more motivated to perform their tasks overall. Beyond financial motivation, this was primarily due to PBF allowing them to work better. However, respondents perceived a discrepancy between the efforts made and the subsidies received. The fact that their expectations were not met led to a sense of frustration and disappointment. Similarly, the way in which the subsidies were distributed and the lack of transparency in the distribution process led to feelings of unfairness among the vast majority of respondents. The results show that frustrations can build up in the early days of the intervention.Conclusion: The PBF implementation in Mali left health workers initial frustrations. The short overall implementation period did not allow actors to adjust their initial expectations and motivational responses, neither positive and negative. This underlines how short-term interventions might not just lack impact, but instill negative sentiments likely to carry on into the future.

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‘Our village is dependent on us. That’s why we can’t leave our work’. Characterizing mechanisms of motivation to perform among Accredited Social Health Activists (ASHA) in Bihar

Health Policy and Planning ◽

10.1093/heapol/czz131 ◽

2019 ◽

Author(s):

Syed S Wahid ◽

Wolfgang Munar ◽

Sharmila Das ◽

Mahima Gupta ◽

Gary L Darmstadt

Keyword(s):

Intrinsic Motivation ◽

Health System ◽

Work Motivation ◽

Health Workers ◽

Healthcare Services ◽

Social Recognition ◽

Social Health ◽

Structured Interviews ◽

Programme Implementation ◽

Middle Income

Abstract Community health workers (CHWs) play major roles in delivering primary healthcare services, linking communities to the formal health system and addressing the social determinants of health. Available evidence suggests that the performance of CHW programmes in low- and middle-income countries can be influenced by context-dependent causal mechanisms such as motivation to perform. There are gaps regarding what these mechanisms are, and what their contribution is to CHW performance. We used a theory-driven case study to characterize motivational mechanisms among Accredited Social Health Activists (ASHAs) in Bihar, India. Data were collected through semi-structured interviews with CHWs and focus group discussions with beneficiary women. Data were coded using a combined deductive and inductive approach. We found that ASHAs were motivated by a sense of autonomy and self-empowerment; a sense of competence, connection and community service; satisfaction of basic financial needs; social recognition; and feedback and answerability. Findings highlight the potential of ASHAs’ intrinsic motivation to increase their commitment to communities and identification with the health system and of programme implementation and management challenges as sources of work dissatisfaction. Efforts to nurture and sustain ASHAs’ intrinsic motivation while addressing these challenges are necessary for improving the performance of Bihar’s ASHA programme. Further research is needed to characterize the dynamic interactions between ASHAs’ motivation, commitment, job satisfaction and overall performance; also, to understand how work motivation is sustained or lost through time. This can inform policy and managerial reforms to improve ASHA programme’s performance.

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“I came to escort someone”: Men’s experiences of antenatal care services in Urban Ghana. A qualitative study

10.21203/rs.3.rs-86210/v1 ◽

2020 ◽

Author(s):

Gloria Abena Ampim ◽

Astrid Blystad ◽

Albert Kpoor ◽

Haldis Haukanes

Keyword(s):

Antenatal Care ◽

Health Workers ◽

Group Discussion ◽

Male Involvement ◽

Active Role ◽

Maternal Health Services ◽

Structured Interviews ◽

Positive Health ◽

Maternity Clinic ◽

Female Space

Abstract BackgroundMale involvement in maternal healthcare has been widely recognized as important for positive health outcomes for expectant mothers and their unborn babies, but few studies have explored men’s experiences of maternal health services. The purpose of this paper is to explore men’s involvement in antenatal care in urban Ghana and to discuss how men navigate their roles in a space that has been constructed as feminine. The study draws upon theories of gender, place and space.MethodsA qualitative exploratory study using semi-structured interviews, focus group discussion and observation was conducted in Accra, Ghana. Expectant fathers and health workers were interviewed and observation was conducted at a selected public hospital in Accra. ResultsThe findings suggest that the few men who attend antenatal care with their expecting partners get involved to a limited extent in activities at the clinic. Beyond a few who take an active role, most men stay on the outskirts of the hospital grounds, and rarely participate in the consultation with their partner and nurse-midwife. Men still view their presence as important, both to acquire knowledge, and as a source of emotional, financial and physical support for their partners. On the health workers’ side, the study found that there was no clear agenda for engaging men at the clinic, and nurses / midwives felt the lack of staff who could engage more directly with the men. ConclusionThe study indicates that most expecting fathers feel too shy and uncomfortable to locate themselves in the female space that makes up antenatal care / maternity wards. Health workers do not feel they have the necessary resources to involve men in a fruitful way. Thus, men do not engage in the activity as hoped but remain on the outskirts of the maternity clinic. However, if men continue to negotiate their involvement at the clinic and become more assertive in their roles, the maternity clinic as a female space could, with time, be transformed into a space where both expecting mothers and fathers can be active and engaged to the benefit of all.

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Informed consent: Towards improved lay-friendliness of patient information sheets

Communication & Medicine ◽

10.1558/cam.v10i3.201 ◽

2014 ◽

Vol 10 (3) ◽

pp. 201-211

Author(s):

Morten Pilegaard ◽

Hanne Berg Ravn

Keyword(s):

Informed Consent ◽

Information Structure ◽

Language Use ◽

Ethical Standards ◽

Structured Interviews ◽

Explorative Study ◽

Microsoft Word ◽

Text Production ◽

Linguistic Intervention ◽

Set Up

Regional research ethics committee (REC) members have voiced a need for the linguistic improvement of informed consent documents to ensure duly informed consent and to ease committee deliberation. We have little knowledge of what elements of language use hamper comprehension, or of the extent of medical researchers’ appreciation of this problem and their willingness to accept intervention. This qualitative, explorative study proposes an intervention design and tests its feasibility and acceptability. Semi-structured interviews with potential REC applicants informed a linguistic intervention benchmarked against existing guidelines, mandated locally and nationally, and then evaluated quantitatively in a semi-controlled set-up and qualitatively via questionnaires. Potential applicants professed the psychological acceptability of linguistic intervention. The intervention comprised a downloadable Microsoft Word template outlining information structure, a detailed guideline offering advice for each move and self-selected linguistic screening. It was used by 14 applicants and had a measurable effect on REC deliberation time and approval rates. The intervention instruments overall made it easier for applicants to produce informed consent documents meeting prescribed ethical standards concerning lay-friendliness. In conclusion, it was found that linguistic intervention is relevant, feasible and psychologically acceptable to REC applicants; it aids their text production process and seems to enhance the lay-friendliness of these texts.

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STUDI KUALITATIF : KEBUTUHAN IBU HAMIL DENGAN DIABETES MELITUS GESTASIONAL DI KABUPATEN KARANGANYAR JAWA TENGAH

Jurnal Kesehatan Kusuma Husada ◽

10.34035/jk.v12i1.476 ◽

2020 ◽

pp. 17-26

Author(s):

Arista Apriani ◽

M Mufdlilah ◽

Menik Sri Daryanti

Keyword(s):

Social Support ◽

Pregnant Women ◽

Health Center ◽

Blood Sugar ◽

Interpretative Phenomenological Analysis ◽

Health Workers ◽

Phenomenological Analysis ◽

Lifestyle Changes ◽

Structured Interviews ◽

Diabetes Melitus

ABSTRAK GDM dapat berpotensi menimbulkan komplikasi serius yang dapat mengakibatkan risiko kesehatan jangka pendek dan jangka panjang bagi ibu dan bayinya. diagnosis GDM menimbulkan efek emosional yang negatif. Persepsi ibu hamil tentang GDM dapat memengaruhi perubahan gaya hidup. Garis pertama penatalaksanaan DMG yaitu dengan perubahan gaya hidup. Tujuan menggali secara mendalam kebutuhan ibu dengan diagnosis diabetes melitus gestasional. Metode penelitian kualitatif dengan pendekatan fenomenologi. Lokasi di Kabupaten Karanganyar yaitu Puskesmas Jaten I, Puskesmas Matesih dan RSUD Kabupaten Karanganyar, pada bulan Oktober 2019 - Januari 2020. Sampel secara criterion sampling Pengumpulan data dengan semistructure interview dengan one on one interview. Uji Keabsahan Data dengan Credibility pada penelitian ini menggunakan strategi validitas triangulasi, Tranferability, Dependability, Confirmability. Analisis data dengan Interpretative Phenomenological Analysis (IPA). Hasil penelitian kebutuhan ibu hamil dengan DMG teridentifikasi empat tema, yaitu dukungan keluarga dalam hal mengontrol pola makan, mengatarkan periksa ke tenaga kesehatan, dan mengingatkan untuk aktifitas olah raga. Dukungan sosial, yaitu cara mengontrol gula darah. Dukungan tenaga kesehatan, yaitu saran dan motivasi untuk mengontrol gula darah. Informasi mendapat saran atau perawatan DMG dalam kehamilan adalah dari tenaga kesehatan yaitu bidan, dokter, serta selain tenaga kesehatan dari teman dan internet. Kesimpulannya kebutuhan ibu hamil dengan DMG teridentifikasi empat tema, yaitu dukungan keluarga, dukungan sosial, dukungan tenaga kesehatan dan informasi. Kata kunci: diabetes melitus gestasional, kehamilan, kebutuhan. ABSTRACT GDM can overcome serious problems that can overcome short-term and long-term health problems for mother and baby. a diagnosis of GDM has a negative emotional effect. Pregnant women 's perception of GDM can affect lifestyle changes. The first line of management of DMG is lifestyle changes. Diagnosis of gestational diabetes mellitus. Qualitative research methods by studying phenomenology. Locations in Karanganyar Regency are Jaten I Health Center, Matesih Health Center and Karanganyar District Public Hospital, in October 2019 - January 2020. Sample sampling criteria Data collection by semi-structured interviews with one-on-one interviews. Data Validity Test with Credibility in this study using the triangulation validity strategy, Transparency, Dependability, Confirmability. Data analysis with Interpretative Phenomenological Analysis (IPA). The results of the study of the needs of pregnant women with DMG identified four themes, namely supporting the family in terms of controlling diet, sending check to health workers, and reminding for sports activities. Social support, which is a way to control blood sugar. Support of Health Workers, namely advice and motivation to control blood sugar. The information obtained from DMG advice or treatment in the assessment is from health workers, namely midwives, doctors, and also health workers from friends and the internet. In conclusion, the needs of pregnant women with DMG identified four themes, namely family support, social support, support of health workers and information.

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