scholarly journals Understanding Barriers to Adoption of Facility Assisted Delivery in a Maasai Community in Ngorongoro District, Tanzania: A qualitative study to document psychosocial preferences, agency for decision-making, access barriers, and other factors that influence where a woman in Nainokanoka Ward will deliver

2019 ◽  
Author(s):  
Paul D Mosley ◽  
Kisiaya Saruni ◽  
Bernadetha Lenga
Keyword(s):  
Decision Making ◽  
Qualitative Study ◽  
Health Sector ◽  
Facility Delivery ◽  
Care Group ◽  
Group Model ◽  
Theory Approach ◽  
Access Barriers ◽  
Study Results ◽  
Assisted Delivery

Abstract BACKGROUND Tanzania’s One Plan II health sector program aims to increase facility deliveries from 50% to 80% from 2015-2020. Success is uneven among certain Maasai pastoralist women in Northern Tanzania who resist going to a facility for birth even after completing 4+ ANC visits. EbOO is a program in Nainokanoka ward to promote facility-births through a care-group model using traditional birth attendants (TBAs) as facilitators. Results to date are promising but show a consistent gap between women completing ANC and those going to a facility for birth. METHODS A qualitative study was conducted in Nainokanoka ward to understand psychosocial preferences, agency for decision-making, and access barriers that influence where a woman in the ward will deliver. Interviews were conducted with twenty-three pregnant and/or parous women, along with 3 men’s and 2 TBA’s focus groups, and finally 3 key-informants from ward health facilities. Interviews were coded and analyzed thematically using a grounded theory approach. RESULTS Most women interviewed expressed preference for a home delivery with a TBA and even those who expressed agency and preference for a facility delivery usually had their last delivery at home attributed to unexpected labor. TBAs are engaged by husbands and play a significant influential role in deciding place of delivery as husbands defer to their judgment. TBAs claim to support facility deliveries but in practice use them as a last resort and reported a significant trust gap based on a bad experience at a facility where women in labor were turned away. CONCLUSIONS EbOO project data and study results show a slow but steady change in norms in Nainokanoka ward. Gaps between expressed intention and practice, especially around ‘unexpected labor’ present opportunities to accelerate this process by more intentionally promoting birth plans, and perhaps constructing a maternity waiting house near the ward health center. Rebuilding trust between facility midwives, TBAs, and the community on the availability of health facility services and assurance that women in labor will not be denied service, could also close the gap between the number of women who are currently using facilities for ANC and those returning for a facility delivery.

scholarly journals Factors influencing adoption of facility-assisted delivery - a qualitative study of women and other stakeholders in a Maasai community in Ngorongoro District, Tanzania

2019 ◽  
Author(s):  
Paul D Mosley ◽  
Kisiaya Saruni ◽  
Bernadetha Lenga
Keyword(s):  
Qualitative Study ◽  
Health Sector ◽  
Home Birth ◽  
Care Group ◽  
Group Model ◽  
Theory Approach ◽  
Study Results ◽  
Assisted Delivery ◽  
Project Data ◽  
Facility Births

Abstract BACKGROUND: Tanzania’s One Plan II health sector program aims to increase facility deliveries from 50% to 80% from 2015-2020. Success is uneven among certain Maasai pastoralist women in Northern Tanzania who robustly prefer home births to facility births even after completing 4+ ANC visits. Ebiotishu Oondomonok Ongera (EbOO) is a program in Nainokanoka ward to promote facility births through a care-group model using trained traditional birth attendants (TBAs) as facilitators. Results to date are promising but show a consistent gap between women completing ANC and those going to a facility for delivery. A qualitative study was conducted to understand psychosocial preferences, agency for decision-making, and access barriers that influence where a woman in the ward will deliver. METHODS: In-depth interviews, focus group discussions and key-informant interviews were conducted with 24 pregnant and/or parous women, 24 TBAs, 3 nurse midwives at 3 health facilities, and 24 married men, living in Nainokanoka ward. Interviews and discussions were transcribed, translated, and analyzed thematically using a grounded theory approach. RESULTS: Most women interviewed expressed preference for a home birth with a TBA and even those who expressed agency and preference for a facility birth usually had their last delivery at home attributed to unexpected labor. TBAs are engaged by husbands and play a significant influential role in deciding place of delivery. TBAs report support for facility deliveries but in practice use them as a last resort, and a significant trust gap was documented based on a bad experience at a facility where women in labor were turned away. CONCLUSIONS: EbOO project data and study results show a slow but steady change in norms around delivery preference in Nainokanoka ward. Gaps between expressed intention and practice, especially around ‘unexpected labor’ present opportunities to accelerate this process by promoting birth plans and perhaps constructing a maternity waiting house in the ward. Rebuilding trust between facility midwives, TBAs, and the community on the availability of health facility services, and increased sensitivity to women’s cultural preferences, could also close the gap between the number of women who are currently using facilities for ANC and those returning for delivery.

scholarly journals Factors influencing adoption of facility-assisted delivery - a qualitative study of women and other stakeholders in a Maasai community in Ngorongoro District, Tanzania

2019 ◽  
Author(s):  
Paul D Mosley ◽  
Kisiaya Saruni ◽  
Bernadetha Lenga
Keyword(s):  
Qualitative Study ◽  
Health Sector ◽  
Home Delivery ◽  
Care Group ◽  
Group Model ◽  
Theory Approach ◽  
Study Results ◽  
Assisted Delivery ◽  
Ngorongoro District ◽  
Project Data

Abstract BACKGROUND: Tanzania’s One Plan II health sector program aims to increase facility deliveries from 50% to 80% from 2015-2020. Success is uneven among certain Maasai pastoralist women in Northern Tanzania who resist going to a facility for birth even after completing 4+ ANC visits. Ebiotishu Oondomonok Ongera (EbOO) is a program in Nainokanoka ward to promote facility-births through a care-group model using trained traditional birth attendants (TBAs) as facilitators. Results to date are promising but show a consistent gap between women completing ANC and those going to a facility for delivery. A qualitative study was conducted to understand psychosocial preferences, agency for decision-making, and access barriers that influence where a woman in the ward will deliver. METHODS: In-depth interviews, focus group discussions and key-informant interviews were conducted with 24 pregnant and/or parous women, 24 TBAs, 3 nurse midwives at 3 health facilities, and 24 married men, living in Nainokanoka ward. Interviews and discussions were transcribed, translated, and analyzed thematically using a grounded theory approach. RESULTS: Most women interviewed expressed preference for a home delivery with a TBA and even those who expressed agency and preference for a facility delivery usually had their last delivery at home attributed to unexpected labor. TBAs are engaged by husbands and play a significant influential role in deciding place of delivery. TBAs claim to support facility deliveries but in practice use them as a last resort and reported a significant trust gap based on a bad experience at a facility where women in labor were turned away. CONCLUSIONS: EbOO project data and study results show a slow but steady change in norms around delivery preference in Nainokanoka ward. Gaps between expressed intention and practice, especially around ‘unexpected labor’ present opportunities to accelerate this process by promoting birth plans and perhaps constructing a maternity waiting house in the ward. Rebuilding trust between facility midwives, TBAs, and the community on the availability of health facility services, and increased sensitivity to women’s cultural preferences, could also close the gap between the number of women who are currently using facilities for ANC and those returning for delivery.

scholarly journals Thoughts, beliefs and concepts concerning infectious childhood diseases of physicians practicing homeopathic, anthroposophic and conventional medicine – a qualitative study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
N. Mittring-Junghans ◽  
C. Holmberg ◽  
C. M. Witt ◽  
M. Teut
Keyword(s):  
Decision Making ◽  
Qualitative Study ◽  
Scarlet Fever ◽  
Conventional Medicine ◽  
Vaccination Schedule ◽  
Anthroposophic Medicine ◽  
Theory Approach ◽  
Parent Child Relationship ◽  
Childhood Diseases ◽  
Child Relationship

Abstract Background Physicians who include complementary medicine in their practice are thought to have an understanding of health and disease different from that of colleagues practicing conventional medicine. The aim of this study was to identify and compare the thoughts and concepts concerning infectious childhood diseases (measles, mumps, rubella, chickenpox, pertussis and scarlet fever) of physicians practicing homeopathic, anthroposophic and conventional medicine. Methods This qualitative study used semistructured interviews. Participating physicians were either general practitioners or pediatricians. Data collection and analysis were guided by a grounded theory approach. Results Eighteen physicians were interviewed (6 homeopathic, 6 anthroposophic and 6 conventional). All physicians agreed that while many classic infectious childhood diseases such as measles, mumps and rubella are rarely observed today, other diseases, such as chickenpox and scarlet fever, are still commonly diagnosed. All interviewed physicians vaccinated against childhood diseases. A core concern for physicians practicing conventional medicine was the risk of complications of the diseases. Therefore, it was considered essential for them to advise their patients to strictly follow the vaccination schedule. Homeopathic-oriented physicians viewed acute disease as a biological process necessary to strengthen health, fortify the immune system and increase resistance to chronic disease. They tended to treat infectious childhood diseases with homeopathic remedies and administered available vaccines as part of individual decision-making approaches with parents. For anthroposophic-oriented physicians, infectious childhood diseases were considered a crucial factor in the psychosocial growth of children. They tended to treat these diseases with anthroposophic medicine and underlined the importance of the family’s resources. Informing parents about the potential benefits and risks of vaccination was considered important. All physicians agreed that parent-delivered loving care of a sick child could benefit the parent-child relationship. Additionally, all recognized that existing working conditions hindered parents from providing such care for longer durations of time. Conclusions The interviewed physicians agreed that vaccines are an important aspect of modern pediatrics. They differed in their approach regarding when and what to vaccinate against. The different conceptual understandings of infectious childhood diseases influenced this decision-making. A survey with a larger sample would be needed to verify these observations.

scholarly journals District decision-making for health in low-income settings: a qualitative study in Uttar Pradesh, India, on engaging the private health sector in sharing health-related data

2016 ◽  
Vol 31 (suppl 2) ◽  
pp. ii35-ii46 ◽  
Author(s):  
Meenakshi Gautham ◽  
Neil Spicer ◽  
Manish Subharwal ◽  
Sanjay Gupta ◽  
Aradhana Srivastava ◽  
...  
Keyword(s):  
Decision Making ◽  
Qualitative Study ◽  
Low Income ◽  
Health Sector ◽  
Uttar Pradesh ◽  
Related Data ◽  
Private Health Sector ◽  
Health Related

scholarly journals Challenges to effective governance in a low income healthcare system: a qualitative study of stakeholder perceptions in Malawi

2020 ◽  
Author(s):  
Sarah C Masefield ◽  
Alan Msosa ◽  
Jean Grugel
Keyword(s):  
Decision Making ◽  
Qualitative Study ◽  
Health System ◽  
National Health ◽  
Low Income ◽  
Service Providers ◽  
Health Sector ◽  
National Health System ◽  
Low Income Countries ◽  
Health Coverage

Abstract BackgroundAll countries face challenging decisions about healthcare coverage. Malawi has committed to achieving Universal Health Coverage (UHC) by 2030, the timeframe set out by the Sustainable Development Goals (SDGs). As in other low income countries, scarce resources stand in the way of more equitable health access and quality in Malawi. Its health sector is highly dependent on donor contributions, and recent poor governance of government-funded healthcare saw donors withdraw funding, limiting services and resources. The 2017 National Health Plan II and accompanying Health Strategic Plan II identify the importance of improved governance and strategies to achieve more effective cooperation with stakeholders. This study explores health sector stakeholders’ perceptions of the challenges to improving governance in Malawi’s national health system within the post-2017 context of government attempts to articulate a way forward.MethodsA qualitative study design was used. Interviews were conducted with 22 representatives of major international and faith-based non-government organisations, civil society organisations, local government and government-funded organisations, and governance bodies operating in Malawi. Open questions were asked about experiences and perceptions of the functioning of the health system and healthcare decision-making. Content relating to healthcare governance was identified in the transcripts and field notes and analysed using inductive content analysis.ResultsStakeholders view governance challenges as a significant barrier to achieving a more effective and equitable health system. Three categories were identified: accountability (enforceability; answerability; stakeholder-led initiatives); health resource management (healthcare financing; drug supply); influence in decision-making (unequal power; stakeholder engagement).ConclusionsHealth sector stakeholders see serious political, structural, and financial challenges to improving governance in the national health system in Malawi which will impact the government’s goal of achieving UHC by 2030. Stakeholders identify the need for improved oversight, implementation, service delivery and social accountability of government-funded service providers to communities. Eighteen months after the introduction of the policy documents, they see little evidence of improved governance and have little or no confidence in the government’s ability to deliver UHC. The difficulties stakeholders perceive in relation to building equitable and effective healthcare governance in Malawi have relevance for other resource-limited countries which have also committed to the goal of UHC.

scholarly journals Challenges to effective governance in a low income healthcare system: a qualitative study of stakeholder perceptions in Malawi

2020 ◽  
Author(s):  
Sarah C Masefield ◽  
Alan Msosa ◽  
Jean Grugel
Keyword(s):  
Decision Making ◽  
Qualitative Study ◽  
Health System ◽  
National Health ◽  
Low Income ◽  
Service Providers ◽  
Health Sector ◽  
National Health System ◽  
Low Income Countries ◽  
Health Coverage

Abstract Background: All countries face challenging decisions about healthcare coverage. The scare resources of low income countries prevent improvements in equitable access and quality. Malawi, one of the poorest countries in the world, has committed to achieving Universal Health Coverage (UHC) by 2030. The health sector is highly dependent on donor contributions, but recent poor governance of government-funded healthcare saw donors withdraw funding, limiting services and resources. The 2017 updated National Health Plan II and accompanying Health Strategic Plan II identify the importance of improved governance and strategies to achieve it, including greater harmonisation with health stakeholders. This study explores health sector stakeholders’ perceptions of challenges to improving governance in the national health system. Methods: A qualitative study design was used. Interviews were conducted with 22 representatives of the major international and faith-based non-government organisations, civil society organisations, local government and government-funded organisations, and governance bodies operating in Malawi. Open questions were asked about experiences and perceptions of the functioning of the health system and healthcare decision-making. The transcripts and field notes were analysed using inductive content analysis.Results: Stakeholders view governance challenges as a barrier to achieving a more effective and equitable health system. Three types of challenges were identified: accountability (enforceability; answerability; stakeholder-led initiatives); health resource management (healthcare financing; drug supply); influence in decision-making (unequal power; stakeholder engagement).Conclusions: Health sector stakeholders see a range of serious challenges to improving governance in the national health system in Malawi which will impact on the government’s goal of achieving UHC by 2030. These can be categorised as political, structural, and financial challenges. Stakeholders identify the need for improved oversight, implementation, service delivery and social accountability of government-funded service providers to communities. Eighteen months after the introduction of the NHP II and HSSP II, they see little evidence of improved governance and have little or no confidence in the government’s ability to deliver UHC in the timeframe set out by the Sustainable Development Goals (SDGs). The difficulties stakeholders perceive in relation to building equitable and effective health governance in Malawi have relevance for other resource-limited countries which have also committed to the goal of UHC.

How Psychosocial Factors Contribute to Japanese Older Adults’ Initiation of Advance Care Planning Discussions: A Qualitative Study

2020 ◽  
pp. 073346482091153 ◽  
Author(s):  
Jun Miyashita ◽  
Ayako Kohno ◽  
Yosuke Yamamoto ◽  
Sayaka Shimizu ◽  
Teruhisa Azuma ◽  
...  
Keyword(s):  
Older Adults ◽  
Decision Making ◽  
Qualitative Study ◽  
Psychosocial Factors ◽  
Advance Care Planning ◽  
Family Caregiving ◽  
Care Planning ◽  
Theory Approach ◽  
Advance Care ◽  
Family Centered

Objectives: This study aimed to reveal the features of older adults’ advance care planning (ACP) discussions by identifying psychosocial factors related to their discussions in Japan, where people value family-centered decision making. Methods: A qualitative study using in-depth interviews was conducted with 39 participants (aged ≥65 years) recruited from the outpatient department of a community hospital in Fukushima, Japan. Data were analyzed using the grounded theory approach. Results: Through experiences of family caregiving, participants became aware of their own feelings about the end of life. Equal relationship with family members was important for lowering the threshold for having discussions. Some participants and their families in the same generation reached agreements on ACP; however, they were willing to yield to children’s decision making despite these discussions. Discussions: These findings provide insights into the psychosocial factors in relation to ACP discussions and support for the role of ACP discussions in the family-centered decision-making culture.

scholarly journals Challenges to effective governance in a low income healthcare system: a qualitative study of stakeholder perceptions in Malawi

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Sarah C. Masefield ◽  
Alan Msosa ◽  
Jean Grugel
Keyword(s):  
Decision Making ◽  
Qualitative Study ◽  
Health System ◽  
National Health ◽  
Low Income ◽  
Service Providers ◽  
Health Sector ◽  
National Health System ◽  
Low Income Countries ◽  
Health Coverage

Abstract Background All countries face challenging decisions about healthcare coverage. Malawi has committed to achieving Universal Health Coverage (UHC) by 2030, the timeframe set out by the Sustainable Development Goals (SDGs). As in other low income countries, scarce resources stand in the way of more equitable health access and quality in Malawi. Its health sector is highly dependent on donor contributions, and recent poor governance of government-funded healthcare saw donors withdraw funding, limiting services and resources. The 2017 National Health Plan II and accompanying Health Strategic Plan II identify the importance of improved governance and strategies to achieve more effective cooperation with stakeholders. This study explores health sector stakeholders’ perceptions of the challenges to improving governance in Malawi’s national health system within the post-2017 context of government attempts to articulate a way forward. Methods A qualitative study design was used. Interviews were conducted with 22 representatives of major international and faith-based non-government organisations, civil society organisations, local government and government-funded organisations, and governance bodies operating in Malawi. Open questions were asked about experiences and perceptions of the functioning of the health system and healthcare decision-making. Content relating to healthcare governance was identified in the transcripts and field notes and analysed using inductive content analysis. Results Stakeholders view governance challenges as a significant barrier to achieving a more effective and equitable health system. Three categories were identified: accountability (enforceability; answerability; stakeholder-led initiatives); health resource management (healthcare financing; drug supply); influence in decision-making (unequal power; stakeholder engagement). Conclusions Health sector stakeholders see serious political, structural, and financial challenges to improving governance in the national health system in Malawi which will impact the government’s goal of achieving UHC by 2030. Stakeholders identify the need for improved oversight, implementation, service delivery and social accountability of government-funded service providers to communities. Eighteen months after the introduction of the policy documents, they see little evidence of improved governance and have little or no confidence in the government’s ability to deliver UHC. The difficulties stakeholders perceive in relation to building equitable and effective healthcare governance in Malawi have relevance for other resource-limited countries which have also committed to the goal of UHC.

scholarly journals Beyond the “information deficit model” - understanding vaccine-hesitant attitudes of midwives in Austria: a qualitative study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Lisa Lehner ◽  
Janna Gribi ◽  
Kathryn Hoffmann ◽  
Katharina T. Paul ◽  
Ruth Kutalek
Keyword(s):  
Decision Making ◽  
Early Childhood ◽  
Qualitative Study ◽  
Healthcare Workers ◽  
Healthcare Professionals ◽  
Scientific Information ◽  
Vaccine Hesitancy ◽  
Theory Approach ◽  
Deficit Model ◽  
The Right

Abstract Background Healthcare workers are considered key stakeholders in efforts to address vaccine hesitancy. Midwives’ influence in advising expectant parents on early-childhood vaccinations is unquestioned, yet they remain an understudied group. The literature on midwives’ attitudes towards vaccinations is also inconclusive. We therefore conducted an explorative qualitative study on midwives’ vaccine-hesitant attitudes towards MMR (measles-mumps-rubella) vaccinations in Austria. Methods We conducted 12 in-depth interviews on their knowledge, concerns, and beliefs with midwives who self-identified as hesitant or resistant towards early-childhood MMR vaccinations. We analyzed the data using a grounded theory approach to distill common themes and meanings. Results Healthcare workers’ stewardship to address vaccine hesitancy is commonly framed in terms of the “information deficit model”: disseminate the right information and remedy publics’ information deficits. Our findings suggest that this approach is too simplistic: Midwives’ professional self-understanding, their notions of “good care” and “good parenthood” inflect how they engage with vaccine information and how they address it to their clients. Midwives’ model of care prioritized good counseling rather than sharing scientific information in a “right the wrong”-manner. They saw themselves as critical consumers of that information and as promoting “empowered patients” who were free, and affluent enough, to make their own choices about vaccinations. In so doing, they also often promoted traditional notions of motherhood. Conclusions Research shows that, for parents, vaccine decision-making builds on trust and dialogue with healthcare professionals and is more than a technical issue. In order to foster these interactions, understanding healthcare professionals’ means of engaging with information is key to understanding how they engage with their constituents. Healthcare workers are more than neutral resources; their daily praxis influenced by their professional standing in the healthcare system. Similarly, healthcare professionals’ views on vaccinations cannot be remedied with more information either. Building better and more diverse curricula for different groups of healthcare workers must attend to their respective roles, ethics of care, and professional beliefs. Taken together, better models for addressing vaccine hesitancy can only be developed by espousing a multi-faceted view of decision-making processes and interactions of healthcare workers with constituents.

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