Normative Beliefs and Values Shape Mother’s Care Seeking Behaviours for Skilled Birth Attendance (Sba) During Birthing in Africa: A Scoping Review Protocol

2020 ◽  
Author(s):  
Choolwe Jacobs ◽  
Adnan Hyder
Keyword(s):  
Scoping Review ◽  
Grey Literature ◽  
Skilled Birth Attendance ◽  
Health Facilities ◽  
Barriers And Facilitators ◽  
Care Seeking ◽  
Normative Beliefs ◽  
Birth Attendance ◽  
Beliefs And Values ◽  
Scoping Reviews

Abstract Background: Skilled birth attendance (SBA) during delivery has been associated with improved maternal health outcome. However, low utilisation of SBA during childbirth has continued in many developing countries including Zambia. An understanding of the beliefs and values and how mothers are influenced by relational normative motivations is critical in understanding some “hidden” barriers and facilitators to utilisation of SBA in health facilities.Methods: A scoping review of normative beliefs and values shaping care seeking behaviours for Skilled Birth Attendance by mothers in Africa will be conducted. Google scholar, PubMed, EBSCOhost, SCOPUS, Embase and WEB of Science will be searched for articles that meet the eligibility criteria. The primary search will include peer-reviewed articles. Further searches will be made on Research gate, including grey literature from university websites for dissertations and theses. We will also search reference lists for relevant articles and studies. Keyword searches will be used to identify articles. Two independent reviewers will begin screening for eligible titles, abstracts and full articles with a third reviewer to help resolve any disputes. During title and abstract screening, duplicates will be removed. Study selection will conform to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines, and the Mixed Method Appraisal Tool will determine the quality of included studies. Content analysis will be used to present the narrative Discussion: Understanding how individual mother’s health seeking behaviours for SBA and those close to them are influenced by their beliefs and values is critical to informing health systems on the possible “hidden” barriers and facilitators to utilisation of SBA in public health facilities. The review will complement evidence base on normative beliefs and values shaping care seeking behaviours for Skilled Birth Attendance by mothers in Africa.

scholarly journals Normative beliefs and values that shape care-seeking behaviours for skilled birth attendance (SBA) during birthing by mothers in Africa: a scoping review protocol

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Choolwe Jacobs ◽  
Adnan A. Hyder
Keyword(s):  
Health Care Providers ◽  
Scoping Review ◽  
Grey Literature ◽  
Skilled Birth Attendance ◽  
Health Facilities ◽  
Care Seeking ◽  
Care Providers ◽  
Normative Beliefs ◽  
Birth Attendance ◽  
Beliefs And Values

Abstract Background Skilled birth attendance (SBA) during delivery has been associated with improved maternal health outcome. However, low utilisation of SBA during childbirth has continued in many developing countries including Zambia. The proposed scoping review aims to map literature on beliefs and values and how mothers are influenced by relational normative motivations in utilisation of SBAs in health facilities. Methods We designed and registered a study protocol for a scoping review. Literature searches will be conducted in multiple electronic databases (from January 2000 onwards), including PubMed, EMBASE, Scopus and Web of Science. Grey literature will be identified through searching dissertation databases, Google Scholar, EBSCOhost and ResearchGate. Keyword searches will be used to identify articles. Only articles published in English, related on beliefs and values surrounding childbirth, and on perceptions towards facility delivery or skilled health care providers will be considered eligible for inclusion. Two reviewers will independently screen eligible titles, abstracts and full articles with a third reviewer to help resolve any disputes. The study methodological quality (or bias) will be appraised using the Mixed Method Appraisal Tool. A narrative summary of findings will be conducted. We will employ NVIVO version 10 software package to extract the relevant outcomes from the included articles using content thematic analysis. This protocol is registered with the Open Science Framework (osf.io/9gn76). Discussion Understanding how individual mother’s health seeking behaviours for SBA and those close to them are influenced by their beliefs and values is critical to informing health systems on the possible ‘hidden’ barriers and facilitators to utilisation of SBA in public health facilities. The review will complement evidence base on normative beliefs and values shaping care-seeking behaviours for skilled birth attendance by mothers in Africa.

scholarly journals Barriers and facilitators for implementation of electronic consultations (eConsult) to enhance specialist access to care: a scoping review protocol

BMJ Open ◽  
2018 ◽  
Vol 8 (9) ◽  
pp. e022733 ◽  
Author(s):  
Mohamed A Osman ◽  
Kara Schick-Makaroff ◽  
Stephanie Thompson ◽  
Robin Featherstone ◽  
Liza Bialy ◽  
...  
Keyword(s):  
Access To Care ◽  
Scoping Review ◽  
Grey Literature ◽  
Primary Care Providers ◽  
Barriers And Facilitators ◽  
Cochrane Library ◽  
Care Providers ◽  
Adoption And Implementation ◽  
Scoping Reviews ◽  
Study Characteristics

IntroductionElectronic consultations (eConsult), asynchronous exchanges of patient health information at a distance, are increasingly used as an option to facilitate patient care and collaboration between primary care providers and specialists. Although eConsult has demonstrated success in increasing efficiency in the referral process and enhancing access to care, little is known about the factors influencing its wider adoption and implementation by end users. In this paper, we describe a protocol to conduct a scoping review of the literature on the barriers and facilitators to a wider adoption and implementation of eConsult service.Methods and analysisThis scoping review will be based on the framework pioneered by Arksey and O’Malley and later developed by Levacet al. We will use the guidance for scoping reviews developed by the Joanna Briggs Institute to report our findings. In addition to several electronic databases (Medline, Embase, Cochrane Library, CINAHL, EBSCOhost and PsycINFO) studies will be identified by including relevant grey literature. Two reviewers will independently screen titles and full texts for inclusion. Studies reporting on barriers and/or facilitators in settings similar to eConsult will be included. Data on study characteristics and key barriers and facilitators will be extracted. Data will be analysed thematically and classified using the Quadruple Aim framework.Ethics and disseminationApproval by research ethics board is not required since the review will only include published and publicly accessible data. Review findings will be used to inform future studies and the development of practice tools to support the wider adoption and success of eConsult implementation. We plan to publish our findings in a peer-reviewed journal and develop a useful and accessible summary of the results.

scholarly journals Barriers and facilitators to buprenorphine use for opioid agonist treatment: protocol for a scoping review

BMJ Open ◽  
2019 ◽  
Vol 9 (12) ◽  
pp. e032285
Author(s):  
Pamela Leece ◽  
Triti Khorasheh ◽  
Kimberly Corace ◽  
Carol Strike ◽  
Ahmed M Bayoumi ◽  
...  
Keyword(s):  
Healthcare Professional ◽  
Scoping Review ◽  
Grey Literature ◽  
Treatment Protocol ◽  
Barriers And Facilitators ◽  
System Level ◽  
Evidence Based ◽  
Opioid Agonist ◽  
Professional Organisation ◽  
Scoping Reviews

IntroductionIn the context of the opioid crisis in North America, the benefits of evidence-based opioid agonist treatments such as buprenorphine/naloxone have not been optimised due to low uptake. Numerous factors contribute to the underuse of buprenorphine, and theory-informed approaches to identify and address implementation barriers and facilitators are needed. This scoping review aims to characterise the barriers and facilitators at the patient, healthcare professional, organisation and system level according to the Theoretical Domains Framework (TDF), and identify gaps to inform practice and policy.Methods and analysisWe will conduct a scoping review using established methods and follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews. We will identify English and French-language peer-reviewed literature by searching five electronic bibliographic databases (MEDLINE, Embase, PsychINFO, CINAHL, and SocINDEX), from inception and use Google, websites of key organisations, and two or more custom search engines to identify relevant grey literature. Eligible records will be quantitative or qualitative studies that examine barriers and facilitators to buprenorphine use at the patient, healthcare professional, organisation and system level, and involve participants with diagnosis of opioid use disorder or professionals involved in their care. Two reviewers will be involved in independently screening, reviewing and charting the data and calibration exercises will be conducted at each stage. We will conduct descriptive analysis for the charted data, and deductively code barriers and facilitators using the TDF.Ethics and disseminationAs a scoping review of the literature, this study does not require ethics approval. Our dissemination strategy will focus on developing tailored activities to meet the needs of diverse knowledge user audiences. Barriers and facilitators mapped to the TDF can be linked to evidence-based strategies for change to improve buprenorphine use and access, and enable practice to reduce opioid-related harms.

scholarly journals Mapping evidence on the effects of gender-affirming hormone therapy on the hard and soft tissues of the craniofacial complex in transgender people: a protocol for a scoping review

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
M. F. Van den Bosch ◽  
C. M. Wiepjes ◽  
M. Den Heijer ◽  
L. J. Schoonmade ◽  
R. E. G. Jonkman ◽  
...  
Keyword(s):  
Systematic Review ◽  
Scoping Review ◽  
Soft Tissues ◽  
Grey Literature ◽  
Cochrane Library ◽  
Sex Characteristics ◽  
Transgender People ◽  
Link Type ◽  
Scoping Reviews ◽  
Craniofacial Complex

Abstract Background Gender-affirming hormone (GAH) therapy aims to support the transition of transgender people to their gender identity. GAHs can induce changes in their secondary sex characteristics such as the development of breasts in transgender females and increased muscle mass in transgender males. The face and its surrounding tissues also have an important role in gender confirmation. The aim of this scoping review is to systematically map the available evidence in order to provide an overview of the effects of GAH therapy on the hard and soft tissues of the craniofacial complex in transgender people. Methods/design The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA) extension for Scoping Reviews was consulted for reporting this protocol. The methods were based on the Arksey and O’Malley’s framework and the Reviewer’s Manual of the Joanna Briggs Institute for conducting scoping reviews. Ten transgender people were involved in the development of the primary research question through short interviews. The eligibility criteria were defined for transgender people undergoing GAH therapy and for quantitative and qualitative outcomes on the hard and soft tissues of the craniofacial complex. Eligible sources of evidence include observational, experimental, qualitative, and mixed method studies. No exclusion criteria will be applied for the language of publication and the setting. To identify eligible sources of evidence, we will conduct searches from inception onwards in PubMed, Embase.com, the Cochrane Library, Web of Science Core Collection, Scopus, CINAHL, LIVIVO, and various grey literature sources such as Google Scholar. Two reviewers will independently select eligible studies in these information sources and will subsequently conduct data extraction. The same operators will chart, categorize, and summarize the extracted data. A narrative summary of findings will be conducted. Frequency counts of quantitative and qualitative data on items such as concepts, populations, interventions, and other characteristics of the eligible sources will be given. Where possible, these items will be mapped descriptively. Discussion We chose the scoping review over the systematic review approach, because the research questions are broad-spectrum and the literature is expected to be widely scattered. No systematic review has previously assessed this topic. Identifying knowledge gaps in this area and summarizing and disseminating research findings are important for a wide spectrum of stakeholders, in particular, for transgender people who want to undergo additional interventions such as plastic or orthognathic surgery or orthodontics. Systematic review registration This protocol was registered in the Open Science Framework: https://osf.io/e3qj6

scholarly journals Scoping review protocol: bladder cancer in Nigeria: what are the gaps in clinical care and research?

BMJ Open ◽  
2021 ◽  
Vol 11 (1) ◽  
pp. e041894
Author(s):  
Joyce Kibaru ◽  
Pinky Kotecha ◽  
Abdulkarim Muhammad Iya ◽  
Beth Russell ◽  
Muzzammil Abdullahi ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Scoping Review ◽  
Low Income ◽  
Clinical Care ◽  
Grey Literature ◽  
Case Series ◽  
Cochrane Library ◽  
Future Research ◽  
Scoping Reviews ◽  
Local Risk

IntroductionBladder cancer (BC) is the 10th common cancer worldwide and ranks seventh in Nigeria. This scoping review aims to identify the gaps in clinical care and research of BC in Nigeria as part of the development of a larger national research programme aiming to improve outcomes and care of BC.Methods and analysisThis review will be conducted according to Arksey and O’Malley scoping review methodology framework. The following electronic databases will be searched: Medline (using the PubMed interface), Ovid Gateway (Embase and Ovid), Cochrane library and Open Grey literature. Two independent reviewers will screen titles and abstracts and subsequently screen full-text studies for inclusion, any lack of consensus will be discussed with a third reviewer. Any study providing insight into the epidemiology or treatment pathway of BC (RCTs, observations, case series, policy paper) will be included. A data chart will be used to extract relevant data from the included studies. Results will be reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews. A consultation process will be carried out with a multidisciplinary team of Nigerian healthcare professionals, patients and scientists.Ethics and disseminationThe results will be disseminated through peer-reviewed publications. By highlighting the key gaps in the literature, this review can provide direction for future research and clinical guidelines in Nigeria (and other low-income and middle-income countries), where BC is more prevalent due to local risk factors and healthcare settings.

Interventions to optimise medication prescribing and adherence in older people with cancer: A systematic scoping review

2021 ◽  
Vol 29 (Supplement_1) ◽  
pp. i23-i24
Author(s):  
M Murphy ◽  
K Bennett ◽  
S Ryan ◽  
C Hughes ◽  
A Lavan ◽  
...  
Keyword(s):  
Older Adults ◽  
Scoping Review ◽  
Grey Literature ◽  
Intervention Development ◽  
Control Group ◽  
Sample Population ◽  
Inclusion Criteria ◽  
Scoping Reviews ◽  
Medication Prescribing ◽  
Broad Overview

Abstract Introduction Older adults with cancer often require multiple medications (polypharmacy) comprising cancer-specific treatments, supportive care medications (e.g. analgesics) and medications for pre-existing conditions. The reported prevalence of polypharmacy in older adults with cancer ranges from 13–92% (1). Increasing numbers of medications pose risks of potentially inappropriate prescribing and medication non-adherence. Aim The aim of this scoping review was to provide an overview of evaluations of interventions to optimise medication prescribing and/or adherence in older adults with cancer, with a particular focus on the interventions, study populations and outcome measures that have been assessed in previous evaluations. Methods Four databases (PubMed, EMBASE, CINAHL, PsycINFO) were searched from inception to 29th November 2019 using relevant search terms (e.g. cancer, older adults, prescribing, adherence). Eligible studies evaluated interventions seeking to improve medication prescribing and/or adherence in older adults (≥65 years) with an active cancer diagnosis using a comparative evaluation (e.g. inclusion of a control group). All outcomes for studies that met inclusion criteria were included in the review. Two reviewers independently screened relevant abstracts for inclusion and performed data extraction. As a scoping review aims to provide a broad overview of existing literature, formal assessments of methodological quality of included studies were not undertaken. Extracted data were collated using tables and accompanying narrative descriptive summaries. The review was reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews (PRISMA-ScR) guidelines (2). Results The electronic searches yielded 21,136 citations (Figure 1). Nine studies met inclusion criteria. Included studies consisted of five randomised controlled trials (RCTs), including one cluster RCT, and four before-and-after study designs. Studies were primarily conducted in oncology clinics, ranging from single study sites to 109 oncology clinics. Sample sizes ranged from 33 to 4844 patients. All studies had a sample population with a mean/median age of ≥65 years, however, only two studies focused specifically on older populations. Interventions most commonly involved patient education (n=6), and were delivered by pharmacists or nurses. Five studies referred to the intervention development process and no studies reported any theoretical underpinning. Three studies reported on prescribing-related outcomes and seven studies reported on adherence-related outcomes, using different terminology and a range of assessments. Prescribing-related outcomes comprised assessments of medication appropriateness (using Beers criteria), drug-related problems and drug interactions. Adherence-related outcomes included assessments of self-reported medication adherence and calculation of patients’ medication possession ratio. Conclusion The main strength of this scoping review is that it provides a broad overview of the existing literature on interventions aimed at optimising medication prescribing and adherence in older adults with cancer. The review highlights a lack of robust studies specifically targeting this patient population and limited scope to pool outcome data across included studies. Limitations of the review were that searches were restricted to English language publications and no grey literature was searched. Future research should focus specifically on older patients with cancer, and exercise rigour during intervention development, evaluation and reporting in order to generate findings that could inform future practice. References 1. Maggiore RJ, Gross CP, Hurria A. Polypharmacy in older adults with cancer. The oncologist. 2010;15(5):507–22. 2. Tricco AC, Lillie E, Zarin W, O'Brien KK, Colquhoun H, Levac D, et al. PRISMA Extension for Scoping Reviews (PRISMA-ScR): Checklist and Explanation. Ann Intern Med. 2018;169(7):467–73.

scholarly journals Sexual health and COVID-19: protocol for a scoping review

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Navin Kumar ◽  
Kamila Janmohamed ◽  
Kate Nyhan ◽  
Laura Forastiere ◽  
Wei-Hong Zhang ◽  
...  
Keyword(s):  
Systematic Review ◽  
Clinical Trials ◽  
Sexual Health ◽  
Scoping Review ◽  
Current Knowledge ◽  
Grey Literature ◽  
Well Being ◽  
World Health ◽  
Original Research ◽  
Scoping Reviews

Abstract Background Global responses to the COVID-19 pandemic have exposed and exacerbated existing socioeconomic and health inequities that disproportionately affect the sexual health and well-being of many populations, including people of color, ethnic minority groups, women, and sexual and gender minority populations. Although there have been several reviews published on COVID-19 and health disparities across various populations, none has focused on sexual health. We plan to conduct a scoping review that seeks to fill several of the gaps in the current knowledge of sexual health in the COVID-19 era. Methods A scoping review focusing on sexual health and COVID-19 will be conducted. We will search (from January 2020 onwards) CINAHL, Africa-Wide Information, Web of Science Core Collection, Embase, Gender Studies Database, Gender Watch, Global Health, WHO Global Literature on Coronavirus Disease Database, WHO Global Index Medicus, PsycINFO, MEDLINE, and Sociological Abstracts. Grey literature will be identified using Disaster Lit, Google Scholar, governmental websites, and clinical trials registries (e.g., ClinicalTrial.gov, World Health Organization, International Clinical Trials Registry Platform, and International Standard Randomized Controlled Trial Number Registry). Study selection will conform to the Joanna Briggs Institute Reviewers’ Manual 2015 Methodology for JBI Scoping Reviews. Only English language, original studies will be considered for inclusion. Two reviewers will independently screen all citations, full-text articles, and abstract data. A narrative summary of findings will be conducted. Data analysis will involve quantitative (e.g., frequencies) and qualitative (e.g., content and thematic analysis) methods. Discussion Original research is urgently needed to mitigate the risks of COVID-19 on sexual health. The planned scoping review will help to address this gap. Systematic review registrations Systematic Review Registration: Open Science Framework osf/io/PRX8E

Biologics in professional and Olympic sport: a scoping review

2021 ◽  
Vol 103-B (7) ◽  
pp. 1189-1196
Author(s):  
Iain R. Murray ◽  
Navnit S. Makaram ◽  
Scott A. Rodeo ◽  
Marc R. Safran ◽  
Seth L. Sherman ◽  
...  
Keyword(s):  
Systematic Reviews ◽  
Scoping Review ◽  
Grey Literature ◽  
Musculoskeletal Injuries ◽  
American Football ◽  
Biologic Therapies ◽  
Olympic Athletes ◽  
Hamstring Injuries ◽  
Consensus Statements ◽  
Scoping Reviews

Aims The aim of this study was to prepare a scoping review to investigate the use of biologic therapies in the treatment of musculoskeletal injuries in professional and Olympic athletes. Methods Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for scoping reviews and Arksey and O’Malley frameworks were followed. A three-step search strategy identified relevant published primary and secondary studies, as well as grey literature. The identified studies were screened with criteria for inclusion comprising clinical studies evaluating the use of biologic therapies in professional and Olympic athletes, systematic reviews, consensus statements, and conference proceedings. Data were extracted using a standardized tool to form a descriptive analysis and a thematic summary. Results A total of 202 studies were initially identified, and 35 met criteria for the scoping review; 33 (94.3%) were published within the last eight years, and 18 (51.4%) originated from the USA. Platelet rich plasma was the most studied biologic therapy, being evaluated in 33 (94.3%) studies. Ulnar collateral ligament and hamstring injuries were the conditions most studied (nine (25.7%) studies and seven (20.0%) studies, respectively). Athletes most frequently participated in baseball, soccer, and American football. Only two (5.7%) studies were level 1 evidence, with interpretation and comparison between studies limited by the variations in the injury profile, biologic preparations, and rehabilitation protocols. Conclusion There is diverse use of biologic therapies in the management of musculoskeletal injuries in professional and Olympic athletes. There is currently insufficient high-level evidence to support the widespread use of biologic therapies in athletes. Further research priorities include the development of condition/pathology-specific preparations of biologic therapies, and of outcome measures and imaging modalities sufficiently sensitive to detect differences in outcomes, should they exist. Cite this article: Bone Joint J 2021;103-B(7):1189–1196.

scholarly journals Information and communication technology-based interventions for suicide prevention implemented in clinical settings: A scoping review protocol

2021 ◽  
Author(s):  
Hwayeon Danielle Shin ◽  
Juveria Zaheer ◽  
Terri Rodak ◽  
John Torous ◽  
Gillian Strudwick
Keyword(s):  
Information And Communication Technology ◽  
Suicide Prevention ◽  
Communication Technology ◽  
Scoping Review ◽  
Implementation Strategies ◽  
Mobile App ◽  
Barriers And Facilitators ◽  
Clinical Settings ◽  
Scoping Reviews ◽  
Information And Communication

IntroductionThere is a surplus of Information and Communication Technology (ICT)-based interventions for suicide prevention. However, it is unclear which of these ICT-based interventions for suicide prevention have been implemented in clinical settings. Furthermore, evidence shows that implementation strategies have often been mismatched to existing barriers. In response, the authors recognize the critical need for prospectively assessing the barriers and facilitators and then strategically developing implementation strategies. This review is part of a multi-phase project to develop and test tailored implementation strategies for mobile app-based suicide prevention in clinical settings. The overall objective of this scoping review is to identify and characterize ICT-based interventions for all levels of suicide prevention in clinical settings. Additionally, this review will identify and characterize the barriers and facilitators to implementing these ICT-based interventions as well as reported measures and outcomes. The findings will directly inform the subsequent phase to maximize implementation and inform future efforts for implementing other types of ICT-based interventions related to suicide prevention in clinical settings.Methods and analysis This review will adhere to the methods described by the Joanna Briggs Institute for conducting scoping reviews. The reporting will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for scoping reviews checklist. The following databases will be searched: Medline, PsycInfo, Embase, CINAHL, Web of Science, and LISTA. Two reviewers will independently screen the articles and extract data using a standardised data collection tool. Then, authors will characterize extracted data using frameworks, typology, and taxonomies to address the proposed review questions. Ethics and disseminationEthics approval is not required for this scoping review. Authors will share the results in a peer-reviewed, open access publication, and conference presentations. Furthermore, the findings will be shared with relevant health organizations through lay language summaries and informal presentations.

scholarly journals Magnitude and determinants of self-referrals among women seeking skilled birth attendance services: a cross-sectional hospital-based study in Marsabit County, Kenya

2021 ◽  
Vol 8 (5) ◽  
pp. 2124
Author(s):  
Joseph O. Adoyo ◽  
Eliphas G. Makunyi ◽  
George O. Otieno ◽  
Alison Yoos
Keyword(s):  
Multiple Logistic Regression Analysis ◽  
Skilled Birth Attendance ◽  
Health Facilities ◽  
Public Hospitals ◽  
Systematic Sampling ◽  
P Value ◽  
Cross Sectional ◽  
Factors Associated ◽  
Birth Attendance ◽  
Referral Hospitals

Background: Self-referral to higher-level hospitals by women seeking skilled birth attendance services reflects in part their non-adherence to established referral pathways. This choice results in an inappropriate utilization of resources within health system. The Kenya Health Sector Referral Strategy aims at optimising the utilization and access of facilities. The aim of this study was to determine the prevalence and factors associated with self-referral among women seeking skilled birth attendance services in Marsabit County between 1st and 31st Oct 2019.Methods: A cross-sectional study was adopted at the maternity department in the selected public hospitals in Marsabit County, by use of interviewer-administered questionnaires to collect information from 161 women, through systematic sampling between 1st and 31st Oct 2019. Chi-square and multiple logistic regression analysis were used to test for factors associated with self-referral at 95% confidence interval.Results: Of the 161 women interviewed, 47.2% (n=76) were self-referrals. The odds of self-referral to the higher level health facilities were more likely among women: - aged 25-29 (AOR 5.174, CI 1.015-26.365, p-value 0.048); those referred for other ANC services (AOR 4.057, CI 1.405-11.720, p-value 0.010); and those, - who visited the referral facility before for delivery (AOR 5.395, CI 1.411 – 20.628, p-value 0.014). However, self-referral were less likely among women who perceived privacy and confidentiality of services at the referral hospitals (AOR 0.370, CI 0.138-0.990, p-value 0.048).Conclusions: Almost half of women seeking skilled birth attendance were self-referrals, relates to a possible implication on an unprecedented increased workload at referral hospitals and underutilization of primary health facilities.

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