Compassionate and Respectful Care From Clients’ Perspectives in Wollega Zones Hospitals, Wollega, West Ethiopia

Introduction : Compassion is a deep awareness of the suffering of another coupled with the wish and action to relieve it. Respecting the patient’s right to self-determination—that is, supporting decisions that reflect the patient’s personal beliefs, values, and interest’s problems. compassionate, respectful and caring (CRC) health workforce initiative in this plan intends to address the concern of Disrespect and Abuse for clients, including laboring mothers. Objective Aim of the study is to assess the provision of compassionate, respectful and caring health care services among health care providers based on client’s perspective. Methods and materials: Hospital-based cross-sectional study was conducted from December 1-25, 2020. A semi-structured interview administered questionnaire was used to collect data from 351 participants. Epi-Data version and Stata version 14.0 were used for data entry and data analysis, respectively. Bivariable and multivariable logistic regression model was fitted to identify the factors associated with compassionate and respectful care from clinical and non-clinical staff of the selected Hospitals. The Adjusted odds ratio with 95% confidence interval and p-value less than 0.06 were used to declare the strength and association of the factors. Results of health care providers were reflected by their being patient while providing care. Clients who were from the poor socio status category were 3.70 times to report getting non compassionate and respectful care from the health care professionals than the clients who are at a better position of wealth status [AOR=3.70(95%CI; 1.27,10.81)]. Similarly, clients with lower grade educational status did not receive compassionate and respectful care when compared to patients with higher educational status [AOR=0.32(95%CI;0.10, 0.99)]. Conclusion Compassionate and respectful care provided to the patients from health care providers in the selected Hospitals of Western Oromia, Ethiopia was high. However, compassionate and respectful care or services rendered from non-clinician staff was low which suggests that immediate actions are necessary to address compassionate and respectful care at hospitals, and hospital management should adopt mitigation measures and should include non-clinician staff during training on CRC or related topics.

Is care of stillborn babies and their parents respectful? Results from an international online survey

Objective To quantify parents’ experiences of respectful care around stillbirth globally. Design Multi-country, online, cross-sectional survey. Setting and Population Self-identified bereaved parents (n=3769) of stillborn babies from 44 high- and middle-income countries. Methods Parents’ perspectives of 7 aspects of care quality, factors associated with respectful care, and 7 bereavement care practices were compared across geographical regions using descriptive statistics. Respectful care was compared between country income groups using multivariable logistic regression. Main Outcome Measures Self-reported experience of care around the time of stillbirth Results A quarter (25.4%) of 3769 respondents reported disrespectful care after stillbirth and 23.5% reported disrespectful care of their baby. Gestation <30 weeks, and primiparity were associated with disrespect. Reported respectful care was lower in middle-income countries (MICs) than in high-income countries (HICs) (aOR=0.35, 95%CI (0.29-0.42), p <0.01). In many countries, aspects of care quality need improvement, such as ensuring families have enough time with providers. Participating respondents from Latin America and Southern Europe reported lower satisfaction across all aspects of care quality compared to Northern Europe. Unmet need for memory-making activities in MICs is high. Conclusions Despite improvements, many parents still experience disrespectful care around stillbirth. The gap between parents’ access to memory-making activities in MICs and HICs needs urgent attention. Tweetable abstract A quarter of parents of stillborn babies experience disrespectful care. There is global unmet need for memory-making activities

Operationalizing respectful maternity care at the healthcare provider level: a systematic scoping review

Background Ensuring the right to respectful care for maternal and newborn health, a critical dimension of quality and acceptability, requires meeting standards for Respectful Maternity Care (RMC). Absence of mistreatment does not constitute RMC. Evidence generation to inform definitional standards for RMC is in an early stage. The aim of this systematic review is clear provider-level operationalization of key RMC principles, to facilitate their consistent implementation. Methods Two rights-based frameworks define the underlying principles of RMC. A qualitative synthesis of both frameworks resulted in seven fundamental rights during childbirth that form the foundation of RMC. To codify operational definitions for these key elements of RMC at the healthcare provider level, we systematically reviewed peer-reviewed literature, grey literature, white papers, and seminal documents on RMC. We focused on literature describing RMC in the affirmative rather than mistreatment experienced by women during childbirth, and operationalized RMC by describing objective provider-level behaviors. Results Through a systematic review, 514 records (peer-reviewed articles, reports, and guidelines) were assessed to identify operational definitions of RMC grounded in those rights. After screening and review, 54 records were included in the qualitative synthesis and mapped to the seven RMC rights. The majority of articles provided guidance on operationalization of rights to freedom from harm and ill treatment; dignity and respect; information and informed consent; privacy and confidentiality; and timely healthcare. Only a quarter of articles mentioned concrete or affirmative actions to operationalize the right to non-discrimination, equality and equitable care; less than 15%, the right to liberty and freedom from coercion. Provider behaviors mentioned in the literature aligned overall with seven RMC principles; yet the smaller number of available research studies that included operationalized definitions for some key elements of RMC illustrates the nascent stage of evidence-generation in this area. Conclusions Lack of systematic codification, grounded in empirical evidence, of operational definitions for RMC at the provider level has limited the study, design, implementation, and comparative assessment of respectful care. This qualitative systematic review provides a foundation for maternity healthcare professional policy, training, programming, research, and program evaluation aimed at studying and improving RMC at the provider level.

Promoting compassionate and respectful maternity care during facility-based delivery in Ethiopia: perspectives of clients and midwives

ObjectiveThe purpose of this qualitative study was to explore clients’ and midwives’ perceptions of compassionate and respectful care during facility-based delivery in Bishoftu District, the regional state of Oromia, Ethiopia.SettingPublic health facilities (two health centres and one district hospital).Study designA qualitative exploratory descriptive research design was used.Study participantsThe research population included purposely sampled women who had given birth in a health facility in the previous 2 weeks and midwifery experts who provided maternity care in the health facility’s labour and delivery wards. Data were gathered through an individual interview (with 10 midwives and 12 women in labour). Interviews were audio-recorded and transcribed immediately. For the research, thematic analysis was performed manually. Both a priori codes (from the query guide) and emerging inductive codes were used in the study. In the thematic data analysis, three inter-related stages were involved, namely data reduction, data display and data conclusion.ResultsFrom the analysis of in-depth interviews with labouring women, three themes emerged, namely: dignified and respectful care, neglectful care and unqualified staff. Five main categories emerged from in-depth interviews with midwives: trusting relationships formed with labouring women, compassionate and respect-based behaviour, good communication skills and holistic care, intentional disrespect toward women, and barriers to compassionate and respectful maternity care due to structural factors. These themes were discovered to be a rich and detailed account of midwives’ perspectives on compassionate and respectful maternity care.ConclusionThe majority of women who witnessed or suffered disrespect and violence during labour and childbirth were dissatisfied with their maternity care during labour and delivery. Despite midwives’ accounts showing that they were aware of the importance of compassionate and respectful maternity care, clients face verbal abuse, neglect, and a lack of supportive treatment during labour and childbirth. Clients’ human rights were violated by disrespectful or abusive acts, whether perpetrated or observed. It is essential to address structural problems such as provider workload, and all other initiatives aimed at improving midwives’ interpersonal relationships with women to provide compassionate and respectful client-centred maternity care.

Lay and healthcare providers’ experiences to inform future of respectful maternal and newborn care in Tanzania and Malawi: an Appreciative Inquiry

ObjectivesDisrespectful care, which remains prevalent in low and middle-income countries (LMICs), acts as a barrier to women accessing skilled birth attendance, compromising care when services are available. Building on what was positive in facilities, we aimed to explore lay and healthcare providers’ experience of respectful care to inform future interventions.SettingFive maternity facilities in Mwanza Tanzania and Lilongwe Malawi.Participants94 participants in Malawi (N=46) and Tanzania (N=48) including 24 women birthing live baby within the previous 12 months; 22 family members and 48 healthcare providers who regularly provided maternity care in the included facilitiesDesignThe study was guided by Appreciative Inquiry (AI). Semistructured, one-to-one interviews were conducted between January and December 2019. Interviews were audio-recorded, translated where necessary, transcribed verbatim, and analysed using the framework approach.ResultsFour main themes describing participants positive experience and their vision of respectful care were identified: (1) empathic healthcare provider–woman interactions including friendly welcome and courteous language, well-timed appropriate care and information sharing, (2) an enabling environment, characterised by improvement of physical environment, the use of screens, curtains and wall partitions for privacy, availability of equipment and provision of incentives to staff, (3) supportive leadership demonstrated by the commitment of the government and facility leaders to provision of respectful care, ensuring availability of guidelines and policies, supportive supervision, reflective discussion and paying staff salaries timely, (4) providers’ attitudes and behaviours characterised by professional values through readiness, compassionate communication and commitment.ConclusionThe positive experiences of service users, families and healthcare providers provided insight into key drivers of respectful care in facilities in Tanzania and Malawi. Interventions targeting improved environment and privacy, healthcare provider communication and developing positive leadership structures in facilities could provide the basis for sustained improvement in respectful and dignified maternal and newborn care in LMICs.

Compassionate and respectful care among outpatient clients at public health facilities in Northwest Ethiopia: A mixed-methods study

Introduction Compassionate and respectful care is a pillar for improving health-seeking behaviour. It has given much attention globally, following the concerns that healthcare often falls significantly; however, less research emphasis was paid in the last decade. Therefore, this study aims to assess compassionate and respectful care and associated factors among outpatient clients at public health facilities in Northwest Ethiopia, 2020. Methods A facility-based quantitative cross-sectional study supplemented with the qualitative findings was conducted from 30 February to 30 March 2020. A semi-structured interviewer-administered questionnaire was used to collect the quantitative data among 593 participants. Systematic and purposive sampling techniques were used to select the quantitative and qualitative participants, respectively. A semi-structured interview guide was also employed for the qualitative data collection. Epi-Data version 4.6 and SPSS version 25 were used for data entry and analysis, respectively. The bi-variable and multivariable logistic regression model was fitted to identify the factors associated with each outcome variable (compassionate and respectful care separately). Adjusted odds ratio (AOR) with 95% confidence interval (CI) and p-value less than 0.05 were used to declare the strength and factors statistically associated with the outcome variables. Results Overall, 72.8% and 82.6% of the respondents experienced compassionate and respectful care, respectively. Patients attending primary or above education (AOR: 0.35; 95% CI: 0.21–0.59), attending at the hospital (AOR: 0.59; 95% CI: 0.39–0.88), new clients (AOR: 0.33; 95% CI: 0.16–0.70) and service users who had three or more visits (AOR: 0.34; 95% CI: 0.17–0.71) were negatively associated with compassionate care. On the other hand, female patients (AOR = 0.53; 95% CI: 0.32–0.87), aged over 36 years (AOR = 0.43; 95% CI: 0.20–0.90), primary or above school attended clients (AOR = 0.18; 95% CI: 0.09–0.36), waiting two or more hours (AOR = 0.28; 95% CI: 0.13–0.62), and use public or private transport access (AOR: 0.49; 95% CI: 0.29–0.83) were negatively associated with a respectful care. Conclusion Compassionate and respectful care provided to the outpatient clients in public health facilities of northwest Ethiopia was high. However, our result suggests that immediate actions are necessary to address respectful and compassionate care at hospitals, and hospital management should adopt mitigation measures. Consideration should be given to foster patient-centric services and educate the health care workers about compassionate and respectful care.

Overview of Literature on RMC and Applications to Tanzania

Respectful maternity care research in Tanzania continues to increase. This is an overview of the literature summarizing research based on the domains which comprise this quality of care indicator, ranging from exploratory and descriptive to quantitative measurements of birth perinatal outcomes when respectful interventions are made. The domains of respectful care are reflected in the seven Universal Rights of Childbearing Women but go further to implicate facility administrators and policy makers to provide supportive infrastructure to allay disrespect and abuse. The research methodologies continue to be problematic and several ethical cautions restrict how much control is possible. Similarly, the barriers to collecting accurate accounts in qualitative studies of disrespect require astute interviewing and observation techniques. The participatory community-based and the critical sociology and human rights frameworks appear to provide a good basis for both researcher and participants to identify problems and determine possible solutions to the multiple factors that contribute to disrespect and abuse. The work-life conditions of midwives in the Global South are plagued with poor infrastructure and significantly low resources which deters respectful care while decreasing retention of workers. Researchers and policy-makers have addressed disrespectful care by building human resource capacity, by strengthening professional organizations and by educating midwives in low-resource countries. Furthermore, researchers encourage midwives not only to acquire attitudinal change and to adopt respectful maternity care skills, but also to emerge as leaders and change agents. Safe methods for conducting care while addressing low resources, skilled management of conflict and creative innovations to engage the community are all interventions that are being considered for quality improvement research. Tanzania is poised to evaluate the outcomes of education workshops that address all seven domains of respectful care.

Overview of Literature on RMC and Applications to Tanzania

Respectful maternity care research in Tanzania continues to increase. This is an overview of the literature summarizing research based on the domains which comprise this quality of care indicator, ranging from exploratory and descriptive to quantitative measurements of birth perinatal outcomes when respectful interventions are made. The domains of respectful care are reflected in the seven Universal Rights of Childbearing Women but go further to implicate facility administrators and policy makers to provide supportive infrastructure to allay disrespect and abuse. The research methodologies continue to be problematic and several ethical cautions restrict how much control is possible. Similarly, the barriers to collecting accurate accounts in qualitative studies of disrespect require astute interviewing and observation techniques. The participatory community-based and the critical sociology and human rights frameworks appear to provide a good basis for both researcher and participants to identify problems and determine possible solutions to the multiple factors that contribute to disrespect and abuse. The work-life conditions of midwives in the Global South are plagued with poor infrastructure and significantly low resources which deters respectful care while decreasing retention of workers. Researchers and policy-makers have addressed disrespectful care by building human resource capacity, by strengthening professional organizations and by educating midwives in low-resource countries. Furthermore, researchers encourage midwives not only to acquire attitudinal change and to adopt respectful maternity care skills, but also to emerge as leaders and change agents. Safe methods for conducting care while addressing low resources, skilled management of conflict and creative innovations to engage the community are all interventions that are being considered for quality improvement research. Tanzania is poised to evaluate the outcomes of education workshops that address all seven domains of respectful care.

Is Respectful Care Provided by Community Health Workers Associated With Infant Feeding Practices? A Cross Sectional Analysis From India

Objectives: Breastfeeding and complementary feeding practices in India do not meet recommendations. Community health care workers (CHWs) are often the primary source of information for pregnant and postpartum women about Infant and Young child Feeding (IYCF) practices. While existing research has evaluated the effectiveness of content and delivery of information through CHWs, little is known about the quality of the interpersonal communication (respectful care). We analyzed the effect of respectful interactions on recommended IYCF practices. Methods: We use data from evaluation of an at-scale mHealth intervention in India that serves as a job aid to the CHWs (N=3,266 mothers of children <12m from 841 villages in 2 Indian states). The binary indicator variable for respectful care is constructed using a set of 7 questions related to trust, respect, friendliness during these interactions. The binary outcomes variables are exclusive breastfeeding, timely introduction of complimentary feeding, and minimum diet diversity for infants. We also explore if most of the pathway from respectful care to improved behaviors is through better recall of messages (mediation analysis). All models controlled for socio-economic-demographic characteristics and number of interactions with the CHW. Results: About half of women reported positive, respectful interactions with CHWs. More respectful interactions were associated with better recall of appropriate health messages. More respectful interactions were associated with a greater likelihood of adopting all child feeding behaviors except timely initiation of breastfeeding. After including recall in the model, the effect of respectful interactions alone reduced. Conclusions: Respectful care from CHWs appears to be significantly associated with some behaviors around infant feeding, with the primary pathway being through better recall of messages. Focusing on improving social and soft skills of CHWs that can translate into better CHW-beneficiary interactions can pay rich dividends.