Factors influencing awareness of healthcare providers on maternal sepsis: a mixed-methods approach

Abstract

Background An awareness campaign set to accompany the Global Maternal Sepsis Study (GLOSS) was launched in 2017. In order to better develop and evaluate the campaign, we sought to understand the factors that influence awareness of maternal sepsis by exploring healthcare providers’ knowledge, perception of enabling environments, and perception of severity of maternal sepsis. Methods We used a mixed-methods approach that included 13 semi-structured interviews to GLOSS regional and country coordinators and 1555 surveys of providers working in GLOSS participating facilities. Directed content analysis and grounded theory were used for qualitative analysis, based on a framework including four overarching themes around maternal health conditions, determinants of maternal health, barriers and facilitators to sepsis identification and management, plus 24 additional sub-topics that emerged during the interviews. Descriptive statistics for frequencies and percentages were used for the quantitative analysis; significance was tested using Pearson χ 2 . Logistic regressions were performed to adjust for selected variables. Results Analysis of interviews described limited availability of resources, poor quality of care, insufficient training and lack of protocols as some of the barriers to maternal sepsis identification and management. Analysis from the quantitative survey showed that while 92% of respondents had heard of maternal sepsis only 15% were able to correctly define it and 43% to correctly identify initial management. Provider confidence, perceived availability of resources and of a supportive environment were low (33%, 38%, and 48% respectively). Overall, the predictor that most explained awareness was training. Respondents from the survey and interviewees identified sepsis among the main conditions affecting women at their facilities. Conclusions Awareness on maternal sepsis, while acknowledged as important, remains low. Healthcare providers need resources and support to feel confident about the correct identification and management of sepsis, as a prerequisite for the improvement of awareness of maternal sepsis. Similarly, providers need to know about maternal sepsis and its severity to understand the importance of reducing sepsis-related mortality and morbidity. Awareness raising campaigns can help bring neglected maternal health conditions, such as sepsis, to the forefront of global and local agendas. Electronic supplementary material The online version of this article (10.1186/s12889-019-6920-0) contains supplementary material, which is available to authorized users.

Early evaluation of the ‘STOP SEPSIS!’ WHO Global Maternal Sepsis Awareness Campaign implemented for healthcare providers in 46 low, middle and high-income countries

“…All Likert scale answers were dichotomised assigning a 1 to the two most favourable responses (ie, they felt very or somewhat confident about making the right decision) and 0 to the combination of remaining options (neutral, not very confident or not confident at all). While previously we assessed dichotomisation using 1 to the single most favourable response (ie, respondent felt very confident) and a 0 to the combination of remaining options (somewhat confident, neutral, not very confident or not confident at all) 23 we decided to include a more flexible definition of confidence, perception of availability of resources and feeling of support to allow for a more robust denominator that would enable comparisons.…”

“…Details regarding the definition used for awareness for this campaign, survey formulation and dissemination, including analysis of baseline data, have been published elsewhere. 23 Briefly, a precampaign 32-question survey was developed to gather baseline information on healthcare providers' awareness of maternal sepsis through self-reported knowledge on maternal sepsis and perception of their work environments as enabling for the identification and management of maternal sepsis. Knowledge was assessed through questions relating to whether respondents had heard of maternal sepsis, correct identification of criteria that define maternal sepsis (infection plus organ dysfunction) and identification of correct initial management of maternal sepsis and infections (antibiotics and fluids) when maternal sepsis was suspected in the case vignette presented in the survey.…”

“…Second, we used multivariate logistic regression models to explore the association between respondents and facilities' characteristics at precampaign and postcampaign and change in components of awareness after campaign implementation. Based on analysis of baseline data and our assumptions on characteristics that would be associated with levels of awareness, 23 we included the following variables in the model: whether respondent was a physician, years of work experience, region where the respondent worked, whether the country had implemented an expanded version of the campaign and whether the facility was a level III facility. Countries were considered to have implemented an expanded version of the campaign if they had printed and displayed all posters and infographics, prepared and disseminated press releases and if they had organised other activities or developed other materials for the campaign.…”

‘We always find things to learn from.’ Lessons from the implementation of the global maternal sepsis study on research capacity: a qualitative study

“…Participants reported implementing changes in how they managed women with infection and sepsis as a result of their participation in GLOSS. Some of these changes could be expected, to some extent, as GLOSS included a campaign aimed at increasing awareness among healthcare providers working in GLOSS participating facilities [ 19 ]. Some studies have shown that the action of conducting research could be an intervention in and of itself, as participation in research can increase awareness on the topic of interest and, therefore, bring about improvements in how patients are cared for [ 20 – 22 ].…”

Maternal sepsis- an audit in a tertiary care center in South India

“…[28][29][30] Awareness among clinicians of sepsis might lead to early diagnosis and effective management of sepsis. 6,31 A long road lies ahead in this battle against maternal sepsis due to the ever-evolving and new data available. Antibiotic stewardship can help in the judicious use of antibiotics and combat antibiotic resistance.…”