Factors influencing the utilisation of facility-based delivery in Nigeria: a qualitative evidence synthesis

Abstract

Introduction High-quality facility-based birth reduces maternal and perinatal morbidity and mortality. Previous multi-country systematic reviews have analysed qualitative research studies to understand the barriers and facilitators of delivery in a health facility. However, questions remain as to the extent to which generic multi-context reviews capture nuanced insights from a specific country context. Nigeria contributes significantly to the global burden of maternal mortality and hence the need to explore the country’s contextual factors affecting maternal mortality viz-a-viz a previous international review. Methods To synthesise published and unpublished qualitative research on factors that influence decision-making and use of facility-based delivery services in Nigeria using a qualitative evidence synthesis methodology. Multiple electronic databases, citation chaining and checking of reference lists were searched. Studies were screened by title, abstract and full text. The quality of the included studies was evaluated using the Critical Appraisal Skills Programme (CASP) checklist for appraising a qualitative study. Synthesis of extracted data followed the ‘best-fit’ framework method which combines deductive and then inductive approaches to analysis. Results 27 eligible studies were identified. Data were organised around four principal themes, further divided into subthemes: perceptions of pregnancy and childbirth, the influence of the sociocultural context and care experiences; resource availability and access and perceptions of quality of care. Conclusions Beyond the structural gaps that exist which affect quality care provided at health facilities, wider social determinants like sociocultural beliefs, care experience and resource availability impact upon the utilisation of facility-based delivery services. Future research should prioritise interventions and programmes to address prevalent gaps involving distance and access. In this way, progress can be made against longstanding deficits in the quality of maternal and infant care.

Exploring Service Accessibility and Quality for Differently-Abled Students: A Qualitative Analysis at a South African University of Technology

“…The study's findings are consistent with existing literature on service quality and delivery and the impact of physical barriers on differently-abled individuals' access to services (Adjei et al, 2019;Mshelia & Analo, 2020;Walsh & Gordon, 2010). The participants' experiences and perspectives underscore the importance of creating a supportive and inclusive environment for all students, as emphasised by previous research on the significance of belonging and empathy for students (Obicci, 2019;Zeithaml et al, 2002).…”

A systematic review of qualitative evidence: Perspectives of fathers whose partner experienced postpartum psychosis

“…Analytical data is concerned with the findings of the studies and contained verbatim statements from participants and author interpretations. Four academic thesis reports (Doucet, 2010;Forde, 2019;Holford, 2016;Wyatt, 2014) of journal versions of the same study (Doucet et al, 2011;Forde et al, 2020;Holford et al, 2018;Wyatt et al, 2015) were included to counter 'truncation bias' which may occur when full reporting of Continues study findings is constrained by the word limit of journals (Mshelia et al, 2020). Additional findings in the theses that were not published in the peer-reviewed studies were extracted.…”