Perspectives on implementing a quality improvement collaborative to improve person-centered care for maternal and reproductive health in Kenya

Abstract

Absrtact Objective To understand perspectives and experiences related to participation in a quality improvement collaborative (QIC) to improve person-centered care (PCC) for maternal health and family planning (FP) in Kenya. Design and setting Semi-structured qualitative interviews were conducted with members of the QIC in four public health facilities in Kenya. Participants Clinical and nonclinical public health facility staff who had participated in the QIC were purposively sampled to participate in the semi-structured interviews. Intervention A QIC was implemented across four public health facilities in Nairobi and Kiambu Counties in Kenya to improve PCC experiences for women seeking maternity or FP services. Main outcome measure Semi-structured interviews with participants of the QIC to understand perspectives and experiences associated with sensitization to and implementation of PCC behaviors in maternity and FP services. Results Respondents reported that sensitization to PCC principles resulted in multiple perceived benefits for staff and patients alike, including improved interactions with patients and clients, deeper awareness of patient and client preferences, and improved interpersonal skills and greater job satisfaction. Respondents also highlighted system-level challenges that impeded their ability to consistently provide high-quality PCC to women, namely staff shortages and frequent turnover, high patient volumes and lack of space in their respective health facilities. Conclusion Respondents were easily able to articulate perceived benefits derived from participation in this QIC, although they were equally able to identify challenges that hindered their ability to consistently provide high-quality PCC to women seeking maternity or FP services.

Can a quality improvement intervention improve person-centred maternity care in Kenya?

“…It is possible that this result was influenced specifically by a better balanced patient-to-staff ratio, more physical space, and lower delivery volumes within the smallest intervention facility (Health facility 3) Results from in-depth interviews conducted with 32 QI team members following the QI collaborative have been published previously and found that many respondents discussed health system constraints in taking a PCMC approach. 20 Challenges to delivering high-quality person-centred care included disproportionate staff-to-patient ratios, high staff turnover, and lack of space. Future work aimed at securing improvements in PCMC within existing resources needs to consider health system challenges and minimum standards of available resources required for improvement to be theoretically possible.…”

Can changes to improve person-centred maternity care be spread across public health facilities in Uttar Pradesh, India?

“…Spreading a Change Package to improve PCMC that has been developed within a context-specific QIC represents a cost-efficient model to move towards scale in a resource-constrained setting. This is especially relevant for public health systems in LMICs, where financial resources are often scant and staffing numbers severely disproportionate to the patient load, 14 making participation in timeintensive interventions especially burdensome.…”

“…13 Challenges to implementing PCMC include staff shortages and frequent staff turnover, high patient volumes, and lack of space in health facilities. 14,15 Given high reported levels of mistreatment within facilities, and an increase in facility-based births in Uttar Pradesh, India, evidence-based quality improvement strategies are needed.…”

The Case for Using a Behavior Change Model to Design Interventions to Promote Respectful Maternal Care

“…We included 16 published interventions in this exercise. 2,[20][21][22][23][24][25][26][27][28][29][30][31][32][33][34] Each publication describing the intervention was reviewed by authors SL, NDS, and DW, for reference to a behavior change or related foundational theory, framing, or framework that grounded the intervention design or strategy. After that, SL, NDS, and DW extracted information on approach(es) taken by each intervention to promote RMC and matched them to the 6 components of the COM-B model.…”