Results of a person-centered maternal health quality improvement intervention in Uttar Pradesh, India

Abstract

Background Poor patient experiences during delivery in Uttar Pradesh, India is a common problem. It delays presentation at facilities after the onset of labor and contributes to poor maternal health outcomes. Patient-centered maternity care (PCMC) is recognized by the World Health Organization as critical to overall quality. Changing PCMC requires changing the process of care, and is therefore especially challenging. Methods We used a matched case-control design to evaluate a quality improvement process directed at PCMC and based on widely established team-based methods used in many OECD countries. The intervention was introduced into three government facilities and teams supported to brainstorm and test improvements over 12 months. Progress was measured through pre-post interviews with new mothers, scored using a validated PCMC scale. Analysis included chi-squared and difference-in-difference tests. Findings On a scale to 100, the PCMC score of the intervention group increased 22.9 points compared to controls. Deliveries attended by midwives, dais, ASHAs or non-skilled providers resulted in significantly higher PCMC scores than those attended to by nurses or doctors. The intervention was associated with one additional visit from a doctor and over two additional visits from nurses per day, compared to the control group. Interpretation This study has demonstrated the effectiveness of a team-based quality improvement intervention to ameliorate women’s childbirth experiences. These improvements were locally designed and led, and offer a model for potential replication.

Adaptation of the Person-Centered Maternity Care Scale in the United States: Prioritizing the Experiences of Black Women and Birthing People

“…Continuous engagement with members of the priority community ensured that the items in the scale capture their unique experiences (Altman et al, 2019;McLemore et al, 2018). The scale items were intentionally developed to include a mix of subjective questions (e.g., feeling respected) to capture people's subjective perceptions, as well as more objective and actionable items (e.g., allowed a companion) that can inform quality improvement (Afulani, Aborigo, et al, 2019;Montagu et al, 2020). The PCMC-U.S. scale is also among the few tools that measure experiences of person-centered care during childbirth in a comprehensive manner (Nilv er et al, 2017).…”

Turkish validity and reliability study for the person‐centered maternity care scale

“…6,7 Accordingly, delayed, unnecessary, insufficient, and harmful care should be minimized. [8][9][10] PCMC plays a key role in this regard. In addition to improving the health of mothers and newborns, PCMC has the notion of improving the satisfaction from health services.…”

The roles of multi-component interventions in reducing mistreatment of women and enhancing respectful maternity care: a systematic review

“…Owing to the wide range of methodological inadequacies of the studies, all selected reports were included in the analysis for pragmatic reasons, which were relevant to the aim of the review and comprised the highest available methodological rigor of all assessed studies. Three of the 12 included studies were RCTs [ 22 , 36 , 38 ], and the remaining nine were pre-and-post/ quasi experimental studies [ 23 , 33 – 35 , 37 , 39 – 42 ]. Out of the 12 studies included, it is worth noting that regardless of no criteria used to exclude studies based on their geographical region, eleven studies were conducted in sub-Saharan Africa (specifically, in Ethiopia, Tanzania, South Africa, Ghana, Kenya, and Sudan) and one study was conducted in India.…”

“…All three cluster RCT studies randomly assigned the intervention to the clusters, as shown in Table 3 . As the interventions in these studies were held at the cluster level, it is less likely to expect concealment of the intervention assignment to the groups, and all of them were scored as not concealed [ 22 , 36 , 38 ]. Even though the groups were recruited by matching samples, significant socio-demographic variation between the survey respondents existed before and after the interventions in each group of all three studies.…”