Understanding maternity waiting home uptake and scale-up within low-income and middle-income countries: a programme theory from a realist review and synthesis

Abstract

IntroductionMaternity waiting homes (MWHs) link pregnant women to skilled birth attendance at health facilities. Research suggests that some MWH-facility birth interventions are more success at meeting the needs and expectations of their intended users than others. We aimed to develop theory regarding what resources work to support uptake and scale-up of MHW-facility birth interventions, how, for whom, in what contexts and why.MethodsA four-step realist review was conducted which included development of an initial programme theory; searches for evidence; selection, appraisal and extraction of data; and analysis and data synthesis.ResultsA programme theory was developed from 106 secondary sources and 12 primary interviews with MWH implementers. The theory demonstrated that uptake and scale-up of the MWH-facility birth intervention depends on complex interactions between three adopter groups: health system stakeholders, community gatekeepers and pregnant women and their families. It describes relationships between 19 contexts, 11 mechanisms and 31 outcomes accross nine context-mechanism-outcome configurations (CMOCs) which were grouped into 3 themes: (1) Engaging stakeholders to develop, integrate, and sustain MWH-facility birth interventions, (2) Promoting and enabling MWH-facility birth utilisation and (3) Creating positive and memorable MWH-facility birth user experiences. Belief, trust, empowerment, health literacy and perceptions of safety, comfort and dignity were mechanisms that supported diffusion and adoption of the intervention within communities and health systems. Examples of resources provided by implementers to trigger mechanisms associated with each CMOC were identified.ConclusionsImplementers of MWHs cannot merely assume that communities will collectively value an MWH-facility birth experience over delivery at home. We posit that MWH-facility birth interventions become vulnerable to under-utilisation when implementers fail to: (1) remove barriers that hinder women’s access to MWH and (2) ensure that conditions and interactions experienced within the MWH and its affiliated health facility support women to feel treated with compassion, dignity and respect.PROSPERO registration numberCRD42020173595.

Knowledge and attitude of women towards maternity waiting homes and associated factors among women who gave birth in the last twelve months in Dega Damot district, northwest Ethiopia

“…Nowadays, MWHs utilization is one part of birth preparedness and complication readiness plan and pregnant mothers can get information on when how they visit MWHs ( 26 ). In addition, women who had ANC visits could receive information regarding the benefit and means of accessing MWHs from the trusted source, become more intended to use the service and develop increased health literacy regarding MWHs ( 27 ).…”

“…The possible explanation might be women who had ANC visits can discuss with health care providers about different health care activities and will have better information regarding danger signs and obstetrics complications that may occur during pregnancy and childbirth and also have awareness regarding birth preparedness and complication readiness (25). Nowadays, MWHs utilization is one part of birth preparedness and complication readiness plan and pregnant mothers can get information on when how they visit MWHs (26). In addition, women who had ANC visits could receive information regarding the benefit and means of accessing MWHs from the trusted source, become more intended to use the service and develop increased health literacy regarding MWHs (27).…”

Realist evaluation of maternity waiting home intervention models in Inhambane, Mozambique: protocol for a comparative embedded case study, the Mozambique-Canada Maternal Health Project

“…An IPT can be elicited using various approaches such as expert consultations, document reviews or literature reviews 17. The PT developed through the realist review will act as the IPT for this realist evaluation 9. Thus, the evaluation represents a move from a global, that is, MWH implementation in LMICs, to a country-level, that is, the Mozambican context.…”

“…The model connecting the MWH intervention to health outcomes indicates that for it to positively influence maternal and child health outcomes, the MWH intervention must be both feasible and acceptable to women and families, while also delivering high-quality care at its associated health facility 8. This connection between an MWH and its affiliated health facility is why an MWH should not be considered a stand-alone intervention but a vital component of a linked MWH–facility birth intervention 9…”

“… 8 This connection between an MWH and its affiliated health facility is why an MWH should not be considered a stand-alone intervention but a vital component of a linked MWH–facility birth intervention. 9 …”