Utility of the three-delays model and its potential for supporting a solution-based approach to accessing intrapartum care in low- and middle-income countries. A qualitative evidence synthesis

Abstract

Background The 3-Delays Model has helped in the identification of access barriers to obstetric care in low and middle-income countries by highlighting the responsibilities at household, community and health system levels. Critiques of the Model include its one-dimensionality and its limited utility in triggering preventative interventions. Such limitations have prompted a review of the evidence to establish the usefulness of the Model in optimising timely access to intrapartum care. Objective To determine the current utility of the 3-Delays Model and its potential for supporting a solution-based approach to accessing intrapartum care. Methods We conducted a qualitative evidence synthesis across several databases and included qualitative findings from stand-alone studies, mixed-methods research and literature reviews using the Model to present their findings. Papers published between 1994 and 2019 were included with no language restrictions. Twenty-seven studies were quality appraised. Qualitative accounts were analysed using the ‘best-fit framework approach’. Results This synthesis included twenty-five studies conducted in Africa, Asia, Latin America and the Caribbean. Five studies adhered to the original 3-Delays Model’s structure by identifying the same factors responsible for the delays. The remaining studies proposed modifications to the Model including alterations of the delay’s definition, adding of new factors explaining the delays, and inclusion of a fourth delay. Only two studies reported women’s individual contributions to the delays. All studies applied the Model retrospectively, thus adopting a problem-identification approach. Conclusion This synthesis unveils the need for an individual perspective, for prospective identification of potential issues. This has resulted in the development of a new framework, the Women’s Health Empowerment Model, incorporating the 3 delays. As a basis for discussion at every pregnancy, this framework promotes a solution-based approach to childbirth, which could prevent delays and support women’s empowerment during pregnancy and childbirth.

Factors influencing decision-making to accept elective caesarean section: A descriptive cross-sectional study

“…Delay in seeking care for obstetric conditions has been attributed to the underestimation of the gravity of the complications, cultural beliefs and customs [ 33 ]. Danna and colleagues' [ 34 ] reported from a review of several studies on delays in accessing maternal health services that in some low and middle-income countries, the decision to access care is often the prerogative of the husband or of the mother-in-law. Some women with CS express concerns about mobility limitations, and frustration at the need for assistance [ 35 ].…”

Management and Outcomes of Paediatric Intracranial Suppurations in Low- and Middle-Income Countries: A Scoping Review

“…However, various strategies have been established to tackle these delays in LMICs (29). In the context of our review, education and employment of parents are crucial (29)(30)(31). Educating the public on the importance of recognising the signs and symptoms and the repercussions of inaction or delayed action will be a key step to address the first delay.…”

“…A poor patient outcome is highly likely if any of these factors lead to the delay. However, various strategies have been established to tackle these delays in LMICs (29). In the context of our review, education and employment of parents are crucial (29)(30)(31).…”

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“…The conclusion of the aforementioned systematic review also proposes considering the individual experience through the Women's Health Empowerment Model (21).…”

“…mHealth interventions have gained traction for improving health outcomes over the past decade, including those relating to maternal outcomes (24). Specific examples include mHealth interventions to strengthen healthcare coordination and delivery through preventative or educational tools for pregnant women, traditional birth attendants or midwives (19)(20)(21)(22)(23).…”