Nandini D P Sarkar1, Joske Bunders-Aelen2, Bart Criel3. 1. Equity and Health Unit, Department of Public Health, Institute of Tropical Medicine at Antwerp, Belgium; Athena Institute, Faculty of Earth and Life Sciences, Vrije Universiteit Amsterdam, The Netherlands; ISGlobal, University of Barcelona, Spain. Electronic address: nsarkar@itg.be. 2. Athena Institute, Faculty of Earth and Life Sciences, Vrije Universiteit Amsterdam, The Netherlands. 3. Equity and Health Unit, Department of Public Health, Institute of Tropical Medicine at Antwerp, Belgium.
Abstract
RATIONALE: Increasing research and reflections on quality of healthcare across the perinatal period slowly propels the global community to lobby for improved standards of quality perinatal healthcare, especially in low- and middle-income countries. OBJECTIVE: The purpose of this qualitative study was to obtain a deeper understanding of how interpersonal dimensions of the quality of care relate to real-life experiences of perinatal care, in a resource-constrained local health system. METHODS: In total, 41 in-depth interviews and five focus group discussions (N = 34) were conducted with perinatal women and local health system health professionals living and working in rural Uganda. Data analysis used an emergent and partially inductive, thematic framework based on the grounded theory approach. RESULTS: The results indicated that interpersonal aspects of quality of perinatal care and service delivery are largely lacking in this low-resource setting. Thematic analysis showed three interrelated process aspects of quality of perinatal care: negative reported patient-provider interactions, the perceptions shaping patient-provider interactions, and emergent consequences arising out of these processes of care. Further reflections expose the central, yet often-unheeded, role of perinatal women's agency in their own health seeking behaviours and overall well-being, as well as that of underlying practical norms surrounding health worker attitudes and behaviours. CONCLUSION: These findings highlight the complexity of patient-centred perinatal healthcare provision in rural Uganda and point to the relevance of linking the interpersonal dimensions of quality of care to the larger systemic and structural dimensions of perinatal healthcare.
RATIONALE: Increasing research and reflections on quality of healthcare across the perinatal period slowly propels the global community to lobby for improved standards of quality perinatal healthcare, especially in low- and middle-income countries. OBJECTIVE: The purpose of this qualitative study was to obtain a deeper understanding of how interpersonal dimensions of the quality of care relate to real-life experiences of perinatal care, in a resource-constrained local health system. METHODS: In total, 41 in-depth interviews and five focus group discussions (N = 34) were conducted with perinatal women and local health system health professionals living and working in rural Uganda. Data analysis used an emergent and partially inductive, thematic framework based on the grounded theory approach. RESULTS: The results indicated that interpersonal aspects of quality of perinatal care and service delivery are largely lacking in this low-resource setting. Thematic analysis showed three interrelated process aspects of quality of perinatal care: negative reported patient-provider interactions, the perceptions shaping patient-provider interactions, and emergent consequences arising out of these processes of care. Further reflections expose the central, yet often-unheeded, role of perinatal women's agency in their own health seeking behaviours and overall well-being, as well as that of underlying practical norms surrounding health worker attitudes and behaviours. CONCLUSION: These findings highlight the complexity of patient-centred perinatal healthcare provision in rural Uganda and point to the relevance of linking the interpersonal dimensions of quality of care to the larger systemic and structural dimensions of perinatal healthcare.
Keywords:
Health seeking behaviour; Local health systems; Patient-centred care; Patient-provider interactions; Perinatal healthcare; Practical norms; Quality of care; Uganda
Authors: Nandini D P Sarkar; Azucena Bardaji; Koen Peeters Grietens; Joske Bunders-Aelen; Florence Baingana; Bart Criel Journal: Int J Environ Res Public Health Date: 2018-06-07 Impact factor: 3.390