Kirsten Austad1,2, Michel Juarez3, Hannah Shryer3, Patricia L Hibberd4, Mari-Lynn Drainoni5,6,7, Peter Rohloff3,8, Anita Chary3,9. 1. Wuqu' Kawoq | Maya Health Alliance, 2da Avenida 3-48 Zona 3, Barrio Patacabaj, Tecpán, Chimaltenango, Guatemala. kirsten.austad@bmc.org. 2. Department of Family Medicine, Boston University School of Medicine, Boston Medical Center, 850 Harrison Avenue, Dowling 5, Boston, MA, 02118, USA. kirsten.austad@bmc.org. 3. Wuqu' Kawoq | Maya Health Alliance, 2da Avenida 3-48 Zona 3, Barrio Patacabaj, Tecpán, Chimaltenango, Guatemala. 4. Department of Global Health, Boston University School of Public Health, 715 Albany Street, Boston, MA, 02118, USA. 5. Section of Infectious Disease, Department of Medicine, Boston University School of Medicine, 801 Massachusetts Avenue, Boston, MA, 02118, USA. 6. Department of Health Law Policy & Management, Boston University School of Public Health, Boston, USA. 7. Evans Center for Implementation and Improvement Sciences, Department of Medicine, Boston University School of Medicine, Boston, USA. 8. Division of Global Health Equity, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA. 9. Department of Emergency Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA.
Abstract
BACKGROUND: Global disparities in maternal mortality could be reduced by universal facility delivery. Yet, deficiencies in the quality of care prevent some mothers from seeking facility-based obstetric care. Obstetric care navigators (OCNs) are a new form of lay health workers that combine elements of continuous labor support and care navigation to promote obstetric referrals. Here we report qualitative results from the pilot OCN project implemented in Indigenous villages in the Guatemalan central highlands. METHODS: We conducted semi-structured interviews with 17 mothers who received OCN accompaniment and 13 staff-namely physicians, nurses, and social workers-of the main public hospital in the pilot's catchment area (Chimaltenango). Interviews queried OCN's impact on patient and hospital staff experience and understanding of intended OCN roles. Audiorecorded interviews were transcribed, coded, and underwent content analysis. RESULTS: Maternal fear of surgical intervention, disrespectful and abusive treatment, and linguistic barriers were principal deterrents of care seeking. Physicians and nurses reported cultural barriers, opposition from family, and inadequate hospital resources as challenges to providing care to Indigenous mothers. Patient and hospital staff identified four valuable services offered by OCNs: emotional support, patient advocacy, facilitation of patient-provider communication, and care coordination. While patients and most physicians felt that OCNs had an overwhelmingly positive impact, nurses felt their effort would be better directed toward traditional nursing tasks. CONCLUSIONS: Many barriers to maternity care exist for Indigenous mothers in Guatemala. OCNs can improve mothers' experiences in public hospitals and reduce limitations faced by providers. However, broader buy-in from hospital staff-especially nurses-appears critical to program success. Future research should focus on measuring the impact of obstetric care navigation on key clinical outcomes (cesarean delivery) and mothers' future care seeking behavior.
BACKGROUND: Global disparities in maternal mortality could be reduced by universal facility delivery. Yet, deficiencies in the quality of care prevent some mothers from seeking facility-based obstetric care. Obstetric care navigators (OCNs) are a new form of lay health workers that combine elements of continuous labor support and care navigation to promote obstetric referrals. Here we report qualitative results from the pilot OCN project implemented in Indigenous villages in the Guatemalan central highlands. METHODS: We conducted semi-structured interviews with 17 mothers who received OCN accompaniment and 13 staff-namely physicians, nurses, and social workers-of the main public hospital in the pilot's catchment area (Chimaltenango). Interviews queried OCN's impact on patient and hospital staff experience and understanding of intended OCN roles. Audiorecorded interviews were transcribed, coded, and underwent content analysis. RESULTS: Maternal fear of surgical intervention, disrespectful and abusive treatment, and linguistic barriers were principal deterrents of care seeking. Physicians and nurses reported cultural barriers, opposition from family, and inadequate hospital resources as challenges to providing care to Indigenous mothers. Patient and hospital staff identified four valuable services offered by OCNs: emotional support, patient advocacy, facilitation of patient-provider communication, and care coordination. While patients and most physicians felt that OCNs had an overwhelmingly positive impact, nurses felt their effort would be better directed toward traditional nursing tasks. CONCLUSIONS: Many barriers to maternity care exist for Indigenous mothers in Guatemala. OCNs can improve mothers' experiences in public hospitals and reduce limitations faced by providers. However, broader buy-in from hospital staff-especially nurses-appears critical to program success. Future research should focus on measuring the impact of obstetric care navigation on key clinical outcomes (cesarean delivery) and mothers' future care seeking behavior.
Authors: Alejandro Cerón; Ana Lorena Ruano; Silvia Sánchez; Aiken S Chew; Diego Díaz; Alison Hernández; Walter Flores Journal: Int J Equity Health Date: 2016-05-13
Authors: Boris Martinez; Enma Coyote Ixen; Rachel Hall-Clifford; Michel Juarez; Ann C Miller; Aaron Francis; Camilo E Valderrama; Lisa Stroux; Gari D Clifford; Peter Rohloff Journal: Reprod Health Date: 2018-07-04 Impact factor: 3.223
Authors: Danny V Colombara; Bernardo Hernández; Alexandra Schaefer; Nicholas Zyznieuski; Miranda F Bryant; Sima S Desai; Marielle C Gagnier; Casey K Johanns; Claire R McNellan; Erin B Palmisano; Diego Ríos-Zertuche; Paola Zúñiga-Brenes; Emma Iriarte; Ali H Mokdad Journal: PLoS One Date: 2016-04-27 Impact factor: 3.240