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Factors influencing postpartum haemorrhage detection and management and the implementation of a new postpartum haemorrhage care bundle (E-MOTIVE) in Kenya, Nigeria, and South Africa
被引:11
|作者:
Forbes, Gillian
[1
]
Akter, Shahinoor
[2
]
Miller, Suellen
[3
]
Galadanci, Hadiza
[4
]
Qureshi, Zahida
[5
]
Fawcus, Sue
[6
]
Hofmeyr, G. Justus
[7
,8
,9
]
Moran, Neil
[10
,11
]
Singata-Madliki, Mandisa
[12
]
Dankishiya, Faisal
[13
,14
]
Gwako, George
[5
]
Osoti, Alfred
[5
]
Thomas, Eleanor
[15
]
Gallos, Ioannis
[16
]
Mammoliti, Kristie-Marie
[16
]
Devall, Adam
Coomarasamy, Arri
[16
]
Althabe, Fernando
Atkins, Lou
[1
]
Bohren, Meghan A.
[2
]
Lorencatto, Fabiana
[1
]
机构:
[1] UCL, Ctr Behav Change, London, England
[2] Univ Melbourne, Ctr Hlth Equ, Gender & Womens Hlth Unit, Sch Populat & Global Hlth, 207 Bouverie St, Carlton, Vic 3053, Australia
[3] Univ Calif San Francisco, Sch Med, Dept Obstet Gynaecol & Reprod Sci, San Francisco, CA USA
[4] Bayero Univ Kano, Afr Ctr Excellence Populat Hlth & Policy, Kano, Nigeria
[5] Univ Nairobi, Dept Obstet & Gynaecol, Nairobi, Kenya
[6] Univ Cape Town, Dept Obstet & Gynaecol, Cape Town, South Africa
[7] Univ Botswana, Dept Obstet & Gynaecol, Gaborone, Botswana
[8] Univ Witwatersrand, Johannesburg, South Africa
[9] Walter Sisulu Univ, East London, South Africa
[10] Univ KwaZulu Natal, KwaZulu Natal Dept Hlth, World Bank Special Programme Res, Durban, South Africa
[11] Univ KwaZulu Natal, Coll Hlth Sci, Sch Clin Med, Dept Obstet & Gynaecol, Durban, South Africa
[12] Univ Witwatersrand & Ft Hare, Dept Obstet & Gynaecol, Effect Care Res Unit, Durban, South Africa
[13] Bayero Univ, Aminu Kano Teaching Hosp, Dept Community Med, Kano, Nigeria
[14] Bayero Univ Kano, Afr Ctr Excellence Populat Hlth & Policy, Kano, Nigeria
[15] Univ Birmingham, Inst Metab & Syst Res IMSR, Tommys Natl Ctr Miscarriage Res, WHO Collaborating Ctr Global Womens Hlth Res, Mendelsohn Way,Edgbaston, Birmingham, England
[16] Univ Birmingham, Inst Metab & Syst Res, Coll Med & Dent Sci, WHO Collaborating Ctr Global Womens Hlth, Birmingham, England
基金:
澳大利亚研究理事会;
比尔及梅琳达.盖茨基金会;
关键词:
Postpartum haemorrhage (PPH);
Maternal health;
Low- and middle-income countries (LMICs);
Clinical care bundle;
Formative research;
Qualitative interviews;
Behaviour Change Wheel;
Implementation interventions;
GUIDELINES;
CONSENSUS;
D O I:
10.1186/s13012-022-01253-0
中图分类号:
R19 [保健组织与事业(卫生事业管理)];
学科分类号:
摘要:
Background Postpartum haemorrhage (PPH) is the leading cause of global maternal deaths, accounting for 30-50% of maternal deaths in sub-Saharan Africa. Most PPH-related deaths are preventable with timely detection and initiation of care, which may be facilitated by using a clinical care bundle. We explore influences on current PPH detection and management and on the future implementation of a new PPH bundle (E-MOTIVE) in low-resource, high-burden settings.Methods Semi-structured qualitative interviews based on the Theoretical Domains Framework were conducted with 45 healthcare providers across nine hospitals in Nigeria, Kenya and South Africa, to identify barriers and enablers to current PPH detection and management and future implementation of a new PPH care bundle. Data were analysed using thematic and framework analysis. The Behaviour Change Wheel was used to identify potential interventions to address identified barriers and enablers.Results Influences on current PPH detection and management fell under 12 domains: Environmental Context and Resources (drug and staff shortages), Skills (limited in-service training), Knowledge (variable understanding of the recommended practice), Behaviour Regulation (limited quality improvement culture), Beliefs about Consequences (drawbacks from inaccurate detection), Emotion (stress from the unpredictability of PPH), Social Influence (teamwork), Memory, Attention and Decision-making (limited guideline use), Social/Professional Role and Identity (role clarity), Beliefs about Capabilities (confidence in managing PPH), Reinforcement (disciplinary procedures) and Goals (PPH as a priority). Influences on bundle uptake included: Beliefs about Consequences (perceived benefits of new blood loss measurement tool), Environmental Context and Resources (high cost of drugs and new tools), Memory, Attention and Decision-making (concerns about whether bundle fits current practice), Knowledge (not understanding 'bundled' approach), Social Influence (acceptance by women and staff) and Intention (limited acceptance of 'bundled' approach over existing practice). These influences were consistent across countries. Proposed interventions included: Education, Training, Modelling (core and new skills), Enablement (monitoring uptake), Persuasion (leadership role) and Environmental Restructuring (PPH emergency trolley/kit).Conclusions A wide range of individual, socio-cultural and environmental barriers and enablers to improving PPH detection and management exist in these settings. We identified a range of interventions that could improve PPH care and the implementation of new care bundles in this context.
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页数:23
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