Informational continuity by midwives during birth at primary care settings in the Western Cape.

Background: Informational continuity ensures that all health and psychosocial information of the pregnant women is available at all encounters with healthcare providers. The World Health Organization recognised that ineffective informational continuity during birth contributed to fragmented care and duplication of services, which ultimately influenced the morbidity and mortality rates of the pregnant women. Aim: The aim of this study was to delve into the midwives' experiences on informational continuity approaches that enable effective care coordination during birth within the primary health care setting. Setting: The study setting was two maternity obstetric units (MOUs) in the Western Cape, South Africa. Methods: A qualitative descriptive phenomenological design was used. Participants were recruited by using purposive sampling. Interviews were audiorecorded, transcribed verbatim and analysed. Results: Three themes emerged from the findings. Theme one: adequate sharing of information with women during the intrapartum period. Theme two: efficient transition of information among midwives and other healthcare providers during the intrapartum period. Theme three: challenges to informational continuity during the intrapartum period. Conclusion: Communication with the women as well as with other healthcare providers during birth was effective. However, with minimal challenges, informational continuity was effectuated through communication among the midwives, the pregnant women and other healthcare providers. Contribution: Informational continuity approaches among the midwives, with the women and between healthcare facilities are a prerequisite to ensure continuity of care and care coordination during birth.

A mixed methods study on continuity and care coordination based on the obstetric near miss approach.

Background: The near-miss approach assumes that mothers facing life-threatening conditions such as severe pre-eclampsia and postpartum haemorrhage share common risk factors. Among these women, those who survive (near-miss cases) can offer insights into the determinants, providing valuable lessons for understanding underlying factors. Aim: To investigate elements of continuity and coordination leading to obstetric near misses. Setting: A major referral hospital and its referral pathway in Kenya. Methods: Explanatory sequential mixed-methods design. Results: Near-miss survivors had lower continuity and coordination of care indices during antenatal visits (COCI = 0.80, p = 0.0026), (modified continuity of care index [MCCI] = 0.62, p = 0.034), and those with non-life-threatening morbidity in the first trimester were more likely to experience a near miss (aOR = 4.34, p = 0.001). Facilities in the western region had a higher burden of near misses compared to the Eastern region. Qualitatively, three deductive themes were identified: sequential coordination, parallel coordination and continuity, along with factors classified as access. In mixed integration, poor continuity indices were explained by quality of interpersonal relationships and woman centredness. Poor coordination was explained by inadequate teamwork between providers in referring and referral facilities and between primary health facilities and the community. Higher near-miss rates in the western region resulted from differences in human and physical resources. Conclusion: Promoting woman-centred care, teamwork, improving communication and introducing innovative coordination roles like case and care managers can enhance continuity and coordination of maternal healthcare. Contributions: This study contributes to our understanding of the challenges of continuity and coordination in maternal healthcare in resource-poor settings by applying the WHO operationalisation of continuity and coordination using mixed methodology.

Informational continuity by skilled birth attendants during antenatal care in Lesotho.

Background: Informational continuity (IC) is one of the four approaches that enables integrated people-centered health services. IC enables the availability of all health and psychosocial information of the pregnant women at all health encounters. World Health Organization (WHO) recognised that ineffective IC results in fragmented health care and duplication of services. Hence, IC may assist in the reduction of maternal morbidity and mortality. Aim: The purpose of this study was to explore and describe the experiences of skilled birth attendants (SBAs) with IC during the antenatal period. Setting: Three primary healthcare centers in Maseru district, Lesotho. Methods: A qualitative descriptive phenomenological design was used with purposive sampling to choose nine participants. Results: Four themes emerged; Theme one: SBAs and pregnant women information communication, theme two: Information communication between the SBAs, theme three: information collection during ANC and theme four: guidelines used during ANC to standardise care. Several challenges regarding information communication form the sources of information, transition of information, information between caregivers and women which demonstrated the frustration between the women and the SBAs during ANC leading to ineffective care coordination. Conclusion: Enabling IC during ANC enables effective data collection from the sources of information, transition of information during care giving within and between health facilities. Contribution: Effective informational continuity enables effective care coordination in ANC in Lesotho.

A systematic review of effective parent-adolescent sexual and reproductive health information communication in lower- and middle-income countries.

Background: Parents play an important role in the sexual and reproductive health (SRH) of their adolescents. Parent-adolescent SRH information communication is cardinal and is expected to improve SRH outcomes of adolescents. Aim: The aim of this systematic review was to search for effective SRH information communication interventions in lower- and middle-income countries (LMICs) to inform the adaptation of parent-adolescent SRH information communication intervention. Method: This is the first phase of an explanatory sequential mixed method study. The systematic review was carried out by employing Joanna Briggs Institute software for reviews. Search sources included Cochrane Reviews Library, EMBASE, CINAHL, PubMed, OVID, Scopus, Web of Science and Science Direct. A systematic search strategy was formulated, making use of the key terms: adolescent, teenager, youth, parent, mother, father, caregiver, reproductive, sexual, health, information, communication and intervention. Results: Five articles met the inclusion criteria for full-text screening. The interventions included addressed sociodemographic covariates; parent-adolescent general communication; parental monitoring; parent-adolescent communication about sex-related topics; parent's sexual communication skills; parent's self-efficacy in sexual communication; parent's responsiveness to sexual communication; communication frequency; quality of sex­related communication and information-motivational-behavioural skills. Conclusion: Findings suggest that evidence-based SRH information communication interventions are effective in improving parent-adolescent SRH information communication to optimise safe SRH behaviour in LMICs. Contribution: This systematic review identified effective SRH information communication interventions in LMICs, which can form the basis of further qualitative exploration for adaptation of a culturally sensitive intervention in Ghana.

Exploring the culturally sensitive sexual and reproductive health information communication skill needs of parents in Ghana.

BACKGROUND: Parents play a vital role in the sexual and reproductive health (SRH) of adolescents. Parents' communication with their adolescents regarding SRH is considered an important part of adolescent development, as this contributes to optimising safe SRH. AIM: This phase of the study explored the culturally sensitive SRH information communication skill needs of parents, based on their personal and social motivation, within the Ghanaian context. SETTING: The study was conducted at the Asante Akyem North Municipality of Ghana. METHODS: This article describes the second phase of an explanatory, sequential, mixed-method study. Following on from the first phase systematic review, this second phase comprised a qualitative descriptive study where 10 purposively sampled parents of adolescents participated in semi-structured interviews to elicit data. Braun and Clarke's thematic data analysis process was applied. Data were saved and managed in Atlas.ti (version 23.0.7). RESULTS: Four themes emerged on communication skills: SRH information, parent and adolescent factors, contextual factors and communication skill needs. Parent and adolescent communication on SRH takes place occasionally. Parents lack the skills to communicate with adolescents regarding SRH. CONCLUSION: Parents in this context require skills to communicate SRH information with their adolescent children. A culturally appropriate intervention that supports SRH information communication between parents and adolescents may have value in guiding this communication process.Contribution: The findings of this study can contribute to the adaptation of a culturally sensitive SRH information communication intervention in Ghana which will promote adolescent SRH.

Self-reported continuity and coordination of antenatal care and its association with obstetric near miss in Uasin Gishu county, Kenya.

BACKGROUND: Continuity and coordination of care are core principles of high-quality primary health care. Optimising continuity and coordination improves maternal satisfaction. However, their association with morbidity and mortality outcomes is unclear. The obstetric near-miss approach can be used to investigate whether continuity and coordination influences the occurrence of a severe maternal outcome. AIM: To compare self-reported continuity and coordination of care between obstetric near-miss survivors and those without near miss during pregnancy, delivery and postpartum. SETTING: Uasin Gishu county, Rift Valley region, Kenya. METHODS: A cross-sectional survey targeting 340 postnatal mothers. Continuity of care index (COCI) and modified continuity of care index (MCCI) were used to estimate longitudinal continuity. The Likert scale was administered to measure perceived continuity and coordination of care. Mann-Whitney U test and binomial logistic regression were used for hypothesis testing. RESULTS: COCI and MCCI were lower among near-miss survivors (COCI = 0.80, p = 0.0026), (MCCI = 0.62, p = 0.034). Near-miss survivors scored lower on items assessing coordination between a higher-level provider and usual antenatal clinic (mean = 3.6, p = 0.006) and general coordination of care during pregnancy (mean = 3.9, p = 0.019). Presence of a non-life-threatening morbidity in pregnancy was associated with occurrence of near miss (aOR = 4.34, p = 0.001). CONCLUSION: Near-miss survivors scored lower on longitudinal continuity and coordination of care across levels. Further research should focus on strengthening coordination, determining the optimal level of longitudinal continuity and improving systems for early identification and management of morbidities in pregnancy.Contribution: The results of this study show that while longitudinal and relational COC is important during the antenatal period, the presence of a non-life-threatening condition in pregnancy remains the most important predictor of the occurrence of a near miss.

Self-perceived competency of midwives in Kenya: A descriptive cross-sectional study.

BACKGROUND: Midwifery competence is demonstrated in the context of midwifery education, regulation and practice to support the quality delivery of care to women. Midwives with appropriate competencies can deliver up to 80% of maternal health services. The pre-service education programmes in Kenya offers different midwifery competencies for the various programmes, influencing expected outcomes in practice. AIM: This study aimed to assess midwives' perceived level of competence based on the International Confederation of Midwives (ICM) standards in Kenya. SETTING: The study was conducted in selected public health facilities in Kenya. METHODS: An observational cross-sectional design was used. A multi-stage sampling technique was used to select the counties and health facilities and random sampling to determine 576 midwives. Data were collected using a self-administered assessment tool adopted from the ICM competency domains. RESULTS: A total of 495 (85.9%) midwife respondents participated in this study, of which 389 (78.6%) respondents in all training categories were highly competent in the four ICM domains. The midwives' qualifications and facility level were associated with their self-perceived competence during practice. Those trained in the direct-entry midwifery programme were more competent, p = 0.016 (Kruskal wallis H = 8.432). CONCLUSION: Midwives' competence was influenced by the level of education and facility where they practice. All pre-service midwifery programme graduates must meet the essential ICM competencies and need to enhance continuous professional development (CPD) programmes and facility-based mentorship for the midwives.Contribution: To optimise midwifery-led practice in primary health care, midwifery competence should be enhanced in pre-service and in-service education for improved health outcomes.

Exploring experiences with sensitivity to cultural practices among birth attendants in Kenya: A phenomenological study.

BACKGROUND:  Sensitivity to women's cultural needs and expectations by care providers is essential. Skilled birth services for women are as essential as traditional birth services. Therefore, collaborative skilled and cultural care optimises childbearing experiences. AIM:  This study explored the experiences of birth attendants (BAs) with sensitivity to cultural practices (CPs) during pregnancy and birth among the Keiyo community in Kenya. SETTING:  The study was conducted in the purposively selected public health centres and dispensaries offering maternity services and the villages in Keiyo South Sub County in Kenya. METHODS:  A qualitative interpretive phenomenological study of BAs was conducted. Iterative and inductive interviews using a semistructured guide were conducted with 11 skilled BAs (SBAs) and eight traditional BAs (TBAs). Audio-recorded interviews were transcribed and analysed using ATLAS.ti software version 8.4.4 (1135), following Van Manen's five thematic analysis steps. RESULTS:  Three themes emerged: birth attendants' cultural encounters, response to cultural encounters and collaboration. Birth attendants' responses to different cultural encounters revealed their awareness of CPs. The response was experienced as a sensitivity to the need for a triad (woman, TBAs and SBAs) collaborative care, enabling collaborative, woman-centred and culturally safe care. CONCLUSION:  Birth attendants are exposed to cultural encounters, and their responses determine their awareness of enabling sensitive care for optimal childbearing experiences. The study illuminated the need for further collaborative engagements between the BAs and the community to facilitate positive experiences by women through woman-centred, culturally safe care.

Exploring experiences with sensitivity to cultural practices among birth attendants in Kenya: A phenomenological study

Background: Sensitivity to women's cultural needs and expectations by care providers is essential. Skilled birth services for women are as essential as traditional birth services. Therefore, collaborative skilled and cultural care optimises childbearing experiences. Aim: This study explored the experiences of birth attendants (BAs) with sensitivity to cultural practices (CPs) during pregnancy and birth among the Keiyo community in Kenya. Setting: The study was conducted in the purposively selected public health centres and dispensaries offering maternity services and the villages in Keiyo South Sub County in Kenya. Methods: A qualitative interpretive phenomenological study of BAs was conducted. Iterative and inductive interviews using a semistructured guide were conducted with 11 skilled BAs (SBAs) and eight traditional BAs (TBAs). Audio-recorded interviews were transcribed and analysed using ATLAS.ti software version 8.4.4 (1135), following Van Manen's five thematic analysis steps. Results: Three themes emerged: birth attendants' cultural encounters, response to cultural encounters and collaboration. Birth attendants' responses to different cultural encounters revealed their awareness of CPs. The response was experienced as a sensitivity to the need for a triad (woman, TBAs and SBAs) collaborative care, enabling collaborative, woman-centred and culturally safe care. Conclusion: Birth attendants are exposed to cultural encounters, and their responses determine their awareness of enabling sensitive care for optimal childbearing experiences. The study illuminated the need for further collaborative engagements between the BAs and the community to facilitate positive experiences by women through woman-centred, culturally safe care.

Perspectives on waiting times in an antenatal clinic: A case study in the Western Cape.

BACKGROUND: Antenatal care (ANC) is vital in reducing maternal and neonatal morbidity and mortality. Globally, 85% of women had one ANC visit with a skilled birth attendant and only 58% received the recommended four ANC visits. Long waiting times (LWTs) in the antenatal clinic affects the utilisation of the service. Long waiting times are viewed as a significant barrier to ANC utilisation and needs further investigation. AIM: The aim of this study was to explore and describe the contextual realities within the antenatal clinic that influenced waiting times (WTs). SETTING: This study was conducted in an antenatal clinic, within a Midwife Obstetric Unit (MOU), Western Cape, South Africa. METHODS: This study utilised a qualitative methodology with a single case study design with three embedded units of analysis. Purposive sampling was used to recruit the participants. Data were collected through unstructured observation and semi-structured interviews with pregnant women and midwives. Interviews were audio recorded, transcribed and analysed using the framework method. RESULTS: The antenatal clinics had LWTs. The barriers to WTs were related to staff factors, patient factors, operational factors, communication, equipment and infrastructure and other research participant recruitment. CONCLUSION: The factors that influenced WTs are multifaceted and interrelated. Many of the factors influencing the WTs could be remedied by implementing appropriate workflow strategies, improving communication and increasing equipment availability. The findings can be used to develop waiting time guidelines and improve WTs in the antenatal clinic.

Accessible continued professional development for maternal mental health.

BACKGROUND:  Changing global health and development trends have resulted in a need for continued professional development (CPD) within the health and development sectors. In low-resource settings, where the need for training and CPD may be highest, there are significant challenges for disseminating information and skills. There is a need to improve mental health literacy and reduce levels of stigma about maternal mental illness. The Bettercare series of distance learning books provides a peer-based format for CPD. We aimed to evaluate the Bettercare Maternal Mental Health book as a format for CPD. AIM:  The aim of this study was to determine whether the Bettercare Maternal Mental Health book significantly improves knowledge and decreases stigma around mental health for care providers from the health and social development sectors. SETTING:  One hundred and forty-one participants (social workers, nursing students and health professionals) were provided with the Bettercare Maternal Mental Health book to study. METHODS:  Before and after studying the book, the same multiple-choice knowledge test and the Mental Illness Clinicians' Attitude Scale were used to assess cognitive knowledge and mental health stigma, respectively. RESULTS:  Participants' knowledge showed a statistically significant (p < 0.001) improvement between the pre- and post-test results, for all six chapters of the book. However, participants' attitudes towards mental illness did not show a statistically significant change between the pre- and post-test results. CONCLUSION:  We found that this method of learning elicited significant improvement in mental health knowledge for care providers. Continued professional development policy planners and curriculum developers may be interested in these findings.