Predictors of Women’s Satisfaction with Hospital-Based Intrapartum Care in Asmara Public Hospitals, Eritrea

Obstetrics and Gynecology International, Volume 2017, Year 2017

Interpretation

Background. Exploring patient satisfaction contributes to provide quality maternity care, but there is paucity of epidemiologic data in Eritrea. Objectives. To determine the predictors of women’s satisfaction with intrapartum care in Asmara public maternity hospitals in Eritrea. Methods. A cross-sectional study among 771 mothers who gave birth in three public Hospitals. Chi-square tests were done to analyze the difference in proportion and logistic regression to assess the predictors of satisfaction with intrapartum care. Results. Overall, only 20.8% of the participants were satisfied with intrapartum service. The key predictors of satisfaction with intrapartum care were provision of clean bed and beddings (AOR = 18.87, 2.33-15.75), privacy during examinations (AOR = 10.22, 4.86-21.48), using understandable language (AOR = 8.72, 3.57-21.27), showing how to summon for help (AOR = 8.16, 4.30-15.48), showing baby immediately after birth (AOR = 8.14, 2.87-23.07), control of the delivery room (AOR = 6.86, 2.65-17.75), receiving back massage (AOR = 6.43, 3.23-12.81), toilet access and cleanliness (AOR = 6.09, 3.25-11.42), availability of chairs for relatives (AOR = 5.96, 3.14-11.30), allowing parents to stay during labour (AOR = 3.52, 1.299-9.56), and request for permission before any procedure (AOR = 2.39, 1.28-4.46). Conclusion. To increase satisfaction with intrapartum care, maternity service providers need to address the general maternity ward cleanliness, improve the quality of physical facilities, and sensitize health providers for better communication with clients. Policy makers need to adopt strategies that ensure more women involvement in decision making and consideration of privacy and reassurance needs during the whole delivery process. A descriptive cross-sectional design was used for this study. This study was conducted in Orotta Maternity National Referral Hospital (OMNRH), Edaga Hamus Hospital (EHH), and Villagio Community Hospital (VCH). These hospitals were selected because they generally have the patient’s profile that is characteristic of most public hospitals in Eritrea. OMNRH is the busiest maternity center with high turnover of mothers giving birth. This hospital has about 8000 normal deliveries annually, representing 34% of the total national normal deliveries. OMNRH is a teaching hospital and accommodates medical students, nurses, nurse midwives, and others. Edaga Hamus Hospital, which is located in North East of Asmara, was renovated in April 2014 and had a total of 467 deliveries in that year. In 2015, delivery services were provided for about 1060 mothers. Villagio Community Hospital is the third public hospital that gives delivery service. It is located in North West of Asmara and started providing delivery service in June 2014. Annual HMIS report indicates that there were about 206 deliveries in 2015. Using a temporal (period) sampling technique [16], 771 women (99.6% response rate) who gave birth at OMNRH, EHH, and VCH hospitals from March to May 2016 participated in the study. All women who delivered by spontaneous vaginal delivery successfully with or without episiotomy and women who were on their immediate postpartum care during the study period were enrolled in the study. Women who were seriously ill, not consented to participate, and with incomplete data and women who experienced birth complications requiring admission to a special care were excluded. The questionnaire was developed after an extensive review of the literature. The tool was modified and finalized according to the suggestions and recommendations of local experts (one gynecology and obstetrics specialist and lecturer at the Asmara College of Health Science, School of Nursing, two midwifery practitioners at the National Maternal and child health referral hospital, and a senior statistician at the Ministry of Health) and the research team. Content validity was secured through in-depth interviews and critical appraisal of the data collection instrument. The final questionnaire had two sections. The first part included questions about the respondent’s age, religion, level of education, parity, mode of delivery, and marital status. The second section was a scale measuring women’s satisfaction with the four dimensions of intrapartum care. The scale was generated by summing up the mean and standard deviation scores of the four subscales. The subscale items were formulated from extensive literature review and expert input. The subscale scores were constructed from responses to individual questions. They were summarized using the average (mean) score plus one standard deviation (SD). Scores above the mean and one standard deviation were considered satisfied [17, 18]. Subscale one contained items related to the provision of physical facilities (6 items). The second subscale included questions regarding the provision of consumables (4 items). The third subscale included questions about women’s satisfaction with pain management methods (3 items). The last subscale contained questions about the communication patterns of health care providers (7 items). Participants were asked to rate their satisfaction with intrapartum care on a five-point Likert scale ranging from strongly disagree (1) to strongly agree (5). The satisfaction scale had a reliability score of 0.702. To address for face validity, the questionnaire was piloted with a group of 20 childbearing women in Villagio Community Hospital. After brief explanation of the study objectives, the respondents were assured about the confidentiality and anonymity of their responses. Written consent was then obtained to participate in the study. Four final year nursing students approached the women and made interviews in the wards behind closed curtains for privacy. After completing the interviews, the filled questionnaires were checked for completeness, consistency, and the presence of outliers. A database was developed in CSPro 6.2 and pretested before the start of data entry. Data entry was supervised by the researchers, and any suspect data were cross-checked against hard copies of the questionnaires. Data were analyzed using the Statistical Package for the Social Sciences (SPSS) version 21. The properties of the instrument were assessed using Cronbach’s alpha for reliability (0.702). Relationships between dependent variable (satisfaction with intrapartum care) and independent variables (demographic, obstetric, and intrapartum care indicator variables) were examined using chi-square tests. Statistically significant variables were then dichotomized. Responses of “very satisfied” and “satisfied” were classified as “satisfied” and responses of “very dissatisfied,” “dissatisfied,” and “neutral” as “unsatisfied.” Neutral responses were categorized as dissatisfied because the interview was done in the hospitals, and interviewer or social desirability bias might have had an effect in disclosing their dissatisfaction [17, 19]. Finally, to identify predictors of satisfaction with intrapartum care, binary and multiple logistic regression analyses were done. Statistical significance was set at P < 0.05.

AI Digest

Study Justification:

This study aimed to explore women’s satisfaction with intrapartum care in Asmara public hospitals in Eritrea. The justification for this study is to contribute to the provision of quality maternity care by understanding the factors that influence women’s satisfaction. This study is important because there is a lack of epidemiologic data on patient satisfaction in Eritrea, and by identifying predictors of satisfaction, healthcare providers and policymakers can make informed decisions to improve the quality of care.

Highlights:

– Only 20.8% of the participants were satisfied with intrapartum service in Asmara public hospitals.
– Key predictors of satisfaction with intrapartum care included provision of clean bed and beddings, privacy during examinations, using understandable language, showing how to summon for help, showing the baby immediately after birth, control of the delivery room, receiving back massage, toilet access and cleanliness, availability of chairs for relatives, allowing parents to stay during labor, and requesting permission before any procedure.
– To increase satisfaction with intrapartum care, maternity service providers need to address general maternity ward cleanliness, improve the quality of physical facilities, and sensitize health providers for better communication with clients.
– Policy makers need to adopt strategies that ensure more women’s involvement in decision making and consider privacy and reassurance needs during the whole delivery process.

Recommendations:

Based on the findings, the following recommendations are made:

1. Improve general maternity ward cleanliness to enhance patient satisfaction.
2. Enhance the quality of physical facilities in the hospitals.
3. Sensitize health providers on effective communication with clients.
4. Adopt strategies that ensure more women’s involvement in decision making during the delivery process.
5. Consider privacy and reassurance needs of women throughout the entire delivery process.

Key Role Players:

1. Maternity service providers: They play a crucial role in addressing the recommendations by improving cleanliness, enhancing physical facilities, and improving communication with clients.
2. Policy makers: They need to adopt strategies that promote women’s involvement in decision making and consider privacy and reassurance needs during the delivery process.
3. Gynecology and obstetrics specialists: They can provide expertise and guidance in implementing the recommendations.
4. Nurses and nurse midwives: They are involved in providing intrapartum care and can contribute to improving patient satisfaction through better communication and support.

Cost Items for Planning Recommendations:

1. Renovation and maintenance of maternity ward facilities.
2. Training and sensitization programs for health providers on effective communication.
3. Implementation of strategies to promote women’s involvement in decision making.
4. Provision of additional resources for cleanliness and hygiene in the maternity wards.
5. Development and distribution of educational materials for patients and families.
6. Monitoring and evaluation of the implementation of recommendations.
Please note that the cost items provided are for planning purposes and do not reflect actual costs.

Strength of Evidence

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is relatively strong, but there are some areas for improvement. The study used a descriptive cross-sectional design and included a large sample size of 771 women, which enhances the generalizability of the findings. The study also utilized statistical analysis, including chi-square tests and logistic regression, to identify predictors of satisfaction with intrapartum care. However, the abstract does not provide information on the validity and reliability of the measurement tool used to assess satisfaction. Additionally, the abstract could benefit from including more specific details about the results, such as the odds ratios and confidence intervals for the predictors of satisfaction. To improve the evidence, future studies could consider using a longitudinal design to assess satisfaction over time and could provide more information on the psychometric properties of the measurement tool.

Abstract

A descriptive cross-sectional design was used for this study. This study was conducted in Orotta Maternity National Referral Hospital (OMNRH), Edaga Hamus Hospital (EHH), and Villagio Community Hospital (VCH). These hospitals were selected because they generally have the patient’s profile that is characteristic of most public hospitals in Eritrea. OMNRH is the busiest maternity center with high turnover of mothers giving birth. This hospital has about 8000 normal deliveries annually, representing 34% of the total national normal deliveries. OMNRH is a teaching hospital and accommodates medical students, nurses, nurse midwives, and others. Edaga Hamus Hospital, which is located in North East of Asmara, was renovated in April 2014 and had a total of 467 deliveries in that year. In 2015, delivery services were provided for about 1060 mothers. Villagio Community Hospital is the third public hospital that gives delivery service. It is located in North West of Asmara and started providing delivery service in June 2014. Annual HMIS report indicates that there were about 206 deliveries in 2015. Using a temporal (period) sampling technique [16], 771 women (99.6% response rate) who gave birth at OMNRH, EHH, and VCH hospitals from March to May 2016 participated in the study. All women who delivered by spontaneous vaginal delivery successfully with or without episiotomy and women who were on their immediate postpartum care during the study period were enrolled in the study. Women who were seriously ill, not consented to participate, and with incomplete data and women who experienced birth complications requiring admission to a special care were excluded. The questionnaire was developed after an extensive review of the literature. The tool was modified and finalized according to the suggestions and recommendations of local experts (one gynecology and obstetrics specialist and lecturer at the Asmara College of Health Science, School of Nursing, two midwifery practitioners at the National Maternal and child health referral hospital, and a senior statistician at the Ministry of Health) and the research team. Content validity was secured through in-depth interviews and critical appraisal of the data collection instrument. The final questionnaire had two sections. The first part included questions about the respondent’s age, religion, level of education, parity, mode of delivery, and marital status. The second section was a scale measuring women’s satisfaction with the four dimensions of intrapartum care. The scale was generated by summing up the mean and standard deviation scores of the four subscales. The subscale items were formulated from extensive literature review and expert input. The subscale scores were constructed from responses to individual questions. They were summarized using the average (mean) score plus one standard deviation (SD). Scores above the mean and one standard deviation were considered satisfied [17, 18]. Subscale one contained items related to the provision of physical facilities (6 items). The second subscale included questions regarding the provision of consumables (4 items). The third subscale included questions about women’s satisfaction with pain management methods (3 items). The last subscale contained questions about the communication patterns of health care providers (7 items). Participants were asked to rate their satisfaction with intrapartum care on a five-point Likert scale ranging from strongly disagree (1) to strongly agree (5). The satisfaction scale had a reliability score of 0.702. To address for face validity, the questionnaire was piloted with a group of 20 childbearing women in Villagio Community Hospital. After brief explanation of the study objectives, the respondents were assured about the confidentiality and anonymity of their responses. Written consent was then obtained to participate in the study. Four final year nursing students approached the women and made interviews in the wards behind closed curtains for privacy. After completing the interviews, the filled questionnaires were checked for completeness, consistency, and the presence of outliers. A database was developed in CSPro 6.2 and pretested before the start of data entry. Data entry was supervised by the researchers, and any suspect data were cross-checked against hard copies of the questionnaires. Data were analyzed using the Statistical Package for the Social Sciences (SPSS) version 21. The properties of the instrument were assessed using Cronbach’s alpha for reliability (0.702). Relationships between dependent variable (satisfaction with intrapartum care) and independent variables (demographic, obstetric, and intrapartum care indicator variables) were examined using chi-square tests. Statistically significant variables were then dichotomized. Responses of “very satisfied” and “satisfied” were classified as “satisfied” and responses of “very dissatisfied,” “dissatisfied,” and “neutral” as “unsatisfied.” Neutral responses were categorized as dissatisfied because the interview was done in the hospitals, and interviewer or social desirability bias might have had an effect in disclosing their dissatisfaction [17, 19]. Finally, to identify predictors of satisfaction with intrapartum care, binary and multiple logistic regression analyses were done. Statistical significance was set at P < 0.05.

Materials

N/A

Innovations

Based on the information provided, the study identified several predictors of women’s satisfaction with intrapartum care in Asmara public maternity hospitals in Eritrea. These predictors include:

1. Provision of clean bed and beddings
2. Privacy during examinations
3. Use of understandable language
4. Showing how to summon for help
5. Showing the baby immediately after birth
6. Control of the delivery room
7. Receiving back massage
8. Toilet access and cleanliness
9. Availability of chairs for relatives
10. Allowing parents to stay during labor
11. Requesting permission before any procedure

These predictors highlight the importance of factors such as cleanliness, privacy, effective communication, support, and involvement of family members in improving women’s satisfaction with intrapartum care. Addressing these factors can contribute to enhancing the overall experience and quality of maternity care.

AI Innovations Description

Based on the study titled “Predictors of Women’s Satisfaction with Hospital-Based Intrapartum Care in Asmara Public Hospitals, Eritrea,” the following recommendations can be developed into an innovation to improve access to maternal health:

1. Improve cleanliness: The study found that the provision of clean beds and beddings was a key predictor of satisfaction with intrapartum care. To address this, hospitals can implement innovative cleaning protocols and ensure that clean and comfortable beds and beddings are readily available for pregnant women.

2. Enhance privacy: Privacy during examinations was also identified as a predictor of satisfaction. Hospitals can innovate by creating private examination areas or using curtains or partitions to provide women with a sense of privacy during their intrapartum care.

3. Improve communication: The use of understandable language and clear communication was found to be important for women’s satisfaction. Hospitals can develop innovative communication strategies, such as providing translation services or using visual aids, to ensure effective communication between healthcare providers and pregnant women.

4. Promote family involvement: Allowing parents to stay during labor and providing chairs for relatives were predictors of satisfaction. Hospitals can innovate by creating family-friendly spaces and policies that encourage the involvement of family members in the birthing process.

5. Focus on patient-centered care: The study highlighted the importance of addressing women’s needs and preferences during the delivery process. Hospitals can innovate by implementing patient-centered care models that prioritize individualized care and involve women in decision-making.

6. Improve pain management: Satisfaction with pain management methods was another predictor of satisfaction. Hospitals can innovate by offering a range of pain management options and ensuring that healthcare providers are trained in providing effective pain relief during labor.

7. Enhance facility infrastructure: The study emphasized the need to improve the quality of physical facilities. Hospitals can innovate by investing in infrastructure improvements, such as upgrading delivery rooms, ensuring clean and accessible toilets, and providing comfortable waiting areas for pregnant women and their families.

8. Sensitize healthcare providers: The study highlighted the importance of sensitizing healthcare providers to better communicate with clients. Hospitals can innovate by implementing training programs and workshops that focus on improving communication skills and promoting patient-centered care among healthcare providers.

9. Increase women’s involvement in decision-making: The study recommended adopting strategies that ensure more women’s involvement in decision-making. Hospitals can innovate by implementing shared decision-making models and providing educational resources that empower women to actively participate in their own care.

10. Emphasize privacy and reassurance: The study emphasized the need to consider privacy and reassurance needs throughout the entire delivery process. Hospitals can innovate by implementing protocols and practices that prioritize women’s privacy and provide emotional support and reassurance during labor and delivery.

By implementing these recommendations as innovative practices, access to maternal health can be improved, leading to higher levels of satisfaction and better overall outcomes for pregnant women in Eritrea.

AI Innovations Methodology

Based on the provided description, here are some potential recommendations to improve access to maternal health:

1. Improve cleanliness and hygiene: Ensuring clean beds and beddings, as well as maintaining cleanliness in the maternity ward and toilet facilities, can significantly impact women’s satisfaction with intrapartum care.

2. Enhance privacy and communication: Providing privacy during examinations, using understandable language, and requesting permission before any procedure can improve women’s satisfaction with intrapartum care. Additionally, improving communication patterns of healthcare providers can contribute to a positive birthing experience.

3. Promote family-centered care: Allowing parents to stay during labor and providing chairs for relatives can create a supportive environment and increase satisfaction with intrapartum care.

4. Facilitate immediate bonding: Showing the baby immediately after birth can enhance the emotional experience for mothers and contribute to their satisfaction with intrapartum care.

To simulate the impact of these recommendations on improving access to maternal health, a methodology could include the following steps:

1. Define the indicators: Identify specific indicators that measure access to maternal health, such as the percentage of women receiving prenatal care, the percentage of women delivering in a healthcare facility, or the average distance traveled to access maternal health services.

2. Collect baseline data: Gather data on the current status of the selected indicators before implementing the recommendations. This can be done through surveys, interviews, or analysis of existing data sources.

3. Implement the recommendations: Introduce the recommended interventions in the selected healthcare facilities or communities. This may involve training healthcare providers, improving infrastructure, or implementing new policies.

4. Monitor and evaluate: Continuously monitor the selected indicators to assess the impact of the recommendations. This can be done through regular data collection, surveys, or interviews with women accessing maternal health services.

5. Analyze the data: Use statistical analysis techniques to compare the baseline data with the post-implementation data. This will help determine the extent to which the recommendations have improved access to maternal health.

6. Draw conclusions and make adjustments: Based on the analysis, draw conclusions about the impact of the recommendations on improving access to maternal health. If necessary, make adjustments to the interventions to further enhance their effectiveness.

7. Share findings and scale up: Communicate the findings of the simulation study to relevant stakeholders, such as policymakers, healthcare providers, and community members. If the recommendations have proven successful, consider scaling up the interventions to reach a larger population and further improve access to maternal health.

Author

Dima Health

Statistics:

Citations: 13

Identifiers:

DOI: 10.1155/2017/3717408

ISSN: 16879589

Research Areas:

Community Interventions, Environmental, Health System and Policy, Maternal Access, Maternal and Child Health, Quality of Care, Social Determinants, Workforce

Study Countries:

Eritrea

Study Design:

Cross Sectional Study, Grounded Theory

Study Approach:

Mixed-methods, Qualitative, Quantitative, Systematic Review

Participants Gender:

Female