Contextualizing a framework for improving postnatal care in Ethiopia

  • Frontiers in Public Health, Volume 10, Year 2022

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Study Justification:
– Postnatal care is a crucial intervention for reducing maternal deaths.
– Low postnatal care utilization in Ethiopia needs improvement.
– Contextualizing and adapting a framework from Kenya can address this issue.
Highlights:
– Quantitative descriptive research design used.
– Data collected from 422 postnatal care providers and coordinators.
– AGREE II questionnaire used to assess adaptability and applicability.
– Framework from Chelagat found to be adaptable for use in Ethiopia.
Recommendations:
– Implement the contextualized framework for improving postnatal care in Ethiopia.
– Increase awareness and training for postnatal care providers.
– Strengthen stakeholder involvement and coordination.
– Monitor and evaluate the implementation of the framework.
Key Role Players:
– Postnatal care providers (midwives, nurses, health officers).
– District, regional, and national reproductive health coordinators.
– Health centers, hospitals, district, and regional health departments.
Cost Items for Planning Recommendations:
– Training programs for postnatal care providers.
– Awareness campaigns and materials.
– Monitoring and evaluation systems.
– Coordination and communication mechanisms.
– Data collection and analysis tools.
– Support for stakeholder involvement and coordination.

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is based on a quantitative descriptive research design and includes data collected from 422 postnatal care providers and coordinators in Ethiopia. The study used the AGREE II questionnaire to assess adaptability and applicability of the framework, and the findings indicated an average domain score of 92% for contextualization possibility. However, the abstract does not provide information on the representativeness of the sample or the response rate. To improve the strength of the evidence, future studies could consider using a larger and more diverse sample, ensuring a high response rate, and providing more details on the methodology and data analysis procedures.

Background: Postnatal care is among the major recommended interventions to reduce maternal deaths. To improve the low postnatal care utilization in Ethiopia, the framework developed for this purpose in Kenya was contextualized and adapted for implementation in the Ethiopian context. Objectives: The objectives of this article are to share the process followed to contextualize Chelagat’s framework for improving postnatal care, for the implementation in Ethiopia as well as the finalized contextualized framework. Methods: A quantitative descriptive research design was adapted. A self-administered questionnaire was used to gather data during November 2018 from 422 postnatal care providers and coordinators, using stratified random sampling. The AGREE II was utilized to assess adaptability and applicability and an open-ended question allowed to assess the challenges and opportunities for utilizing the framework. The data were analyzed using SPSS computer software, Version 23. Results: The findings revealed that the framework from Chelagat was adaptable to use for the improvement of postnatal care in the Ethiopian context. The results from the analysis of the data using AGREE II indicated an average domain score of 92%, for contextualization possibility. Conclusion: The framework originally developed by Chelagat was contextualized and refined to be implemented in Ethiopia to improve postnatal care.

A quantitative descriptive cross-sectional study design was employed to assess, adapt, and contextualize the framework developed for the Kenyan context for the possible implementation in Ethiopia. The study was conducted in Oromia regional state, purposively selected as it is geographically large in comparison with other regions and nearly one-third of the Ethiopian population live in the Oromia region (3). The stakeholders (national and provincial reproductive health coordinators as well as all midwives and nurses allocated to midwifery units in all hospitals in Kenya) participating and contributing to the development of Chelagat’s framework, were similar to the stakeholders involved in postnatal care in Ethiopia. Therefore, the postnatal care service providers, namely, midwives, nurses, and health officers at health facilities, as well as the district, regional, and national reproductive health coordinators in the Ethiopian health system assisted in adapting and contextualizing the framework. The postnatal care providers and coordinators working at the 80 health centers, 25 hospitals, the district and regional postnatal care coordinators in the district health departments, as well as the regional health department, formed the population. The identified populations are key to postnatal care in the Ethiopian health system. The total number of participants comprised of 422 participants (294 nurses, 74 midwives, 46 health officers, 6 district postnatal care coordinators, and 2 regional postnatal care coordinators). The study respondents were selected by using stratified simple random sampling as there was a sampling frame prepared by the researcher based on the existing lists of postnatal care providers and coordinators at each health facility or health department. The total sample size was determined, using the single population proportion formula as described by Kothari (29): The assumptions under this formula were as follows: Considering a non-response rate of 10%, the final sample size was 422. The sampling frames were the lists of individuals from which the researcher selected the sample, namely, the lists of postnatal care providers and postnatal care coordinators. A questionnaire was used to collect data from each participant to assess applicability, for the adaptation and contextualization of the framework in the Ethiopian context. Ten trained field workers were purposively selected from university graduate nurses to gather the data. Before commencement of the actual data collection, a pilot study was conducted with 5% (21) of the participants who were outside the study area but who were postnatal care providers and coordinators (30). The AGREE II, a standardized and tested questionnaire (30, 31), was used for data collection. Additional questions, guided by standardized WHO guidelines, were added to the AGREE II to assess baseline information on postnatal care services in Ethiopia as to compare the data, with that available from Kenya. The data from the questionnaires were analyzed with the assistance of a statistician. The Statistical Package for Social Scientists (SPSS) computer program, Version 21 was used to process and analyze the data. Descriptive statistics, using frequencies and percentages for categorical data were used, and the results for this study were presented in text form, in tables, and in pie charts. For guideline or framework adaptability assessment, AGREE is a commonly used instrument. The instrument allows for assessing methodological rigor and transparency in which a guideline or framework is developed. The original AGREE instrument has been refined, which has resulted in the new AGREE II version and a new user’s manual which was published in 2013 (31). AGREE II includes 23 appraisal criteria (items) organized within six domains and two overall assessments as follows: (1) Overall framework quality; (2) Recommendation for use. The six domains are (1) overall aim of the guideline, (2) stakeholder involvement, (3) rigor of development, (4) clarity of presentation, (5) applicability, and (6) editorial independence. Each domain in AGREE II assesses, by means of a Likert scale, a unique dimension of the developed framework quality. The participants were allowed to provide individual opinions on what they believe would improve the quality of the guidelines or framework to be contextualized in the space that was provided additional to the AGREE II tool. Ten data collectors (6 males and 4 females) from a university college of medicine and health sciences were purposively selected for assisting with data collection. They were chosen based on their experience as fieldworkers. They shared with all eligible respondents an information and recruitment letter them and provided a consent form to complete, if volunteering to participate. The data collectors distributed the questionnaires to all consenting participants, requesting them to complete it in private and return the completed questionnaire within 2 days. The data analysis was done, using statistical procedures as well as open coding for the open-ended questions. Quantitative data were analyzed, summarized, and presented in tables and pie charts using frequencies and percentages (32), applying the principles suggested by AGREE II (2013:10). The analysis of the questionnaire, thus, was based on the following six domains indicated in AGREE II: (1) Scope and Purpose; (2) Stakeholder Involvement; (3) Rigor of Development; (4) Clarity of Presentation; (5) Applicability, and (6) Editorial Independence. As recommended in AGREE II, each of the AGREE II items and the two global rating items were rated on a 7-point scale that ranged from 1 to 7 (1–strongly disagree to 7–strongly agree). The AGREE II User’s Manual section was used to rate each domain. Accordingly, the AGREE II was used to calculate the domain scores by summing up all the scores of the individual items in a domain and scaling the total as a percentage of the maximum possible score for that domain calculated as follows: As recommended in AGREE II, the scaled domain for the contextualization possibility of the framework was assessed using the formula (31): An inductive thematic analysis was employed for the narrative data from open-ended questions. Themes and categories were identified after the data were read and coded so that similar ideas were grouped as themes that were underpinned by categories. Ethical approval to conduct the study was obtained from the ethics committee from the custodian university (HSHDC/452/2015). Permission and support to conduct the study and gain access into the field were obtained from the respective administrative offices of Oromia Regional State Health Bureau, each health facility, including health centers, hospitals, district, and regional health departments as well as from each individual respondent who volunteered to participate.

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Innovation 1: Contextualizing and adapting the framework for improving postnatal care in Ethiopia. This involves tailoring the framework developed for postnatal care in Kenya to suit the specific needs and context of Ethiopia. By adapting the framework, it is expected to improve postnatal care and enhance access to maternal health services in Ethiopia.

Innovation 2: Utilizing the AGREE II tool to assess the adaptability and applicability of the framework. The AGREE II tool is a standardized questionnaire that assesses the methodological rigor and transparency in which a guideline or framework is developed. By using this tool, the researchers were able to evaluate the adaptability of the framework for the Ethiopian context and determine its potential for implementation.

Innovation 3: Conducting a quantitative descriptive research design to gather data from postnatal care providers and coordinators in Ethiopia. This research design allowed for the collection of quantitative data to assess the adaptability of the framework and identify challenges and opportunities for its utilization. The data collected from 422 participants provided valuable insights into the feasibility of implementing the framework in Ethiopia.

Innovation 4: Publishing the findings in the journal Frontiers in Public Health. By sharing the research findings in a reputable journal, the researchers contribute to the body of knowledge on improving postnatal care and access to maternal health services. This publication allows other researchers and stakeholders to learn from the study and potentially replicate or build upon the findings.
AI Innovations Description
The recommendation that can be developed into an innovation to improve access to maternal health is the contextualization and adaptation of a framework for improving postnatal care. This recommendation is based on a study conducted in Ethiopia, where the framework developed for postnatal care in Kenya was adapted and refined for implementation in the Ethiopian context.

The study employed a quantitative descriptive research design and gathered data from 422 postnatal care providers and coordinators in Ethiopia. The AGREE II tool was used to assess the adaptability and applicability of the framework, and an open-ended question was included to identify challenges and opportunities for utilizing the framework.

The findings of the study revealed that the framework from Kenya was adaptable for use in improving postnatal care in Ethiopia. The analysis using the AGREE II tool indicated an average domain score of 92% for contextualization possibility.

The innovation lies in the contextualization and adaptation of the framework to suit the specific needs and context of Ethiopia. By tailoring the framework to the Ethiopian context, it is expected to improve postnatal care and ultimately enhance access to maternal health services.

This recommendation and its findings were published in the journal Frontiers in Public Health in 2022.
AI Innovations Methodology
The methodology used to simulate the impact of the recommendations in improving access to maternal health could involve the following steps:

1. Identify the key indicators of access to maternal health: This could include metrics such as the number of women receiving postnatal care, the timeliness of postnatal care visits, the quality of care provided, and the overall satisfaction of women with the postnatal care services.

2. Collect baseline data: Before implementing the contextualized framework, gather data on the current state of postnatal care in Ethiopia. This could involve conducting surveys or interviews with postnatal care providers and women who have recently given birth. Collect data on the key indicators identified in step 1.

3. Implement the contextualized framework: Introduce the adapted framework for improving postnatal care in Ethiopia. Train postnatal care providers on the new framework and ensure that they have the necessary resources and support to implement it effectively.

4. Monitor and evaluate the implementation: Continuously monitor the implementation of the contextualized framework. Collect data on the key indicators identified in step 1 at regular intervals (e.g., every 3 months) to assess the impact of the framework on improving access to maternal health.

5. Analyze the data: Use statistical analysis techniques to analyze the data collected in step 4. Compare the baseline data with the data collected after implementing the contextualized framework to determine if there have been any improvements in access to maternal health.

6. Assess the impact: Based on the analysis of the data, assess the impact of the contextualized framework on improving access to maternal health. This could involve calculating changes in the key indicators, identifying any trends or patterns in the data, and determining the overall effectiveness of the framework.

7. Make adjustments and improvements: Based on the findings from the impact assessment, make any necessary adjustments or improvements to the contextualized framework. This could involve refining certain aspects of the framework, providing additional training or support to postnatal care providers, or addressing any challenges or barriers that were identified during the implementation.

8. Repeat the monitoring and evaluation process: Continuously monitor and evaluate the implementation of the adjusted framework. Collect data on the key indicators identified in step 1 to assess the impact of the improvements made.

By following this methodology, it will be possible to simulate the impact of the recommendations from the abstract on improving access to maternal health in Ethiopia. The data collected and analyzed will provide valuable insights into the effectiveness of the contextualized framework and inform future efforts to enhance access to maternal health services.


Identifiers:
DOI: 10.3389/fpubh.2022.919175
Research Areas:
Community Interventions, Health System and Policy, Maternal Access, Maternal and Child Health, Quality of Care, Sexual and Reproductive Health, Social Determinants, Workforce
Study Countries:
Ethiopia, Kenya, Multi-Countries
Study Design:
Cross Sectional Study, Exploratory Study, Grounded Theory, Narrative Study
Study Approach:
Mixed-methods, Qualitative, Quantitative
Participants Gender:
Female
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