Evidence on respectful maternity care for adolescents: a systematic review protocol

Systematic Reviews, Volume 10, No. 1, Year 2021

Interpretation

Background: Intrapartum mistreatment of women is an ubiquitous public health and human rights challenge. The issue reportedly has severe maternal and neonatal outcomes including mortality, and generally leads to a decreased satisfaction with maternity care. Intrapartum mistreatment, despite being ubiquitous, indicates higher incidence amongst adolescent parturients who are simultaneously at a higher risk of maternal morbidity and mortality. Studies have suggested that Respectful Maternity Care interventions reduce intrapartum mistreatment and improve clinical outcomes for women and neonates in general. However, evidence on the effect of RMC on adolescents is unclear. Hence, the specific aim of this study is to synthesise the available evidence relating to the provision of RMC for adolescents during childbirth. Methods: The methodology of the proposed systematic review follows the procedural guideline depicted in the preferred reporting items for systematic review protocol. The review will include published studies and gray literature from January 1, 1990, to June 30, 2021. Electronic databases including MEDLINE, PubMed, ScienceDirect, Cochrane, CINAHL, PsycINFO, Scopus, Google Scholar and Web of Science will be searched to retrieve available studies using the appropriate search strings. Studies included in the review will be appraised for quality using tools tailored to each study design. If appropriate, we will conduct random effects meta-analysis of data to summarise the pooled estimates of respectful maternity care prevalence and outcomes. The selection of relevant studies, data extraction and quality assessment of individual studies will be carried out by two independent authors. Results: Summaries of the findings will be compiled and synthesised in a narrative summary. In addition to the narrative synthesis, where sufficient data are available, a random-effects meta-analysis will be conducted to obtain a pooled estimate value for respectful maternity care prevalence and outcomes. Discussion: Respectful Maternity Care for adolescents holds great promise for improved maternal and neonatal care. However, there is a gap in knowledge on the interventions that work and the extent of their effectiveness. Findings from this study will be beneficial in improving Adolescents Sexual and Reproductive Health and Rights and reducing maternal mortality, especially for adolescents. Systematic review registration: PROSPERO CRD42020183440 This study protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO) with code CRD42020183440. This study protocol is being reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P) statement [18] and checklist (Additional file 1). Studies will be selected using the Population, Intervention, Comparator, Outcome and Study design (PICOS framework) [18]. Only studies that are focused on adolescent parturients as a main study population or sub-analyses population of interest will be included. Adolescent parturient refers to anyone between 10 and 19 years old who has delivered within the past 6 months. Any studies whose aim mentions interventions aimed towards providing respectful or compassionate care for adolescents will be included. Studies that focus on adolescent perspectives and experiences of quality of care will also be included. Comparators will include studies that compare facilities or programmes that deliver the normal or standard quality of care for adolescents to facilities or programmes that are not specifically targeted at reducing intrapartum mistreatment. The outcomes of interest are the reported experiences of RMC by participants. These outcomes include reported satisfaction with care and maternal and neonatal physical and psychosocial outcomes. Studies eligible for inclusion include relevant primary qualitative and quantitative research studies. These may include cross-sectional, cohort (prospective and retrospective), case control, experimental and intervention designs. Qualitative observations of respectful care experiences will also be included. Studies published in English and between January 1, 1990, and June 30, 2021, will be included. This timeline is selected to reflect the period from which the concept of respectful maternity care gained momentum in the 1990s to the most recent studies of 2021. The sources of information will be electronic databases including MEDLINE, PubMed, ScienceDirect, Cochrane, CINAHL, PsycINFO, Scopus, Google Scholar and Web of Science. Reference lists of selected studies will also be searched for relevant papers. Additionally, grey literature searches will be conducted on organisational websites such as World Health Organisation, White Ribbon Alliance, USAID and Population Council, a search strategy using medical subject headings (MeSH) on the terms ‘Intrapartum Mistreatment’, ‘Disrespect and Abuse’, ‘Respectful Maternity Care’, ‘Adolescents’, ‘Teenager’, ‘Pregnancy’ and ‘Compassionate care’ together with BOOLEAN operators (‘AND’/’OR’) will be used. The searches will be conducted by HH. All identified studies will be saved into the online-based Mendeley reference manager. This reference manager has been selected for this study as it allows orderly download and storage of the selected abstracts as well as any available full-text versions. It also allows shared access by all the reviewers. The relevant titles and abstracts will be independently screened by two reviewers HH and JM. Articles meeting the selection criteria will be retained for independent assessment against the selection criteria by HH and JM. A data extraction tool in Ms-Excel will be used to assess and extract the pertinent preliminary information from the available abstracts. Components of the tool will be used to extract the relevant data which include author(s) names, year of publication, study design and/or methodology, study population, intervention(s), study setting, geographic location and results. The final list of articles will be downloaded in full text for detailed review. A PRISMA flowchart will be used to demonstrate the process of screening and identification of articles to include in the systematic review, with reasons for exclusion noted. Any discrepancies that arise will be reassessed and resolved by the full team. Studies will be individually assessed for quality using the suitable Joanna Briggs Institute critical appraisal tool [19] for each study design. Criteria that will be assessed will include congruity between the study aims and objectives, its philosophical perspective and methodology as well as the analyses method used in the studies. Two authors (HH and JM) will review the studies against the eligibility criteria and the checklist independently. Discrepancies will be resolved by discussion, with the involvement of a third reviewer when there is a disagreement. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines 18 will be followed during the review. A combination of narrative and thematic synthesis is proposed as most suitable for achieving this review’s objectives which aim to describe the existing literature as well as identify the strategies, outcomes, gaps and challenges in previous interventions. The descriptive [20] narration will firstly summarise the methods, results and conclusions of the studies in prose. Subsequently, the running themes in the studies will be identified and grouped in a thematic analyses [21]. The most prominent and recurrent themes will then be identified and analysed. The characteristics and themes will also be summarised in a tabular form in addition to the prose narratives. If the included studies are sufficiently homogeneous (relating to study population, methodology, intervention and outcome), meta-analyses will be considered, using random-effects model in STATA version 16 software to account for between-study variability. If a meta-analysis is conducted, statistical heterogeneity will be assessed using the X2 test having a 10% significance level and quantified using the I2 statistic.

AI Digest

Study Justification:

– Intrapartum mistreatment of women is a significant public health and human rights issue.
– Adolescent parturients are at a higher risk of maternal morbidity and mortality, and they also experience higher rates of intrapartum mistreatment.
– Respectful Maternity Care (RMC) interventions have shown promise in reducing mistreatment and improving outcomes for women and neonates.
– However, the evidence on the effectiveness of RMC specifically for adolescents is unclear.
– This study aims to synthesize the available evidence on the provision of RMC for adolescents during childbirth.

Study Highlights:

– The study will follow a systematic review protocol, using established guidelines for reporting.
– A comprehensive search will be conducted in multiple electronic databases and grey literature sources.
– Studies that focus on adolescent parturients and interventions aimed at providing respectful care will be included.
– The outcomes of interest include reported satisfaction with care and maternal and neonatal physical and psychosocial outcomes.
– The findings will be compiled and synthesized in a narrative summary, and if appropriate, a meta-analysis will be conducted.

Study Recommendations:

– The findings from this study will contribute to improving Adolescents Sexual and Reproductive Health and Rights.
– The study will provide valuable insights into the interventions that work and their effectiveness in reducing maternal mortality for adolescents.

Key Role Players:

– Researchers: Responsible for conducting the systematic review and analysis.
– Reviewers: Involved in the screening and assessment of studies for inclusion.
– Policy Makers: Can utilize the findings to inform policies and interventions aimed at improving maternity care for adolescents.

Cost Items for Planning Recommendations:

– Research Personnel: Budget for researchers and reviewers involved in the study.
– Database Access: Cost for accessing electronic databases and grey literature sources.
– Data Extraction Tool: Budget for the use of a data extraction tool.
– Statistical Software: Budget for using STATA version 16 software for meta-analysis.
– Publication Fees: Cost for publishing the study in a journal.
Please note that the provided cost items are general suggestions and may vary depending on the specific circumstances of the study.

Strength of Evidence

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is rated 7 because the study protocol outlines a systematic review that follows established guidelines and includes a comprehensive search strategy. The protocol also mentions the use of quality appraisal tools and the potential for meta-analysis. However, the abstract does not provide specific details on the number or types of studies to be included, and it does not mention any preliminary findings or results. To improve the strength of the evidence, the abstract could include more information on the expected number and types of studies to be included, as well as any preliminary findings or results if available.

Abstract

This study protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO) with code CRD42020183440. This study protocol is being reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P) statement [18] and checklist (Additional file 1). Studies will be selected using the Population, Intervention, Comparator, Outcome and Study design (PICOS framework) [18]. Only studies that are focused on adolescent parturients as a main study population or sub-analyses population of interest will be included. Adolescent parturient refers to anyone between 10 and 19 years old who has delivered within the past 6 months. Any studies whose aim mentions interventions aimed towards providing respectful or compassionate care for adolescents will be included. Studies that focus on adolescent perspectives and experiences of quality of care will also be included. Comparators will include studies that compare facilities or programmes that deliver the normal or standard quality of care for adolescents to facilities or programmes that are not specifically targeted at reducing intrapartum mistreatment. The outcomes of interest are the reported experiences of RMC by participants. These outcomes include reported satisfaction with care and maternal and neonatal physical and psychosocial outcomes. Studies eligible for inclusion include relevant primary qualitative and quantitative research studies. These may include cross-sectional, cohort (prospective and retrospective), case control, experimental and intervention designs. Qualitative observations of respectful care experiences will also be included. Studies published in English and between January 1, 1990, and June 30, 2021, will be included. This timeline is selected to reflect the period from which the concept of respectful maternity care gained momentum in the 1990s to the most recent studies of 2021. The sources of information will be electronic databases including MEDLINE, PubMed, ScienceDirect, Cochrane, CINAHL, PsycINFO, Scopus, Google Scholar and Web of Science. Reference lists of selected studies will also be searched for relevant papers. Additionally, grey literature searches will be conducted on organisational websites such as World Health Organisation, White Ribbon Alliance, USAID and Population Council, a search strategy using medical subject headings (MeSH) on the terms ‘Intrapartum Mistreatment’, ‘Disrespect and Abuse’, ‘Respectful Maternity Care’, ‘Adolescents’, ‘Teenager’, ‘Pregnancy’ and ‘Compassionate care’ together with BOOLEAN operators (‘AND’/’OR’) will be used. The searches will be conducted by HH. All identified studies will be saved into the online-based Mendeley reference manager. This reference manager has been selected for this study as it allows orderly download and storage of the selected abstracts as well as any available full-text versions. It also allows shared access by all the reviewers. The relevant titles and abstracts will be independently screened by two reviewers HH and JM. Articles meeting the selection criteria will be retained for independent assessment against the selection criteria by HH and JM. A data extraction tool in Ms-Excel will be used to assess and extract the pertinent preliminary information from the available abstracts. Components of the tool will be used to extract the relevant data which include author(s) names, year of publication, study design and/or methodology, study population, intervention(s), study setting, geographic location and results. The final list of articles will be downloaded in full text for detailed review. A PRISMA flowchart will be used to demonstrate the process of screening and identification of articles to include in the systematic review, with reasons for exclusion noted. Any discrepancies that arise will be reassessed and resolved by the full team. Studies will be individually assessed for quality using the suitable Joanna Briggs Institute critical appraisal tool [19] for each study design. Criteria that will be assessed will include congruity between the study aims and objectives, its philosophical perspective and methodology as well as the analyses method used in the studies. Two authors (HH and JM) will review the studies against the eligibility criteria and the checklist independently. Discrepancies will be resolved by discussion, with the involvement of a third reviewer when there is a disagreement. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines 18 will be followed during the review. A combination of narrative and thematic synthesis is proposed as most suitable for achieving this review’s objectives which aim to describe the existing literature as well as identify the strategies, outcomes, gaps and challenges in previous interventions. The descriptive [20] narration will firstly summarise the methods, results and conclusions of the studies in prose. Subsequently, the running themes in the studies will be identified and grouped in a thematic analyses [21]. The most prominent and recurrent themes will then be identified and analysed. The characteristics and themes will also be summarised in a tabular form in addition to the prose narratives. If the included studies are sufficiently homogeneous (relating to study population, methodology, intervention and outcome), meta-analyses will be considered, using random-effects model in STATA version 16 software to account for between-study variability. If a meta-analysis is conducted, statistical heterogeneity will be assessed using the X2 test having a 10% significance level and quantified using the I2 statistic.

Materials

Innovations

Based on the provided information, it seems that the study protocol is focused on conducting a systematic review to gather evidence on respectful maternity care (RMC) for adolescents during childbirth. The aim is to identify interventions that work and assess their effectiveness in improving maternal and neonatal care for adolescents. The study will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and will include both qualitative and quantitative research studies published in English between January 1, 1990, and June 30, 2021. The sources of information will include electronic databases such as MEDLINE, PubMed, ScienceDirect, Cochrane, CINAHL, PsycINFO, Scopus, Google Scholar, and Web of Science. Grey literature searches will also be conducted on organizational websites. The selected studies will be assessed for quality using the Joanna Briggs Institute critical appraisal tool. The findings will be synthesized using a combination of narrative and thematic synthesis, and if the included studies are sufficiently homogeneous, a meta-analysis will be considered. Statistical heterogeneity will be assessed using the X2 test and quantified using the I2 statistic.

AI Innovations Description

The recommendation that can be developed from this study protocol is to implement Respectful Maternity Care (RMC) interventions specifically targeted at adolescent parturients. The study aims to synthesize the available evidence on the provision of RMC for adolescents during childbirth. By implementing RMC interventions, it is expected to reduce intrapartum mistreatment and improve clinical outcomes for adolescent mothers and their neonates.

The recommended innovation to improve access to maternal health is to develop and implement comprehensive RMC programs that specifically address the needs and experiences of adolescent parturients. These programs should focus on providing compassionate and respectful care, ensuring that the rights and dignity of adolescent mothers are upheld throughout the childbirth process.

Key components of the innovation could include:

1. Training healthcare providers: Provide training and education to healthcare providers on adolescent-friendly care, communication skills, and the importance of respectful maternity care. This will help ensure that healthcare providers are equipped with the knowledge and skills to provide compassionate and respectful care to adolescent mothers.

2. Creating a supportive environment: Establish a supportive and non-judgmental environment within healthcare facilities that caters to the unique needs of adolescent mothers. This can include creating separate spaces or dedicated units for adolescent mothers, providing age-appropriate information and resources, and involving adolescent mothers in decision-making processes.

3. Empowering adolescent mothers: Empower adolescent mothers by providing them with information about their rights, options, and available support services. This can include providing comprehensive sexuality education, promoting informed decision-making, and ensuring access to contraception and family planning services.

4. Addressing social and cultural barriers: Recognize and address social and cultural barriers that may prevent adolescent mothers from accessing maternal health services. This can include community engagement and awareness campaigns to reduce stigma and discrimination, as well as working with community leaders and influencers to promote positive attitudes towards adolescent mothers.

5. Monitoring and evaluation: Implement a robust monitoring and evaluation system to assess the effectiveness of the RMC interventions for adolescent mothers. This can include collecting data on maternal and neonatal outcomes, measuring patient satisfaction, and conducting regular feedback sessions with adolescent mothers to identify areas for improvement.

By implementing these recommendations, it is expected that access to maternal health services for adolescent mothers will be improved, leading to better health outcomes for both mothers and their neonates.

AI Innovations Methodology

The study protocol you provided aims to conduct a systematic review on the provision of Respectful Maternity Care (RMC) for adolescents during childbirth. The goal is to synthesize the available evidence on the effect of RMC on adolescents and improve their sexual and reproductive health, reduce maternal mortality, and enhance neonatal care.

To simulate the impact of recommendations on improving access to maternal health, a methodology can be developed using the following steps:

1. Identify the recommendations: Based on the findings of the systematic review, identify the specific recommendations that have shown potential to improve access to maternal health for adolescents. These recommendations could include interventions aimed at providing respectful and compassionate care, improving facilities or programs, or addressing specific challenges faced by adolescent parturients.

2. Define the simulation model: Develop a simulation model that represents the current state of access to maternal health for adolescents. This model should include relevant factors such as healthcare facilities, healthcare providers, availability of resources, geographical factors, and socio-cultural factors that influence access to maternal health.

3. Incorporate the recommendations: Integrate the identified recommendations into the simulation model. This could involve modifying the model parameters, introducing new variables, or adjusting the existing processes to reflect the impact of the recommendations on improving access to maternal health.

4. Simulate the impact: Run the simulation model with and without the incorporated recommendations to compare the outcomes. This could include measuring indicators such as the number of adolescent parturients receiving respectful maternity care, satisfaction with care, maternal and neonatal outcomes, and reduction in intrapartum mistreatment. The simulation should also consider the potential scalability and sustainability of the recommendations.

5. Analyze the results: Analyze the simulation results to assess the impact of the recommendations on improving access to maternal health. This could involve comparing the outcomes between the scenarios with and without the recommendations, identifying any significant improvements, and evaluating the cost-effectiveness of the recommendations.

6. Refine and iterate: Based on the analysis, refine the simulation model and recommendations if necessary. Iterate the simulation process to further explore different scenarios or variations of the recommendations to optimize the impact on improving access to maternal health.

By following this methodology, stakeholders can gain insights into the potential impact of specific recommendations on improving access to maternal health for adolescents. This can inform decision-making, policy development, and resource allocation to prioritize interventions that have the greatest potential for positive change.

Author

Dima Health

Identifiers:

DOI: 10.1186/s13643-021-01829-9

Research Areas:

Community Interventions, Genetics and Genomics, Health System and Policy, Maternal and Child Health, Quality of Care, Sexual and Reproductive Health, Social Determinants

Study Design:

Case-Control Study, Cohort Study, Cross Sectional Study, Narrative Study, randomised-control-trial

Study Approach:

Mixed-methods, Qualitative, Quantitative, Systematic Review

Participants Gender:

Female