Development of a patient-centred in-service training programme for midwives to increase client satisfaction with child-birth care in Kumasi, Ghana

Abstract

Background: Satisfaction with the care mothers receive during child-birth is known to have a very strong influence on their future use of facility-based care during child-birth. Women and children continue to die from complications associated with pregnancy and child-birth and the majority of the causes that lead to mortality are related to labour and delivery. For this reason it is imperative for mothers to access facility-based child-birth care to receive skilled birth care. Mothers report dissatisfaction with facility-based child-birth care as one of the reasons for home births without skilled attendants. The presence of the skilled birth attendants is known to reduce maternal and neonatal mortality rates because of their ability to diagnose any early complications, and to intervene appropriately. Aim: The aim of the current study was to develop an in-service training programme for midwives to provide patient-centred child-birth care that would increase client satisfaction with child-birth care. Method and findings: The intervention research model by Rothman and Thomas (1994) – Design and development (D & D) – was used as the research framework. Only the first four of the six phases of the D & D model were applied in this study. In the first phase, a situational analysis was done using a qualitative study. The expectations, experiences, and satisfaction with child-birth care of antenatal and postnatal mothers, were explored. The research was conducted in four health institutions within the Kumasi Metropolis. Between 12 and 15 participants were purposively sampled in each hospital. Data were collected by means of individual in-depth interviews using an interview guide and data were analysed using content analysis. The study found that mothers expected to receive respectful care and safe care. Mothers had encouraging experiences and discouraging experiences during their child-birth care. The discouraging experiences did not align with their expectations of care, leading to dissatisfaction with child-birth care. In the second phase of the study an integrative literature review was conducted to identify evidence-based best practices to deal with client dissatisfaction with health care. The integrative literature review indicated that in-service training was commonly used as best-practice to improve health professionals' knowledge, skills and attitudes towards work and consequently to improve health outcomes for patients, including client satisfaction. In the third phase of the study, the in-service training programme to enhance patient-centred care was developed using Chinn and Kramer (2005) guidelines for programme development and steps to programme development by Management Sciences for Health (2012). The fourth phase entailed an assessment of feasibility and usability of the in-service training programme using 6 midwives in a district Hospital. The procedure was guided by the I-Tech Technical Implementation guide (2010). The outcomes of the assessment was used to refine and revise the developed in-service training programme. Conclusion: This study sought to develop an intervention to increase client satisfaction with child-birth care service by engaging the following processes in phases: • Assessing the expectations and experiences of mothers about child-birth care services. • An integrative literature review for evidence-based best practice to tackle client dissatisfaction with health care. • Designing a patient-centred care in-service training programme together with experts in the field of maternal and child health. • As assessment of feasibility and usability of the in-service training programme by means of a pilot test to refine the programme. Recommendations: It was recommended among others that, the study is carried out on a national scale to cover all administrative regions of Ghana. It is further recommended that the study findings and the programme developed form part of the continuous professional assessment course requirement for nurses and midwives.