Factors influencing postpartum haemorrhage detection and management and the implementation of a new postpartum haemorrhage care bundle (E-MOTIVE) in Kenya, Nigeria, and South Afric...

• Autores: Forbes, Gillian; Akter, Shahinoor; Miller, Suellen; Galadanci, Hadiza; Qureshi, Zahida; Fawcus, Sue; Hofmeyr, G. Justus; Moran, Neil; Singata Madliki, Mandisa; Dankishiya, Faisal; Gwako, George; Osoti, Alfred; Thomas, Eleanor; Gallos, Ioannis; Mammoliti, Kristie Marie; Devall, Adam; Coomarasamy, Arri; Althabe, Fernando; Atkins, Lou; Bohren, Meghan A.; Lorencatto, Fabiana
• Año de publicación: 2023
• Idioma: inglés
• Tipo de recurso: artículo
• Materia: Behaviour Change Wheel; Clinical care bundle; Formative research; Implementation interventions
• Institución: Consejo Nacional de Investigaciones Científicas y Técnicas

Background: Postpartum haemorrhage (PPH) is the leading cause of global maternal deaths, accounting for 30-50% of maternal deaths in sub-Saharan Africa. Most PPH-related deaths are preventable with timely detection and initiation of care, which may be facilitated by using a clinical care bundle. We explore influences on current PPH detection and management and on the future implementation of a new PPH bundle (E-MOTIVE) in low-resource, high-burden settings.Methods: Semi-structured qualitative interviews based on the Theoretical Domains Framework were conducted with 45 healthcare providers across nine hospitals in Nigeria, Kenya and South Africa, to identify barriers and enablers to current PPH detection and management and future implementation of a new PPH care bundle. Data were analysed using thematic and framework analysis. The Behaviour Change Wheel was used to identify potential interventions to address identified barriers and enablers.Results: Influences on current PPH detection and management fell under 12 domains: Environmental Context and Resources (drug and staff shortages), Skills (limited in-service training), Knowledge (variable understanding of the recommended practice), Behaviour Regulation (limited quality improvement culture), Beliefs about Consequences (drawbacks from inaccurate detection), Emotion (stress from the unpredictability of PPH), Social Influence (teamwork), Memory, Attention and Decision-making (limited guideline use), Social/Professional Role and Identity (role clarity), Beliefs about Capabilities (confidence in managing PPH), Reinforcement (disciplinary procedures) and Goals (PPH as a priority). Influences on bundle uptake included: Beliefs about Consequences (perceived benefits of new blood loss measurement tool), Environmental Context and Resources (high cost of drugs and new tools), Memory, Attention and Decision-making (concerns about whether bundle fits current practice), Knowledge (not understanding ´bundled´ approach), Social Influence (acceptance by women and staff) and Intention (limited acceptance of ´bundled´ approach over existing practice). These influences were consistent across countries. Proposed interventions included: Education, Training, Modelling (core and new skills), Enablement (monitoring uptake), Persuasion (leadership role) and Environmental Restructuring (PPH emergency trolley/kit).Conclusions: A wide range of individual, socio-cultural and environmental barriers and enablers to improving PPH detection and management exist in these settings. We identified a range of interventions that could improve PPH care and the implementation of new care bundles in this context.
Fil: Forbes, Gillian. University College London; Estados Unidos
Fil: Akter, Shahinoor. University of Melbourne; Australia
Fil: Miller, Suellen. University of California; Estados Unidos
Fil: Galadanci, Hadiza. Bayero University Kano; Nigeria
Fil: Qureshi, Zahida. University of Nairobi; Kenia
Fil: Fawcus, Sue. University of Cape Town; Sudáfrica
Fil: Hofmeyr, G. Justus. University of Botswana; Botsuana
Fil: Moran, Neil. University of KwaZulu-Natal; Sudáfrica
Fil: Singata Madliki, Mandisa. Universities of Witwatersrand and Fort Hare; Sudáfrica
Fil: Dankishiya, Faisal. Bayero University Kano; Nigeria
Fil: Gwako, George. University of Nairobi; Kenia
Fil: Osoti, Alfred. University of Nairobi; Kenia
Fil: Thomas, Eleanor. University Of Birmingham;
Fil: Gallos, Ioannis. University Of Birmingham;
Fil: Mammoliti, Kristie Marie. University Of Birmingham;
Fil: Devall, Adam. University Of Birmingham;
Fil: Coomarasamy, Arri. University Of Birmingham;
Fil: Althabe, Fernando. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones en Epidemiología y Salud Pública. Instituto de Efectividad Clínica y Sanitaria. Centro de Investigaciones en Epidemiología y Salud Pública; Argentina
Fil: Atkins, Lou. University College London; Estados Unidos
Fil: Bohren, Meghan A.. University of Melbourne; Australia
Fil: Lorencatto, Fabiana. University College London; Estados Unidos