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Health care workers' perspectives of the influences of disrespectful maternity care in rural Kenya

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Abstract
While disrespectful treatment of pregnant women attending health care facilities occurs globally, it is more prevalent in low-resource countries. In Kenya, a large body of research studied disrespectful maternity care (DMC) from the perspective of the service users. This paper examines the perspective of health care workers (HCWs) on factors that influence DMC experienced by pregnant women at health care facilities in rural Kisii and Kilifi counties in Kenya. We conducted 24 in-depth interviews with health care workers (HCWs) in these two sites. Data were analyzed deductively and inductively using NVIVO 12. Findings from HCWs reflective narratives identified four areas connected to the delivery of disrespectful care, including poor infrastructure, understaffing, service users' sociocultural beliefs, and health care workers' attitudes toward marginalized women. Investments are needed to address health system influences on DMC, including poor health infrastructure and understaffing. Additionally, it is important to reduce cultural barriers through training on HCWs' interpersonal communication skills. Further, strategies are needed to affect positive behavior changes among HCWs directed at addressing the stigma and discrimination of pregnant women due to socioeconomic standing. To develop evidence-informed strategies to address DMC, a holistic understanding of the factors associated with pregnant women's poor experiences of facility-based maternity care is needed. This may best be achieved through an intersectional approach to address DMC by identifying systemic, cultural, and socioeconomic inequities, as well as the structural and policy features that contribute and determine peoples' behaviors and choices.
Keywords
disrespectful maternity care, respectful care, violence, maternity, obstetric, rural, Kenya, MIDDLE-INCOME COUNTRIES, WOMENS EXPERIENCE, CHILDBIRTH, INTERVENTIONS, DELIVERY, BARRIERS, ABUSE

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MLA
Lusambili, Adelaide, et al. “Health Care Workers’ Perspectives of the Influences of Disrespectful Maternity Care in Rural Kenya.” INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH, vol. 17, no. 21, 2020, doi:10.3390/ijerph17218218.
APA
Lusambili, A., Wisofschi, S., Shumba, C., Obure, J., Mulama, K., Nyaga, L., … Temmerman, M. (2020). Health care workers’ perspectives of the influences of disrespectful maternity care in rural Kenya. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH, 17(21). https://doi.org/10.3390/ijerph17218218
Chicago author-date
Lusambili, Adelaide, Stefania Wisofschi, Constance Shumba, Jerim Obure, Kennedy Mulama, Lucy Nyaga, Terrance J. Wade, and Marleen Temmerman. 2020. “Health Care Workers’ Perspectives of the Influences of Disrespectful Maternity Care in Rural Kenya.” INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 17 (21). https://doi.org/10.3390/ijerph17218218.
Chicago author-date (all authors)
Lusambili, Adelaide, Stefania Wisofschi, Constance Shumba, Jerim Obure, Kennedy Mulama, Lucy Nyaga, Terrance J. Wade, and Marleen Temmerman. 2020. “Health Care Workers’ Perspectives of the Influences of Disrespectful Maternity Care in Rural Kenya.” INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 17 (21). doi:10.3390/ijerph17218218.
Vancouver
1.
Lusambili A, Wisofschi S, Shumba C, Obure J, Mulama K, Nyaga L, et al. Health care workers’ perspectives of the influences of disrespectful maternity care in rural Kenya. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH. 2020;17(21).
IEEE
[1]
A. Lusambili et al., “Health care workers’ perspectives of the influences of disrespectful maternity care in rural Kenya,” INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH, vol. 17, no. 21, 2020.
@article{8695917,
  abstract     = {{While disrespectful treatment of pregnant women attending health care facilities occurs globally, it is more prevalent in low-resource countries. In Kenya, a large body of research studied disrespectful maternity care (DMC) from the perspective of the service users. This paper examines the perspective of health care workers (HCWs) on factors that influence DMC experienced by pregnant women at health care facilities in rural Kisii and Kilifi counties in Kenya. We conducted 24 in-depth interviews with health care workers (HCWs) in these two sites. Data were analyzed deductively and inductively using NVIVO 12. Findings from HCWs reflective narratives identified four areas connected to the delivery of disrespectful care, including poor infrastructure, understaffing, service users' sociocultural beliefs, and health care workers' attitudes toward marginalized women. Investments are needed to address health system influences on DMC, including poor health infrastructure and understaffing. Additionally, it is important to reduce cultural barriers through training on HCWs' interpersonal communication skills. Further, strategies are needed to affect positive behavior changes among HCWs directed at addressing the stigma and discrimination of pregnant women due to socioeconomic standing. To develop evidence-informed strategies to address DMC, a holistic understanding of the factors associated with pregnant women's poor experiences of facility-based maternity care is needed. This may best be achieved through an intersectional approach to address DMC by identifying systemic, cultural, and socioeconomic inequities, as well as the structural and policy features that contribute and determine peoples' behaviors and choices.}},
  articleno    = {{8218}},
  author       = {{Lusambili, Adelaide and Wisofschi, Stefania and Shumba, Constance and Obure, Jerim and Mulama, Kennedy and Nyaga, Lucy and Wade, Terrance J. and Temmerman, Marleen}},
  issn         = {{1660-4601}},
  journal      = {{INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH}},
  keywords     = {{disrespectful maternity care,respectful care,violence,maternity,obstetric,rural,Kenya,MIDDLE-INCOME COUNTRIES,WOMENS EXPERIENCE,CHILDBIRTH,INTERVENTIONS,DELIVERY,BARRIERS,ABUSE}},
  language     = {{eng}},
  number       = {{21}},
  pages        = {{18}},
  title        = {{Health care workers' perspectives of the influences of disrespectful maternity care in rural Kenya}},
  url          = {{http://doi.org/10.3390/ijerph17218218}},
  volume       = {{17}},
  year         = {{2020}},
}

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