Sowing the seeds of transformative practice to actualize women’s rights to respectful maternity care: reflections from Kenya using the consolidated framework for implementation research
Abstract Background Despite years of growing concern about poor provider attitudes and women experiencing mistreatment during facility based childbirth, there are limited interventions that specifically focus on addressing these issues. The Heshima project is an evidence-based participatory implemen...
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| Format: | Article |
| Language: | English |
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BMC
2017-08-01
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| Series: | BMC Women's Health |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12905-017-0425-8 |
| _version_ | 1819116465773608960 |
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| author | Charlotte E Warren Charity Ndwiga Pooja Sripad Melissa Medich Anne Njeru Alice Maranga George Odhiambo Timothy Abuya |
| author_facet | Charlotte E Warren Charity Ndwiga Pooja Sripad Melissa Medich Anne Njeru Alice Maranga George Odhiambo Timothy Abuya |
| author_sort | Charlotte E Warren |
| collection | DOAJ |
| description | Abstract Background Despite years of growing concern about poor provider attitudes and women experiencing mistreatment during facility based childbirth, there are limited interventions that specifically focus on addressing these issues. The Heshima project is an evidence-based participatory implementation research study conducted in 13 facilities in Kenya. It engaged a range of community, facility, and policy stakeholders to address the causes of mistreatment during childbirth and promote respectful maternity care. Methods We used the consolidated framework for implementation research (CFIR) as an analytical lens to describe a complex, multifaceted set of interventions through a reflexive and iterative process for triangulating qualitative data. Data from a broad range of project documents, reports, and interviews were collected at different time points during the implementation of Heshima. Assessment of in-depth interview data used NVivo (Version 10) and Atlas.ti software to inductively derive codes for themes at baseline, supplemental, and endline. Our purpose was to generate categories of themes for analysis found across the intervention design and implementation stages. Results The implementation process, intervention characteristics, individual champions, and inner and outer settings influenced both Heshima’s successes and challenges at policy, facility, and community levels. Implementation success stemmed from readiness for change at multiple levels, constant communication between stakeholders, and perceived importance to communities. The relative advantage and adequacy of implementation of the Respectful Maternity Care (RMC) resource package was meaningful within Kenyan politics and health policy, given the timing and national promise to improve the quality of maternity care. Conclusion We found the CFIR lens a promising and flexible one for understanding the complex interventions. Despite the relatively nascent stage of RMC implementation research, we feel this study is an important start to understanding a range of interventions that can begin to address issues of mistreatment in maternity care; replication of these activities is needed globally to better understand if the Heshima implementation process can be successful in different countries and regions. |
| first_indexed | 2024-12-22T05:17:31Z |
| format | Article |
| id | doaj.art-49119e756d454a5ebc5854dd41aa62d9 |
| institution | Directory Open Access Journal |
| issn | 1472-6874 |
| language | English |
| last_indexed | 2024-12-22T05:17:31Z |
| publishDate | 2017-08-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Women's Health |
| spelling | doaj.art-49119e756d454a5ebc5854dd41aa62d92022-12-21T18:37:48ZengBMCBMC Women's Health1472-68742017-08-0117111810.1186/s12905-017-0425-8Sowing the seeds of transformative practice to actualize women’s rights to respectful maternity care: reflections from Kenya using the consolidated framework for implementation researchCharlotte E Warren0Charity Ndwiga1Pooja Sripad2Melissa Medich3Anne Njeru4Alice Maranga5George Odhiambo6Timothy Abuya7Population CouncilPopulation CouncilPopulation CouncilDepartment of Family Medicine, UCLA David Geffen School of MedicineDivision of Reproductive Health, Ministry of HealthFederation of Women’s Lawyers, (FIDA) KenyaNational Nurses Association: Midwives Chapter of KenyaPopulation CouncilAbstract Background Despite years of growing concern about poor provider attitudes and women experiencing mistreatment during facility based childbirth, there are limited interventions that specifically focus on addressing these issues. The Heshima project is an evidence-based participatory implementation research study conducted in 13 facilities in Kenya. It engaged a range of community, facility, and policy stakeholders to address the causes of mistreatment during childbirth and promote respectful maternity care. Methods We used the consolidated framework for implementation research (CFIR) as an analytical lens to describe a complex, multifaceted set of interventions through a reflexive and iterative process for triangulating qualitative data. Data from a broad range of project documents, reports, and interviews were collected at different time points during the implementation of Heshima. Assessment of in-depth interview data used NVivo (Version 10) and Atlas.ti software to inductively derive codes for themes at baseline, supplemental, and endline. Our purpose was to generate categories of themes for analysis found across the intervention design and implementation stages. Results The implementation process, intervention characteristics, individual champions, and inner and outer settings influenced both Heshima’s successes and challenges at policy, facility, and community levels. Implementation success stemmed from readiness for change at multiple levels, constant communication between stakeholders, and perceived importance to communities. The relative advantage and adequacy of implementation of the Respectful Maternity Care (RMC) resource package was meaningful within Kenyan politics and health policy, given the timing and national promise to improve the quality of maternity care. Conclusion We found the CFIR lens a promising and flexible one for understanding the complex interventions. Despite the relatively nascent stage of RMC implementation research, we feel this study is an important start to understanding a range of interventions that can begin to address issues of mistreatment in maternity care; replication of these activities is needed globally to better understand if the Heshima implementation process can be successful in different countries and regions.http://link.springer.com/article/10.1186/s12905-017-0425-8MistreatmentRespectful maternity careImplementationDisrespect and abuse |
| spellingShingle | Charlotte E Warren Charity Ndwiga Pooja Sripad Melissa Medich Anne Njeru Alice Maranga George Odhiambo Timothy Abuya Sowing the seeds of transformative practice to actualize women’s rights to respectful maternity care: reflections from Kenya using the consolidated framework for implementation research BMC Women's Health Mistreatment Respectful maternity care Implementation Disrespect and abuse |
| title | Sowing the seeds of transformative practice to actualize women’s rights to respectful maternity care: reflections from Kenya using the consolidated framework for implementation research |
| title_full | Sowing the seeds of transformative practice to actualize women’s rights to respectful maternity care: reflections from Kenya using the consolidated framework for implementation research |
| title_fullStr | Sowing the seeds of transformative practice to actualize women’s rights to respectful maternity care: reflections from Kenya using the consolidated framework for implementation research |
| title_full_unstemmed | Sowing the seeds of transformative practice to actualize women’s rights to respectful maternity care: reflections from Kenya using the consolidated framework for implementation research |
| title_short | Sowing the seeds of transformative practice to actualize women’s rights to respectful maternity care: reflections from Kenya using the consolidated framework for implementation research |
| title_sort | sowing the seeds of transformative practice to actualize women s rights to respectful maternity care reflections from kenya using the consolidated framework for implementation research |
| topic | Mistreatment Respectful maternity care Implementation Disrespect and abuse |
| url | http://link.springer.com/article/10.1186/s12905-017-0425-8 |
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