Self-reported provision of person-centred maternity care among providers in Kenya and Ghana: scale validation and examination of associated factors

Patience A Afulani, Raymond A Aborigo, Jerry John Nutor, Jaffer Okiring, Irene Kuwolamo, Beryl A Ogolla, Edwina N Oboke, John Baptist K Dorzie, Osamuedeme J Odiase, Jody Steinauer, Dilys Walker, Patience A Afulani, Raymond A Aborigo, Jerry John Nutor, Jaffer Okiring, Irene Kuwolamo, Beryl A Ogolla, Edwina N Oboke, John Baptist K Dorzie, Osamuedeme J Odiase, Jody Steinauer, Dilys Walker

Abstract

Introduction: Person-centred maternity care (PCMC), which refers to care that is respectful and responsive to women's preferences needs, and values, is core to high-quality maternal and child health. Provider-reported PCMC provision is a potentially valid means of assessing the extent of PCMC and contributing factors. Our objectives are to assess the psychometric properties of a provider-reported PCMC scale, and to examine levels and factors associated with PCMC provision.

Methods: We used data from two cross-sectional surveys with 236 maternity care providers from Ghana (n=150) and Kenya (n=86). Analysis included factor analysis to assess construct validity and Cronbach's alpha to assess internal consistency of the scale; descriptive analysis to assess extent of PCMC and bivariate and multivariable linear regression to examine factors associated with PCMC.

Findings: The 9-item provider-reported PCMC scale has high construct validity and reliability representing a unidimensional scale with a Cronbach's alpha of 0.72. The average standardised PCMC score for the combined sample was 66.8 (SD: 14.7). PCMC decreased with increasing report of stress and burnout. Compared with providers with no burnout, providers with burnout had lower average PCMC scores (β: -7.30, 95% CI:-11.19 to -3.40 for low burnout and β: -10.86, 95% CI: -17.21 to -4.51 for high burnout). Burnout accounted for over half of the effect of perceived stress on PCMC.

Conclusion: The provider PCMC scale is a valid and reliable measure of provider self-reported PCMC and highlights inadequate provision of PCMC in Kenya and Ghana. Provider burnout is a key driver of poor PCMC that needs to be addressed to improve PCMC.

Keywords: health services research; maternal health.

Conflict of interest statement

Competing interests: None declared.

© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Figures

Figure 1
Figure 1
Distribution of PCMC items. PCMC, person-centred maternity care.

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