Caring for providers to improve patient experience (CPIPE): intervention development process

ABSTRACT

A growing body of research has documented disrespectful, abusive, and neglectful treatment of women in facilities during childbirth, as well as the drivers of such mistreatment. Yet, little research exists on effective interventions to improve Person-Centred Maternal Care (PCMC)—care that is respectful and responsive to individual women's preferences, needs, and values. We sought to extend knowledge on interventions to improve PCMC, with a focus on two factors – provider stress and implicit bias – that are driving poor PCMC and contributing to disparities in PCMC. In this paper we describe the process towards the development of the intervention. The intervention design was an iterative process informed by existing literature, behaviour change theory, formative research, and continuous feedback in consultation with key stakeholders. The intervention strategies were informed by the Social Cognitive Theory, Trauma Informed System framework, and the Ecological Perspective. This process resulted in the ‘Caring for Providers to Improve Patient Experience (CPIPE)’ intervention, which has 5 components: provider training, peer support, mentorship, embedded champions, and leadership engagement. The training includes didactic and interactive content on PCMC, stress, burnout, dealing with difficult situations, and bias, with some content integrated into emergency obstetric and neonatal care (EmONC) simulations to enable providers apply concepts in the context of managing an emergency. The other components create an enabling environment for ongoing individual behavior and facility culture change. The pilot study is being implemented in Migori County, Kenya. The CPIPE intervention is an innovative theory and evidence-based intervention that addresses key drivers of poor PCMC and centers the unique needs of vulnerable women as well as that of providers. This intervention will advance the evidence base for interventions to improve PCMC and has great potential to improve equity in PCMC and maternal and neonatal health.

KEYWORDS:

• Person-centered maternity care
• stress
• implicit bias
• Kenya
• respectful maternity care

Responsible Editor

Julia Schröders

Responsible Editor

Julia Schröders

Acknowledgments

We thank the Migori county, sub-county, and health facility leadership, and all the providers who participated in the study. PA would also like to thank her K99 mentorship team (Craig Cohen, Sandra Weiss, Audrey Lyndon, Wendy Berry Mendes, Marleen Temmerman, Leah Kirumbi, Dilys Walker, and Ken Epstein), who provided guidance and support during various stages of the project.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Author contributions

PA: project lead, conceptualised study, study design, lit review, manuscript vision and theory of change, data analysis, writing. EO: project implementation, data collection, analysis, writing. BO: project implementation, data collection, analysis, review of manuscript. MG: project implementation, data analysis, reviewed and edited manuscript. JK: project implementation, reviewed and edited manuscript. IO: project implementation (CAB chair), reviewed manuscript. JO: project implementation (Deputy CAB chair), reviewed manuscript. LO: project co-lead, study design, project implementation, reviewed and edited manuscript. All authors approve the final manuscript and agree to be accountable for all aspects of the work.

Ethics and consent

The study was reviewed and approved by the University of California, San Francisco Institutional Review Board (IRB number 17–22783) and the Kenya Medical Research Institute Scientific and Ethics Review Unit (SERU 3682). The Kenya National Commission for Science, Technology & Innovation (NACOSTI) also approved the study to be conducted in Kenya and approval for the study within Migori was granted by the County Commissioner and the County Director of Health. All participants provided written informed consent prior to participation.

Paper context

Theory and evidence-based interventions that address key drivers of poor person-centred maternal care and centre the unique needs of vulnerable women and providers are lacking. We used an iterative process informed by existing literature, behaviour change theory, and formative research to develop an intervention that bridges this gap. Implementation and evaluation of this intervention will advance the evidence base for interventions to improve person-centred maternal care and achieve equity in maternal health.

Additional information

Funding

This study is funded by a Eunice Kennedy Shriver National Institute of Child Health and Human development K99/R00 grant to PA [K99HD093798/R00HD093798]. The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.