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Can changes to improve person-centred maternity care be spread across public health facilities in Uttar Pradesh, India?

Authors
  • Sudhinaraset, May1
  • Giessler, Katie2
  • Nakphong, Michelle Kao3
  • Roy, Kali Prosad4
  • Sahu, Ananta Basudev5
  • Sharma, Kovid6
  • Montagu, Dominic7
  • Green, Cathy8
  • Villa Healthcare, Mark Berger
Type
Published Article
Journal
Sexual and reproductive health matters
Publication Date
Dec 01, 2021
Volume
29
Issue
1
Pages
1–15
Identifiers
DOI: 10.1080/26410397.2021.1892570
PMID: 33704027
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

Poor quality person-centred maternity care (PCMC) leads to delays in care and adverse maternal and newborn outcomes. This study describes the impact of spreading a Change Package, or interventions that other health facilities had previously piloted and identified as successful, to improve PCMC in public health facilities in Uttar Pradesh, India. A quasi-experimental design was used including matched control-intervention facilities and pre-post data collection. This study took place in Uttar Pradesh, India in 2018-2019. Six large public health facilities participated in the evaluation of the spread study, including three intervention and three control facilities. Intervention facilities were introduced to a quality improvement (QI) Change Package to improve PCMC. In total, 1200 women participated in the study, including 600 women at baseline and 600 women at endline. Difference-in-difference estimators are used to examine the impact of spreading a QI Change Package across spread sites vs. control sites and at baseline and endline using a validated PCMC scale. Out of a 100-point scale, a 24.93 point improvement was observed in overall PCMC scores among spread facilities compared to control facilities from baseline to endline (95% CI: 22.29, 27.56). For the eight PCMC indicators that the Change Package targeted, spread facilities increased 33.86 points (95% CI: 30.91, 36.81) relative to control facilities across survey rounds. Findings suggest that spread of a PCMC Change Package results in improved experiences of care for women as well as secondary outcomes, including clinical quality, nurse and doctor visits, and decreases in delivery problems.Trial registration: ClinicalTrials.gov identifier: NCT04208841..

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