Authors: Elisabeth Engl, Steve Kretschmer, Mokshada Jain, Saransh Sharma, Ram Prasad,B. M. Ramesh, Mrunal Shetye, Seema Tandon, Sanjiv Kumar, Tisa Barrios Wilson, Sema K. Sgaier
Inadequate quality of care in healthcare facilities is one of the primary causes of patient mortality in low- and middle-income countries, and understanding the behavior of healthcare providers is key to addressing it. Much of the existing research concentrates on improving resource-focused issues, such as staffing or training, but these interventions do not fully close the gaps in quality of care. By contrast, there is a lack of knowledge regarding the full contextual and internal drivers–such as social norms, beliefs, and emotions–that influence the clinical behaviors of healthcare providers.
We aimed to provide two conceptual frameworks to identify such drivers, and investigate them in a facility setting where inadequate quality of care is pronounced. Using immersion interviews and a novel decision-making game incorporating concepts from behavioral science, we systematically and qualitatively identified an extensive set of contextual and internal behavioral drivers in staff nurses working in reproductive, maternal, newborn, and child health (RMNCH) in government public health facilities in Uttar Pradesh, India.
We found that the nurses operate in an environment of stress, blame, and lack of control, which appears to influence their perception of their role as often significantly different from the RMNCH program’s perspective. That context influences their perceptions of risk for themselves and for their patients, as well as self-efficacy beliefs, which could lead to avoidance of responsibility, or incorrect care.
A limitation of the study is its use of only qualitative methods, which provide depth, rather than prevalence estimates of findings. This exploratory study identified previously under-researched contextual and internal drivers influencing the care-related behavior of staff nurses in public facilities in Uttar Pradesh.
We recommend four types of interventions to close the gap between actual and target behaviors: structural improvements, systemic changes, community-level shifts, and interventions within healthcare facilities.
Citation: Engl E, Kretschmer S, Jain M, Sharma S, Prasad R, Ramesh BM, et al. (2019) Categorizing and assessing comprehensive drivers of provider behavior for optimizing quality of health care. PLoS ONE 14(4): e0214922. https://doi.org/10.1371/journal.pone.0214922
This brief identifies the opportunity gaps in the effective coverage cascade for prevention of anaemia among pregnant women in India. The effective coverage cascade is used to identify coverage gaps, quantify coverage at each step, determine where the largest gaps exist within the cascade and prioritize where actions are most urgent. The findings are based on NFHS 5 data.
The fifteenth edition of PAHAL newsletter throws light on UP TSU’s support to GoUP in adopting a scientific approach for allocating Area of Responsibility (AoR) to ANMs working in sub-centres; also, geo-mapping of more than 1,80,000 Anganwadi Centres across the state by ICDS department with the support of UP TSU has been the highlight of the quarter.
The 14th issue of PAHAL offers insights on UP TSU’s work in the second quarter of 2022. This issue provides an update on the initiatives taken by UP TSU for enhancing the availability of Iron Folic Acid supplementation for pregnant women, accelerating PPH Emergency Care by Bundle Approach, the activation of district hospital level validation committee meetings and other key interventions.