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
The Uttar Pradesh COVID-19 Unified Data Platform was developed and implemented as the state’s digital response to the pandemic. This comprehensive platform brought together all the public and private stakeholders engaged in the state’s COVID-19 health response, thus ensuring that the State has a single point of truth with respect to the pandemic management.
India’s National Health Mission has trained community health workers called Accredited Social Health Activists (ASHAs) to visit and counsel women before and after birth. This study aimed to examine whether ASHAs’ third trimester home visits may have contributed to equitable improvements in institutional delivery and reductions in perinatal mortality rates between women with varying education levels in Uttar Pradesh, India.
The ninth issue of PAHAL provides glimpse of major activities carried out in the first quarter of 2021. Some of these activities include rolling out integrated counselling for RMNCHA and AFHC counsellors, activation of blood storage units, accreditation of new medical colleges for LSAS and EmOC courses, and social mapping of ASHA and Anganwadi workers’ area-alignment for enhanced community service delivery, among others.