1.
Title of the project:
Exploring patient
reported experience measure in prenatal care of
tertiary teaching hospital.
2. Type of Study: Prospective
Study
3. Aims & objectives:
Aim
The
aim of this study is to assess how satisfied pregnant women are with the care
they receive at the hospital during prenatal visits.
Objectives
1.
To measure PREM of
prenatal care experience among tertiary
teaching care hospital.
2.
To identify areas of improvement
of PREM labels.
4.Justification for study (whether of national significance with
rationale):
PREMs
are crucial for evaluating the patient’s experiences and identifying areas for
healthcare improvement. Regular measurement of PREMs enables a comprehensive
assessment of care quality, optimizes disease management, and meets patient
needs. Prenatal care is a critical aspect of maternal and child health.
Researching patient experiences in this context can generate valuable insights
for academic institutions, healthcare professionals and researchers interested
in improving prenatal care practices. Through patient feedback, healthcare
providers can improve communication with pregnant individuals. Effective
communication can lead to better informed decisions and a more positive care
experience.
Also,
inviting patients to provide feedback through PREMs surveys can empower them to
take an active role in their care.
Overall,
exploring PREMs in prenatal care at a tertiary teaching hospital is a
multifaceted approach that benefits patients, healthcare providers, and the
healthcare system by improving care quality, patient satisfaction and the
overall healthcare experience.
5.
Departments
involved: Department of gynecology and obstetrics
6. Study period:
The study will commence immediately upon
receiving Institutional Ethics Committee (IEC) approval. The study is planned
to start from October 2023 and to be completed by 30th
April 2024, with the last date of data collection and analysis set as 30th
April 2024.
7. Sample size :
332
8.
Materials and methods:
A) Inclusion and exclusion criteria:
a)
Inclusion: I) Women
less than one year of postpartum.
II) Women who are
willing to participate.
b) Exclusion: I) Women not willing to
participate.
B) Biological
materials required (type - blood, tissue etc. and quantity): nil
C)
Statistical methods: Descriptive statistics and inferential statistics
D) Tools used: Data will be collected using a validated
questionnaire of person-centered maternity care (PCMC) which has open access.
9. Detailed description of procedure / processes:
A survey would be conducted using validated
questionnaire of PCMC from study validation person centered maternity care
scale in India which has open access.
Respondent
will be postpartum women aged 15 to 49 with less than one year of postpartum.
Eligible women will be identified. The survey will be conducted in English as
well as Kannada language.
All
participants will be provided with written informed consent after receiving
information about the research.
Each
questionnaire would reflect responses ranging from 0 to 3, 0 as the lowest
level to 3 as the highest level.
After the
data collection is done from the survey, the data would be analyzed using SPSS software.
The PCMC scale
is composed of 3 subscales: dignity and respect (6 items), communication and
autonomy (9 items), and supportive care (12 items). Responses ranged from 0
(“No, neverâ€) Yes, a few times – 1 Yes, most of the time – 2 to 3 (“Yes, all
the timeâ€) Negatively worded items were reverse coded, and responses were
totaled across all 27 items to obtain a total PCMC score from 0 to 81.
Higher
scores indicated better PCMC. In addition, total scores were calculated for
each subscale, ranging from 0 to 18 for dignity and respect, 0 to 27 for
communication and autonomy, and 0 to 36 for supportive care.
Furthermore, categorical variables were
created, classifying total PCMC and subscale scores as “low,†“medium,†or
“high,†with scores in the lower 25th i.e., 22.25 and upper 75th percentiles i.e.,
64.75 being defined as “low†and “high,†respectively.
Characteristics
of respondents would be presented using frequency and percentages.
Mean PCMC
scores and Standard deviation would be calculated and compared across various
independent variables such as sociodemographic characteristics of the
respondents e.g., age, education, marital status, insurance coverage, domicile
status(urban/rural), occupation status and time of start of antenatal care using
t-tests and analysis of variance (ANOVA).
We will use
Pearson correlation to test association of total PCMC score with overall
satisfaction from maternity care.
Interpret
the results, draw conclusions and report the findings: Summarize the
main findings, draw conclusions based on the analysis, and report the results
in a clear and concise manner. Analyze the findings and interpret the results. Discuss limitations and further considerations.
10. Outcome
measures:
To analyze experiences and overall satisfaction of post-partum
women in prenatal care of tertiary teaching hospital.
11. Potential risks and benefits
:
Potential risks: This
study is of minimal risk as it is survey based. Hence minimal discomfort could
be there in taking time to answer the questionnaire.
Benefits:
I. PREM are valuable tools
in knowing the patient experiences in improving service delivery.
II.
Helps hospital improve patient satisfaction by making use of inputs provided by
patients.
12. Eethical considerations
and methods to address issues:
Informed
consent of the participant will be taken, and participant is made aware of
participant information sheet which mentions all the details related to study
and frequently asked questions by the participants are all addressed in the
patient information sheet.
13. Budget (give
details) and proposed funding source: Nil
14. Review
of literature (within 1000 words):
Daniel C Ogbuabor,2019
this study focused on validating PCMC scale and investigating
post-partum women’s perceptions of PCMC in Enugu state, Nigeria. According to this
woman who married at different ages, employment status, participation in
decision making, place of delivery and pregnancy complications all influenced
the level of PCMC received. The study’s findings highlight the need for
improvements in PCMC within Enugu state and highlight key areas for
intervention.
Elizabeth K
Stierman,2023This study examines person-centered maternity care
in Ethiopia, emphasizing the importance of effective communication, respect,
and emotional support during childbirth. It employs a validated scale to assess
the quality of care experienced by postpartum women in six regions of Ethiopia. A
significant portion of women reported not being asked for permission before
medical procedures, and explanations for these procedures were lacking. This
highlights a crucial need for healthcare providers to enhance patient-provider
communication and involve women in decision-making during childbirth.
Socioeconomic
factors, such as wealth and education, were associated with higher
person-centered maternity care scores, underlining the role of social
determinants in shaping childbirth experiences.
Fen taw
Teshome,2022 This study conducted in South Wollo Zone public hospitals
in Ethiopia sheds light on the state of person-centered maternity care. It
emphasizes that globally, insufficient attention has been paid to addressing
abuse and disrespect in maternity care.
The
research findings reveal a concerning gap in person-centered maternity care,
with an overall score of only 64%. While the sub-scales for dignity and respect
fared better at 81.9%, communication and autonomy (56.4%) and supportive care
(61.6%) showed notable deficiencies. Qualitative insights from interviews
pointed to infrastructure and resource limitations within government hospitals,
which likely contributed to the suboptimal care experienced by mothers.
The study
underscores the urgent need for health sector improvements, particularly in
terms of enhancing communication between healthcare providers and clients and
creating a more supportive environment within healthcare facilities.
May Sudhinaraset,2021
This study provides insights into the impact of person-centered maternity care
on maternal and newborn health outcomes.
The
findings highlight the importance of person-centered maternity care in reducing
the risk of maternal complications, postpartum depression, and newborn
complications. Moreover, the study highlights that higher scores in the
supportive care subscale are particularly effective in decreasing the risk of
complications for both mothers and newborns.
Overall,
these results emphasize the potential for enhancing maternal and newborn health
outcomes through investments in improving the quality of care provided during
childbirth, with a specific focus on dignified and respectful treatment,
effective communication, and support for women’s autonomy.
Lyzette T
,2022 This mixed-methods prospective cohort study in the
Netherlands explores the experiences of women in completing and discussing
patient-reported outcome measures (PROM) and patient-reported experience
measures (PREM) related to pregnancy and childbirth. The study involved women
who received these questionnaires as part of routine perinatal care. The
findings indicate that more than half of the participants felt the need to
discuss the questionnaire outcomes with their healthcare providers. Overall,
women found the questionnaires acceptable and useful for symptom detection and
personalized care up to six months postpartum. The study highlights the
importance of tailoring care based on these outcomes and identifies
facilitators such as increased awareness of health status.
15. References:
1. Ogbuabor
DC, Nwankwor C. Perception of person-centred maternity care and its associated
factors among post-partum women: Evidence from a cross-sectional study in Enugu
State, Nigeria. Int J Public Health [Internet]. 2021;66. Available from: http://dx.doi.org/10.3389/ijph.2021.612894
2. Stierman EK, Zimmerman LA, Shiferaw S, Seme A,
Ahmed S, Creanga AA. Understanding variation in person-centered maternity care:
Results from a household survey of postpartum women in 6 regions of Ethiopia.
AJOG Glob Rep [Internet]. 2023;3(1):100140. Available from: http://dx.doi.org/10.1016/j.xagr.2022.100140
3. Dagnaw FT, Kehali KY, Agago TA, Hailemeskel HS.
Person-centered maternity care among mothers who gave birth in South Wollo Zone
public hospitals, Northeastern Ethiopia: A mixed-method study. Health Serv
Insights [Internet]. 2022; 15:117863292211279. Available from: http://dx.doi.org/10.1177/11786329221127946
4. Sudhinaraset M, Landrian A, Golub GM, Cotter SY,
Afulani PA. Person-centered maternity care and postnatal health: associations
with maternal and newborn health outcomes. AJOG Glob Rep [Internet].
2021;1(1):100005. Available from: http://dx.doi.org/10.1016/j.xagr.2021.100005
5. Laureij LT,
Depla AL, Kariman SS, Lamain-de Ruiter M, Ernst -Smelt HE, Hazelzet JA, et al.
Women’s experiences with using patient-reported outcome and experience measures
in routine perinatal care in the Netherlands: a mixed-methods study. BMJ Open
[Internet]. 2023;13(3): e064452. Available from: http://dx.doi.org/10.1136/bmjopen-2022-064452
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