Attitudes and behaviours of maternal health care providers in interactions with clients: a systematic review.

J. Fisher,M. Chersich,S. Luchters,K. Durrant,P. Mannava

doi:10.1186/s12992-015-0117-9

Abstract

BackgroundHigh maternal mortality and morbidity persist, in large part due to inadequate access to timely and quality health care. Attitudes and behaviours of maternal health care providers (MHCPs) influence health care seeking and quality of care.MethodsFive electronic databases were searched for studies from January 1990 to December 2014. Included studies report on types or impacts of MHCP attitudes and behaviours towards their clients, or the factors influencing these attitudes and behaviours. Attitudes and behaviours mentioned in relation to HIV infection, and studies of health providers outside the formal health system, such as traditional birth attendants, were excluded.FindingsOf 967 titles and 412 abstracts screened, 125 full-text papers were reviewed and 81 included. Around two-thirds used qualitative methods and over half studied public-sector facilities. Most studies were in Africa (n = 55), followed by Asia and the Pacific (n = 17). Fifty-eight studies covered only negative attitudes or behaviours, with a minority describing positive provider behaviours, such as being caring, respectful, sympathetic and helpful. Negative attitudes and behaviours commonly entailed verbal abuse (n = 45), rudeness such as ignoring or ridiculing patients (n = 35), or neglect (n = 32). Studies also documented physical abuse towards women, absenteeism or unavailability of providers, corruption, lack of regard for privacy, poor communication, unwillingness to accommodate traditional practices, and authoritarian or frightening attitudes. These behaviours were influenced by provider workload, patients’ attitudes and behaviours, provider beliefs and prejudices, and feelings of superiority among MHCPs. Overall, negative attitudes and behaviours undermined health care seeking and affected patient well-being.ConclusionsThe review documented a broad range of negative MHCP attitudes and behaviours affecting patient well-being, satisfaction with care and care seeking. Reported negative patient interactions far outweigh positive ones. The nature of the factors which influence health worker attitudes and behaviours suggests that strengthening health systems, and workforce development, including in communication and counselling skills, are important. Greater attention is required to the attitudes and behaviours of MHCPs within efforts to improve maternal health, for the sake of both women and health care providers.Electronic supplementary materialThe online version of this article (doi:10.1186/s12992-015-0117-9) contains supplementary material, which is available to authorized users.

Highlights

Despite major advances in reducing maternal mortality worldwide, the pace of progress is too slow to achieve the maternal health target of Millennium Development Goal (MDG) 5 [1,2,3]
The review documented a broad range of negative maternal health care providers (MHCPs) attitudes and behaviours affecting patient well-being, satisfaction with care and care seeking
Greater attention is required to the attitudes and behaviours of MHCPs within efforts to improve maternal health, for the sake of both women and health care providers

Summary

Introduction

Despite major advances in reducing maternal mortality worldwide, the pace of progress is too slow to achieve the maternal health target of Millennium Development Goal (MDG) 5 [1,2,3]. Several factors hinder access to the health care services needed to avert maternal and newborn deaths and morbidity These include cultural norms, gender discrimination and lack of a right’s based approach which emphasizes human dignity and attention to the needs of women in planning and delivering health services, inadequate knowledge of signs and symptoms of illness and services available, cost of services, lack of transport options and poor quality of care. The latter, quality of care, has recently received greater attention as a key reason for maternal mortality and morbidity remaining high in several countries despite substantial increases in coverage of maternal health services [6]. Attitudes and behaviours of maternal health care providers (MHCPs) influence health care seeking and quality of care

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