The complex challenge of providing patient-centred perinatal healthcare in rural Uganda: A qualitative enquiry

• Published in: Social science & medicine (1982) 2018-05, Vol.205, p.82-89
• Main Authors: Sarkar, Nandini D.P., Bunders-Aelen, Joske, Criel, Bart
• Format: Article
• Language: English
• Subjects: Employee attitude; Gender roles; Grounded theory; Health behavior; Health seeking behaviour; Health services; Health services utilization; Help seeking behavior; Life experiences; Local health systems; Low income groups; Medical personnel; Patient care planning; Patient communication; Patient-centered care; Patient-centred care; Patient-provider interactions; Patients; Perinatal care; Perinatal healthcare; Perinatal period; Practical norms; Public health; Qualitative research; Quality of care; Rural areas; Rural communities; Uganda; Well being; Women; Working women
• ISSN: 0277-9536; 1873-5347
• DOI: 10.1016/j.socscimed.2018.03.029

Increasing research and reflections on quality of healthcare across the perinatal period slowly propels the global community to lobby for improved standards of quality perinatal healthcare, especially in low- and middle-income countries. The purpose of this qualitative study was to obtain a deeper understanding of how interpersonal dimensions of the quality of care relate to real-life experiences of perinatal care, in a resource-constrained local health system. In total, 41 in-depth interviews and five focus group discussions (N = 34) were conducted with perinatal women and local health system health professionals living and working in rural Uganda. Data analysis used an emergent and partially inductive, thematic framework based on the grounded theory approach. The results indicated that interpersonal aspects of quality of perinatal care and service delivery are largely lacking in this low-resource setting. Thematic analysis showed three interrelated process aspects of quality of perinatal care: negative reported patient-provider interactions, the perceptions shaping patient-provider interactions, and emergent consequences arising out of these processes of care. Further reflections expose the central, yet often-unheeded, role of perinatal women's agency in their own health seeking behaviours and overall well-being, as well as that of underlying practical norms surrounding health worker attitudes and behaviours. These findings highlight the complexity of patient-centred perinatal healthcare provision in rural Uganda and point to the relevance of linking the interpersonal dimensions of quality of care to the larger systemic and structural dimensions of perinatal healthcare. •Interpersonal processes in perinatal care provision are complex acts of negotiation.•Perceived low quality of care can alter perinatal women's health-seeking behaviours.•Health worker practices are based on everyday practical norms.•Participatory mutual trust building and community engagement essential for progress.•Distributed leadership engagement has potential to effect change in rural Uganda.