A qualitative study of women's network social support and facility delivery in rural Ghana

Similar to many sub-Saharan African countries, maternal mortality in Ghana ranks among the highest (39th) globally. Prior research has demonstrated the impact of social network characteristics on health facility delivery in sub-Saharan Africa. However, in-depth examination of the function of all members in a woman’s network, in providing various types of support for the woman’s pregnancy and related care, is limited. We qualitatively explore how women’s network social support influences facility delivery. Qualitative data came from a mixed methods evaluation of a Maternal and Newborn Health Referral project in Ghana. In 2015 we conducted in-depth interviews with mothers (n = 40) and husbands (n = 20), and 4 focus group interviews with mothers-in-law. Data were analyzed using narrative summaries and thematic coding procedures to first examine women’s network composition during their pregnancy and childbirth experiences. We then compared those who had homebirths versus facility births on how network social support influenced their place of childbirth. Various network members were involved in providing women with social support. We found differences in how informational and instrumental support impacted women’s place of childbirth. Network members of women who had facility delivery mobilized resources to support women’s facility delivery. Among women who had homebirth but their network members advocated for them to have facility delivery, members delayed making arrangements for the women’s facility delivery. Women who had homebirth, and their network members advocated homebirth, received support to give birth at home. Network support for women’s pregnancy-related care affects their place of childbirth. Hence, maternal health interventions must develop strategies to prioritize informational and instrumental support for facility-based pregnancy and delivery care

Creating Information Resources and Trainings for Farmworker-Serving Community Health Workers

BACKGROUND: Farmworker-serving community health workers have limited access to farmworker health research findings, training, and education resources. With funding from the National Library of Medicine, we are working to improve the health information literacy of both community health workers and farmworkers. We conducted focus group discussions with community health workers to explore their experiences providing health education and information to farmworkers, their information-seeking behaviors, and their technology and information needs. Data from the focus groups provided insights into the main areas in which community health workers would like to receive professional development. CASE PRESENTATION: Our team, which includes health sciences librarians, developed a resource list of educational materials for farmworker health, videos to increase community health workers' skills finding health information online, and webinars to introduce these resources to community health workers. Videos, available in Spanish and English, included instruction on finding and evaluating online health information, accessing reputable online consumer health information sources, and advanced searching tips for Google and PubMed. Through three webinars, we introduced the resource list, videos, and design software for creating handouts and infographics to community health workers. CONCLUSIONS: Community health workers have a critical role in providing health education and information to farmworkers, and our efforts represent a first step in addressing community health workers' limited access to professional development. Health sciences librarians are well positioned to partner with interdisciplinary teams working to reduce health disparities and provide resources and training to community health workers, farmworkers, and other underserved communities

Birth location preferences of mothers and fathers in rural Ghana: Implications for pregnancy, labor and birth outcomes

Abstract Background Maternal deaths in Sub-Saharan Africa are largely preventable with health facility delivery assisted by skilled birth attendants. Examining associations of birth location preferences on pregnant women’s experiences is important to understanding delays in care seeking in the event of complications. We explored the influence of birth location preference on women’s pregnancy, labor and birth outcomes. Methods A qualitative study conducted in rural Ghana consisted of birth narratives of mothers (n = 20) who experienced pregnancy/labor complications, and fathers (n = 18) whose partners experienced such complications in their last pregnancy. All but two women in our sample delivered in a health facility due to complications. We developed narrative summaries of each interview and iteratively coded the interviews. We then analyzed the data through coding summaries and developed analytic matrices from coded transcripts. Results Birth delivery location preferences were split for mothers (home delivery–9; facility delivery–11), and fathers (home delivery–7; facility delivery–11). We identified two patterns of preferences and birth outcomes: 1) preference for homebirth that resulted in delayed care seeking and was likely associated with several cases of stillbirths and postpartum morbidities; 2) Preference for health facility birth that resulted in early care seeking, and possibly enabled women to avoid adverse effects of birth complications. Conclusion Safe pregnancy and childbirth interventions should be tailored to the birth location preferences of mothers and fathers, and should include education on the development of birth preparedness plans to access timely delivery related care. Improving access to and the quality of care at health facilities will also be crucial to facilitating use of facility-based delivery care in rural Ghana

Structural and functional network characteristics and facility delivery among women in rural Ghana

Abstract Background Health facility births contribute to the prevention of maternal deaths. Although theoretical and empirical evidence suggest that social network characteristics influence facility delivery, examination of this relationship in sub-Saharan Africa is limited. We determined whether network structural and functional characteristics were associated with, or had an interactive effect on health facility delivery in rural Ghana. Methods Data on mothers (n = 783) aged 15–49 years came from a Maternal and Newborn Health Referral (MNHR) project in Ghana, and included egocentric network data on women’s social network characteristics. Using multivariate logistic regression we examined the relationship between facility delivery and women’s network structure and functions, as well as the interaction between network characteristics and facility delivery. Results Higher levels of instrumental support (e.g. help with daily chores or seeking health care [OR: 1.60, CI: 1.10–2.34]) and informational support (OR: 1.66, CI: 1.08–2.54) were significantly associated with higher odds of facility delivery. Social norms, such as knowing more women who had received pregnancy-related care in a facility, were significantly associated with higher odds of facility delivery (OR: 2.20, CI: 1.21–4.00). The number of network members that respondents lived nearby moderated the positive relationship between informational support and facility delivery. Additionally, informational support moderated the positive relationship between facility delivery and the number of women the respondents knew who had utilized a facility for pregnancy-related care. Conclusions Social support from network members was critical to facilitating health facility delivery, and support was further enhanced by women’s network structure and norms favoring facility delivery. Maternal health interventions to increase facility delivery uptake should target women’s social networks

Integrating community outreach into a quality improvement project to promote maternal and child health in Ghana

Quality improvement (QI) is used to promote and strengthen maternal and child health services in middle and low-income countries. Very little research has examined community-level factors beyond the confines of health facilities that create demand for health services and influence health outcomes. We examined the role of community outreach in the context of Project Fives Alive!, a QI project aimed at improving maternal and under-5 outcomes in Ghana. Qualitative case studies of QI teams across 6 regions of Ghana were conducted. We analyzed the data using narrative and thematic techniques. QI team members used two distinct outreach approaches: community-level outreach, including health promotion and education efforts through group activities and mass media communication; and direct outreach, including one-on-one interpersonal activities between health workers and pregnant women and/or mothers of children under-5. Specific barriers to community outreach included structural, cultural, and QI team-level factors. QI efforts in both rural and urban settings should consider including context-specific community outreach activities to develop ties with communities and address barriers to health services. Sustaining community outreach as part of QI efforts will require improving infrastructure, strengthening QI teams, and ongoing collaboration with community members

Increasing health facility childbirth in Ghana: the role of network and community norms

Abstract Background Reducing pregnancy-related deaths in Sub-Saharan Africa through increases in health facility births may be achieved by promoting community norms and network norms favoring health facility births. However, the process of how both norms shift attitudes and actions towards facility delivery is little studied. We examined the association of network and community norms with facility birth, following a quality improvement intervention to improve facility births in Ghana. Methods A 2015 mixed methods evaluation of a Maternal and Newborn Health Referral (MNHR) project in Ghana included a cross-sectional survey of women (N = 508), aged 15–49 years; in-depth interviews (IDIs) with mothers (n = 40), husbands (n = 20) and healthcare improvement collaborative leaders (n = 8); and focus group discussions (FGDs) with mothers-in-law (n = 4) and collaborative members (n = 7). Multivariable logistic regression was used to examine the association of network and community norms with facility birth. Thematic analysis of the qualitative data was conducted to explain this relationship. Results The network norm of perceived family approval of facility delivery (AOR: 5.54, CI: 1.65–18.57) and the community norm of perceived number of women in the community that deliver in a facility (AOR: 3.00, CI: 1.66–5.43) were independently associated with facility delivery. In qualitative IDIs and FGDs both norms were also collectively perceived as influencing facility delivery. However, network norms were more influential in women’s utilization of facility-based pregnancy-related care. Healthcare improvement collaboratives were important in swaying both network and community norms toward facility-based delivery by offering pregnancy-related health information, antenatal care, and support for facility delivery. Conclusion Quality improvement initiatives impact both community and network norms. To be most impactful in advancing facility-based pregnancy-related care, these initiatives should focus on highlighting the shifting trend toward facility delivery in rural communicates and promoting support for facility delivery among women’s personal networks