Staff perspectives of barriers to women accessing birthing services in Nepal: A qualitative study

Background: Nepal has made significant progress with regard to reducing the maternal mortality ratio but a major challenge remains the under-utilisation of skilled birth attendants who are predominantly facility based. Studies have explored women's views of the barriers to facility birth; however the voices of staff who offer services have not been studied in detail. This research explores the views of staff as to the key reasons why pregnant women do not give birth in a maternity-care facility. Methods: This mixed methods study comprised qualitative interviews and non-participant observation. The study was conducted in two small non-governmental hospitals, one semi-rural and one urban, in Kathmandu Valley. Twenty interviews were conducted with health care providers and other staff in these hospitals. The interviews were undertaken with the aid of a Nepali translator, with some interviews being held in English. Twenty-five hours of non-participant observation was conducted in both maternity hospitals . Both observation and interview data were analysed thematically. Ethical approval was granted by the Nepal Research Health Council and Bournemouth University's Ethics Committee. Results: Key themes that emerged from the analysis reflected barriers that women experience in accessing services at different conceptual levels and resembled the three phases of delay model by Thaddeus and Maine. This framework is used to present the barriers. First Phase Delays are: 1) lack of awareness that the facility/services exist; 2) women being too busy to attend; 3) poor services; 4) embarrassment; and 5) financial issues. Themes for the second Phase of Delay are: 1) birthing on the way; and 2) by-passing the facility in favour of one further away. The final Phase involved: 1) absence of an enabling environment; and 2) disrespectful care. Conclusion: This study highlights a multitude of barriers, not all of the same importance or occuring at the same time in the pregnancy journey. It is clear that staff are aware of many of the barriers for women in reaching the facility to give birth, and these fit with previous literature of women's views. However, staff had limited insight into barriers occuring within the facility itself and were more likely to suggest that this was a problem for other institutions and not theirs

Scenes, saliency maps and scanpaths

The aim of this chapter is to review some of the key research investigating how people look at pictures. In particular, my goal is to provide theoretical background for those that are new to the field, while also explaining some of the relevant methods and analyses. I begin by introducing eye movements in the context of natural scene perception. As in other complex tasks, eye movements provide a measure of attention and information processing over time, and they tell us about how the foveated visual system determines what to prioritise. I then describe some of the many measures which have been derived to summarize where people look in complex images. These include global measures, analyses based on regions of interest and comparisons based on heat maps. A particularly popular approach for trying to explain fixation locations is the saliency map approach, and the first half of the chapter is mostly devoted to this topic. A large number of papers and models are built on this approach, but it is also worth spending time on this topic because the methods involved have been used across a wide range of applications. The saliency map approach is based on the fact that the visual system has topographic maps of visual features, that contrast within these features seems to be represented and prioritized, and that a central representation can be used to control attention and eye movements. This approach, and the underlying principles, has led to an increase in the number of researchers using complex natural scenes as stimuli. It is therefore important that those new to the field are familiar with saliency maps, their usage, and their pitfalls. I describe the original implementation of this approach (Itti & Koch, 2000), which uses spatial filtering at different levels of coarseness and combines them in an attempt to identify the regions which stand out from their background. Evaluating this model requires comparing fixation locations to model predictions. Several different experimental and comparison methods have been used, but most recent research shows that bottom-up guidance is rather limited in terms of predicting real eye movements. The second part of the chapter is largely concerned with measuring eye movement scanpaths. Scanpaths are the sequential patterns of fixations and saccades made when looking at something for a period of time. They show regularities which may reflect top-down attention, and some have attempted to link these to memory and an individual’s mental model of what they are looking at. While not all researchers will be testing hypotheses about scanpaths, an understanding of the underlying methods and theory will be of benefit to all. I describe the theories behind analyzing eye movements in this way, and various methods which have been used to represent and compare them. These methods allow one to quantify the similarity between two viewing patterns, and this similarity is linked to both the image and the observer. The last part of the chapter describes some applications of eye movements in image viewing. The methods discussed can be applied to complex images, and therefore these experiments can tell us about perception in art and marketing, as well as about machine vision

The Creative Process in Science and Engineering

This chapter discusses the elements defining the creative thinking process within the scientific and engineering domains, in the light of the dynamic definition of creativity. Elements such as dynamism, time and space dependence, and the variables influencing the potential of the creative process in both realms are described. The contrast and co-existence of both creative achievement and inconclusiveness are presented, indicating that extensive exploration, multiple trials and errors, as well as difficulty or absence of recognition are constitutive elements of the creative process. These concepts are mapped onto the classic 4Ps framework, to achieve a broad view about the creative process in science and engineering, which are shown to be distinguishable but connected through an epistemological circle, with impact on both knowledge and practical endeavors