Ensuring quality obstetric care in rural Ghana: Shared experiences of obstetric care providers

Purpose: To explore care provider lived experiences with obstetric care delivery in rural Ghana. Methods: This interpretative phenomenological study utilised a semi-structured interview guide to collect data on care provider lived experiences with obstetric care delivery. Participants comprised purposively sampled obstetric care providers in selected health care facilities in the Northern Region of Ghana. Data processing and presentation followed interpretative phenomenological analysis procedure. Results: Findings reveal four superordinate themes: being persuasive, striving to provide quality care, using evasive mechanisms and subtle preventive schemes. These specifically refer to the use of alternative care, soliciting partner involvement, voluntarily donating blood, stocking essential items and drugs, refusing care in some instances and performing unconsented interventions. Conclusion: In their quest to provide quality care, obstetric care providers in some of Ghana’s rural health facilities adopt a mix of altruistic, innovative, excessive and unethical approaches most of which are driven by systemic failures. A government-community collaboration and commitment to quality maternal health care delivery is essential to improving health outcomes of rural mothers

Factors influencing long-term medication non-adherence among diabetes and hypertensive patients in Ghana: A qualitative investigation.

Evidence remains limited on why diabetes and hypertensive patients admitted to long-term drug therapy miss doses or discontinue medication taking. We examined this phenomenon from the perspective of diabetes and hypertension patients at a Ghanaian teaching hospital.Between July and December 2015, we conducted a qualitative study targeting caregivers and their patients with chronic diabetes and hypertensive on re-admission at the Korle Bu Teaching Hospital due to non-adherence to prescribed medication. Participants were sampled purposefully and taking through in-depth interviews using an interview guide. Notes and audio recordings of interviews were transcribed, managed and coded for themes guided by the thematic network analysis recommended by Attride-Stirling.Non-adherence was the result of perceptions that the medications are not effective for managing the conditions. Patients with these perceptions rejected the medications and turned to herbal medicines and spiritual healing as therapeutic alternatives, because of their easy accessibility, perceived efficacy and affordability. Other factors identified to influence non-adherence included polypharmacy practice; tight work schedules; social norms; poor prescription instruction by health providers; and knowledge and experience of medication.Findings suggests the need for health providers to adopt therapeutic approaches that take into account patients' beliefs, values and norms in administering medications. Sensitisation of patients and caregivers during admission on the implication of non-adherence, as well as interventions that monitor and provide feedback mechanisms on patients' medication taking behaviour holds promise for maximising diabetes and hypertensive medication adherence

Strengthening quality of acute care through feedback from patients in Ghana

Quality of acute care has attracted attention in recent years with policy initiatives in Ghana. Such initiatives need to be complemented with patient feedback systems for strengthening quality. Therefore the goal of this study is to examine factors associated with quality of acute care and to propose a range of options for improving the existing model of healthcare delivery. Methods: Cross-sectional data were collected from 379 patients presenting to emergency centres in five public health facilities. A structured questionnaire developed based on the literature and expert advice by physicians and nurses was used to collect data. Principal component analysis (PCA) was used to extract the factors salient to patients’ perspective of quality of care. Logistic regression was then used to examine association between these factors and overall quality of acute care. Results: The majority of the patients (17.2%) presented with obstetrical related conditions, 15% with Road Traffic Accidents (RTAs), 11.3% with diarrhoea related problems and the least number (8.4%) with bronchial asthma. The average days of admission was high for patients with bronchial asthma (mean = 9), RTA (mean = 8) and burns (means = 7). The PCA produced four factors of quality (interpersonal care; prompt care; physical environment and privacy; drugs and equipment) all of which had a positive statistically significant association with overall quality of acute care after controlling for patient’s socio-demographic characteristics. Conclusion: Study findings provide important feedback not only for optimising clinical operations but also for improving in-hospital quality of acute care with short-term and long-term approaches

Characteristics of study participants.

<p>Characteristics of study participants.</p

CLD of the interaction effect of perceived medication efficacy, recourses to herbal medicine and spiritual healing on non-adherence to diabetes and hypertension medication.

<p>CLD of the interaction effect of perceived medication efficacy, recourses to herbal medicine and spiritual healing on non-adherence to diabetes and hypertension medication.</p

Codes and themes building process.

<p>Codes and themes building process.</p