caring for providers to improve patient experience (cpipe) trial

Conditions: Stress, Psychological; Maternal Health; Healthcare Provider; Adverse Outcomes; Stress, Emotional; Mental Health Issue; Burnout; Burnout, Psychological; Discrimination, Social

Summary: the activities described in this proposal are aimed at addressing health care provider stress and unconscious bias to improve quality of maternal health care, particularly related to the person-centered dimensions of care-i.e. care that is respectful and responsive to women's needs, preferences, and values. the investigators focus on health provider stress and unconscious bias because they are key drivers of poor-quality care that are often not addressed in interventions designed to improve quality of maternal health care. the investigators plan to (1) test the effectiveness of an intervention that targets provider stress and bias to improve pcmc; (2) assess the cost-effectiveness of cpipe; (3) examine the mechanisms of impact of cpipe on pcmc; and (3) assess impact of the cpipe intervention on distal outcomes including maternal health seeking behavior and maternal and neonatal health.

poor person-centered maternal care (pcmc) contributes to high maternal mortality and morbidity, directly and indirectly, through lack of, delayed, inadequate, unnecessary, or harmful care. the proposed r01 will test the effectiveness of an intervention that targets provider stress and bias to improve pcmc. the investigators will accomplish this through 3 aims. aim 1: to assess the effectiveness of the cpipe intervention on pcmc in kenya and ghana. the investigators hypothesize that cpipe will improve pcmc for all women, and especially for low ses women. the primary outcome is pcmc measured with the pcmc scale through multiple cross-sectional surveys of mothers who gave birth in the preceding 12 weeks in study facilities at baseline (prior to intervention), midline (6 months post-baseline), and endline (12 months post-baseline) (n=2000 at each time point). a sub-aim 1 will assess the cost-effectiveness of cpipe. aim 2: to examine the mechanisms of impact of cpipe on pcmc. the investigators will assess the effect of cpipe on intermediate outcomes such as provider knowledge, self-efficacy, stress, burnout, and bias levels; and conduct mediation analysis to assess if changes in these outcomes account for the effect of cpipe on pcmc. aim 3: to assess impact of the cpipe intervention on distal outcomes including maternal health seeking behavior and maternal and neonatal health; and examine if changes in pcmc account for these effects.

Eligibility criteria:
women's survey eligibility criteria 1. women receiving care at the study facilities. 2. have given birth within the 12 weeks preceding the data collection. 3. capable and willing to provide informed consent. 4. age 15 or above, with individuals aged 15-17 meeting the criteria for emancipated minors as defined by kenyan or ghana law (pregnant or parenting, living apart from their parents or guardian; living separately with or without their parents or guardian's consent, regardless of duration; and, controlling their financial affairs regardless of the source of income). exclusion criteria 1. women who are too ill to participate or do not live within a feasible location if interviews are scheduled to be conducted in the community. 2. women who are younger than 15 years of age. provider's cohort eligibility criteria 1. healthcare providers working in maternal health units for at least 6 months at the time of data collection. 2. capable and willing to provide informed consent. 3. able and committed to attending the intervention training and follow up activities. 4. age 18 or above. exclusion criteria 1. healthcare providers planning to no longer be working at the facilities in the next six months, at the time of enrollment.

Keywords: quality of care kenya providers mental health burnout stress person-centered care discrimination prejudice unconscious bias