Care Decision Making of Frontline Providers of Maternal and Newborn Health Services in the Greater Accra Region of Ghana

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Abstract

Objectives: To explore the "how" and "why" of care decision making by frontline providers of maternal and newborn services in the Greater Accra region of Ghana and determine appropriate interventions needed to support its quality and related maternal and neonatal outcomes. Methods: A cross sectional and descriptive mixed method study involving a desk review of maternal and newborn care protocols and guidelines availability, focus group discussions and administration of a structured questionnaire and observational checklist to frontline providers of maternal and newborn care. Results: Tacit knowledge or 'mind lines' was an important primary approach to care decision making. When available, protocols and guidelines were used as decision making aids, especially when they were simple handy tools and in situations where providers were not sure what their next step in management had to be. Expert opinion and peer consultation were also used through face to face discussions, phone calls, text messages, and occasional emails depending on the urgency and communication medium access. Health system constraints such as availability of staff, essential medicines, supplies and equipment; management issues (including leadership and interpersonal relations among staff), and barriers to referral were important influences in decision making. Frontline health providers welcomed the idea of interventions to support clinical decision making and made several proposals towards the development of such an intervention. They felt such an intervention ought to be multi-faceted to impact the multiple influences simultaneously. Effective interventions would also need to address immediate challenges as well as more long-term challenges influencing decision-making. Conclusion: Supporting frontline worker clinical decision making for maternal and newborn services is an important but neglected aspect of improved quality of care towards attainment of MDG 4 & 5. A multi-faceted intervention is probably the best way to make a difference given the multiple inter-related issues. © 2013 Oduro-Mensah et al.

Figures

  • Figure 1. Initial Conceptual framework. ‘‘How’’ and ‘‘Why’’ care decisions are made by frontline providers of maternal and newborn services doi:10.1371/journal.pone.0055610.g001
  • Figure 2. Final Conceptual framework based on data analysis. ‘‘How’’ and ‘‘Why’’ care decisions are made by frontline providers of maternal and newborn services. doi:10.1371/journal.pone.0055610.g002
  • Table 3. Responses to the use of Information Communication Technology as Aids to Clinical Decision Making.
  • Table 6. Summary of responses to the open ended question: ‘‘List three ways in which you believe you can best be assisted to make the right decisions at the point of service delivery when faced with an emergency and uncertain as to what to do’’.

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CITATION STYLE

APA

Oduro-Mensah, E., Kwamie, A., Antwi, E., Amissah Bamfo, S., Bainson, H. M., Marfo, B., … Agyepong, I. A. (2013). Care Decision Making of Frontline Providers of Maternal and Newborn Health Services in the Greater Accra Region of Ghana. PLoS ONE, 8(2). https://doi.org/10.1371/journal.pone.0055610

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