Initiatives for enhancing utilisation of maternal healthcare services : a participatory action research

Abstract

Healthcare utilisation has a strong impact on maternal health. Any delay in accessing obstetric care may result in the death of a mother and the unborn child. The fundamental aim of this study was to develop and implement initiatives for enhancing utilisation of maternal healthcare services through a collaborative and participatory research process. The subjective voices of the maternal healthcare users, providers and community members were integrated in the study through iterative processes of action and reflection. From a critical theory perspective, the research challenged the operational, individual, socio-cultural and religious norms and values that inhibit utilisation of maternal healthcare services. Equipped with this new insight, the cooperative inquiry group (CIG) members addressed issues that were pertinent. Bob Mash’s cooperative inquiry, a participatory action research (PAR) design guided this three-cycle study. Cycle 1, the situational analysis explored maternal healthcare services utilisation in Mhondoro-Ngezi district. Quantitative and qualitative data were collected sequentially. Descrptive and inferential statistics and Tesch’s thematic analysis were used to analyse quantitative and qualitative data respectively. Findings revealed that women in Mhondoro-Ngezi district do not book their pregnancy before three months of gestation and some women only come to give birth to obtain birth records. Few women utilize postnatal care services at day 7 and six weeks, resulting in missed opportunities in full uptake of scheduled interventions. Furthermore, the study revealed disrespect and maltreatment of maternal healthcare users and failure to appreciate and integrate traditional and religious knowledge and practices. Data generated was used to develop a birth preparedness information booklet, a check-list to evaluate health personnel attitudes and create awareness for enhancing utilisation of maternal healthcare services in Cycle 2. Evaluation of the impact of the developed initiatives was undertaken in Cycle 3 using the same methods used in Cycle 1 to generate data. The major finding was that community participatory approach for disseminating maternal health information may be the most effective community-based health promotion programme. The study recommends adoption of the developed check-list and birth preparedness information booklet nationally and beyond, to strengthen health information dissemination.