Patient-provider relationship

The U.S. healthcare system faces significant cost management and efficiency challenges, with patient-provider matching emerging as a crucial factor in optimizing healthcare delivery and reducing unnecessary expenditures. In 2022, the spending on healthcare in the U.S. increased by 4.1%, amounting to $4.5 trillion. This expenditure represented 17.3% of the nation's Gross Domestic Product [1]. It is broadly acknowledged that up to 5% of the GDP is squandered by the U.S. healthcare system [2]. The United States allocates more funds to healthcare than any other nation, with expenditures nearing 18% of its Gross Domestic Product (GDP). Previous research has suggested that around 30% of healthcare expenditures are wasteful. Despite initiatives aimed at minimizing unnecessary treatments, enhancing the quality of care, and tackling overpayment issues, significant inefficiencies in U.S. healthcare spending are likely to persist [3]. The total yearly costs attributed to waste were estimated to be between $760 billion and $935 billion [4]. According to multiple studies, the estimated annual costs of waste in healthcare are broken down as follows: between $102.4 billion and $165.7 billion is attributed to failures in care delivery; failures in care coordination cost between $27.2 billion and $78.2 billion; and overtreatment or low-value care amounts to between $75.7 billion and $101.2 billion [3]. Historically, discrepancies between what patients need and what providers specialize in have often resulted in less-than-optimal health outcomes, higher healthcare expenses, and diminished satisfaction among patients. Given the high stakes of healthcare costs in the U.S., employing artificial intelligence to refine how patients are matched with providers stands to enhance efficiency and lower costs greatly. In the United States, where healthcare costs are a significant concern, leveraging A.I. to improve the patient-provider matching process can significantly contribute to cost reduction and efficiency improvements. Artificial Intelligence (A.I.) presents a transformative solution, potentially strengthening the patient-provider matching process, improving healthcare outcomes, and reducing costs. This paper explores the application of A.I. in patient-provider matching as a strategy for cost reduction, detailing the mechanisms through which A.I. can achieve these goals, the challenges to be overcome, and the implications for the U.S. healthcare system.

Background One of the factors affecting quality of care is that clients do not demand care practises during antenatal, intrapartum and postnatal care. This study aimed to identify care practices that can be demanded by the mother in the continuum of care from antenatal to postnatal. Methods The study respondents included 122 mothers, 31 health workers and 4 psychologists. The researchers conducted 9 Key Informant Interviews with service providers and psychologists, 8 Focus Group Discussions with 8 mothers per group, and 26 vignettes with mothers and service providers. Data was analysed using Interpretative Phenomenological Analysis (IPA) where themes were identified and categorised. Results During antenatal and postnatal care, mothers demanded all recommended services presented to them. Some services seen as demandable during labour and delivery included 4-hourly assessments of vital signs and blood pressure, emptying of the bladder, swabbing, delivery counselling, administration of...

Background: Experiences and perceptions of poor quality of care is a powerful determinant of utilisation of maternity services. With many reports of disrespect and abuse in healthcare facilities in low-resource settings, women's and healthcare providers' understanding and perception of disrespect and abuse are important in eliminating disrespect and abuse, but these are rarely explored together. Methods: This was a qualitative study assessing the continuum of maternity care (antenatal, intrapartum and postnatal care) at the Maternity Unit of Bwaila Hospital in Lilongwe, Malawi. Focus group discussions (FGDs) were conducted separately for mothers attending antenatal clinic and those attending postnatal clinic. For women who accessed intrapartum care services, in-depth interviews were used. Participants were recruited purposively. Key informant interviews were conducted with healthcare providers involved in the delivery of maternal and newborn health services. Topic guides were developed based on the seven domains of the Respectful Maternity Care (RMC) Charter. Data was transcribed verbatim, coded and analysed using the thematic framework approach. Results: A total of 8 focus group discussions and 9 in-depth interviews involving 64 women and 9 key informant interviews with health care providers were conducted. Important themes that emerged included: the importance of a valued patient-provider relationship as determined by a good attitude and method of communication, the need for more education of women regarding the stages of pregnancy and labour, what happens at each stage and which complications could occur, the importance of a woman's involvement in decision-making, the need to maintain confidentiality when required and the problem of insufficient human resources. Prompt and timely service was considered a priority. Neither women accessing maternity care nor trained healthcare providers providing this care were aware of the RMC Charter. Conclusions: This study has highlighted the most essential aspects of respectful maternity care from the viewpoint of both women accessing maternity care and healthcare providers. Although RMC components are in place, healthcare providers were not aware of them. There is the need to promote the RMC Charter among both women who seek care and healthcare providers.

Indigenous persons suffer from among the highest rates of chronic pain in the United States. Using a relationship-centered medical decision-making framework, this study sought to examine the influence of Indigenous racial concordance and patient ethnic salience on providers' assessment of pain. From May to October 2010, pre-identified healthcare providers working exclusively with Indigenous patients in the United States were randomly assigned an online clinical case vignette presenting an Indigenous patient reporting chronic lower back pain. A 2 × 2 analysis of variance, between-subjects design, was conducted with the predictor variables racial concordance and patient ethnic salience on the outcome measure of providers' ratings of patient's pain on a visual analogue scale. We found a significant interactional effect between racial concordance and patient ethnic salience on providers' pain assessment ratings. Indigenous providers tended to rate the patient with higher Indigenous ethnic salience more congruently with the self-reported pain ratings, perhaps due to perceived similarities and lowered unconscious bias. This is the first known study to examine racial concordance of the healthcare provider and ethnic salience of the patient in pain care. This study informs healthcare provider practice and consideration of patients' racial/cultural attributes and possible influence on assessment bias, which may be particularly relevant among Indigenous patients. More research is needed to identify specific interventions to improve cultural awareness and sensitivity for Indigenous persons who suffer from pain.

Background One of the factors affecting quality of care is that clients do not demand care practises during antenatal, intrapartum and postnatal care. This study aimed to identify care practices that can be demanded by the mother in the continuum of care from antenatal to postnatal. Methods The study respondents included 122 mothers, 31 health workers and 4 psychologists. The researchers conducted 9 Key Informant Interviews with service providers and psychologists, 8 Focus Group Discussions with 8 mothers per group, and 26 vignettes with mothers and service providers. Data was analysed using Interpretative Phenomenological Analysis (IPA) where themes were identified and categorised. Results During antenatal and postnatal care, mothers demanded all recommended services presented to them. Some services seen as demandable during labour and delivery included 4-hourly assessments of vital signs and blood pressure, emptying of the bladder, swabbing, delivery counselling, administration of oxytocin, post-delivery palpation, and vaginal examination. For the child mothers demanded head to toe assessment, assessment of vital signs, weighing, cord stamp and eye antiseptics, and vaccines. Women observed that they could demand birth registration even though it was not among the recommended services. Respondents proposed empowerment of mothers with cognitive, behavioural and interpersonal skills to demand services e.g., knowledge of service standards and health benefits in addition to improved self-confidence and assertiveness. In addition, efforts have to be made to address perceived or real health worker attitudes, mental health for the client and the service provider, service provider workload, and availability of supplies. Conclusion The study found that if a mother is informed in simple language about services that she is supposed to receive, she can demand numerous services in the continuum of care from antenatal to postnatal. However, demand cannot be a standalone solution for improving quality of care. What the mother can ask for is a step in the guidelines, but she cannot probe deeper to influence quality of the procedure. In addition, empowerment of mothers needs to be coupled with services and systems strengthening in support of health workers.

Background: Respectful maternity care is one of the facilitators of women's access to maternity healthcare services. However, it has been evidenced that maternal healthcare services are compromised during the pandemic of coronavirus disease 19 (COVID-19). Moreover, there was a dearth of evidence on healthcare provider's adherence to respectful maternity care guidelines through direct observation. Hence, this study intended to assess healthcare provider's adherence to respectful maternity care guidelines during COVID-19 in northwest Ethiopia. Methods: A multicenter observational cross-sectional study was conducted at hospitals in northwest Ethiopia from November 15th/2020 to March 10th/2021. A simple random sampling technique was employed to select 406 healthcare providers. Data were collected through face-to-face interviews and direct observation using a structured questionnaire and standardized checklist respectively. The data were entered into Epi Info 7.1.2 and exported to SPSS version 25 for analysis. A binary logistic regression model was fitted. Both bivariable and multivariable logistic regression analyses were undertaken. The level of significance was claimed based on the adjusted odds ratio (AOR) with a 95% confidence interval (CI) at a p-value of ≤0.05. Results: The proportion of healthcare providers adhering to respectful maternity care guidelines during COVID-19 was 63.8% (95% CI: 59.1, 68.4). Job satisfaction (AOR = 1.82; 95% CI: 1.04, 3.18), professional work experience of 3-5 years (AOR = 2.84; 95% CI: 1.74, 4.6) and ≥6 years (AOR = 2.21; 95% CI: 1.11, 4.38), and having education parallel to work (AOR = 0.33; 95% CI: 0.21, 0.51) have an independent statistical significant association with adherence to respectful maternity care guidelines. Conclusion: In this study, six out of ten healthcare providers had good adherence to respectful maternity care guidelines. Ensuring health worker's job satisfaction and providing education opportunities by the government would improve healthcare provider's adherence to respectful maternity care standards.

Author Contributions M. Aghvinian was responsible for the conceptualization, methodology, and formal analysis of the study, wrote the original draft, and oversaw all revisions. E. Morris, M. J. Savin, A. Summers, C. Crook, and J. Stiver all provided support with conceptualization, methodology, and writing of the original draft, as well as draft review and editing. J. Gonzalez and D. Byrd were responsible for supervision of data acquisition in addition to draft review and editing. M. Rivera Mindt contributed to the manuscript's conceptualization, methodology, funding acquisition, supervision, draft review, and editing. Disclosures The authors report no real or perceived vested interests related to this article that could be construed as a conflict of interest.

Title: "We are the ones who should make the decision" Knowledge and understanding of the rights-based approach to maternity care Authors: Yasmin Jolly (ybjolly@doctors.org.uk) Mamuda Aminu (Mamuda.Aminu@lstmed.ac.uk) Florence Mgawadere (Florence.Mgawadere@lstmed.ac.uk) Nynke van den Broek (Nynke.vandenBroek@lstmed.ac.uk) Version: 2 Date: 19 Nov 2018 Author’s response to reviews: 10th September 2018

Functional gastrointestinal disorders (FGIDs), the most common diagnoses in gastroenterology are recognized by morphological and physiological abnormalities that often occur in combination including motility disturbance, visceral hypersensitivity, altered mucosal and immune function, altered gut microbiota and altered central nervous system processing. Research on these gut-brain interaction disorders is based on using specific diagnostic criteria. The Rome Foundation has played a pivotal role in creating diagnostic criteria thus operationalizing the dissemination of new knowledge in the field of FGIDs. Rome IV is a compendium of the knowledge accumulated since Rome III was published 10 years ago. It improves upon Rome III by: 1) updating the basic and clinical literature, 2) offering new information on gut microenvironment, gut-brain interactions, pharmacogenomics, biopsychosocial, gender and cross cultural understandings of FGIDs, 3) reduces the use of imprecise and occassionally ...

Background One of the factors affecting quality of care is that clients do not demand care practises during antenatal, intrapartum and postnatal care. This study aimed to identify care practices that can be demanded by the mother in the continuum of care from antenatal to postnatal. Methods The study respondents included 122 mothers, 31 health workers and 4 psychologists. The researchers conducted 9 Key Informant Interviews with service providers and psychologists, 8 Focus Group Discussions with 8 mothers per group, and 26 vignettes with mothers and service providers. Data was analysed using Interpretative Phenomenological Analysis (IPA) where themes were identified and categorised. Results During antenatal and postnatal care, mothers demanded all recommended services presented to them. Some services seen as demandable during labour and delivery included 4-hourly assessments of vital signs and blood pressure, emptying of the bladder, swabbing, delivery counselling, administration of...

ObjectiveTo understand participant perceptions about insulin and identify key behaviors of healthcare professionals (HCPs) that motivated initially reluctant adults from seven countries (n=40) who had type 2 diabetes (T2D) to start insulin treatment.Research design and methodsTelephone interviews were conducted with a subset of participants from an international investigation of adults with T2D who were reluctant to start insulin (EMOTION). Questions related to: (a) participants’ thoughts about insulin before and after initiation; (b) reasons behind responses on the survey that were either ‘not helpful at all’ or ‘helped a lot’; (c) actions their HCP may have taken to help start insulin treatment; and (d) advice they would give to others in a similar situation of starting insulin. Responses were coded by two independent reviewers (kappa 0.992).ResultsStarting insulin treatment was perceived as a negative experience that would be painful and would lead down a ‘slippery slope’ to comp...

Background Woman-centred maternity care is respectful and responsive to women's needs, values, and preferences. Women's views and expectations regarding the quality of health services during pregnancy and childbirth vary across settings. Despite the need for context-relevant evidence, to our knowledge, no reviews focus on what women in sub-Saharan African Low and Low Middle-Income Countries (LLMICs) regard as quality intrapartum care that can inform quality guidelines in countries. Methods We undertook a qualitative meta-synthesis using a framework synthesis to identify the experiences and expectations of women in sub-Saharan African LLMICs with quality intrapartum care. Following a priori protocol, we searched eight databases for primary articles using keywords. We used Covidence to collate citations, remove duplicates, and screen articles using a priori set inclusion and exclusion criteria. Two authors independently screened first the title and abstracts, and the full texts of the papers. Using a data extraction excel sheet, we extracted first-order and second-order constructs relevant to review objectives. The WHO framework for a positive childbirth experience underpinned data analysis. Results Of the 7197 identified citations, 30 articles were included in this review. Women's needs during the intrapartum period resonate with what women want globally, however, priorities regarding the components of quality care for women and the urgency to intervene differed in this context given the socio-cultural norms and available resources. Women received sub-quality intrapartum care and global standards for woman-centred care were often compromised. They were mistreated verbally and physically. Women experienced poor communication with their care providers and non-consensual care and were rarely involved in decisions concerning their care. Women were denied the companion of choice due to cultural and structural factors. Conclusion To improve care seeking and satisfaction with health services, woman-centred care is necessary for a positive childbirth experience. Women must be meaningfully engaged in the design of health services, accountability frameworks, and evaluation of maternal services. Research is needed to set minimum indicators for woman-centred outcomes for low-resource settings along with actionable strategies to enhance the quality of maternity care based on women's needs and preferences.

Improving interpersonal continuity of care provider (PCP) over time-is often considered a goal of primary care. Continuity of care is frequently of longitudinal continuity, or the proportion of encounters with one practitioner, overlooking aspects of the patient provider relationship that are key to interpersonal continuity of care. Further, few studies explore patients' perspectives regarding which care experiences enhance or detract from the patient group interviews, a patient experience CAHP experiences at 10 primary care clinics influenced their perceptions of their relationship with their PCPs. Focus group interviews with 63 participants indicated that patients' experience perceptions of the patient-provider relationship. The relationship between patient experience and interpersonal continuity was empirically assessed using survey responses and medical records (n=645). W that their provider knows them as a person as a measure of interpersonal continuity. Logistic regression results indicated that being seen within 15 minutes, receiving visit reminders, effective provider communication, and sati positively influenced patient perceptions of the patient shaped their perceptions of the patient-provider relationship independent of their satisfaction with care. The mixed methods design adds depth to our understanding of patients' care experiences, and illustrates that these experiences are critical for understanding the patient-provider relationship. Future research on interpersonal continuity should take patient experiences into account.

Background: Experiences and perceptions of poor quality of care is a powerful determinant of utilisation of maternity services. With many reports of disrespect and abuse in healthcare facilities in low-resource settings, women's and healthcare providers' understanding and perception of disrespect and abuse are important in eliminating disrespect and abuse, but these are rarely explored together. Methods: This was a qualitative study assessing the continuum of maternity care (antenatal, intrapartum and postnatal care) at the Maternity Unit of Bwaila Hospital in Lilongwe, Malawi. Focus group discussions (FGDs) were conducted separately for mothers attending antenatal clinic and those attending postnatal clinic. For women who accessed intrapartum care services, in-depth interviews were used. Participants were recruited purposively. Key informant interviews were conducted with healthcare providers involved in the delivery of maternal and newborn health services. Topic guides were developed based on the seven domains of the Respectful Maternity Care (RMC) Charter. Data was transcribed verbatim, coded and analysed using the thematic framework approach. Results: A total of 8 focus group discussions and 9 in-depth interviews involving 64 women and 9 key informant interviews with health care providers were conducted. Important themes that emerged included: the importance of a valued patient-provider relationship as determined by a good attitude and method of communication, the need for more education of women regarding the stages of pregnancy and labour, what happens at each stage and which complications could occur, the importance of a woman's involvement in decision-making, the need to maintain confidentiality when required and the problem of insufficient human resources. Prompt and timely service was considered a priority. Neither women accessing maternity care nor trained healthcare providers providing this care were aware of the RMC Charter. Conclusions: This study has highlighted the most essential aspects of respectful maternity care from the viewpoint of both women accessing maternity care and healthcare providers. Although RMC components are in place, healthcare providers were not aware of them. There is the need to promote the RMC Charter among both women who seek care and healthcare providers.

Introduction: Respectful maternity care is the universal right of every childbearing woman, which promotes the practices that recognize women’s preferences and women’s and newborns’ needs. The objective of the study was to assess disrespect and abuse during facility-based childbirth in Pokhara. Methods: Postnatal mothers having vaginal institutional delivery were included in the study. Non-probability purposive sampling technique was done to select 231 samples. Face to face interview technique with structured interview schedule was used. Descriptive and inferential statistics were used for data analysis. Results: Most (88.3%) of the mothers were between the age of 20 and 34 years with the mean age of 25.39±4.799 years. More than half of them had spontaneous vaginal delivery with episiotomy and (87%) of mothers had no any complications during childbirth. The overall disrespect and abuse during facility-based childbirth was (70.1%) and only (29.9%) of the postnatal mothers received re...

RMC training workshops in the field of sexual and reproductive health, as well as skills updates in emergency obstetric and newborn care training. It provides experienced facilitators with the background information, materials, instructions, and tips necessary to effectively deliver a package of interventions to promote respectful care in the provision of reproductive, maternal, and newborn health services at both the facility and community levels. This Resource Package includes activities and materials that advance a specific agenda: to promote increased support, advocacy, and provision of high-quality, woman-centered maternity care. These changes are not likely to occur immediately after one workshop; they may be incremental. It takes a hands-on approach to empower service providers, communities, and policymakers with the knowledge and skills to tackle disrespect and abuse during childbirth.

Background: Preconception care has the potential to reduce maternal and child morbidities and mortalities. It is a window of opportunity to timely alter or eliminate risk factors for adverse pregnancy outcomes. However, despite strong evidence on the effectiveness of preconception care in safeguarding maternal and child health, its uptake remains low. Therefore, this study aimed to explore barriers to the uptake of preconception care. Methods: A descriptive qualitative study was conducted in Mana district, Jimma Zone, Oromia region, Southwest Ethiopia from March 02 to April 10, 2019. A purposive sampling approach was used, and 13 key informant interviews (6 in rural and 7 in urban areas) were held with women of different age groups, health extension workers, and health care providers of different professions. In addition, 4 focused group discussions with women of reproductive age groups (two with rural women only and two with urban women only) were conducted. The data were collected by trained experts using semi-structured guides. An inductive process of thematic analysis was employed and the data were coded, categorized, and thematized using Atlas ti version 7.0.71 software. Results: Four women of reproductive age groups, 1 older woman (grandmother), 2 health extension workers, and 6 health care providers of different professions were interviewed. In addition, a total of 38 women of reproductive age groups participated in the 4 focused group discussions: 20 in the two rural-focused group discussions and 18 in the two urban-focused group discussions. The findings indicated the presence of many barriers affecting the uptake of preconception care and organized into five themes: women-related barriers, husband-related barriers, community-related barriers, health-service-related barriers, and media-related barriers.

Background: The Nigerian health system as a whole has been plagued by problems associated with the quality of service, including but not limited to unfriendly staff attitudes to patients, inadequate skills, decaying infrastructures, and chronic shortages of essential drugs. Approximately two-thirds of all Nigerian women deliver outside of health facilities and without the presence of medically skilled attendants. The study was carried out to assess the awareness and knowledge of women regarding their rights during pregnancy and childbirth, and to explore the extent to which women's rights were respected during pregnancy and childbirth. Methods: This descriptive study was conducted among randomly selected 140 women at Mother and Child Hospital, Akure, Ondo state, Nigeria. Data was collected with a pretested questionnaire and was analysed using Statistical Packages for Social Sciences (SPSS) version 21. Results: Findings revealed that majority (76.9%) of the women had a fair knowledge of their rights in pregnancy and childbirth, with the source of knowledge majorly from their friends. Right to information, informed consent and refusal, even distribution of healthcare services, maintenance of attainable level of health regarding proper monitoring were fairly observed by the health care providers. Right of women against verbal and physical abuse, privacy, treatment with dignity and respect were least accorded to women. Conclusions: Respective Maternity Care remains a challenge that demands policy interventions in most public health facilities to enhance positive endorsement and utilisation of maternal and health care services.

Several recent studies have attempted to measure the prevalence of disrespect and abuse (D&A) of women during childbirth in health facilities. Variations in reported prevalence may be associated with differences in study instruments and data collection methods. This systematic review and comparative analysis of methods aims to aggregate and present lessons learned from published studies that quantified the prevalence of Disrespect and Abuse (D&A) during childbirth. We conducted a systematic review of the literature in accordance with PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analysis) guidelines. Five papers met criteria and were included for analysis. We developed an analytical framework depicting the basic elements of epidemiological methodology in prevalence studies and a table of common types of systematic error associated with each of them. We performed a head-to-head comparison of study methods for all five papers. Using these tools, an independent revie...

Several recent studies have attempted to measure the prevalence of disrespect and abuse (D&A) of women during childbirth in health facilities. Variations in reported prevalence may be associated with differences in study instruments and data collection methods. This systematic review and comparative analysis of methods aims to aggregate and present lessons learned from published studies that quantified the prevalence of Disrespect and Abuse (D&A) during childbirth. We conducted a systematic review of the literature in accordance with PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analysis) guidelines. Five papers met criteria and were included for analysis. We developed an analytical framework depicting the basic elements of epidemiological methodology in prevalence studies and a table of common types of systematic error associated with each of them. We performed a head-to-head comparison of study methods for all five papers. Using these tools, an independent revie...

RMC training workshops in the field of sexual and reproductive health, as well as skills updates in emergency obstetric and newborn care training. It provides experienced facilitators with the background information, materials, instructions, and tips necessary to effectively deliver a package of interventions to promote respectful care in the provision of reproductive, maternal, and newborn health services at both the facility and community levels. This Resource Package includes activities and materials that advance a specific agenda: to promote increased support, advocacy, and provision of high-quality, woman-centered maternity care. These changes are not likely to occur immediately after one workshop; they may be incremental. It takes a hands-on approach to empower service providers, communities, and policymakers with the knowledge and skills to tackle disrespect and abuse during childbirth.

RMC training workshops in the field of sexual and reproductive health, as well as skills updates in emergency obstetric and newborn care training. It provides experienced facilitators with the background information, materials, instructions, and tips necessary to effectively deliver a package of interventions to promote respectful care in the provision of reproductive, maternal, and newborn health services at both the facility and community levels. This Resource Package includes activities and materials that advance a specific agenda: to promote increased support, advocacy, and provision of high-quality, woman-centered maternity care. These changes are not likely to occur immediately after one workshop; they may be incremental. It takes a hands-on approach to empower service providers, communities, and policymakers with the knowledge and skills to tackle disrespect and abuse during childbirth.

families and friends generally, and it is only brought into the public domain when the outcomes are deleterious and traumatic for families. The problem for countries like Jamaica is that there is a lack of comprehensive documentation of D&A experienced by women in childbirth facilities, specifically its nature, forms, causes and prevalence. Abuya, et al. [1], Freedman [2] have found that as many as 19% to 28% of women will experienced disrespectful and/or abusive treatment from health providers in Healthcare facilities during childbirth in low and middle income nations. Prior to their findings a landscape analysis was conducted by Bowser & Hill in 2010 [3] grouped disrespect and abusive care into seven major categories which they stated tend to overlap and occur on a continuum from subtle disrespect and humiliation to overt violence. The categories are physical abuse, care that was given without consent, treating the woman with disrespect, not adhering to confidentiality, discrimination, detention in the facilities and abandonment of care [3]. Subsequent studies carried out in countries like Kenya, Peru, Zimbabwe, Ethiopia and the United States of America have used this typology as the basis to study D&A its form, causes, consequences and prevalence in the respective countries. Bohren, et al. [4] have also developed an evidenced based typology of mistreatment to include physical abuse, sexual abuse, verbal abuse, stigma and discrimination, failure to meet professional standard of care, poor rapport between

RMC training workshops in the field of sexual and reproductive health, as well as skills updates in emergency obstetric and newborn care training. It provides experienced facilitators with the background information, materials, instructions, and tips necessary to effectively deliver a package of interventions to promote respectful care in the provision of reproductive, maternal, and newborn health services at both the facility and community levels. This Resource Package includes activities and materials that advance a specific agenda: to promote increased support, advocacy, and provision of high-quality, woman-centered maternity care. These changes are not likely to occur immediately after one workshop; they may be incremental. It takes a hands-on approach to empower service providers, communities, and policymakers with the knowledge and skills to tackle disrespect and abuse during childbirth.

Background Improving quality of care including the clinical aspects and the experience of care has been advocated for improved coverage and better childbirth outcomes. Objective This study aimed to explore the quality of care relating to the prevalence and manifestations of mistreatment during institutional birth in Gombe State, northeast Nigeria, an area of low institutional delivery coverage. Methods The frequency of dimensions of mistreatment experienced by women delivering in 10 health facilities of Gombe State were quantitatively captured during exit interviews with 342 women in July–August 2017. Manifestations of mistreatment were qualitatively explored through in-depth interviews and focus groups with 63 women living in communities with high and low coverage of institutional deliveries. Results The quantitative data showed that at least one dimension of mistreatment was reported by 66% (95% confidence interval (CI) 45–82%) of women exiting a health facility after delivery. Mi...

Background:
Experiences and perceptions of poor quality of care is a powerful determinant of utilisation of maternity services. With many reports of disrespect and abuse in healthcare facilities in low-resource settings, women’s and healthcare providers’ understanding and perception of disrespect and abuse are important in eliminating disrespect and abuse, but these are rarely explored together.

Methods:
This was a qualitative study assessing the continuum of maternity care (antenatal, intrapartum and postnatal care) at the Maternity Unit of Bwaila Hospital in Lilongwe, Malawi.

Focus group discussions (FGDs) were conducted separately for mothers attending antenatal clinic and those attending postnatal clinic. For women who accessed intrapartum care services, in-depth interviews were used. Participants were recruited purposively. Key informant interviews were conducted with healthcare providers involved in the delivery of maternal and newborn health services.

Topic guides were developed based on the seven domains of the Respectful Maternity Care (RMC) Charter. Data was transcribed verbatim, coded and analysed using the thematic framework approach.

Results:
A total of 8 focus group discussions and 9 in-depth interviews involving 64 women and 9 key informant interviews with health care providers were conducted.

Important themes that emerged included: the importance of a valued patient-provider relationship as determined by a good attitude and method of communication, the need for more education of women regarding the stages of pregnancy and labour, what happens at each stage and which complications could occur, the importance of a woman’s involvement in decision-making, the need to maintain confidentiality when required and the problem of insufficient human resources. Prompt and timely service was considered a priority. Neither women accessing maternity care nor trained healthcare providers providing this care were aware of the RMC Charter.

Conclusions:
This study has highlighted the most essential aspects of respectful maternity care from the viewpoint of both women accessing maternity care and healthcare providers. Although RMC components are in place, healthcare providers were not aware of them. There is the need to promote the RMC Charter among both women who seek care and healthcare providers.

The physician-patient relationship is important to the successful delivery of health care. Health locus of control (HLOC) of the patient, the extent to which individuals attribute their health to
their own actions or to external agents, may affect the patient-provider relationship. This study examined the influences of HIV and HLOC on trust in physician among a population of predominantly minority women and their family members. Powerful others HLOC demonstrated a positive relationship with trust in physician and chance HLOC had a negative relationship with trust in physician. HIV moderated both of these relationships.