| Title:
|
To call or not to call: exploring the validity of telephone interviews to derive maternal self-reports of experiences with facility childbirth care in northern Nigeria |
| Abstract:
|
BACKGROUND: To institutionalise respectful maternity care frequent data on the experience of childbirth care is needed by health facility staff and managers. Telephone interviews have been proposed as a low-cost alternative to derive timely and actionable maternal self-reports of experience of care. However evidence on the validity of telephone interviews for this purpose is limited. METHODS: Eight indicators of positive maternity care experience and 18 indicators of negative maternity care experience were investigated. We compared the responses from exit interviews with women about their childbirth care experience (reference standard) to follow-up telephone interviews with the same women 14 months after childbirth. We calculated individual-level validity metrics including agreement sensitivity specificity area under the receiver operating characteristic curve (AUC). We compared the characteristics of women included in the telephone follow-up interviews to those from the exit interviews. RESULTS: Demographic characteristics were similar between the original exit interview group (n=388) and those subsequently reached for telephone interview (n=294). Seven of the eight positive maternity care experience indicators had reported prevalence higher than 50% at both exit and telephone interviews. For these indicators agreement between the exit and the telephone interviews ranged between 50% and 92%; seven positive indicators met the criteria for validation analysis but all had an AUC below 0.6. Reported prevalence for 15 of the 18 negative maternity care experience indicators was lower than 5% at exit and telephone interviews. For these 15 indicators agreement between exit and telephone interview was high at over 80%. Just three negative indicators met the criteria for validation analysis and all had an AUC below 0.6. CONCLUSIONS: The telephone interviews conducted 14 months after childbirth did not yield results that were consistent with exit interviews conducted at the time of facility discharge. Womens reports of experience of childbirth care may be influenced by the location of reporting or changes in the recall of experiences of care over time. |
| Published:
|
2022-03-16 |
| Journal:
|
BMJ Glob Health |
| DOI:
|
10.1136/bmjgh-2021-008017 |
| DOI_URL:
|
http://doi.org/10.1136/bmjgh-2021-008017 |
| Author Name:
|
Umar Nasir |
| Author link:
|
https://covid19-data.nist.gov/pid/rest/local/author/umar_nasir |
| Author Name:
|
Schellenberg Joanna |
| Author link:
|
https://covid19-data.nist.gov/pid/rest/local/author/schellenberg_joanna |
| Author Name:
|
Hill Zelee |
| Author link:
|
https://covid19-data.nist.gov/pid/rest/local/author/hill_zelee |
| Author Name:
|
Bhattacharya Antoinette Alas |
| Author link:
|
https://covid19-data.nist.gov/pid/rest/local/author/bhattacharya_antoinette_alas |
| Author Name:
|
Muzigaba Moise |
| Author link:
|
https://covid19-data.nist.gov/pid/rest/local/author/muzigaba_moise |
| Author Name:
|
Tunalp zge |
| Author link:
|
https://covid19-data.nist.gov/pid/rest/local/author/tunalp_zge |
| Author Name:
|
Sambo Nuraddeen Umar |
| Author link:
|
https://covid19-data.nist.gov/pid/rest/local/author/sambo_nuraddeen_umar |
| Author Name:
|
Shuaibu Abdulrahman |
| Author link:
|
https://covid19-data.nist.gov/pid/rest/local/author/shuaibu_abdulrahman |
| Author Name:
|
Marchant Tanya |
| Author link:
|
https://covid19-data.nist.gov/pid/rest/local/author/marchant_tanya |
| sha:
|
55fce82d502d242362d21dac1e5596e8403b3e43 |
| license:
|
cc-by |
| license_url:
|
https://creativecommons.org/licenses/by/4.0/ |
| source_x:
|
Medline; PMC |
| source_x_url:
|
https://www.medline.com/https://www.ncbi.nlm.nih.gov/pubmed/ |
| pubmed_id:
|
35296464 |
| pubmed_id_url:
|
https://www.ncbi.nlm.nih.gov/pubmed/35296464 |
| pmcid:
|
PMC8928249 |
| pmcid_url:
|
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8928249 |
| url:
|
https://www.ncbi.nlm.nih.gov/pubmed/35296464/
https://doi.org/10.1136/bmjgh-2021-008017 |
| has_full_text:
|
TRUE |
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| Extracted Text Content in Record:
|
First 5000 Characters:Background To institutionalise respectful maternity care, frequent data on the experience of childbirth care is needed by health facility staff and managers. Telephone interviews have been proposed as a low-cost alternative to derive timely and actionable maternal self-reports of experience of care. However, evidence on the validity of telephone interviews for this purpose is limited. Methods Eight indicators of positive maternity care experience and 18 indicators of negative maternity care experience were investigated. We compared the responses from exit interviews with women about their childbirth care experience (reference standard) to followup telephone interviews with the same women 14 months after childbirth. We calculated individual-level validity metrics including, agreement, sensitivity, specificity, area under the receiver operating characteristic curve (AUC). We compared the characteristics of women included in the telephone follow-up interviews to those from the exit interviews. Results Demographic characteristics were similar between the original exit interview group (n=388) and those subsequently reached for telephone interview (n=294). Seven of the eight positive maternity care experience indicators had reported prevalence higher than 50% at both exit and telephone interviews. For these indicators, agreement between the exit and the telephone interviews ranged between 50% and 92%; seven positive indicators met the criteria for validation analysis, but all had an AUC below 0.6. Reported prevalence for 15 of the 18 negative maternity care experience indicators was lower than 5% at exit and telephone interviews. For these 15 indicators, agreement between exit and telephone interview was high at over 80%. Just three negative indicators met the criteria for validation analysis, and all had an AUC below 0.6. Conclusions The telephone interviews conducted 14 months after childbirth did not yield results that were consistent with exit interviews conducted at the time of facility discharge. Women's reports of experience of childbirth care may be influenced by the location of reporting or changes in the recall of experiences of care over time.
This study complements the ongoing global response towards eliminating mistreatment during facility-based childbirth and the institutionalisation of respectful maternity care. 1 2 The global commitment to improve positive experience during labour and childbirth has resulted in a renewed impetus to typify positive and negative experiences during facilitybased childbirth, and develop tools to capture
What is already known? ► Frequent data are needed to promote positive childbirth experience in health facilities, but conventional data collection methods, including face-to-face household surveys or exit interviews, are resource intensive limiting their routine use in low-income and middle-income countries.
What are the new findings?
► We explored the validity of telephone interviews to derive estimates of respectful maternity care and observed similar demographic characteristics between the women interviewed at the time of facility discharge and those reached by telephone interview. ► However, women's answers given at exit interview and subsequent telephone interview 14 months after childbirth about positive and negative maternity care experiences diverged.
What do the new findings imply? ► Our findings suggest that telephone interviews can be used to reach women who access facility-based childbirth care. ► Measures of women's experience of facility-based childbirth care may change over time, by location, or by data collection method and more studies are needed to explore this further.
and evaluate women's experiences following facilitybased maternity care. [3] [4] [5] [6] [7] [8] [9] [10] [11] In low-income and middle-income countries (LMIC) such as Nigeria, quantitative data on the reported experience of care are mostly sourced through face-to-face community surveys or exit surveys. [12] [13] [14] These methods are resource intensive and are typically applied in research settings, mostly as standalone and cross-sectional studies, and do not apply harmonised measurement tools. 12 15 To have valid, timely and actionable data on the experience of childbirth care, novel methodologies need to be explored.
The proliferation of mobile phone ownership in LMIC presents an opportunity to transform the current methods of data collection via telephone interviews. 15 16 Mobile phones are the fastest adopted technologies in recent times, and ownership cuts across all socioeconomic levels. 15 17 Mobile phone spread per unique user, a good proxy for mobile phone ownership, is moderate to high in LMIC: 87% in Kenya, 84% in South Africa, 74% in Ghana and 64% in Nigeria. 17 Compared with face-to-face survey methods, using telephone interviews to collect data from communities could considerably increase the timeliness and reach of data while also reducing cost and logistical challenge |
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| Extracted PMC Text Content in Record:
|
First 5000 Characters:This study complements the ongoing global response towards eliminating mistreatment during facility-based childbirth and the institutionalisation of respectful maternity care.1 2 The global commitment to improve positive experience during labour and childbirth has resulted in a renewed impetus to typify positive and negative experiences during facility-based childbirth, and develop tools to capture and evaluate women's experiences following facility-based maternity care.3–11
In low-income and middle-income countries (LMIC) such as Nigeria, quantitative data on the reported experience of care are mostly sourced through face-to-face community surveys or exit surveys.12–14 These methods are resource intensive and are typically applied in research settings, mostly as standalone and cross-sectional studies, and do not apply harmonised measurement tools.12 15 To have valid, timely and actionable data on the experience of childbirth care, novel methodologies need to be explored.
The proliferation of mobile phone ownership in LMIC presents an opportunity to transform the current methods of data collection via telephone interviews.15 16 Mobile phones are the fastest adopted technologies in recent times, and ownership cuts across all socioeconomic levels.15 17 Mobile phone spread per unique user, a good proxy for mobile phone ownership, is moderate to high in LMIC: 87% in Kenya, 84% in South Africa, 74% in Ghana and 64% in Nigeria.17
Compared with face-to-face survey methods, using telephone interviews to collect data from communities could considerably increase the timeliness and reach of data while also reducing cost and logistical challenges.15 16 18 But they may also introduce selection bias (if phone interviews under-represent people of lower education or economic status) and social desirability bias (if respondents prefer not to answer sensitive questions over the phone).19 20 Other possible issues might be reduced credibility of telephone interviewers and respondents being more easily distracted when answering questions over the phone.
There is currently a dearth of evidence on the validity of telephone interviews to derive estimates of respectful maternity care. This study reports the validity of experience of care responses derived from telephone interviews with women who had a childbirth in health facilities in northern Nigeria, when compared with their responses during facility exit interviews.
Gombe State, the study setting, is one of the 36 states of the Federal Republic of Nigeria, located in the country's North-East region. Gombe State has an estimated population of 2.6 million, based on population projections from the 2006 national census. About 75% of the state is rural, with a high fertility rate of 7.0 live births per 1000 females aged 15–49. Service utilisation for maternal and newborn health services is low: for example, only 44% of pregnant women sought 4 or more antenatal care visits in 2019, only 28% had a facility-based childbirth and only 21% of the deliveries were conducted by a skilled birth assistant.21–23
We collected data on 26 experience of maternity care indicators focusing on 8 positive maternity care experiences and 18 negative maternity care experiences. The negative maternity care experience indicators were drawn from the typology of mistreatment, which included domains of physical abuse, verbal abuse, sexual abuse, stigma and discrimination, failure to meet professional standards of care, poor rapport and communication between women and providers, and health systems conditions and constraints.12 We referred to the literature on improving quality of maternal and newborn care in health facilities and the earlier literature assessing experience of childbirth care to identify the eight positive maternity care experience indicators (ie, practices that recognise women's preferences and needs).7 13 24–26 The research team agreed on the final list of indicators described in online supplemental table S1 through discussion and consensus.
The study was nested within a programme of work aimed at understanding the quality of maternal and newborn care in Gombe State, Nigeria.27 We collected exit interview data from mothers in 10 primary healthcare (PHC) facilities, in Gombe State, in August–September 2019. Mothers were eligible and invited for the exit interviews if they were discharged (usually within 24 hours of childbirth) with a live baby following facility-based childbirth and provided informed consent to participate in the study. The exit interviews were conducted in Hausa. The exit interview instrument covered demographic information of study participants, the content of care provided to the mother and the newborn, and experiences of facility-based childbirth care. Women were also asked about their access to mobile phones and, for those with access, permission to make a follow-up call in the future was solicited.
In October–November 2020, we conducted telephone interviews with the same |
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