Trust in Maternity Care: A Contextual Exploration of Meaning and Determinants in Peri-Urban Kenya
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Date
2015-06-26
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Johns Hopkins University
Abstract
Background: Trust in providers and health facilities is important to care-seeking and to health system quality and accountability. In Kenya, trust has been little-explored. ‘Trust’ is a multidimensional concept offering a distinctive lens on facility responsiveness during labor and delivery. This study explores the meaning and determinants of trust, and potential trust-building avenues, in the maternity setting.
Methods: A theoretically-driven qualitative approach was used to study trust from a range of local perspectives. Focus groups (n=8, N=70) with recently delivered women (RDW), pregnant women, and male partners and in-depth-interviews (n=33) with RDW, providers, management, and community health workers (CHWs), were conducted in and around a public sub-county-level hospital in peri-urban Central Kenya. Interviews were audio-recorded, transcribed, and translated. Textual analysis consisted of inductive and deductive coding of themes and memo writing.
Results: Chapter IV describes the meaning and types of trust in maternity care reported across all participants. Trust in the maternity setting is nested within understandings of institutional and societal trust and can be analyzed into relational types. Content areas of trust include confidence, communication, integrity, mutual respect, competence, fairness, confidentiality, and systems trust. Overlap of trust content areas across relationship types suggests a shared understanding of trust across hierarchical perspectives: women and communities (use care/least power), CHWs (facilitate accessing care/low-medium power), providers (deliver care/medium-high power), and management (affect care/high power). Chapters V and VI describe a multi-faceted determinants framework for trust in the maternity setting clustered around patient/individual, provider, health facility, community, accountability, and structural factors. Chapter VII shows that building trust in maternity care requires a multi-faceted effort by various actors. This chapter presents cross-perspective evidence that critical trust-building mechanisms center on users, provider-patient interactions, provider-management interactions, facility environments, community-facility relationships, and supportive socio-political commitments.
Conclusions: Trust is contextually relevant to maternity care in Kenya. This study’s findings about the multidimensionality of trust contribute to a growing body of global and regional trust research. In particular, the study highlights the multi-faceted clustering of trust determinants and recognizes the importance of perspective and socio-political context in understanding and building trust.
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Keywords
trust, maternal health, health systems, qualitative research, LMICs, Kenya