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Exploring the sustainability of perinatal audit in four district hospitals in the Western Cape, South Africa: a multiple case study approach
INTRODUCTION: Maternal and perinatal death surveillance and response (MPDSR) is an intervention process that uses a continuous cycle of identification, notification and review of deaths to determine avoidable causes followed by actions to improve health services and prevent future deaths. This study...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BMJ Publishing Group
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9226866/ https://www.ncbi.nlm.nih.gov/pubmed/35738843 http://dx.doi.org/10.1136/bmjgh-2022-009242 |
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author | Kinney, Mary Bergh, Anne-Marie Rhoda, Natasha Pattinson, Robert George, Asha |
author_facet | Kinney, Mary Bergh, Anne-Marie Rhoda, Natasha Pattinson, Robert George, Asha |
author_sort | Kinney, Mary |
collection | PubMed |
description | INTRODUCTION: Maternal and perinatal death surveillance and response (MPDSR) is an intervention process that uses a continuous cycle of identification, notification and review of deaths to determine avoidable causes followed by actions to improve health services and prevent future deaths. This study set out to understand how and why a perinatal audit programme, a form of MPDSR, has sustained practice in South Africa from the perspectives of those engaged in implementation. METHODS: A multiple case study design was carried out in four rural subdistricts of the Western Cape with over 10 years of implementing the programme. Data were collected from October 2019 to March 2020 through non-participant observation of seven meetings and key informant interviews with 41 purposively selected health providers and managers. Thematic analysis was conducted inductively and deductively adapting the extended normalisation process theory to examine the capability, contribution, potential and capacity of the users to implement MPDSR. RESULTS: The perinatal audit programme has sustained practice due to integration of activities into routine tasks (capability), clear value-add (contribution), individual and collective commitment (potential), and an enabling environment to implement (capacity). The complex interplay of actors, their relationships and context revealed the underlying individual-level and organisational-level factors that support sustainability, such as trust, credibility, facilitation and hierarchies. Local adaption and the broad social and structural resources were required for sustainability. CONCLUSION: This study applied theory to explore factors that promote sustained practice of perinatal audit from the perspectives of the users. Efforts to promote and sustain MPDSR will benefit from overall good health governance, specific skill development, embedded activities, and valuing social processes related to implementation. More research using health policy and system approaches, including use of implementation theory, will further advance our understanding on how to support sustained MPDSR practice in other settings. |
format | Online Article Text |
id | pubmed-9226866 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | BMJ Publishing Group |
record_format | MEDLINE/PubMed |
spelling | pubmed-92268662022-07-08 Exploring the sustainability of perinatal audit in four district hospitals in the Western Cape, South Africa: a multiple case study approach Kinney, Mary Bergh, Anne-Marie Rhoda, Natasha Pattinson, Robert George, Asha BMJ Glob Health Original Research INTRODUCTION: Maternal and perinatal death surveillance and response (MPDSR) is an intervention process that uses a continuous cycle of identification, notification and review of deaths to determine avoidable causes followed by actions to improve health services and prevent future deaths. This study set out to understand how and why a perinatal audit programme, a form of MPDSR, has sustained practice in South Africa from the perspectives of those engaged in implementation. METHODS: A multiple case study design was carried out in four rural subdistricts of the Western Cape with over 10 years of implementing the programme. Data were collected from October 2019 to March 2020 through non-participant observation of seven meetings and key informant interviews with 41 purposively selected health providers and managers. Thematic analysis was conducted inductively and deductively adapting the extended normalisation process theory to examine the capability, contribution, potential and capacity of the users to implement MPDSR. RESULTS: The perinatal audit programme has sustained practice due to integration of activities into routine tasks (capability), clear value-add (contribution), individual and collective commitment (potential), and an enabling environment to implement (capacity). The complex interplay of actors, their relationships and context revealed the underlying individual-level and organisational-level factors that support sustainability, such as trust, credibility, facilitation and hierarchies. Local adaption and the broad social and structural resources were required for sustainability. CONCLUSION: This study applied theory to explore factors that promote sustained practice of perinatal audit from the perspectives of the users. Efforts to promote and sustain MPDSR will benefit from overall good health governance, specific skill development, embedded activities, and valuing social processes related to implementation. More research using health policy and system approaches, including use of implementation theory, will further advance our understanding on how to support sustained MPDSR practice in other settings. BMJ Publishing Group 2022-06-23 /pmc/articles/PMC9226866/ /pubmed/35738843 http://dx.doi.org/10.1136/bmjgh-2022-009242 Text en © Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY. Published by BMJ. https://creativecommons.org/licenses/by/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/. |
spellingShingle | Original Research Kinney, Mary Bergh, Anne-Marie Rhoda, Natasha Pattinson, Robert George, Asha Exploring the sustainability of perinatal audit in four district hospitals in the Western Cape, South Africa: a multiple case study approach |
title | Exploring the sustainability of perinatal audit in four district hospitals in the Western Cape, South Africa: a multiple case study approach |
title_full | Exploring the sustainability of perinatal audit in four district hospitals in the Western Cape, South Africa: a multiple case study approach |
title_fullStr | Exploring the sustainability of perinatal audit in four district hospitals in the Western Cape, South Africa: a multiple case study approach |
title_full_unstemmed | Exploring the sustainability of perinatal audit in four district hospitals in the Western Cape, South Africa: a multiple case study approach |
title_short | Exploring the sustainability of perinatal audit in four district hospitals in the Western Cape, South Africa: a multiple case study approach |
title_sort | exploring the sustainability of perinatal audit in four district hospitals in the western cape, south africa: a multiple case study approach |
topic | Original Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9226866/ https://www.ncbi.nlm.nih.gov/pubmed/35738843 http://dx.doi.org/10.1136/bmjgh-2022-009242 |
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