Assessing the impact of a motivational intervention to improve the working lives of maternity healthcare workers:a quantitative and qualitative evaluation of a feasibility study in Malawi

Abstract

BACKGROUND: Globally too many mothers and babies die during childbirth; 98% of maternal deaths are avoidable. Skilled clinicians can reduce these deaths; however, there is a world-wide shortage of maternity healthcare workers. Malawi has enough to deliver 20% of its maternity care. A motivating work environment is important for healthcare worker retention. To inform a future trial, we aimed to assess the feasibility of implementing a motivational intervention (Appreciative Inquiry) to improve the working lives of maternity healthcare workers and patient satisfaction in Malawi. METHODS: Three government hospitals participated over 1 year. Its effectiveness was assessed through: a monthly longitudinal survey of working life using psychometrically validated instruments (basic psychological needs, job satisfaction and work-related quality of life); a before and after questionnaire of patient satisfaction using a patient satisfaction tool validated in low-income settings with a maximum score of 80; and a qualitative template analysis encompassing ethnographic data, semi-structured interviews and focus groups with staff. RESULTS: The intervention was attended by all 145 eligible staff, who also participated in the longitudinal study. The general trend was an increase in the scores for each scale except for the basic psychological needs score in one site. Only one site demonstrated strong evidence for the intervention working in the work-related quality of life scales. Pre-intervention, 162 postnatal women completed the questionnaire; post-intervention, 191 postnatal women participated. Patient satisfaction rose in all three sites; referral hospital 4.41 rise (95% CI 1.89 to 6.95), district hospital 10.22 (95% CI 7.38 to 13.07) and community hospital 13.02 (95% CI 10.48 to 15.57). The qualitative data revealed that staff felt happier, that their skills (especially communication) had improved, behaviour had changed and systems had developed. CONCLUSIONS: We have shown that it is possible to implement Appreciative Inquiry in government facilities in Malawi, which has the potential to change the way staff work and improve patient satisfaction. The mixed methods approach revealed important findings including the importance of staff relationships. We have identified clear implementation elements that will be important to measure in a future trial such as implementation fidelity and inter-personal relationship factors.

Publication DOI: https://doi.org/10.1186/s40814-021-00774-7
Divisions: College of Health & Life Sciences > School of Psychology
College of Health & Life Sciences
Funding Information: AM was funded for her PhD through Birmingham Women’s Hospital, University of Birmingham and Ammalife. This fieldwork was funded by Ammalife.
Additional Information: This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
Uncontrolled Keywords: Appreciative Inquiry,Malawi,Maternity care,Patient satisfaction,Staff working life,Medicine (miscellaneous)
Publication ISSN: 2055-5784
Last Modified: 19 Mar 2024 08:23
Date Deposited: 08 Feb 2021 10:02
Full Text Link:
Related URLs: http://www.scop ... tnerID=8YFLogxK (Scopus URL)
https://pilotfe ... 21-00774-7#Abs1 (Publisher URL)
PURE Output Type: Article
Published Date: 2021-01-29
Accepted Date: 2021-01-12
Authors: Merriel, Abi
Dembo, Zione
Hussein, Julia
Larkin, Michael (ORCID Profile 0000-0003-3304-7000)
Mchenga, Allan
Tobias, Aurelio
Lough, Mark
Malata, Address
Makwenda, Charles
Coomarasamy, Arri

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