The Heshima study investigated the effects of a multicomponent intervention on disrespect and abuse during childbirth in 13 facilities in Kenya. The multicomponent intervention encompassed facility and community-based interventions including facility-based training in promoting respectful care including values clarification and attitude transformation, support to quality improvement teams, caring for carers, monitoring of disrespect and abuse, mentorship, and open maternity days. Community level interventions included community workshops (e.g. respectful care sensitization meetings), mediation/alternative dispute resolution and counseling of community members. The intervention was associated with an overall reduction in disrespect and abuse from 20% to 13% as reported by postnatal women after discharge from maternity units, with most sub-categories of disrespect and abuse declining by 40–50 % (e.g. verbal abuse). Observations of patient-provider interactions also measured significant reductions in observed disrespect and abuse. Of note, observers reported D & A with more frequency than patients in interviews, a phenomenon that has been documented in other studies. Night shift deliveries were associated with greater verbal and physical abuse. The Heshima study findings suggest that locally designed multifaceted interventions across system levels have the potential to reduce the occurrence of disrespect and abuse.
Multicomponent Interventions included:
Facility Level
- Training in promoting respectful care including values clarification and attitude transformation (VCAT)
- Quality improvements teams (QITs)
- Caring for carers
- D&A Monitoring
- Mentorship
- Maternity open days
Community Level
- Community workshops
- Mediation/alternative dispute resolution
- Counseling community members