Authors: Elisabeth Engl, Steve Kretschmer, Mokshada Jain, Saransh Sharma, Ram Prasad,B. M. Ramesh, Mrunal Shetye, Seema Tandon, Sanjiv Kumar, Tisa Barrios Wilson, Sema K. Sgaier

Abstract

Inadequate quality of care in healthcare facilities is one of the primary causes of patient mortality in low- and middle-income countries, and understanding the behavior of healthcare providers is key to addressing it. Much of the existing research concentrates on improving resource-focused issues, such as staffing or training, but these interventions do not fully close the gaps in quality of care. By contrast, there is a lack of knowledge regarding the full contextual and internal drivers–such as social norms, beliefs, and emotions–that influence the clinical behaviors of healthcare providers.

We aimed to provide two conceptual frameworks to identify such drivers, and investigate them in a facility setting where inadequate quality of care is pronounced. Using immersion interviews and a novel decision-making game incorporating concepts from behavioral science, we systematically and qualitatively identified an extensive set of contextual and internal behavioral drivers in staff nurses working in reproductive, maternal, newborn, and child health (RMNCH) in government public health facilities in Uttar Pradesh, India. 

We found that the nurses operate in an environment of stress, blame, and lack of control, which appears to influence their perception of their role as often significantly different from the RMNCH program’s perspective. That context influences their perceptions of risk for themselves and for their patients, as well as self-efficacy beliefs, which could lead to avoidance of responsibility, or incorrect care.

A limitation of the study is its use of only qualitative methods, which provide depth, rather than prevalence estimates of findings. This exploratory study identified previously under-researched contextual and internal drivers influencing the care-related behavior of staff nurses in public facilities in Uttar Pradesh. 

We recommend four types of interventions to close the gap between actual and target behaviors: structural improvements, systemic changes, community-level shifts, and interventions within healthcare facilities.

Citation: Engl E, Kretschmer S, Jain M, Sharma S, Prasad R, Ramesh BM, et al. (2019) Categorizing and assessing comprehensive drivers of provider behavior for optimizing quality of health care. PLoS ONE 14(4): e0214922. https://doi.org/10.1371/journal.pone.0214922

Read More
SHARE:

Recent Post

Onward and Upward: Documenting the journey of competency building initiatives for RMNCAH+N Counsellors in Uttar Pradesh

The RMNCAH+N strategy in Uttar Pradesh is key to improving maternal and child health outcomes. With unique challenges such as high rates of early marriage and low contraceptive use, an integrated approach to family planning is essential. UP TSU supported the Government of Uttar Pradesh by developing a competency-building framework to strengthen knowledge and skills of RMNCAH+N counsellors. This brief highlights the journey of these competency-building initiatives to address critical health challenges in the state.

PAHAL Issue 23

PAHAL Issue 23 highlights UPTSU’s contributions to improving healthcare in Uttar Pradesh. The key interventions include facilitating newborn care initiatives, launching training programs for healthcare staff, supporting ICDS in training Mukhya Sevikas, and improving vaccine coverage. These efforts demonstrate UP TSU’s commitment to making healthcare more accessible and effective across the state. The issue also highlights the activities conducted by the State Technical Support Unit TB – Uttar Pradesh, which includes the strategic push adopted to enhance the presumptive TB examination rate and also the training and pilot launch of the  Pharmacy app.

PAHAL Issue 22

The summer edition of this year’s PAHAL newsletter, highlights the remarkable progress UP-TSU has made in supporting the Health Department to advance public health across community, facility, and system levels in Uttar Pradesh.