A socioecological description of the influencing factors to midwives’ management of preeclampsia in a Ghanaian tertiary hospital

Isabella Garti, Michelle Gray, Angela Bromley, Benjamin Tan

Research output: Contribution to journalArticlepeer-review

3 Citations (Scopus)
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In low-resource settings, midwives are the first contact for women with preeclampsia and lead the coordination of care. Unfavourable preeclampsia outcomes create a burden for women, families, and the health system. It is therefore important to understand the unique context of midwives’ practice and the complex factors that influence the delivery of maternal healthcare. 

Aim This qualitative study explored the perspectives of key stakeholders in a tertiary hospital in Ghana regarding the facilitators and barriers influencing midwives’ provision of preeclampsia care using a socioecological model. 

Methods Semi-structured interviews were conducted with 42 participants comprising senior managers (n = 7) and hospital midwives (n = 35) in 2021. Thematic analysis used Braun and Clarke’s six-step method, and the findings were organised within four levels of the socioecological model: individual, interpersonal, organisational, and public policy. 

Results Two main themes were identified: 1) Facilitators of preeclampsia management, and 2) Barriers to preeclampsia management. Facilitators were identified at three levels (individual, interpersonal, and organisational) and included midwives’ knowledge of preeclampsia; midwives’ self-efficacy; midwives’ skillset to enhance preeclampsia care; collaborative practice; and strategies for preeclampsia care quality improvement. At the individual level, the barriers were inadequate pre-service preparation, lack of evidence-based midwifery care, and colleagues’ work attitudes. Hierarchical decision-making and staff views of women’s risk perceptions were identified as barriers at the interpersonal level. At the organisational level, the barriers were: scarce resources and staff shortages, and a lack of midwifery-specific guidelines. Two barriers were identified within the public policy level: the high cost of preeclampsia care and issues with the referral system.

Conclusion Multi-faceted factors play a significant role in midwives’ management of preeclampsia. Hence context-specific multi-level interventions have the potential to improve the quality-of-care women in Ghana receive.

Original languageEnglish
Article numbere0291036
Pages (from-to)1-16
Number of pages16
JournalPLoS One
Issue number9 September
Publication statusPublished - Sept 2023

Bibliographical note

Funding Information:
Support for the study is by an Australian Government Research Training Program Scholarship.

Publisher Copyright:
© 2023 Garti et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


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