Abstract
Background: Pre-eclampsia is a hypertensive disorder of pregnancy with multi-organ effects resulting in adverse maternal and fetal outcomes. The global significance of pre-eclampsia lies in the fact that it is a leading cause of mortality in low- and middle-income countries (LMICs), with 99% of these fatalities occurring in these regions. In Ghana, pre-eclampsia and eclampsia are the leading cause of maternal deaths in tertiary healthcare settings where the management occurs. Despite the adoption of multidisciplinary care approaches for pre-eclampsia, midwives in LMICs are the initial point of contact for women encountering pregnancy complications like pre-eclampsia. Midwives' ability to promptly recognize and initiate essential care can positively influence outcomes and reduce maternal mortality rates. However, there is currently limited research addressing midwives' involvement with pre-eclampsia and eclampsia care, particularly in Ghana and similar settings.Aim: The study aimed to obtain a contemporary overview of the multi-level factors influencing midwives’ management of pre-eclampsia and eclampsia in a Ghanaian tertiary hospital.
Research question: What multi-level factors are important in pre-eclampsia and eclampsia management in a tertiary hospital setting and how these factors influence midwives’ management of pre-eclampsia and eclampsia?
Study design: The study utilised a qualitatively driven convergent parallel mixed-method design within a pragmatist approach. Data was collected in four phases. The first phase consisted of a document analysis of pre-eclampsia guidelines and midwives’ scope of practice. In the second phase, thirty-five midwives participated in individual semi-structured interviews to share their experiences with pre-eclampsia management. In the third phase, seven key informants from the multidisciplinary team were interviewed regarding the institutional factors influencing midwives’ care of women with pre-eclampsia. In the final phase, 250 midwives participated in an online survey to determine their level of knowledge of pre-eclampsia and their continuing professional development needs. Data was
analysed separately, and the results were merged during interpretation aided by the Socioecological model (SEM).
Results: The combined results paint a picture depicting barriers and enablers across the individual midwife level, the interpersonal level, the organisational level, and the public policy levels. Phase One highlighted the variations in Ghanaian pre-eclampsia management guidelines and constrained responsibilities for midwives related to pre-eclampsia. Participants in phases Two and Three described challenges with the referral system, the expenses associated with pre-eclampsia care, pregnant women’s risk perceptions, and the lack of resources including medical logistics and limited access to continuing professional development. The findings also showed that midwives believed that having knowledge of pre-eclampsia, self-efficacy, necessary clinical skills, supportive interprofessional collaborative practice, and an organisational commitment to quality of care enabled them to optimise their roles. The survey findings in phase Four indicated that the majority of the midwives (68.8%) possessed a moderate level of knowledge about pre-eclampsia. Midwives expressed the need for training in research-related activities and specific clinical skills for preeclampsia management. System improvement opportunities identified included enhancing midwives' competence by expanding opportunities for contextualised training and expansion of existing infrastructure and resources.
Conclusion and recommendations: The contribution of this study has been to delineate the myriad factors influencing midwives’ involvement in pre-eclampsia management within a multidisciplinary team. This study identifies critical areas including improvements in pre-service midwifery education, targeted continuing professional development, enhancement of the hospitals’ facilities andresources, and health system strengthening. These findings will be useful in developing evidenceinformed context-specific strategies, tailored to address the influencing factors identified to promote woman-centred care by Ghanaian midwives and improved quality care for women with pre-eclampsia.
| Date of Award | 2024 |
|---|---|
| Original language | English |
| Supervisor | Professor Benjamin Tan (Supervisor), Angela Bromley (Supervisor) & Michelle Gray (Supervisor) |
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